Spring is finally here! That means more and more older runners and athletes are flocking to my Grapevine, Texas, office complaining of a multitude of aches and pains. 'Tis the season to overtrain and suffer from the dreaded tendonitis. What is this mysterious 'itis? Why does it effect aging athlete's more than the younger ones? Why does one person have multiple bouts of recurrent tendonitis all over their body and another does not? These are all great questions!
Let's start with the basics. A tendon connects your muscles to the bones. It is a flexible but really tough band of fibrous tissue. A muscle contracts to move one of your joints and transmits a force on the tendon to cause the movement. Tendons, when functioning normally, glide very smoothly when the muscle contracts. When they are irritated, they cause pain and even creaking when they glide. This is tendonitis or in easier terms, inflammation of the tendon.
Tendonitis can occur in any tendon, but in your foot and ankle the most common tendons effected are the ones that stabilize you foot when you run, jump and play with the other kids. These are the Achilles tendon, the posterior tibial tendon, the anterior tibial tendon and the peroneal tendons. Less likely to be irritated are the multitude of smaller flexor and extensor tendons in your feet.
Tendonitis is more common in your aging athletes between 40 and 60. This is because the lovely aging process causes our tendons to become less elastic and therefore less forgiving. A stress that would've been easily absorbed in our 20-year-old tendons causes tendonitis and even rupture in our 40+-year-old tendons.
Tendonitis is usually due to repetitive stress with an underlying biomechanical abnormality or anatomical deviation. This is why it is important to treat the tendonitis and the underlying cause before return to sport. If not, recurrence rates are high!
What does tendonitis feel like? Pain and swelling in the tendons usually first thing in the morning or at the beginning of an activity. The pain and stiffness often "warms up" in the early stages, but can become constant if you ignore the early symptoms. Sharp stabbing pains can occur but these are usually a sign that your tendon is so stressed it may actually tear!
How is it diagnosed? Usually your doctor will perform a physical exam and then rule out a bone problem or fracture with an x-ray. Sometimes an MRI is needed to rule out a small or partial tendon tear.
Treatment for tendonitis begins with relative rest. Take the stress off the inflamed tendon by doing alternative exercise like cycling or swimming. Sometimes complete rest is needed. Ice, anti-inflammatory medicines, bracing, physical therapy and even a cortisone injection may be needed. Functional foot orthotics are often quite helpful in chronic tendonitis because they stabilize the abnormal movements and help treat the underlying biomechanics of your feet.
Remember that after having a bout of tendonitis, slowly return to activity and try to avoid the overuse that caused the tendonitis in the first place! Too much, too soon, too fast syndrome is often the culprit in tendonitis!
HEEL PAIN (PLANTAR FASCIITIS)
This syndrome is most commonly caused by several factors, including, but not limited to:
-Tight calf muscles
-Increase in body weight
-Sudden change in the amount of intensity of exercise
-Improper or worn out shoes
-Abnormal foot biomechanics (excessive pronation or supination)
Due to any of the above factors, the plantar fascia (the ligament that holds up your arch) is pulled or strained so that a portion of this very strong ligament starts to tear or fray like a rope at its weakest point (where it attaches to you heel bone). This tearing causes microscopic internal bleeding in this area. Your body reacts by causing inflammation, which in turn causes irritation to the nerves, bursae and muscles in this area. As the inflammation occurs, the body tries to heal itself by depositing calcium in the area of the tear. This creates the “spur”. Not everyone will have a visible spur on x-ray, especially in the early stages. The spur is not the cause of the pain! It is just a tangible sign that extensive tearing has occurred. The tearing and straining is the cause of the pain and then the nerve becomes inflamed which makes the pain more sharp and long-lasting. The straining must be stopped, along with the inflammation, in order to resolve this problem.
Diagnosis of plantar fasciitis is made with a physical examination including a biomechanical exam. X-ray are recommended to rule out a stress fracture or tumor in the area. Shoe gear is also evaluated. (Don't forget to bring your running shoes to your appointment!)
Treatment initially includes all of the items listed below. If any of these treatments increases your pain, please call or contact the office. It has been estimated that 85% of heel pain can be eliminated by non-surgical treatements; but these take time and effort on the part of the patient and doctor. BE PATIENT! Your heel pain did not appear overnight, and it will take a while to totally eliminate the pain.
Conservative therapy can include:
1. Ice (at least 15 minutes twice a day);
2. Stretching (your doctor will give you calf and arch stretching);
3. Anti-inflammatories (either orally or in an injection); and
4. Arch supports/Taping/or orthotics.
Remember that treating the biomechanics of your feet treats the underlying cause where the other treatments are only treating the symptoms! Some people need physical therapy, night splints, and casting for relief. Conservative treatment often takes 4-6 months to eliminate plantar fasciitis.
Surgical treatment is the last alternative, after conservative therapy has been exhausted. Extracorporal shock wave therapy (ESWT) is a relatively non-invasive surgery that is quite effective, but deemed experimental by many insurance companies. If you are interested in more information about ESWT, click on the word underlined above.
There are two common surgical approaches to heel pain: the traditional approach (removes the spur) and the endoscopic approach (lengthens the ligament to reduce the strain and therefore reduce your pain). If your pain is not eliminated by conservative treatment after 4-6 months, we will discuss which approach is best for you.
Remember, the earlier you seek medical help for heel pain, the faster it will go away! If you have pain more than 5-7 days in a row in the same spot, call or contact our office for an appointment.
Need help with stretching? Go to our video Donnie and Dr Crane amatuer video heping you stretch your way to pain relief on YouTube! You are not allowed to make fun of our amatuer photography!
Run Happy! And treat your heel pain early for the fastest results!
The jury is still out when it comes to stretching in the running community. I have been running for almost 30 years with multiple coaches on numerous competitive levels, all of them told us to stretch daily to get faster and avoid injury. Yet many incredibly competitive runners never stretch and never seem to get injured. Is there any proof that this common recommendation is actually valid? What do the studies say about stretching? Does it really prevent injury? Will it make me faster? Again, the experts really don’t agree on much! In most arguments between stretchers and non-stretchers, it inevitably comes down to "stretching helps prevent injuries" and "stretching is a leading cause of injuries in runners".
The motion of running, repeated over many years, strengthens and shortens several posterior muscles. The most affected are the calves, the hamstrings and the lower back muscles. These muscles play a primary role in lifting the feet and moving the runner forward. Exercise physiologists blame shortened muscles for a reduced range of motion, decreased athletic performance and increased risk of injury. To add insult to injury, the aging process contributes to further loss of joint and muscle flexibility.
The majority of runners and coaches believe stretching improves performance and reduces the risk of injury. In the meantime, experts disagree on the benefits and dangers of stretching. While many experts credit stretching with numerous benefits, improper stretching remains the second leading cause of running injuries! So, if we believe in stretching; what is the most effective method?
First and Foremost; the warm up and cool down should never be optional in your running routine. Cold muscles are at the highest risk for injury; by warming up and increasing the temperature of your muscles they will be more flexible and have an increased speed of motion. Warming up can loosen your muscles and soft tissue as much as 20 percent. The cool down allows blood to continue flowing through your muscles, working its way more slowly from a high level of exertion to its normal resting condition. Build stretching into your regular schedule, both before and after your daily run; after warm up and as part of your cool down. Take the time, it’s worth it!
Bottom line: Most experts agree that stretching reduces muscle soreness after running and results in better athletic performance. Gentle stretching after a race or intense workout can also promote healing and lactic acid removal from the muscles. Stretching is most effective when performed several times each week; a minimum of one stretching session per week is sufficient to maintain flexibility. Most coaches and runners believe in stretching before and after every workout. The experts never agree on much, but the majority seems to feel that stretching is beneficial to runners if done properly. So follow the precautions outlines and always warm up prior to stretching. Your body will thank you and who knows, you may even get a little faster!
Run Happy! And warm up and stretch before!
Did you know that low back pain at some point in time will inflict over 80% of the population? Proper footwear can potentially prevent, reduce and treat biomechanical factors associated with low back pain in runners. Back pain can be a mysterious thing. Every time your feet hit the ground, the reacting shock is transferred up your legs to your hips and spine, and any biomechanical imbalance can ultimately cause lower back pain.
It could be that you have flat feet, and your over-pronation (rolling in of your feet) is causing your back ache. It could be that you have really high-arched, rigid feet and the lack of pronation is causing your back pain. It could be that one of your legs is ever-so-slightly shorter than the other, or that your pelvis is just a tiny bit uneven or tilted. You could have a curve in your spine. More seriously, one of the discs between the vertebrae of your spine could be degenerating or arthritis is setting in.
Back pain can be a tough mystery to solve, but with a little help from your friendly neighborhood sports medicine specialist you should be able to track down the cause. By far the most common diagnosis in patients with low back pain is the lumbar sprain/strain, which accounts for about 75% of all cases of low back pain. While muscle strain is the most common cause of back pain for runners, play it safe and visit a sports medicine orthopedist or a chiropractor to have your spine and vertebrae examined if you are experiencing severe pain.
If you have ruled out all the worrisome spine issue, you may have an uneven pelvis or unequal leg lengths. These conditions are relatively common and can be ascertained with a good biomechanical exam. With either, the muscles on one side are being pulled. They're tense to begin with, and the added stress of running can put them into spasm. Relatively weak abdominal and lower back muscles might also contribute to the problem. Running generally tends to cause strength imbalances between these muscle groups. Add tight hamstrings, another common condition among runners, and you have a nifty recipe for back pain. Core strengthening exercises and a lot of stretching can help.
Finally, the root cause is often in your foot, the last place most people look! Back pain is one of the many possible injuries associated with flat feet and over-pronation. Likewise, if your feet are rigid and high-arched, their lack of stress relief and under-pronation can cause stress imbalance resulting in back pain.
For immediate relief, cut back on the mileage, moist heating pads, anti-inflammatories like ibuprofen, and a good massage. If the problem is disc deterioration or spinal arthritis, surgery may be necessary, and an adjustment in training is absolutely required. Take this condition seriously, and see a spinal specialist. If your spine is merely out of alignment, manipulation by a chiropractor or physical therapist may help ease your pain. This may also ease your muscle strain.
If your doctor confirms that you have an uneven pelvis or unequal leg lengths, the solution will likely be to try to correct the problem with a heel lift on the short side. This may be as simple as putting a piece of 1/4" foam or cork into the heel of your running shoe. If you don't get any relief at all within a week, go ahead and take the lift out. If it does no good, its better just not to wear one; your body may have adjusted to different leg lengths, and "fixing" it may cause more discomfort. Whatever the case, make sure that the remedy matches the problem; do not use a heel lift if your doctor does not confirm that you have an uneven pelvis or unequal leg lengths, or you may only make your problems worse.
If your problem is in the structure of your foot, your solution may be as simple as wearing different running shoes or adding orthotics to the mix. Most shoes loose 75% of their shock absorption after approximately 500 miles. This appears to be the critical point in which injuries tend to develop as a result of shoe wear. Thus it is important to have a rough idea how many miles are on your shoes and to replace them before soreness begins. If your shoes are not worn out, see your podiatrist for recommendations of shoe types and to see if an orthotic will help decrease the biomechanical strain causing your back pain. . In most cases of lower back pain, you will benefit from exercises to strengthen your back and abdominal muscles.
Back pain can be an indicator of a serious problem and can lead to a cascading injury that slows your running to a complete halt! Muscular back pain is the most common and can be annoying and complicated to treat due to the myriad of causes. If you have severe pain, seek medical attention immediately. If your pain is mild and seems to be directly related to your running, look to your feet as a possible contributor to you pain.
Run Happy! And Pain-Free!
...featuring Donnie! Better quality coming soon...this is our first attempt!
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