Insertional Achilles Tendonitis, Oh My!

Cindysphinx

Cindysphinx

G.O.A.T.
Does anyone have any advice on how to deal with Insertional Achilles Tendonitis?

Here's the deal.

In March, I was doing a run and I felt weirdness in the back of my heel. Like someone was holding a match there. I fiddled with my socks, fiddled with my shoes, finally just walked back home.

Figured my shoes must be old, got new ones. Didn't help. Went to a running store for a fitting, got new shoes. Didn't help.

Laid off running and tennis for a week, used RICE. Things calmed down, and the main problem was (and is) that my ankle is very stiff is the morning, but doesn't bother me much during activity. I could play tennis, but there would be a price the next day, and I don't want to risk an achilles rupture.

Stopped running, but played some doubles to finish out the season. Rested again for a week. Things calmed down with RICE, but symptoms returned when I tried to play.

Finally went to my podiatrist (sports podiatry, surgery) in June. Xrays showed bone spurs at the back of both heels, but only the right heel bothers me. Added heel lifts, prescribed PT. Went to two PT sessions but stopped because, well, I can do those stretches at home for free.

In July, went back to podiatrist, who prescribed MRI. He said he could do a Platelet-Rich Plasma injection. He said most places charge $1000-$2000, but that is a rip-off and he could do it for $450. Don't know how much experience he has with this.

I got the MRI on Friday, haven't reviewed the results with him yet.

OK. I am now in my fourth month of dealing with this, and I haven't played tennis for a full month. I took the foot on a test drive this week. I ran at the slowest possible speed that can technically be called jogging. No dice. I can still feel that the heel isn't right.

Does anyone have experience with PRP? Should I seek out a foot and ankle Orthopedic Surgeon specialist, or should I go with my podiatrist? Is there anything else I can try?

All this sitting around is making me unhappy and fat. :(
 
mikeler

mikeler

Moderator
The insoles that come with most shoes are garbage. I throw them out immediately and replace with gel sports insoles otherwise my heels will hurt after a few matches.
 
Cindysphinx

Cindysphinx

G.O.A.T.
mikeler said:
The insoles that come with most shoes are garbage. I throw them out immediately and replace with gel sports insoles otherwise my heels will hurt after a few matches.
Click to expand...

Yeah, I have custom orthotics, so I've done all I can there.

I had a battle with PF in 2008, so I know this is not PF.
 
C

Chas Tennis

G.O.A.T.
If injured, preventive exercises or stretches intended for healthy tendons might cause farther injury. Clear with your Dr. Stop stressing the tendon.

Thread with Achilles Injury information
http://tt.tennis-warehouse.com/showthread.php?t=419204

Tendinitis (with inflammation) & Tendinosis (with defective healing). See the one page, reply, #1, & longer paper, reply #15.
http://tt.tennis-warehouse.com/showthread.php?t=442912

Follow ">" link.
Chas Tennis said:
Plantar fasciitis is often associated with the calf muscle being tight and short. This condition stresses the calves, achilles, and plantar fascia/tissues. Tight calves are often a life-style issue - many hours of the week with the calves held in a shortened position and then playing tennis for a few hours where the calves, achilles, and plantar fascia(tissues) are stretched and stressed.

In my case, the PF got worse over a year as I played tennis. I took off 3 months from tennis to get rid of it.

Injury issues have an aging factor and a conditioning factor. You can learn about the conditioning factors and change them.





Learn the common tennis injuries and associated conditioning for injury prevention. Research any of these injury issues elsewhere in detail and double check corrective conditioning for prevention from other sources. For injuries and treatment, see a Dr.

http://www.med.nyu.edu/pmr/residenc...clinics NA_sports med/MSK injuries tennis.pdf

http://www.usta.com/Improve-Your-Game/Sport-Science/339840_Injuries_and_Tennis_Technique/

http://cstl-hhs.semo.edu/pujol/hl34...ries_in_Tennis_Players__Exercises_to.6[1].pdf

Shoulder
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2577490/
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ollinger

ollinger

G.O.A.T.
The elephant in the room is the bone spurs at the back of both heels. A bone spur associated with symptoms and not responsive to conservative measures may require surgery, particularly in someone who wants to be very active.
 
C

Chas Tennis

G.O.A.T.
This informative site has some information on heelspurs. In this case, it is aimed at the heelspurs that accompany plantar fasciitis - under the heel and extending toward the front of the foot. Often these heelspurs are not accompanied by pain.

http://heelspurs.com/_intro.html

I have a 3/4" bone spur on my elbow that does not cause symptoms. My Dr was not even going to mention it until I asked about it.

The forces on the calf muscle, Achilles and plantar fascia(?) tissues are closely related because they are all connected. These forces can be high from normal activity such as walking and climbing steps, as often the entire body weight is supported by one leg and Achilles.
 
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Cindysphinx

Cindysphinx

G.O.A.T.
Torres said:
I had some midpoint AT last year and a recurrence recently. Would normally have suggested eccentric heel drops off the edge of a step but this suggests a variation where the AT is at the point of insert.

http://www.runningwritings.com/2011/09/injury-series-flat-eccentric-heel-drops.html?m=1

The other thing to do is calf stretches and deknotting of the calf muscle, ultra sound on the tendon, physio massage to encourage healing etc
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Thanks, Torres. This sounds like something I could do.

My physical therapist had me doing two standing calf stretches. I was also supposed to use a band to do ankle exercises pushing away, pulling toward, and rotating inward and outward. This didn't seem to accomplish much.

I remember that Drak wrote a post about using an ice bath at 50 degrees instead of ice bags. I tried that this morning. He's right. It works great.
 
T

Torres

Banned
Cindysphinx said:
My physical therapist had me doing two standing calf stretches. I was also supposed to use a band to do ankle exercises pushing away, pulling toward, and rotating inward and outward. This didn't seem to accomplish much.
Click to expand...

Correct calf stretches are important to do because a supple stretched calf muscle puts less strain on the Achilles. Of itself it obviously won't heal the tendon because its a different part of the body but a regular regime will help, its good for calf muscles anyway and also reduces the likelihood of muscle pulls or tears.
 
S

Say Chi Sin Lo

G.O.A.T.
I'm not sure if I have a case of "Insertional Achilles Tendonitis", but what OP described is similar to what I'm dealing with.

Virtually asymptomatic when I'm on the court, but afterwards, my left heel is in agony (it's my landing foot when I serve). When I first noticed the discomfort after playing, I didn't really think too much of it. Because like I said, when I'm active, it's asymptomatic. It's only when I come home, I would have a hard time walking. Usually, icing it takes care of it. But over time, the discomfort intensified to the point where I decided to let it rest for ~a month.

After a month's rest, I was still having problems with post-play discomfort. So I started wearing this:

Pro-Tec Gel Force Ankle Sleeve
http://www.tennis-warehouse.com/Pro-Tec_Gel_Force_Ankle_Support/descpagePROTEC-PGFAS.html

Not really sure how and why, but it alleviated much of my post-play discomfort.
 
R

RogueFLIP

Professional
Cindysphinx said:
My physical therapist had me doing two standing calf stretches. I was also supposed to use a band to do ankle exercises pushing away, pulling toward, and rotating inward and outward. This didn't seem to accomplish much.
Click to expand...

You went to PT twice and then stopped. Of course the Theraband isn't going to accomplish anything.


Torres said:
The other thing to do is calf stretches and deknotting of the calf muscle, ultra sound on the tendon, physio massage to encourage healing etc
Click to expand...

I'm hoping that the PT did some kind of ultrasound on your achilles and/or gastroc? Also some kind of hands on manual work?

Because it sounds like you've still got some kind of unresolved soft tissue restrictions that need to be worked on and out. Also possibly, because of the time frame, you could be misaligned somewhere along your leg and pelvis from compensating from the pain....these compensations may be putting undue stress to your symptomatic areas and prevent things from resolving.

Always sad to hear a fellow player unable to do what they love...good luck and speedy recovery!
 
Cindysphinx

Cindysphinx

G.O.A.T.
Well, I stopped going. I didn't stop the exercises and stretches. Just didn't want to pay her to watch me do them

I am starting PT this week for a hip impingement on the same side. I think the two things are related. New PT lady will work on both problems at once; first PT lady wanted separate visits -- so 4x per week. Not gonna happen.

Does that ultrasound treatment really work? Feels like hocus pocus to me.
 
R

RogueFLIP

Professional
Cindysphinx said:
Well, I stopped going. I didn't stop the exercises and stretches. Just didn't want to pay her to watch me do them

I am starting PT this week for a hip impingement on the same side. I think the two things are related. New PT lady will work on both problems at once; first PT lady wanted separate visits -- so 4x per week. Not gonna happen.

Does that ultrasound treatment really work? Feels like hocus pocus to me.
Click to expand...

Oh, everything's all connected and related. As much as we like to try to separate things, we can't.

I'm sure you can find research studies that correlate that US can help, and I'm sure you can find just as many that find that it doesn't.

I've probably gotten better results when the machine was unplugged.

If I had 10 minutes to set up, clean up and use the US machine, I'd rather use those 10 minutes to use my hands on finding and releasing the soft tissue or correcting postural issues.
 
P

Posture Guy

Professional
well, I was going to say you have a posture problem, and then you share about the hip impingement.

I've never once seen heel spurs on a client with anything close to a proper, functional foot strike when they walk or run. You get bone spurs when the bone is consistently presented with friction that exceeds tolerance. When you walk and run, your feet are not contacting the ground as designed. The problem is NOT at the ankle, and may not even be at the hip. You need to have someone assess your posture and biomechanics as a whole. If this PT can do that, great. If not, find someone else.

Here's a way to determine whether or not they have any clue what they're doing. Has this PT watched you walk and assessed your gait, and explained to you what they see in clear, understandable terms? If not, leave and find someone else. Just because they examine your gait doesn't mean they're good, but if they haven't examined the gait of someone with heel spurs, then that's a clear sign they don't know what they're doing and don't understand how the body works.
 
Cindysphinx

Cindysphinx

G.O.A.T.
The first PT lady is the one I didn't care for. She was of the "Tennis and running are bad for you. You should go swimming instead" school of physical therapy.

In our session, she asked what I do for fitness. I said I play doubles, I run once or twice a week, I do a morning boot camp program, and I do upper body classes at the gym, just depending on what I feel like any given day. Her response: "No wonder you have all these problems." Blech.

The first session was an assessment (and yes, she did watch me walk). The second was literally me doing the six exercises/stretches she had given me in the first session, with her counting the reps. Massage, ultrasound, stim, ice, C-ya.

New therapist might or might not be any better. We shall see.

We do have to recognize certain limitations, Postureguy. I have insurance that pays for 52 total visits per year. It pays for PT for 60 days from diagnosis, and that is it. Some providers accept this insurance; many do not. I have to live in the real world, a world where I cannot pay thousands out of pocket to have someone address my posture.

Gotta hope this next PT also doesn't believe weightbearing exercise is the root of all evil.

Cindy -- who is going to lose it if one more person suggests she go swimming
 
S

sureshs

Bionic Poster
^^^ Have you considered taking up swimming instead of tennis?

Running is bad for your feet. It is true that ancient hunter-gatherers did a lot of running to catch a prey or away from a predator, but they did not live long enough to suffer the consequences.

Since you already play tennis, you do a little running. I say little because you only play doubles. Additional running is not good. Substitute it by slow walking or swimming.
 
Cindysphinx

Cindysphinx

G.O.A.T.
sureshs said:
^^^ Have you considered taking up swimming instead of tennis?
Click to expand...

Good one! :)

There is no way I will ever take up swimming, let alone use that as a substitute for tennis.

Suggesting that someone take up swimming makes as much sense as suggesting that someone take up equestrian sports. Both require access to special equipment (pool, horses) and skill at the activity.

Swimming takes skill if you hope to avoid sucking up a lot of water. I cannot swim well enough to get my heart rate up, let alone build some muscle. I will surely spend a lot of time clinging to the side of the pool sucking air, but there is a difference between aerobic activity and a panic attack. Add up the time to drive to the pool, change, work out, shower, do my hair, change and drive home, and swimming is a huge time suck.

Tennis is a running sport. To play tennis (even doubles), you need to be able to run from point A to point B. If the only running you ever do is on a tennis court, you will be slow and are much more likely to get hurt when you take off to run down that lob. That is my opinion.

Running moderate distances at a reasonable pace is efficient exercise and is good weight-bearing exercise for someone my age. Indeed, I think my current woes stem from being lazy and skipping too many runs over the winter.

I know from prior discussions that you and I differ on this, so we will have to agree to disagree.
 
newpball

newpball

Legend
Cindysphinx said:
Running moderate distances at a reasonable pace is efficient exercise and is good weight-bearing exercise for someone my age.
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I think that playing a lot of tennis and running is not an ideal combination for your age. I assume you play on hard courts and playing tennis on hard courts is not easy on the legs and running is obviously not either.

I would consider making a choice either take tennis or running not both.

Cindysphinx said:
Indeed, I think my current woes stem from being lazy and skipping too many runs over the winter.
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I think the opposite is likely true, you may be doing too much.

Furthermore if it hurts you need rest, perhaps for quite a long time, if you ignore it you run the risk of this becoming a chronic issue and then it will only get worse.
 
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P

Posture Guy

Professional
suresh....do you have any evidence to point towards to back up your assertion that running is 'bad for feet'? To me, it's the same crowd that believes running is 'bad for your knees', which simply is not true.

Cindy, your body is designed to run and play tennis and do whatever you want to do. I know you are very focused on using what is cheaply available to attempt to fix your problem. In my opinion, standard PT will be of limited value here. Continuing to do it because insurance covers it is like the guy who walks by a bar and sees someone crawling around under a lamppost. He asks him "what are you doing?" The guy answers "looking for my keys." the first guy responds "you lost your keys out here?" The other guy responds "no, in the bar, but the light is better out here."

There are a lot of ways to make this better and address the root issue. Some involve spending thousands. Some involve spending less than $20. Do what seems right to you, and good luck, but I'd suggest you endeavor to figure out WHY you are having all these different issues, and then go fix the core reason driving them all instead of dealing with them as if they are separate problems.
 
Cindysphinx

Cindysphinx

G.O.A.T.
Yes, I agree that I would love to know why I have tendonitis and a dodgy hip. It's always better to know and treat cause rather than symptoms.

Trouble is, if I present myself to a PT or a doctor, they seem not to know how to take a holistic view of this.

I could go back to the sports chiropractor I used a few years back. That didn't strike me as especially holistic either. Like the doc or the PT, the chiropractor only has certain tools in his tool bag and tends to think his tools are the right tools because those are the tools he has.

It seems to me that the medical profession is quite compartmentalized. Everyone is trained to do one thing very well, but no one can put the pieces together. I guess that is up to the patient, which is part of why I started this thread.
 
C

Chas Tennis

G.O.A.T.
Which muscle(s) of your calf might be tight?

When do you review the MRI with your Dr.? When you get it be sure to get a copy of the report written by the MRI imaging Dr. He/she will list all findings good and bad. Research those terms and conditions.

Most players try to deal with tendon pain for some time before seeing a Dr. With tendon injuries - based on the references in my reply - that much time with stressed healing probably means that some degree of tendinosis is possible in the Achilles tendons.

If it were me, I would consider some months of rest, still with conditioning, so that all possible healing might occur with minimal stress from tennis or running. Search for the CharlieFedererer replies showing healing times.

Deciding to take time off is even more important if some really important tennis is coming up for you, tournament, winter block time starts, etc. The last time I played with a recent injury that felt OK, I paid the price.

I had plantar fasciitis and then later some mild Achilles tendon pain. I took off for three months to get rid of the PF. I felt OK and stretched but was very aware that my Achilles might be starting to have issues. Both have gone away.

A few years earlier, and for more than a year, I had some sensitivity, tenderness and possibly a little extra bulge where the Achilles inserts on the heel. It did not seem to hurt much, but was not right, and if I bumped it it was much more sensitive than normal. It was on both heels. That has gone away and the insertion locations do not seem to have a bulges.

I believe that my calves were and are too tight. I stretch both the Soleus and the Gastrocnemius but not often enough.

I believe with running that muscles of the calves get a lot of force.

I recently read that in a cat's leg the Soleus has predominantly slow twitch muscle fibers and that the Gastrocnemius has most fast twitch muscle fibers. The researcher thought that might also apply to humans. The Soleus might also function mostly as the spring for running according to that reference. (D. Knudson text on biomechanics.)

Is one of your calf muscles tighter/shorter than the other? Can your physical therapist measure the ranges of motion of both your Soleus and Gastrocnemius?

When the knee is bent the Gastrocnemius cannot apply forces to the knee but the Soleus still can. This is due to the attachment points.

I read that if you have trouble squatting your Soleus might be tight. I have balance problems when I squat.
 
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Cindysphinx

Cindysphinx

G.O.A.T.
I get the MRI results tomorrow. Smart money predicts the result will be, "Your MRI shows you have insertional achilles tendonitis."

So no one has any experience with PRP, huh?

Well, it's been a month of no tennis. I am definitely going to wait this out. I feel like I have a month of rest "invested," so no way I am going to squander it by playing before this is fixed.

The last time I needed a long layoff I worked on my serve, which paid off handsomely. Maybe some 30-minute lessons on serving and some practice will take my mind off of things . . .
 
P

Posture Guy

Professional
Cindy.....PRP can be very cool, but if you get it without first addressing the reason why the area is inflamed, you're wasting your money. Tendons don't spontaneously inflame just to screw with you. They do it in response to prolonged friction over tolerance.

Here's what I would recommend: get the book Pain Free by Pete Egoscue. Read the first 3 chapters, then read the chapter on foot and ankle pain. Then feel free to email me directly with any questions and I'm happy to guide you from there.

You're absolutely right about doctors and most PTs being "compartmentalized". They're great people who are very well trained and want very much to help you, but both the educational system and the insurance system is setup to discourage more holistic assessment protocols. I just had a new client start last week, guy with severe sciatic pain down his right leg. Wife is a PT, and a good one, but she was frustrated she couldn't help him. During the assessment she could see how his posture was compromised in such a way that he couldn't load his LEFT side. So he was actually limping ON to his right side, beating it up, everything was getting tight and it was pulling the spine out of position. You could give that guy 'back exercises' all day long but until we got him loading his left side functionally again, he was screwed.

Once you see the body that way, it's really simple, but most medical professionals just aren't trained to look at the body either posturally or functionally at a holistic level.

Good luck on your healing journey.
 
S

sureshs

Bionic Poster
Cindysphinx said:
If the only running you ever do is on a tennis court, you will be slow and are much more likely to get hurt when you take off to run down that lob.
Click to expand...

Yeah so you will be slow. You are only playing doubles. I play singles and still manage to run a little (during tennis).

Just run a couple of times round the court before you play.

I do a lot of walking at work so I don't want to do any more damage. You don't do that so maybe it is OK to run more. But my wife says "working" at home is even more walking so I don't know.
 
R

RogueFLIP

Professional
Posture Guy said:
Cindy.....PRP can be very cool, but if you get it without first addressing the reason why the area is inflamed, you're wasting your money. Tendons don't spontaneously inflame just to screw with you. They do it in response to prolonged friction over tolerance.
Click to expand...

Agreed....and if you don't reduce any soft tissue restrictions which can go down to the cellular level, PRP, cortisone, and whatever else you decide to inject, swallow, soak won't make a lick of difference. It'll be like pouring water over a stone.

But that's not to say that any of those things don't/won't work for you OP.


Posture Guy said:
You're absolutely right about doctors and most PTs being "compartmentalized".
Click to expand...

Didn't I just say that a few posts ago? Everyone tries to separate things, but don't realize that everything is all connected.


Posture Guy said:
Once you see the body that way, it's really simple, but most medical professionals just aren't trained to look at the body either posturally or functionally at a holistic level.
Click to expand...

I've found that even the ones that are, don't know what to do about it. I'll explain to patients about how ie their pelvis is rotated, upslipped, what have you; they'll respond, "Oh, that's what my ____ said too". And I'm like "Well, what did they do about it?" And then no response. Wonderful.
 
P

Posture Guy

Professional
yeah, I hear that a LOT. "my ____ said my pelvis was rotated", then did nothing to address it. Like, 'oh well, I guess you're screwed.'

No matter who you go to, Cindy, ask these questions:

- why is my tendon inflamed?

- if they say it's because of your activities, then my response would be "well, I actually run and play tennis using BOTH feet and ankles, so why does only one have this problem?" This question actually reveals the complete stupidity of their supposition that it's your activity level causing the problem. I had a client who told me his doctor told him his left hip was degenerative and needing replacement because he was 75. I asked him "ok, how old is your other hip?" Frankly, it's just laziness on the part of the practitioner.

- the first two questions will weed out most practitioners. They won't have an answer that goes beyond them. If that's the case, walk out. Literally, just terminate the appointment and leave, don’t' waste another minute with that person. They don't know what they're doing.

- if you find someone who can credibly answer the questions above, make sure they explain it in layman's language YOU can understand. If they say something like "well, your left pelvis is rotated anteriorly which is driving your femur external and pushing the ankle into a varus orientation, thus causing the foot to supinate", that may be true and could be a perfectly reasonable explanation, but if you don't understand it and couldn't explain it to someone else, then make them do it again to your satisfaction. YOU need to understand what is going on here.

- then ask what the action plan is to remedy THAT problem. As soon as I hear someone with ankle spurs being given little but exercises to stretch and strengthen the ankle, I'm pretty sure we're dealing with someone who has a very limited conception of how the body works.

- then ask them to help you set reasonable expectations provided you follow their recommended protocol.

And if the practitioner is encouraging you to permanently move less, to give up things like running and tennis, terminate the appointment and go find someone who believes in the body's ability to move, heal and regenerate.
 
P

Posture Guy

Professional
RogueFLIP said:
The other myth that seems to be out there is that Pain = Weakness....therefore you must strengthen.
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Yes!

That seems to be the prevailing mentality in physical therapy, sadly. Back pain? Let's give you exercises to strengthen the back. Knee pain? Let's strengthen the quads. And they never assess to see if what they are strengthening is remotely in a functional position capable of constructively being strengthened and then deploying that power. Usually what happens is you take a dysfunctional kinetic chain and increase its ability to apply dysfunctional load. I.e., you increase the body's ability to blow itself up.

Brilliant. Ok, I'm going to bed now. This stuff drives me crazy when I think about it.
 
Cindysphinx

Cindysphinx

G.O.A.T.
Some practitioners act like activity can just be tossed into the dustbin. "Ah, we'll. You've had a good run. Just sit down and wait for the rest of your body to give out."

I'm not having it. Being active is important, and I don't think I would be very healthy if I scaled back.

I have an elderly relative who just got out of a nursing home after recovering from a fall. I spent way more time in that nursing home than I wanted. I am sure the residents had ll sorts of ailments. But I didn't see anyone who looked like they were there because they ad been *too* active.
 
R

RogueFLIP

Professional
Chas Tennis said:
When the knee is bent the Gastrocnemius cannot apply forces to the knee but the Soleus still can. This is due to the attachment points.
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I don't mean to hijack this thread but Chas...we had this discussion before in another thread....can't remember where....

To clarify the gastroc is a secondary knee flexor....while a weak one, it still contracts. So it CAN apply forces to the knee whether it's bent or straight.

And since I know you like studies so much:

http://books.google.com/books?id=63...ge&q=gastroc forces on knee when bent&f=false

http://jp.physoc.org/content/507/2/593.full
 
S

sureshs

Bionic Poster
Cindysphinx said:
Some practitioners act like activity can just be tossed into the dustbin. "Ah, we'll. You've had a good run. Just sit down and wait for the rest of your body to give out."

I'm not having it. Being active is important, and I don't think I would be very healthy if I scaled back.

I have an elderly relative who just got out of a nursing home after recovering from a fall. I spent way more time in that nursing home than I wanted. I am sure the residents had ll sorts of ailments. But I didn't see anyone who looked like they were there because they ad been *too* active.
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Well, you cannot know why they are there by just looking at them. They may have been active or not.

I like to be active for the mental pleasure. I know that swimming, yoga or gym work is much better for me than tennis, but they bore me.
 
C

Chas Tennis

G.O.A.T.
RogueFLIP said:
I don't mean to hijack this thread but Chas...we had this discussion before in another thread....can't remember where....

To clarify the gastroc is a secondary knee flexor....while a weak one, it still contracts. So it CAN apply forces to the knee whether it's bent or straight.

And since I know you like studies so much:

http://books.google.com/books?id=63...ge&q=gastroc forces on knee when bent&f=false

http://jp.physoc.org/content/507/2/593.full
Click to expand...

The gastrocnemius goes over two joints, the knee joint and the ankle joint. Its main function is to supply force at the ankle when the knee is mostly extended.

1) Ankle Extension:

Your first reference says

"The gastrocnemius muscle is most effective as a plantar flexor when the knee is extended; as the knee becomes progressively more flexed, this muscle loses effectiveness and plantar flexion of the foot is accomplished increasing by the soleus muscle."

2) Knee Flexion:

The gastrocnemius also attaches above the knee and can supply weak force to flex the knee.

The same reference says that the gastrocnemius can supply forces to flex the knee when the knee joint is very flexed, such as at 90°, because the leverage improves. That is probably a very minor weak torque considering the other large muscles that are flexing the knee at 90°. and that the muscle force from the gastrocnemius is reduced when the muscle is very shorted.

Interesting, that the gastrocnemius can still have an effect to flex the knee when the knee is so bent and the muscle is shortened. Please post if you have find more links.

Some links that illustrate bent knee & the Soleus:

Soleus muscle strains when running.
http://www.massagetherapy.com/articles/index.php/article_id/2035/Soleus-Muscle-Strain

Seated calf exercises for the Soleus.
http://www.aprioriathletics.com/coolfitnessgifts/seatedcalfraise.html

Soleus stretch with bent knee.
http://www.topendsports.com/medicine/stretches/calf-soleus.htm

This issue is important because most people who stretch calves only do the straight leg stretch. That possibly could leave the Soleus tight. ?
 
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Cindysphinx

Cindysphinx

G.O.A.T.
Chas Tennis said:
Cindy, were you stretching your calves before the injury?
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Oh, who knows?

I stretch when I stretch. Sometimes I am diligent, sometimes not. I go to a stretching class, but only when it is offered at the gym (2x/week) and when it fits my schedule (rarely).

If I decide to stretch at home (with my green stretching strap while watching episodes of "Chopped"), it can easily take a full hour. I do not always have time for this.

I am now doing the stretches for calves that the PT suggested, 'cause she suggested it.
 
Raul_SJ

Raul_SJ

G.O.A.T.
In the case of someone with achilles tendonitis, and given that the calf muscles attach to the achilles tendon, is there much risk of further damaging the tendon by stretching the calf muscles?
 
C

Chas Tennis

G.O.A.T.
If injured, including tendinitis and tendinosis, they should see a Dr for the best advice on whether stretches are OK. There's uncertainty with injuries.
 
C

Chas Tennis

G.O.A.T.
You may have read that eccentric exercises are one of the more promising areas of research for treating tendinosis. (Not close to a magic bullet yet as far as I know.)

Eccentric treatment is mentioned in the longer tendinosis reference in my earlier reply.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445129/

The Flexibar exercise for tennis elbow is a method for loading the tennis elbow tendon eccentrically - applying lengthening force when the muscle is already held shortened.

If you search for "Achilles" and "eccentric" you can find papers that deal with this subject. Some of the early research that most stimulated interest was on chronic Achilles tendinosis. Probably searchable in TW also.

This very positive experience was meticulously documented and posted by ChicagoJack
http://tt.tennis-warehouse.com/showthread.php?t=101633
 
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R

RogueFLIP

Professional
Raul_SJ said:
In the case of someone with achilles tendonitis, and given that the calf muscles attach to the achilles tendon, is there much risk of further damaging the tendon by stretching the calf muscles?
Click to expand...

1. Healthy or not, there's always a risk....

2. Don't force anything....slow into the stretch, slow out of the stretch.

3. Once you start to feel a gentle stretch, stop at that point, breathe relax, soften into it. Time frame I give my patients is 5 minutes.

4. Common sense: listen to your body! If you're not forcing anything, if you're breathing and softing into it, and it starts to become painful, slowly disengage!

Your body is telling you it's not ready for that.

Bottom line, if you don't force anything, you won't hurt yourself.
 
P

Posture Guy

Professional
I cannot stress enough how sound the advice below is. I see people "stretching" all the time and it's like they're trying to turn it into an aerobic sport. Fast, violent, sometimes they actually bounce at the end of the stretch.....terrible.

Stretching should not be akin to performing an act of violence upon one's body. Put the body into gentle positions where constricted tissue is INVITED to release, not demanded to release. Then let the tissue guide you on how to proceed from there.

Great stuff.

RogueFLIP said:
1. Healthy or not, there's always a risk....

2. Don't force anything....slow into the stretch, slow out of the stretch.

3. Once you start to feel a gentle stretch, stop at that point, breathe relax, soften into it. Time frame I give my patients is 5 minutes.

4. Common sense: listen to your body! If you're not forcing anything, if you're breathing and softing into it, and it starts to become painful, slowly disengage!

Your body is telling you it's not ready for that.

Bottom line, if you don't force anything, you won't hurt yourself.
Click to expand...
 
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Cindysphinx

Cindysphinx

G.O.A.T.
Update:

I think I finally turned the corner.

I missed the entire summer league season. I stopped running or even fitness walking. My ankles bothered me even when I wore flats or sandals, especially if I had to walk a bit. Even walking from the car to the restaurant in flats was bothering me. Instead of just the right ankle, the left ankle started acting up also.

Then I did three things:

1. I bought a high density foam roller and started rolling my calves and hamstrings. Last thing at night, first thing in the morning.

2. I got new running shoes with a significant heel to toe drop (flashy orange Mizunos!).

3. I wore my flashy orange Mizunos pretty much all the time. I stopped wearing flats and wore heels if I needed to look decent.

Things have improved so much that I was able to do most of the running -- including a bit of hill work! -- in my exercise class this morning.

Those foam rollers are amazing. I'm also rolling my IT band, and my hips feel much better also.
 
C

Chas Tennis

G.O.A.T.
That's great news.

When you raise the heel so that there is an added "the heel to toe drop" that you mention, you shorten the calf muscles and Achilles tendon by basically putting a wedge under your foot. That relieves the tension on the Achilles when walking or running.

After you have healed enough, research if you can somehow find a gradual way to get back to the normal calf length and foot posture. If your feet are at a new angle will it affect some important capability such as how the feet pronate or supinate to move for tennis? Does it matter?? This is a complicated subject best addressed by a podiatrist.
 
P

Posture Guy

Professional
I agree with Chas Tennis, you DEFINITELY want to work on the shortening of the calf and achilles your shoes are creating. I disagree that it would be best addressed by a podiatrist, in fact that in my opinion would be one of the worst to address it. All too often, that community's answer to foot problems is simply to use expensive orthotics. And those tend to create more problems than they solve.

Find a physical therapist who is well versed in the use of eccentric loading exercises, that would be well indicated here.

It's terrific that you're feeling better and becoming active again! Now, the fact that you get pain and limitation with your heels on the same plane as the balls of the feet is a sign that some postural and functional change is still needed for your body to work properly.
 
Cindysphinx

Cindysphinx

G.O.A.T.
Here's the weird thing:

I can walk just fine barefoot. But if I put on a pair of ballet flats, it flares up immediately.

Why would that be? If the reason it feels better is that I have raised my heel in relation to my toes, shouldn't it kill me to walk barefoot?
 
C

Chas Tennis

G.O.A.T.
That is weird assuming that ballet flats have a thin sole/heel that is about the same thickness front and back. It does not seem that there should be any difference. ?

Try pressing around on your heel. Maybe some small injured area on/around the insertion of the Achilles gets pressed by the small amount of padding in the shoes. Barefoot there is less pressure on that injured area and more on the heel bone. ? You mentioned bone spurs. ?
 
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R

RogueFLIP

Professional
Good to hear that part of your recovery involved some soft tissue work; keep at it.

Agree with Posture about restoring normal calf length when appropriate, and 2nd his opinion about not seeing a podiatrist.

Maybe there's probably a small difference in your gait and how you hit the ground with heel strike barefoot and with flats which could account for your discrepancy in pain.
 
P

Posture Guy

Professional
yeah, that's weird that barefoot is fine but flats are an issue. Usually if an elevated heel helps, anything that puts the heel and ball of foot on the same plane is a problem, including barefoot.

Not sure what's up there, would have to see the flats, then watch your gait both barefoot and in the flats and compare the two.
 
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