“There’s a strange sort of clanging from the clock in the hall, and the bells in the steeple too…” No I am not about to launch into song from a rather well known 1950’s musical (as much as I am apt to do at times) but this line springs to mind as I contemplate in hindsight the onset of a pain in my left ankle/foot. The niggling, subtle, tension as you point your once delicate arched foot in a remembered position and then wonder ‘why on earth isn’t my foot arching the way it used to?’ and ‘what is that strange restriction in my Achilles area?’ was an indication that something was beginning. An indication I foolishly ignored.
It’s a pell of the solitary bell, forewarning you of something sinister that if you don’t address becomes an ever increasing disturbance to your athletic ability.
OK - let’s just say this – “I don’t get injured”. It was one of the things I prided myself on (in my day). The ability of my physical constitution to keep bashing out leaps and jumps, continuously recovering and able to consisistently ‘keep on’ no matter the workload. It was one thing that I felt I had, particularly as I worked with younger and younger colleagues – as they lay on the side bemoaning their injuries, I was striding forward with my yoga mat and resilient nature asking the question ‘can you keep up with the old girl?’
The inevitable march of time does spell out some resurfacing of old injuries and pains but also it brings with it the new sensations (oh happy day) where you’ve heard of these awful conditions that contribute to the unease and despair of ‘lesser athletes’ (that comment is going to have some karmic whiplash) and suddenly they are visited upon you. Welcome to the march of the overuse injury.
Just to get technical for a moment. There is some confusion amongst the lay person as we get into anatomical terms such as Tendinopathy vs Tendonitis vs Tendinosis!!! For the record:
· Tendinitis – inflammation of the tendon
· Tendinosis – deterioration of the tendon due to wear and deconditioning of fibres
· Tendinopathy – is a term used to describe the general pathway of tendon issues, from inflammation through to deterioration.
Likewise there are specific terms for specific locations of conditions. In this case:
· Heel Spur – denotes the formation of a spur on the sole of the foot at the base of the calcaneous. This formation grows along the same line as the plantar fascia, the fibrous band of tissue that is responsible for reinforcing the longtitudinal arch and assisting with plantar flexion of the ankle (jumping)
· Insertional Achilles Tendinosis – affects the back of the calcaneus (heel) where the Achilles inserts into the bone.
The latter condition is perhaps more appropriate to ‘older’ athletes or active persons (I think I just came up with a new PC term that I must now surrender myself to) whereby the overuse of the tendon in jumping or running exacerbates the irritation leading to calcification and more chronic pain. The inability to tackle stairs and the slow onset of this pain rather than a traumatic accident makes this condition more ominous to the active individual. Yes it is a sign of the ageing athlete – another thing that the over 40’s can bitch about at the end of the day when everyone in the team is nursing their tired body.
So now I am forced to render my reputation falliable as I find myself with the unnerving condition – the bone spur. Bone spurs are created by the body in response to a need for healing or growth. Sometimes with increased activity and wear on a muscular insertion, the body lays down calcium and forms extra growths at the site of the attachment to make the joint more resilient. This sometimes leads to the formation of extra bone or ‘spur’.
Oddly enough the actual spur itself is often not the problem. It doesn’t create the inflammation that occurs in the area or that radiates to the underfoot. It is documented that in some cases a bone spur of up to 1cm on both heels only illicits pain in a single foot. Some say as little as 5% of bone spurs result in inflammation and painful conditions. The issue comes about when a bony formation occurs close to or at the site of a tendinous insertion. Its not necessarily that the spur irritates the tendon, moreso it creates a bio-mechanic (the way that an articulation/joint moves or operates) that can create an inflammatory response or ask too much of a tendon/muscle to overperform. So indeed you are often not necessarily treating the spur but the condition that is being caused by it.
We have talked before about Plantar Fasciitis and the ways to deal and treat this condition. Thus looking at the bone spur on the underfoot you would naturally be looking to treat the plantar fascia with massage work to the lower leg intrinsic muscles and eccentric loading of the plantar flexors. See article here
The latter condition of Insertional Achilles Tendonitis is similarly influenced from a protruding spur interrupting the normal function of the tendon. Due to the nature of the insertion of the Achilles tendon, a bone spur that is formed underneath it will create less space for the tendon to operate in normal function or create an irritable protusion that interrupts the smooth flow and flex of the tendon.
In both cases as an athlete or practitioner, we are treating the irritation of the tendons. That means we want to create as much space as possible in the activation and operation of the structure. Its about trying to create space in the tendon that’s having trauma. More space usually means less irritation. Thus with the plantar flexors that lie deep on the tibia/fibula as well as the power muscles associated with the gastrocnemius/soleus (calf) that insert into the Achilles, these are the first targets for treatment.
1. Proper warm up – get it ready to fire and get the supportive muscles ready to bear the load.
2. Ensuring proper warm up pre event and the use of warming balms/heat gels during activity to ensure the most amount of movement as possible
3. Consistent and committed stretching post exercise is vital to keeping these tendons open and free from the irritating spurs.
4. Epsom Salt baths – flush the areas with minerals and healthy healing properties – whether it’s a foot bath or a whole body bath – THIS WORKS
5. Get some treatment to help with keeping everything open and free. Remedial Massage can help with the tendon and muscular tension and, depending on how far along the injury track you have gone as well, there are also ways of dealing with any calcification or bony formations via acupuncture. Acupuncture as well is very much a good way of treating the inflammatory response of the system as well as the acute nature of the injury.
So as one limps early out of bed and tenderly places their foot on the shag pile on these cooler mornings that are about to become more common, I am reconciled in the fact that I have access to the right people about me that is going to allow me to get through the current tournament season without giving too much credence to my own susceptibility to injury!
Being conscious of where pain starts to present and acting upon it early is important in the identification of movement patterns and biomechanics that may be leading you to other issues. Back to the rehab wobble board!