Posts Tagged ‘posterior tibial tendon’
9/18/10 – A 2 mile Run! – I had a little help from my friends…
Posted by admin in Training (running, cycling, etc.) on October 2nd, 2010
So, after such a wonderful experience with the race, I figured I would up my training with a longer run. I also invited my husband to join me, and he did. I’m glad he did because I was not quite as up to the task as I was last week at the race.
We started running downhill toward the waterfront where we live. I truly despise running downhill because it is so jarring to my knees and back, even though I was wearing my stability shoes. However, here we were going downhill, which does lend itself to speed. The terrain leveled out at the water, and we began to run along a long flat stretch. I was really flagging. So, I decided in my head that I would run one mile and take a 1/4 mile breather/walk before starting my second mile. I told my husband to be prepared b/c I was going to walk. He encouraged me to keep going, but I was tired and a little scared that I might over do it and cause my posterior tibial tendon to flare up again.
So, I walked at my one mile mark.
I then decided to run the last mile.
OMG – that was so hard! What a mind game! I ran a half mile, gave up, but my husband urged me on. Then at the last .1 mile to go, I completely gave up. My husband did not. He placed his hand on my back and began to literally push me to finish. So, I did.
That two mile run was one of the most difficult ever. I know that I upped my training from an easy 1.5 miles with walks in between to trying to do 2 miles straight through, but, seriously, that was intense.
I am happy to report that I did not have a tendon flare up, and the rest of my body (right shoulder included) did just fine.
Not so sure I’m keeping 2 miles as my training distance, though….
8/10/10 – Run 7A – Trying for 1.25 Miles, not so much.
Posted by admin in Training (running, cycling, etc.) on August 10th, 2010
Today, I was going for upping my mileage to
Walk 1/4, run 1/2, walk 1/4, run 3/4, walk 1/4.
The first half mile run was going well. My ankle felt great, my quads a little tight, but not too bad. So, I tried for 3/4 mile, but I only made it to 1/2 mile on the second run due to the small, yet, sharp pain running up my posterior tibial tendon just above my left ankle. Even though I could have kept going, I kept hearing Travis in my ear saying, “There should be no symptoms. Stop running if you have symptoms.” Well, I guess a pain in my tendon counts as a symptom.
I will try again to up the mileage next time. For now, one mile it is!
Oh, I was wearing my stability running shoes and prescription orthotics.
Also, next time I run, it will be 90 degrees outside – geeze!
7/26/10 – OUCH!!!
Posted by admin in Reflections on July 26th, 2010
The stride-outs huuuurt! That means they are AWESOME 🙂
For posterity, I am going to detail what’s going on.
Yesterday, my feet, specifically, my left posterior tibial tendon all the way up my calf and my right posterior tibial tendon – not in the foot, but up the calf. Despite this, I insanely agreed to go on a three mile walk through a park. OMG.
We went down to a beach to look at a lighthouse. It was maybe 1/2 mile of downhill and steps. That motion is, I think, part of the eccentric move of my posterior tibial tendon. For those who don’t know, eccentric in this case is the lowering of the foot, toe to heel. When working the muscles that way you can get twice the strength. Conversely, when walking downhill that way, you can get twice the pain.
When we got to the beach, I was in so much pain that I really would have liked a winged monkey to come and carry me back to the parking lot. However, we were half way through the hike, and you can’t quit there – you have to hike out. AAAAAHHHHH!!!!
Needless to say, I was hobbling by the end of the night. When you sit down and rest, those angry muscles just get tight and truly testy.
My wonderful husband gave me a massage that revealed some knarly knots in my calf muscles as well as along the posterior tibial tendon in the left foot. The right foot and leg mostly had the knots in the calf muscle itself. The bottoms of both feet hurt with the left being much higher. I’d say this was a 7.5 out of 10.
Today, I woke up feeling slightly less tight, but still OMG sore. I hobbled around the apartment until time to go, and my absolutely, overwhelmingly awesome husband drove me to work because I don’t think I could have walked there.
I had this delusion that I’d be able to go to the gym and do my workout today, but that was so not in the cards. I am still hobbling.
Due to the run and consequent pain following, I have not done my personal training workout, and I’m supposed to meet Melissa again on Wednesday. I’m thinking I need to rest again tomorrow, but I am really feeling the need to move. Perhaps a swim?
However, this ouch is clearly a sore muscle ouch, not an inflamed ouch. It is getting better much quicker, and I am looking forward to continuing everything by next weekend at the latest.
Perhaps 2 stride-outs next time, rather than 6….
7/4/10 Waterskiing on Lake Ouachita in Arkansas
Posted by admin in Reflections on July 15th, 2010
Well, I traveled to the truly exotic location of Lake Ouachita in Arkansas for the 4th this year, and boy was it fantastic! For those of you who do not know me very well, I am a terrible water skier. I rarely get up on the skis and almost always eat tons of lake water. However, this year, I was able to ski until I was ready to drop!!! It was phenomenal 🙂
However, while skiing, I noticed that my left leg was getting tired. So, I decided to give the left leg a rest and just transfer the bulk of the work to the right leg. When I did that, I noticed that my brother-in-law began scrambling around the boat like a mad man. I thought to myself, “What is he doing?” Then, he came up with a camera. Now, we had been skiing for two days, and everyone had been photographed while skiing. So, I couldn’t figure out why he had decided that I needed a photo at that particular moment. I also decided that I was ready to quit skiing because my right leg was getting tired of doing most of the work. So, I signaled to go down, and I dropped, which was awesome because I’m usually wiping out in some truly epic fashion.
When I got into the boat, my brother-in-law was animatedly telling me how freaky my legs were because I looked completely bowlegged. Apparently, my left knee had gone in toward the right knee at a grotesque angle. I was so excited by this discovery that I asked him if he had gotten a picture, but he couldn’t figure my camera out. Thus, no picture 🙁
However, I decided to ski again the next day so that I could get a look at my left leg. Sure enough, once I was up and skiing, my left knee decided to bend in toward the right leg in a truly freakish angle. I worked to get it straightened out by pushing harder with my big toe on the left foot. This worked! However, as soon as I stopped looking, it went right back toward the right leg again.
I have been water skiing several times before this, and I have never had this particular problem. My theory is that I am definitely using the posterior tibialis tendon in ways that I have never used it before. Thus, it is still adjusting to the extra responsibility – even in water skiing!
Although it was just skiing to everyone else, it was another affirmation to me that I am on the right track with my training! Go me!!! 🙂
Physical Therapist 6/29/10 – MORE PICTURES :-) and an EDIT
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.
First Run 4/30/10 – One week later…
Posted by admin in Training (running, cycling, etc.) on May 3rd, 2010
So, I finally did it! After the hike, my tendon continued to hurt, and I think I found some pollen on the trail that really got me down for several days. Thus, I iced everyday and decided that Friday was the day.
The walking one mile and running only 1/4 mile was surprisingly challenging. It was fantastic, though. I felt really good, and I worked on trying to take longer strides. Turns out that when I am working on having a longer stride, I need a lot more strength from my quadriceps. Thus, I end up banging my feet on the ground. Then, I find myself chanting – out loud, mind – “lighter, lighter, lighter…” Now, lets talk about trying to do a mid-foot strike in motion control shoes with prescription orthotics – oh wait! It’s not possible! All of these aspects lend themselves toward a solid heel strike. At least, that is how I found my foot falling – firmly on the heel. More ground slapping when I tried to mid-strike. Therefore, I was not so successful on the mid-foot strike this last time. Whew! At least it was only 1/4 mile.
So, I’m wondering if looking into some straight up stability (not motion control) shoes is a good option. I will say that I am certainly not interested in plunking down $100 for a trial and error go at this point. My current shoes are in very good shape b/c I only use them for running. We shall see as I continue to train this time around.
I took two days off this weekend. I will resume the plan tomorrow morning. See you bright and early if your out and about!
Physical Therapy Visit 4/8/10
Wow! It has been four weeks since starting physical therapy! And guess what?! Travis had me push my foot against his hand today, and he said that it was definitely stronger! Hooray! It’s working! I’m not ready to run, yet, but things are looking up. Not to mention, I’m very close to running 🙂
Ok, this visit I was so sore from my personal training session with Melissa, that I was really in sad shape to do much for Travis. He kept it simple, but definitely challenging. First, we started with the bridge with a twist – my feet were on a big ball. However, Melissa had made me hold a bridge on one leg for one minute each leg. It was too good of an exercise, and my sore muscles rebelled.
So, Travis, then moved through a series of exercises. My homework is to do them as close to everyday as possible. I took the weekend off, but I started tonight (Monday) with a bang! I did Melissa’s workout combined with Travis’s! Man, was it ever nice to walk into the gym with a plan.
Also, Travis did have me run in my super stiff running shoes with orthotics for 2 minutes. He told me that I picked my feet up at neutral, which does indicate a tight hip flexor, as Melissa had found. So, he said to continue stretching those. He also said that my right foot looked great, while my left foot continued to fall around the arch/ posterior tibialis. So, more work is needed.
Next time I go in, Travis is going to record me running in my super stiff running shoes and my Vibram’sâ„¢. I cannot wait! He said that I might be able to put it up on the blog. So, stay tuned! You might be lucky enough to witness my feet in motion!
Until next time….
Run 6 – Thursday, March 4, 2010, oh man.
Posted by admin in Training (running, cycling, etc.) on March 7th, 2010
Okay. Remember how I said that I had been trying to run since I was 18. Well, the cycle is something like: don’t run for a long time, run, inflame a tendon (patellular tendonitis, IT band-itis, etc.), quit running to let it heal, and don’t run for a long time….. I am continuing the cycle.
On Thursday, I was on the fence for running, but I ultimately said to myself, “Self, let’s try to establish this routine and go run.” So, that’s what I did. I met my friend, and we did a different location run/walk for about 3.5 miles. I wore my super stiff running shoes with orthotics. When we finished, the run proved to be another posterior tibial inflamer! WAHHHH!!!!
I am not going to lie. At this point I was incredibly disappointed. I went home Thursday night and did the ice, heat, ice cycle twice. It felt better by the time I went to bed. However, Friday morning was another story. The left foot really did not like it when I walked on it. I even broke down and took ibuprofen when I got to work. I was at wits end.
How can I prove to the world that I can run in barefeet with my flat feet if this stupid tendon won’t stop hurting?! Doesn’t it understand that this is really important? GGGAAAAHHHH!
Then, I realized this is part of the process. The process of getting my feet acclimated. So, hang on tight, folks, as I take you through some additional steps for getting over the beginning bump of working out with flat feet.
First, I enlisted the help of the physical therapist I had been to in October when I was going to start training for a half-marathon (no specific half, just any half-marathon at this point). However, once I quit going to him, I pretty much just stopped running and working out period. Man do I need to have some stick-to-it-tiveness in my life.
Anyway, I emailed him about the inflammation with two quesitons: 1. How long does it take inflammation to clear up. 2. Should I stop weight-bearing exercise while letting the inflammation heal?
His answers: 1. 2-3 weeks depending on the inflammation, etc. 2. YES! Stop the weight-bearing exercise immediately.
He also said that ice is the only thing that I needed to do (no ice, heat, ice), and that I should do 15min 3x’s MAX ice per day. He also recommended that I come in for an appointment so he can see my foot and give me some pointers on training in barefeet (his company had recently done a mini-seminar on barefoot running – what timing!).
My response since then, I iced for 15min on Friday night. I am planning to call on Monday to make an appointment, and hopefully I’ll see him next week to get new stuff going.
Second, I had an appointment with my chiropractor (I see my chiropractor at least once per month, and I highly recommend this action for everyone – more on that later), and at the end of these appointments, I also have a massage to help the body’s muscles realign with the adjustment or something.
During this particular appointment, I was worried because I was getting a new massage therapist. It turned out that I had absolutely nothing to worry about. She was fantastic and very in tune with the body. It was interesting because they keep a file on me, and she knew about my history with TMJ even though I didn’t mention it. I always get a little freaked out when the massage therapist goes, we’ll need time to massage your jaw for your TMJ, when I have only mentioned that my left posterior tendon is killing me. My massage therapist is AWESOME!
Ok, back to the massage, when she got down to my legs, it was the usual OMG pain in the quadriceps from all the new work they’ve been doing (expected), but there was this excruciating pain across the top of my ankle. She said that this is a band of muscles that the wrist and ankle have because they are the “weak link” in the body. Well, let me tell you, my band of muscles were super tight! She worked on the left foot first, and then the right foot. Her observation was that the “right foot is a lot less gristly than the left foot.” And boy was she correct!
Overall, I felt so much better with my chiropractic adjustment and massage, that I am going to increase the frequency during my early stages of training. I will start with once every two weeks and see if that is enough. I am also going to enlist the help of my physical therapist. Let me tell you, folks, it really does take a village!
This is not the end! It is merely an obstacle on the way to success!
Run 5 – Monday, March 1, 2010 – Uh Oh….
Posted by admin in Training (running, cycling, etc.) on March 2nd, 2010
So, I spent Sunday blogging :-), which gave my unhappy posterior tibial tendon a rest. I will say that I hobbled all day, but I noticed a reduction in pain by Sunday night. This was important because I have a standing run scheduled with my friend every Monday on the wonderful 3 mile gravel loop.
I decided that going ahead with the run would be fine given that I take it easy during said run and wear my orthotics and super stiff running shoes if I don’t feel that it is at least 50% better by 4pm. I also decided to wear my Danskoâ„¢ shoes today as they are supposed to be so good that you don’t need your orthotics with them.
Sidetrack for the Danskoâ„¢ shoes:
Up until today, I had no idea why these shoes were so great or why people loved them so much. I bought mine on the recommendation of my mother, who loves hers, and she bought hers on the recommendation of her foot doctor. Why not? My mom thinks they’re great, and she and I share some foot similarities. Plus, they are doctor approved. I wore them, and I liked them. However, they didn’t make me jump for joy because they felt so good. That is until today.
I now know why the Danskoâ„¢ shoe is so great for flat footed or orthotic wearing people, even without being able to put orthotics in them. Those shoes do all the work for your foot! I mean, my tendon didn’t do anything. The shoe is so rigid that your foot does not have to push off or bend or do anything! It was amazing to my over-worked and inflamed tendon. I was quite pleased with my Danskoâ„¢ shoes on my morning commute (walk) to work, and I had been really worried about really aggravating that tendon.
Back to the run:
Throughout the day I paid attention to how my left foot felt. It didn’t really get “better”, but I didn’t want to bow out of my run since I am establishing a behavior. I decided to go ahead and run, but I had to wear my orthotics and super stiff running shoes. I was very bummed.
We got to the super 3 mile gravel loop and decided to do the loop in run/walk mode. I noticed the difference in shoes immediately. Running in my othotics is like running with a corset on my foot. I couldn’t move my feet to adjust for objects in my way as quickly as when I am “barefoot”. I couldn’t adjust my forefoot at all. I really tried to maintain mid-foot running today, but it was really difficult as my running shoes are definitely pushing me to heel run. Not to mention, I was aware of my IT bands, again. Yes, after one day! I haven’t felt them at all in my “barefoot” runs. AAAAARRRRGGGGHHHH!
However, my tendon was much relieved and made it through just fine. It is happily icing right this minute. I also noticed that I hobbled not at all and the pain was considerably less after my run today in the orthotics. Hmmm.
So, I am now determined to get this tendon feeling better, and to take it more slowly with maybe a half barefoot/half running shoe run. I haven’t decided. I am going to do more balancing exercises specifically for the left ankle. I have found the most effective to be standing on the Bosu® on one foot for 30 seconds. Talk about challenging – definitely be prepared to fall off 🙂
I am still disappointed, but I will say that my right foot is adjusting perfectly. It is no longer sore. All I have to do now is get my left foot up to strength. I think I can! We shall see.