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!

 

Run Happy!

HEEL PAIN (PLANTAR FASCIITIS)

 

 Heel pain is the most common complaint we see in our office. The pain is greatest usually when you get up in the morning, but continues to worsen over time – until it hurts with every step you take and can even ache at night when resting.

 

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 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!

 

The Do’s and Don’ts of stretching:

 

Do

 

 

Don’t