ChicagoJack
Hall of Fame
Hi Courtrage -
This is my second suggestion for you to get to a doctor and have this thing evaluated. I see the worse case scenario here as a partial tear, If you had a full rupture, you’d know instantly something was wrong, you'd have been looking around for the guy that just shot you in the back of the leg, and you would not be able to rise on your toes with the injured leg. With a partial tear, you’d still have some ability to control the foot and walk normally. A partial tear left undiagnosed as such is a full rupture waiting to happen, and the doc might put you into a walking boot right then and there in the office. This possibility is of course, pure speculation on my part, but is is one example of why you might wnat to get this thing looked at by a professional. Sounds funny coming from me, as I am one example of the medical field failing me on this issue. I am not so jaded as to think the whole system does not work.
[..]
It's beneficial with tendinitis, and tendinosis (if that is what you have) to separate the overall course of action into four separate phases. Phase one is to cool off the overuse injury. Get the pain under control. Get to the point where you can perform normal walking around without producing symptoms of pain. This is the prep for phase two which would be conservative physical therapy. If you enter into PT without having first cooled off pain stemming the inflammation / and or degenerative changes, the danger is that you will only add fuel to the fire of what is a plain and simple overuse injury. I speak from experience. This was my first big mistake with my rehab. I never took a break from tennis, never iced, never rested, never took any anti-inflammatory medication. Just hopped straight into PT. Trouble with have pain 24/7 is you don't know how to interpret progress. PT is based on the concept of feedback. You do a set of exercises for a few weeks, and if your body handles that OK then the weight or reps is increased, it is the first crawl, then walk, then run concept. If you never get to Zero, never get to the no pain zone, your feedback loop is garbled. If you are experiencing pain all the time you get confused with the messages you body is sending you. You can't figure out what it likes and does not like.
[..]
Here is what worked for me. Here is how I cooled off the pain to the point where I could do normal daily activities. Forget tennis for the moment, you need to get to the point where life is not beating you up first. You had a post a few pages ago that you were sitting at home just hanging your legs over a chair and that produced pain. I would call this a very big sign you are still in the acute pain phase.
1. I Stopped Playing Tennis.
2. Ice 3x daily, I did once on my lunch break, and twice in the evening at home. Do at least ten minutes per, but never more than 20. at more than 20 minutes, studies suggest inflammation gets worse, not better. Avoid taking long hot baths.
3. I used 400-600mg per day of celebrex for one week, then tapered down to 100-200 daily. I’ve yet to get clear about the long term effects of this particular medication, and will be a topic for my next primary care appointment. I tried other anti-inflammatories but was only able to tolerate small doesages due to stomach irritation. Once I got to the 400-600 range, it was a whole new ball game. I’d say the eccentric PT was my primary fixer, but the medication helped me get through it with out firing up the inflammation fire. If you have history of gastro intestinal issues, you should approach anti-inflammatory meds with great caution.
4. I was wearing off court shoes that were too small, and threw them away. They are too small if you can only wear them with a thin sock, but a thick sock makes the fit too snug. A tight fighting shoe can irritate the surrounding bursa in the back of the heel. An irritated bursa is bursitis waiting to happen. You mentioned pain at the back of the heel. This is a no brainer.
5. Give your tendon a rest by getting your heel elevated. Remember, I'm talking about your off court shoes. You can figure out a court shoe later, first things first. You can get an off the shelf heel wedge, or if it doesn't seem odd to you, a good set of dansko brand clogs is perfect. I used to be a chef (it's what brought me to chicago) and lived in these 12 hours per day for 10 years, it's no accident that the hardest working folks in show bidness wear them. You will get built in arch support, a heel lift, and no possibility of heel irritation. It’s a little odd for guys to wear in some work places, but I currently work in a city warehouse converted to loft photo studio filled with tatooed and pierced 20 somethings who view their day job as a temporary stop on the way to being rock stars. Merril makes a good clog that looks pretty normal under a pair of jeans. That would be a good choice also. When my doc recommended clogs for my bursitis + tendinitis + partial tear, I had no hestitation following the advice.
6. If you have excessive pronation, try a set of arch supports off the rack. If that does not work for you, then go for the custom footbed. In my court shoe I have sof soles brand "arch plus" I also have a custom made semi rigid footbed that cost me 400 bucks. I’m going to eventually transition these into my court shoes but very gradually. My court approach is to buy a neutral shoe that won't roll on you, then season the footbed with an orthodic to taste.
7. Per NoBadMojo’s advice I avoided stretching. If you could wave a magic wand and ask for anything for your achilles-calf complex, you’d want something strong, and flexible. Nobody would dispute that. You need to be at least flexible enough to to the acitivties you want to perform on the court. nobody will dispute that either. If you re-enter your sport with a tight achilles you are an injury waiting to happen. The issue is not if you stretch, but when, how much, and what flavor (static vs dynamic). The first specialist I saw suggested a PT program based on stretching and strength building. I did 10 weeks of this, and my condition only got worse. My experience has been that stretching during the acute phase is counter productive. My experience is that static stretching when you are currently experiencing pain, will aggravate the pain, not lessen it. Dynamic strecthing such as what you will get naturally when doing an eccentric heel drop has worked for me as part of an overall, multi phase plan. If you research deeper into this topic you’ll find there is some debate about whether or not the achilles tendon can actually be stretched. I asked my physical therapist, If it was possible to actually stretch your achilees tendon. He gave me a sly look and said “ you know, that’s a good question” the response that followed was a quite educated, but fairly nuanced reply regarding how the tendon ties into the belly of the calf muscle.
I've started doing Bikram Yoga recently and there's quite a bit of stretching going on for that hour and a half. This has not flared up my symptoms, but something I avoided last year when my wife was certain that tagging along to her yoga class would be the magic bullet to all of my problems. I'm counting on Yoga being an important part of the injury prevention phase I am currently in.
[..]...................
The trouble with us tennis players, is we want to return as quickly as possible, to the very situation that prompted the injury in the first place. That my dear friends, is the nub of the problem. Whether you are the pot bellied weekend warrior who merely utilizes his body as a means to move his head from place to place, has no business attempting to stretch a single into a double at the company beer and pizza slow pitch softball game, or a world class triathlete carefully rationing and intensifying interval training to arrive at record breaking peak performance, the root of the injury is the same. Your tendon and calf complex was simply to weak to handle the work load you were asking it to handle. The key successful recovery is finding just the right amount of each ingredient, at just the right pace. Ice and rest too long, you run the risk of losing muscle mass due to atrophy. Push too fast, and too hard, with too few rest days in the physical therapy phase, you might add more fuel to the fire of what is a red hot overuse injury. This is the type of injury in which you might be doing everything right, but still fail. You might be doing everything right, but perhaps too much, too little, too fast or too slow. It is a learning process. It is a matter of trial and error. The good news is, your body is fairly good at telling the idiot driving the show, what it likes and what it does not. The messages are there, you just have to be willing to listen.
Best regards to you, and take care
-Jack
This is my second suggestion for you to get to a doctor and have this thing evaluated. I see the worse case scenario here as a partial tear, If you had a full rupture, you’d know instantly something was wrong, you'd have been looking around for the guy that just shot you in the back of the leg, and you would not be able to rise on your toes with the injured leg. With a partial tear, you’d still have some ability to control the foot and walk normally. A partial tear left undiagnosed as such is a full rupture waiting to happen, and the doc might put you into a walking boot right then and there in the office. This possibility is of course, pure speculation on my part, but is is one example of why you might wnat to get this thing looked at by a professional. Sounds funny coming from me, as I am one example of the medical field failing me on this issue. I am not so jaded as to think the whole system does not work.
[..]
It's beneficial with tendinitis, and tendinosis (if that is what you have) to separate the overall course of action into four separate phases. Phase one is to cool off the overuse injury. Get the pain under control. Get to the point where you can perform normal walking around without producing symptoms of pain. This is the prep for phase two which would be conservative physical therapy. If you enter into PT without having first cooled off pain stemming the inflammation / and or degenerative changes, the danger is that you will only add fuel to the fire of what is a plain and simple overuse injury. I speak from experience. This was my first big mistake with my rehab. I never took a break from tennis, never iced, never rested, never took any anti-inflammatory medication. Just hopped straight into PT. Trouble with have pain 24/7 is you don't know how to interpret progress. PT is based on the concept of feedback. You do a set of exercises for a few weeks, and if your body handles that OK then the weight or reps is increased, it is the first crawl, then walk, then run concept. If you never get to Zero, never get to the no pain zone, your feedback loop is garbled. If you are experiencing pain all the time you get confused with the messages you body is sending you. You can't figure out what it likes and does not like.
[..]
Here is what worked for me. Here is how I cooled off the pain to the point where I could do normal daily activities. Forget tennis for the moment, you need to get to the point where life is not beating you up first. You had a post a few pages ago that you were sitting at home just hanging your legs over a chair and that produced pain. I would call this a very big sign you are still in the acute pain phase.
1. I Stopped Playing Tennis.
2. Ice 3x daily, I did once on my lunch break, and twice in the evening at home. Do at least ten minutes per, but never more than 20. at more than 20 minutes, studies suggest inflammation gets worse, not better. Avoid taking long hot baths.
3. I used 400-600mg per day of celebrex for one week, then tapered down to 100-200 daily. I’ve yet to get clear about the long term effects of this particular medication, and will be a topic for my next primary care appointment. I tried other anti-inflammatories but was only able to tolerate small doesages due to stomach irritation. Once I got to the 400-600 range, it was a whole new ball game. I’d say the eccentric PT was my primary fixer, but the medication helped me get through it with out firing up the inflammation fire. If you have history of gastro intestinal issues, you should approach anti-inflammatory meds with great caution.
4. I was wearing off court shoes that were too small, and threw them away. They are too small if you can only wear them with a thin sock, but a thick sock makes the fit too snug. A tight fighting shoe can irritate the surrounding bursa in the back of the heel. An irritated bursa is bursitis waiting to happen. You mentioned pain at the back of the heel. This is a no brainer.
5. Give your tendon a rest by getting your heel elevated. Remember, I'm talking about your off court shoes. You can figure out a court shoe later, first things first. You can get an off the shelf heel wedge, or if it doesn't seem odd to you, a good set of dansko brand clogs is perfect. I used to be a chef (it's what brought me to chicago) and lived in these 12 hours per day for 10 years, it's no accident that the hardest working folks in show bidness wear them. You will get built in arch support, a heel lift, and no possibility of heel irritation. It’s a little odd for guys to wear in some work places, but I currently work in a city warehouse converted to loft photo studio filled with tatooed and pierced 20 somethings who view their day job as a temporary stop on the way to being rock stars. Merril makes a good clog that looks pretty normal under a pair of jeans. That would be a good choice also. When my doc recommended clogs for my bursitis + tendinitis + partial tear, I had no hestitation following the advice.
6. If you have excessive pronation, try a set of arch supports off the rack. If that does not work for you, then go for the custom footbed. In my court shoe I have sof soles brand "arch plus" I also have a custom made semi rigid footbed that cost me 400 bucks. I’m going to eventually transition these into my court shoes but very gradually. My court approach is to buy a neutral shoe that won't roll on you, then season the footbed with an orthodic to taste.
7. Per NoBadMojo’s advice I avoided stretching. If you could wave a magic wand and ask for anything for your achilles-calf complex, you’d want something strong, and flexible. Nobody would dispute that. You need to be at least flexible enough to to the acitivties you want to perform on the court. nobody will dispute that either. If you re-enter your sport with a tight achilles you are an injury waiting to happen. The issue is not if you stretch, but when, how much, and what flavor (static vs dynamic). The first specialist I saw suggested a PT program based on stretching and strength building. I did 10 weeks of this, and my condition only got worse. My experience has been that stretching during the acute phase is counter productive. My experience is that static stretching when you are currently experiencing pain, will aggravate the pain, not lessen it. Dynamic strecthing such as what you will get naturally when doing an eccentric heel drop has worked for me as part of an overall, multi phase plan. If you research deeper into this topic you’ll find there is some debate about whether or not the achilles tendon can actually be stretched. I asked my physical therapist, If it was possible to actually stretch your achilees tendon. He gave me a sly look and said “ you know, that’s a good question” the response that followed was a quite educated, but fairly nuanced reply regarding how the tendon ties into the belly of the calf muscle.
I've started doing Bikram Yoga recently and there's quite a bit of stretching going on for that hour and a half. This has not flared up my symptoms, but something I avoided last year when my wife was certain that tagging along to her yoga class would be the magic bullet to all of my problems. I'm counting on Yoga being an important part of the injury prevention phase I am currently in.
[..]...................
The trouble with us tennis players, is we want to return as quickly as possible, to the very situation that prompted the injury in the first place. That my dear friends, is the nub of the problem. Whether you are the pot bellied weekend warrior who merely utilizes his body as a means to move his head from place to place, has no business attempting to stretch a single into a double at the company beer and pizza slow pitch softball game, or a world class triathlete carefully rationing and intensifying interval training to arrive at record breaking peak performance, the root of the injury is the same. Your tendon and calf complex was simply to weak to handle the work load you were asking it to handle. The key successful recovery is finding just the right amount of each ingredient, at just the right pace. Ice and rest too long, you run the risk of losing muscle mass due to atrophy. Push too fast, and too hard, with too few rest days in the physical therapy phase, you might add more fuel to the fire of what is a red hot overuse injury. This is the type of injury in which you might be doing everything right, but still fail. You might be doing everything right, but perhaps too much, too little, too fast or too slow. It is a learning process. It is a matter of trial and error. The good news is, your body is fairly good at telling the idiot driving the show, what it likes and what it does not. The messages are there, you just have to be willing to listen.
Best regards to you, and take care
-Jack
that didnt seem blunt at all ...
