Heel That Pain

Heel That Pain

shapeimage_1-20The achilles tendon.  The largest tendon in the body and perhaps one of the most debilitating if it tears.  You have heard of the mythological figure Achilles of the trojan war.  He was said to be invulnerable in his body except for his heal. He died because of a wound to his heal.  An arrow was shot by Apollo and punctured his heel. This wound proved to be fatal.  Even the term “achilles heel” has come to be known to describe a persons main weakness.

Injuries to the achilles tendon are common and can be difficult to come back from.  Highly preventable in Todays Athlete, and thankfully so as we rely on them so much for mobility.

The achilles is one of the largest and toughest tendons in the body.  it is connected to both the gastronemius and the soleus muscle in the calf and  inserts into the heel, or calcaneus.

Excessive over use is often the cause of achilles problems in Todays Athlete and with out adequate time to rest and restore it weakens and can even tear. One of my clients presented with an inflamed achilles today. She had just recently been prescribed orthotics and a heal lift in her foot (not the one that was hurting). I had her stand before me in her barefeet and slowly shifted her posture so she was more balanced, she laughed and said “I feel like I am falling backwards!”  Her tendency is to shift all of her weight forward, which already has created stress on the achilles.   Add a lift to one foot with out addressing the already shortening of the front of the foot and shin and  the added tension to the achilles sets the stage for trouble.

droppedImage-2 I was given this analogy (photo left) and it gives a great visual as the stress and strain put on the achilles as the heal is moved back behind the calf. If her postural alignment and spacial awareness are not addressed, putting a lift in the other foot is only going to create further problems.  I find that most people who suffer from low-back pain have a forward leaning posture which puts added stress and strain on the back muscles as well as all the muscles along the backside of the body.  This forward leaning posture causes the calf muscle to tighten and can put a lot of stress and strain on the achilles.  Add to this her forward leaning posture is now creating  more of a pronation of her foot and all this requires more muscle power and fatigue along the backside of her body all in an effort for her to maintain her balance.

droppedImage_1-3Think about the many ways in which todays athlete maintains this imbalanced hold on the foot.  Not just in a forward leaning posture but I am finding as I write this the position of my feet underneath my chair up on the balls of my feet is creating a constant pull on my achilles.  Think about all of the sports then that require a doris flexion and push off of the foot  and the repetitive action.

Abrupt changes in muscles tension is a frequent occurrence for todays athlete, be it quick stops, starts and changes of direction, or the repeated loading of the heel when walking or running.  All these can begin to weaken the Achilles creating an environment for a serious injury.

images-3-1Static and dynamic conditioning are so important  to strengthen and lengthen the achilles and attention must also be given to the muscles of the calf and the hamstrings.  Once again we see an imbalance of strength and flexibility putting to much stress sets the stage for injury. It is not all about strength or all about stretching.  It is finding a balance between the two.   Over stretch and under strengthen creates imbalance, and learning to discern whether a sensation is caused by one or the other can be confusing to todays athlete.

Is it a dis-ease caused by muscle fatigue, or a dis-ease caused by being  over stretched and lengthened?

Finding the answer to this makes more sense  to me then simply changing the foundation.  The advent of postural supports, orthotics, arch supports etc…… is not addressing the structural imbalance, in fact it is ignoring it and creating additional concerns for todays athlete.

Here are a few exercises you can add to your daily practice to help prevent injury to the achilles and begin to find a balance between strength and flexibility.  Alternate between repetitive movement and dynamic conditioning.  Remember Repetitive movement  will increase strength while the dynamic movement will increase endurance and help break up connective tissue that is causing a shortening in the muscle fiber.

 

Resistance Band Plantar flexion

This is a gentle exercise to start with. Hold a loop of resistance band and use it to apply resistance as you point the foot away.

 

Seated Calf Raise

Again this is a gentle exercise but this one will strengthen the Soleus muscles.

 

Calf Raise- Both Legs

Stand on the edge of a step and lower the heels down slowly, both at the same time.

Place the emphasis on the downward phase.

Reverse the movement and rise up onto your tip toes.

 

Practicing Balancing postures on a surface that is not firm is another great way to strengthen the ankles and the lower legs.  Close the eyes and you are in for a real proprioceptor treat.

In your Yoga practice it is important to pay attention to the flexion and extension of your feet.  Alternate between pointing the toes and extending thru the heels while flexing the toes back as well as exploring the internal and external rotation of the ankle.  The ankle is not a hinge joint and it is important to remember to explore its full ROM beyond the linear movement of dorsi and plantar flexion to maintain joint ease and movement.

How might your yoga expression be adapted to express the full ROM of your ankle in  a more balanced way.

Do you find you get stuck on energetically extending thru the heels or the ball of the big toe and the little toe.  Maybe you never point your toes.  Free up the ankle and the foot, expand and reach it to its full potential.

 

See you, on the mat!

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