This last week has been another bummer. On Friday, I spent the day in the kitchen making tomato sauce (Picture 20lbs of tomatoes, and you’re on the right track.) and baking a Yay-You-Finished-Your-First-Marathon cake for my husband. By the time he got home, my left posterior tibial tendon was crying out for mercy.
Today, at my physical therapy appointment, Travis started me back at what certainly does feel like square one. 🙁
This is just part of the process. I know that my foot is improving because it is USING the posterior tibial tendon, but the tendon is not strong enough (even with all the work I’ve put into getting it stronger), yet.
The Story of Muscle: [Edit – I stand corrected :-)]
Travis Orth, my physical therpist, had a few corrections on my story of muscle.
“So, I think you got the story of muscle close, but not quite right. Â I probably was not as clear as I could have been so here is another explanation. Â With strengthening, if you are actively completing exercises for the first 2 weeks there will not actually be an increase in muscle size, but you may experience a gain in strength. Â This gain in strength is attributed to increased muscle fiber recruitment (of muscle fibers that you already have) from your brain to that muscle group. Â It takes approximately 4 weeks to verify the increase in muscle cross-sectional area, so any strength increases prior to this point are likely attributed to improvements in neuromotor recruitment. Â This is all somewhat flexible and there is likely some actual muscle growth prior to the 4 weeks, but they are the numbers and guidelines that I like to follow. Â So with your feet, there are likely increases in muscle size, that is why you see such a dramatic difference in foot position. Â If you were simply recruiting more muscle fibers of the muscle that you already had I don’t think you would see these changes. Â Furthermore the changes are likely due to increased resting tension on the tendon, tibialis posterior, that is pulling up the arch of your foot and preventing collapse of the foot. Â This increased resting tension is from actual increased muscle size, so congrats you did it! Â However, as you have noted, there are still gains that can be made and the muscles can get even larger and stronger.
A lot of the information that I have provided is from the Shirley Sahrmann book titled “Diagnosis and Treatment of Movement Impairment Syndromes”, and she cites the article:
Moritani H, Devries HA: Neural factors versus hypertrophy in the time course of muscle strength gain. Â Am J Phys Med 58: 115, 1979.”
Travis wrote the above quote in an email after reading the blog. I thought I would share it with all of you fine folks so that you are not misguided by my not as educated guesses on muscles 🙂
——Back to the original post—-
All of this muscle building got me wondering just how my feet may or may not have changed. So, now for the pictures!
Before 2.27.10
After 6/29/10
LOOK!!! I think I can tell that my left ankle is not caving as bad! Yahoo!!!
Before 2.27.10
After 6/29/10
Are those the same feet and ankles? No wonder my posterior tibial tendon is sore. Look at all the work it has been doing! My left ankle is noticeably straighter in this picture. I cannot tell you how very good it feels to have some part of my hard work pay off 🙂
Before 2/27/10
After 6/29/10
After careful scrutiny of these two pictures I have several things of note.
1. I really need to keep the perspectives and lighting the same.
2. In the Before picture the left foot looks like a fan, but in the After picture, it is beginning to look more like a foot. i.e. the left foot getting thicker and straighter from the heel to the toe. 🙂
3. I think I see some muscles that weren’t there on the outside of the left foot!!! Yay!!!
Overall, I am really liking what I see after a mere four months! That is all! And that is a lot. I am looking at a very long time frame. The goal will come. It just might take another year.
Tags: goal, left foot, muscle, physical therapist, pictures, posterior tibial tendon, success