Being a runner, I have experienced many aches and pains. Today, I thought I'd start with some thoughts on an injury that is very common to endurance athletes and can present with many different feels.
Usually divided in research, Achilles injuries can present in 3 general areas: back of the heel, mid-tendon, and upper tendon/calf muscle region. It is believed that most Achilles injuries felt by endurance athletes are primarily degenerative changes rather than inflammatory changes. The caveat to this would be acute rupture, partial tear, or strain which would commonly be caused by an abnormal force rather than a on/off pain presenting during different periods of endurance exercise and waxing-waning in level. I will focus on Achilles tendinopathies or degenerative changes due to my interest of addressing a common endurance athlete injury in this post. If suffering an injury acutely, it is important to address the issue as soon as possible to prevent further damage. Injuries that crop up from explosive activities or stepping into a surface that causes the leg to buckle should be professionally assessed and therefore will not be appropriate material for a blog such as this. Injuries that do not accept weight are often fractures and should be professionally evaluated.
*It is important to remember to only do stretches and exercises that can be performed without causing additional injury. This blog is meant for education and idea collection only. It is important to understand your own body and to evaluate your need prior to deciding on trying any program of exercise as we are all different. Please consult your primary physician or therapist as these exercises are done at your own risk. Feel free to ask questions about how they are properly utilized and performed in someone who requires them.*
1. PAIN IN THE HEEL
If pain is occurring in the heel there are usually a few different areas to treat to address the area under stress. These areas include the bottom of the foot: primarily the plantar fascia, and the calf itself: composed of the gastrocnemius, soleus, and their transition into the Achilles tendon.
To focus treatment on those individuals suffering from pain in the heel I will demonstrate and discuss 5 different exercises commonly used by physical therapists for this presentation. Usually, both the calf muscle/achilles tendon and the plantar fascia have an involvement.
First, here is a simple video on performing myofascial release to the bottom of the foot:
Besides needing to improve my video creation skills, this video shows the tennis ball providing a stretch and massage to the muscles and fascia of the plantar aspect of the foot. This procedure may feel uncomfortable and this would not necessarily be a reason to stop. Stretching, fluid movement, and adhesion removal are all benefits of this exercise.
Second, here is a simple stretch of the plantar fascia:
This video shows the heel being stabilized, followed by the ball of the foot being pressed towards the shin as well as the big toe being extended in order to stretch the bottom of the foot and plantar fascia. This stretch can be tricky, but it helps to remember that you are trying to maximize the distance from your heel (calcaneus) to your big toe (first phalange) in order to provide the most beneficial stretch.
Third, a video of towel scrunching with your toes. This exercise is meant to strengthen the intrinsic muscles of the foot:
Perform the exercise demonstrated in this video for 1 minute, and build to 2 or 3 minutes over the next couple weeks.
Fourth, a video of a gastrocnemius stretch. This main calf muscle crosses the back of the knee and thus requires the knee being extended in order to provide a stretch.
Hold the gastrocnemius stretch for 30 seconds. Repeat 3 times after running or lightly when the muscles is cold (not after warm-up or exercise).
Fifth, a video of a soleus stretch. This important postural muscle located underneath the gastrocnemius does not cross the knee and is best stretched with the knee bent in order to assure the gastrocnemius is not limiting your soleus stretch.
Hold the soleus stretch for 30 seconds. Repeat 3 times on a warm muscle or lightly on a cold muscle.
Try these 5 exercises daily and in combination with anti-inflammation techniques it is possible to greatly reduce your symptoms of pain in the heel. Please comment or e-mail with any questions.
-Nick
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