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3930 Views 7 Replies Latest reply: Mar 20, 2012 3:27 PM by JamesJohnsonLMT
PaintingLady Legend 906 posts since
Dec 12, 2009
Currently Being Moderated

Mar 18, 2012 5:10 PM

Sports Doc, Podiatrist, or Physical Therapist- who to see??

Here is the situation: trouble w/ calcaneal bursa or achilles tendon at insertion pt on back of heel since May, 2011. The pain was noticeable, but tolerable. 3-4 on scale of 10 and would ease off after first mile of run. I went for a dozen physical therapy sessions that didn't help the pain much. Plus I did all of the at home therapy: excentric heel raises, other stretching and strength exercises, iced, & ibuprophen for pain (only when I HAD to).

The pain was noticeable until first mile or so and then it went away, or I got in the groove and forgot about it. Ran a half marathon w/ no problems.

During the winter I ran on indoor track which is suspended hard floor (concrete?) a couple of times (6 miles) and then a couple of treadmill runs of equal distance. These runs beat my feet up, but still all was ok. Then I did a speed session (nothing new as I've been doing them, but this was maybe a harder session) which is a half mile distance on walkway over river it is concrete w/ pavement topper. After 5 miles the bottom of my heel was hurting.

I stretched, iced, rested. Still sore, so took off about 10 days. It felt a wee bit better, so I ran an easy 3 miles. Afterward my foot hurt like the dickens. From what I read it is like plantar fasciitius. So I've massage my tight arch fascia & tendons and they are loosing up.

The pain is worse in morning, but if I do an easy 3 mile run, I will be suffering for 3 days after (including being awakened at night).

Going barefoot feels better than wearing shoes. But either way, I walk w/ a limp.

It has now been almost a month and I've decided something has got to give. So see a professional and see if there is something more than meets the eye or if  something can be done that I'm not already doing.

Since my insurance carries a $5000 deductible, I need to make the best choice as to whether I should see a sports doctor, a podiatrist or go back to the physical therapist?

Suggestions and advise will be appreciated.


Other info which may or may not be pertinent: I'm a 60 yr old female, normal weight, running for 3 yrs, previous injuries other than heal problems were a stress fracture in rt hip (opposite of the problem foot), used to running in Asics Nimbus Gels, which I now think may be part of problem due to them being so stiff. Also run in Asics Speed Stars. Very high arches and inflexible feet. Normally run 18-25 miles/wk.

Marie from Tennessee

Training for Disney 2013 Goofy Challenge.....Yes, I'm certifiably CRAZY!

61 year olds must be out of their minds to run a half marathon followed by a full the next day!

Disney Half Marathon 1/7/2012 2:37:59

Bear Hunt 5K 9/24/11 28:28 pb

Trojan Trek Trail 5K 8/6/11 31:45

Expo 10K 5/28/11 1:01:28,

Expo 10K 5/26/12 1:05:39

Eastman 10K 9/8/2012 1:01:11 pb

"Let us run with perseverance the race marked out for us." Hebrews 12:1

  • BOSNPM We're Not Worthy 2,482 posts since
    Nov 20, 2007

    Marie, for me I would start with my PT guy.  He is great and will/would tell me if he can correct it or I should see a sports doc or a podiatrist.  Good luck

  • Damien Howell Legend 312 posts since
    Feb 27, 2008

    Take a look at this short article Who you going to call - choosing a Healthcare Professional.

    Damien Howell PT, DPT, OCS

  • JamesJohnsonLMT Legend 1,291 posts since
    Aug 23, 2009

    It seems to me that your post contains the answers as to why you have this condition right now. It developed over a period of time, so I would not expect it to disappear rapidly and allow you to continue training this way. I don't think you'll find a credible professional who will promise rapid results, either, so there is no reason why you can't take your time slowly undoing a problem that was slowly created. Especially with a $5,000 deductible!


    High arches are produced by a tight plantar fascia, which is in part produced by tight plantarflexor muscles. Heel raises can lead to a tight Gastroc muscle, which refers pain directly to the heel. Speedwork is notorious for tightening plantarflexors, and hard surfaces require more shock absorption from them. Indoor tracks tend to be short and curved. Indoor running stresses the outer plantarflexors around each curve, picking on one leg to the exclusion of the other. Did you frequently reverse directions? Even so, it's an unbalanced workout that can create unequal tension.


    I see nothing in the remedial regimens mentioned above that would relieve any of this tension, but plenty that would make it worse, including stretching and strengthening exercises. These protocols often lead to PF in the first place. You would only be further punishing yourself with aggressive regimens.


    Ice does not heal damaged tissue, only numbs it so you can stress it some more. Same with anti-inflammatory meds. I would not waste any money looking for some thing or person to heal you from the outside. Health professionals know that real healing always comes from within. It has wisely been built into your body already. You just need to activate it, allow time for it, and mostly, stop doing anything that is fighting the healing process.


    Most of the time, a wise health professional will tell you to cut back on your training, knowing this alone will produce most of the positive benefits. The rest of the treatment is window dressing, the primary benefits of which are the faith to relax you more so you can sleep better, and allow your immune system to heal the damaged tissues. Sometimes just believing in someone who seems to know what they are doing causes us to relax. That's why doctors who make us nervous tend to have poorer outcomes. A good bedside manner is half the battle. A doctor that can get you to relax and heal can look like a miracle worker.


    So, relax. I've run high mileage seasons before, followed by low mileage seasons, and back to high without losing anything. I recently posted about that 100 year old marathoner who took up running in his eighties and now runs 10 miles a day. In view of this, we should ask ourselves, what's the hurry? When I see runners of mature age (like myself) racing against time, the eventual breakdown is a self-fulfilling prophecy. If we relax and recover, we can always come back. I recently ran some of my best interval times ever, after battling back from a low-mileage mid season. It's true that if you don't use it, you lose it, but that does not mean you can't get it back.


    One thing is for sure - you won't get it back if you don't give yourself the time to heal. However, I must tell you in all honesty it is not quite that simple. Rest alone does not relax all muscle fibers. When you flex or stretch your muscles, it is usually assumed that all fibers in those muscles are of equal tension. In a healthy muscle, that is mostly true, but as muscles continue to tighten or weaken from overuse, the inequality of resting tension between the fibers increases. Even without an actual tear in progress, this fact alone is why continued exercise and stretching make actual tears more likely. Flexing or stretching even a single muscle fiber that is already kinked in spasm greatly increases its chance of rupture.


    Not only that, but it just takes a few unreleased muscle fibers to produce 24-hour tension on the joints they act upon, leading to chronic inflammation and pain. Joints need rest too, and they don't get it when muscles do not release their tension. Doctors often prescribe muscle relaxers for this purpose, but these drugs act throughout the body, causing sloppy muscle coordination that can increase chances of injury. On the other hand, there are natural ways to relax muscle tissue. For example, oils of eucalyptus, peppermint, and lavender are good topical muscle relaxers, when mixed with an inert carrier oil. Yellow mustard when consumed eases cramps. Ginger and Turmeric (also in yellow mustard) ease inflammatory pain.


    The most effective way to therapeutically relax your plantarflexors is to massage them yourself daily. I use soap and water in the shower, but there are other ways, like slowly lowering your calf over the opposite knee in a chair. I prefer using direct finger pressure though, because it is better adapted to the 3-dimensional contours of the leg muscles and bones than any implement, including a foam roller. Direct, targeted pressure has been shown over many years to relax the small groups of tight muscle fibers that can produce pain in the involved joints. Just be gentle, yet firm and consistent, with the pressure.


    There is a continuous band of fascia running through the back of the leg, over the heel into the PF, and it needs to be relaxed too. Tightened, inflexible fascia can be affected somewhat by massage, and rolling a golf ball under the arch for a few minutes is one way that has been shown to stretch out the PF fascia, though it can be somewhat painful. Since you already have pain in your heel, I would expect any attempt to stretch out any of this fascia, at any point, to be painful. In your case, there are likely to be problems with the chemical composition of your fascia that have dehydrated it somewhat, which may be due to nutritional factors aside from water consumption.


    For this reason, the first place to start when seeking outside help may be with someone who understands the dietary links between nutrition and tissue flexibility. You may benefit from an elimination diet that reduces factors associated with tissue dehydration. There may even be pathogens involved that this could correct.


    In short, focusing on the injury itself can lead to disappointment. It is better to focus on what could be continuing to cause it, potentially bringing it back after it heals.

  • JamesJohnsonLMT Legend 1,291 posts since
    Aug 23, 2009

    I'm glad you are asking this question, because every time someone asks a question, I am just as eager to know the answer. If I don't already know the answer, I research until I do. While this takes a lot of time, I enjoy time spent learning. A condition such as PF is something any one of us can get, so it is important for everyone to understand and differentiate between the kinds of inflammation that produce pain and growth, or pain and degeneration. Along the way I accumulated more knowledge of the complicated roles that water and enzymes play in the human body.


    Water in tissues takes an interesting journey with many twists. Enzymes are another another fascinating study. Both are important for converting food to energy, and for muscles to contract. Without the enzyme CoQ-10, for example, the heart stops beating. Without enzymes, there can be no healing, and without water, no enzymatic activity.


    You've probably heard or read that endurance athletes dehydrate frequently because they can't absorb water as fast as they sweat it out. This has been found to be true in the winter as well, because of the loss of moisture in the dry air. All those puffs of steam are water gone. One of the effects of dehydration is a loss of enzymatic activity in the body, because of the need of water to make enzymes work. Without enzymes, we lose the ability to continue functioning. Of course, runners usually stop before this problem reaches a critical level. When they don't, we often read about it.


    The body creates its own enzymes from proteins. They are also present in uncooked (raw) food, or produced by our intestinal flora as they digest what our own enzymes cannot. An example of this process is the breakdown of dietary fiber, which we cannot digest ourselves. In fact, fiber, as an indigestible carbohydrate, is one of the main nutrients for the many bacteria living in our intestines (where these tiny organisms outnumber human cells 10 to 1). This is true whether the microbes produce beneficial by-products, or pathogenic ones.


    Enzymes are highly specific in their actions, whether they are produced by our body, foods, or microbes. Foods in their natural state often contain the very enzymes needed to break them down. We see this when a piece of fruit falls to the ground, and is consumed by itself very quickly. Enzymes normally break down dead tissue, but this can change. During starvation, enzymes break down living tissue for food. They also break down living tissue in auto-immune disorders.


    Catabolic activity normally refers to digestion of food, but it also means that living tissue can be chemically tagged and targeted for destruction, to be rebuilt later as needed. It is known that some pathogens, as well as cancer cells, chemically "cloak" themselves so as not to appear alien to the immune system, whereas normal tissue is mis-identified as alien in diseases like arthritis, or chronic inflammation. Both are examples of immune activity gone awry, when living tissue is continually being dismantled by immune cells and their enzymes, past the limit when it is beneficial, yet foreign bodies are spared. The system can be fooled.


    Research continues into the processes involved in the non-mechanical degradation of human tissue, but too little is known to cure many of the most common inflammatory diseases. While anti-inflammatory drugs that inhibit the COX-2 enzyme can slow or stop the painful inflammatory process, the unfortunate result is that activity to rebuild tissue cannot continue when this process is interrupted. The baby is thrown out with the bath water. Low-grade inflammation is important to the regeneration of human tissue, because it is how damaged tissue is removed.


    There is clearly a need to properly control enzymatic activity, but moreover a need to understand how it can be misdirected by the body and its immune system. Since enzymes are vital to life, and are made from proteins, is there a point at which the body has to cannibalize itself in order to sustain these vital processes? Or, are there components not accounted for in the difference between healthy and unhealthy metabolic processes?


    It turns out that having an immune system is not unique to us, and the things we eat have defense mechanisms of their own. While processing foods strips them of their natural enzymes, eating them whole introduces their immune functions to ours. Chemicals that would normally protect a plant from predators, including microscopic pests, confront our immune systems head on as we attempt to digest them. One of these potent defense mechanisms is called a lectin, which binds to human tissue and transforms it into the equivalent of a foreign invader. Lectins can break down the mucosal lining of the digestive tract, allowing our own enzymes to consume that lining (ulcers), and they can also disable enzymatic activity.


    So foods are not defenseless after all, at least in their natural state, but there are clever ways to get around these defense mechanisms. Over the years, humans have learned to treat foods in ways that strip away some of the problematic substances they contain. Washing, peeling, coring, cooking, and fermentation have all been developed to make the nutrition of foods more available, while disabling some or all of their defenses. Even primitive cultures throughout the world have developed ways to best prepare the foods available in their habitat.


    The importance of enzymes in all this is two-fold. The foods we eat, once rich in enzymes needed to break them down, are now stripped of enzymes by processing and sterilization. This forces the liver and pancreas to produce more enzymes from the body's own resources. Water is necessary for these chemical reactions to take place, and is both a by-product and raw material for enzymatic processes, depending on whether they are synthetic or hydrolytic. The latter process requires water to dismantle molecules, while the other frees it up to build them.


    The importance of lectins is also two-fold, in that they interfere with proper digestion and act as agents to cause our body to destroy its own tissues. How do we mitigate the potentially hazardous aspects of the foods we eat, without interfering with the vital enzymatic activity that helps us to utilize them, all the while making the most economic use of our vital organs and tissues, and protecting them from damage?


    Well, good comic relief would be, "heck if I know," but you probably expect more, and I feel obliged to deliver. The truth is, I don't know exactly how this works. I just know that it does. First, I'll offer a theory: Our bodies are simply not equipped to do it alone. The laundering of our food supply may have protected us from the kind of pestilence that attends large concentrations of people into settlements and breeds disease, but it left something very important out. Those microbes that have been part of our world for millennia have been more important than we thought, as factories for vital enzymes, defenders from, and digesters of the vast array of defenses present in the foods we crave.


    The interaction between our own cells, the microscopic ones we host, and the ones we want to eat is still being studied, and is far too complicated to discuss in a running forum, even if it were known well enough to reveal. However, the laboratory of time has tested and approved some strange and exotic diets of what are best called "living foods" - foods teeming with bacterial or yeast cultures. Once again, I don't know how they work, but simply that they do for cultures that have used them long enough to prove their worth.


    A little story here: This morning I spoke with my Mom about a relative who had recently passed, at the ripe old age of 93. We thought he should have lasted longer as others in the family have, but being younger, he lived more of his life the modern way. I brought up this very topic of the contribution of traditional fermented foods to health, and recalled a homemade sauerkraut I had recently enjoyed, as prepared by a friend who is an expert cook. My Mom gushed as she recalled an acquaintance who prepared and ate her own sauerkraut all her life, and lives today over 100 years old, described by some as having the mind and disposition of a 65 year old.


    While there are right and wrong ways to prepare fermented foods, bacterial cultures can be quite hostile to strangers in their midst. The substances they produce mark their territory in a way that pretty much rules out contamination by more dangerous microbes, when properly cultured (why it is such a time-honored method of food preservation). One thing I have found after sampling a number of fermented products, is that they are not only tangy and tasty, but have a very pleasant effect on digestion and my general feeling of well-being. I think this may relate to the low load pre-digested food has on the body's own digestive organs. We don't have to churn out as many enzymes when they are made fresh daily by the foods we eat.


    Here are some of the known benefits: Fermented foods act as chelators of heavy metals and other contaminants that find their way into our food supply. A chelator is something that chemically binds with and neutralizes or removes an unwanted substance (not to be confused with cheation therapy). Basically, the bacteria digest harmful substances, converting them to less dangerous substances. In some cases, they are simply voided rather than being stored in body tissues. This could be a factor in auto-immune conditions, which may be the body's ill-fated defense against stored contaminants.


    Fermented foods make more nutrients available for absorption. Many nutrients we require cannot be absorbed until they are broken down by bacteria. Ensuring a rich supply of these bacteria, along with the food itself, is a potent guarantee of adequate nutrition. Fermented foods have been shown to have a positive effect on inflammation, chemical imbalances, including those in the brain (DId you know that most of your seratonin is manufactured and stored in your intestines?). They even reduce the amount of dental plaque we accumulate. Fermented foods reduce our cravings for sweets and other foods by making the nutrition from the foods we eat more immediately available, reducing cravings that result from incomplete digestion. They act to break down fats in the intestine, into shorter chain fats that can be utilized to carry vital fat-soluble nutrients. The list goes on.


    Before I melt the Active server with another e-book, I'll let you go experiment, with some links to other reading material.


    Here's a good article by an expert on cultured foods.


    This testimonial page on the GAPS diet, is aimed primarily at neurological disorders, but valuable as a diagnostic or transition diet for anyone seeking to make a major change.


    An interesting article written by a podiatrist, on the mostly mechanical aspects of PF, from a holistic perspective (reviews are understandably mixed).


    A Livestrong article on helpful nutritional strategies.


    Holistic dentistry article on systemic enzymes.


    Message was edited for clarification by: James Johnson LMT

  • Damien Howell Legend 312 posts since
    Feb 27, 2008

    While going through my Google Reader today interestingly after reading follow up postings on your original question this post from a Science Based Medicine entitled How to Choose a Doctorwas posted.  This post speaks to selecting health care provider based on science based medicine as opposed to alternative complementary based medicine.  .

    Damien Howell PT, DPT, OCS

  • JamesJohnsonLMT Legend 1,291 posts since
    Aug 23, 2009

    My apologies, Marie, for only addressing one of your questions (Diet). After my phone conversation, the topic was fresh on my mind, so I had a go at it and got carried away. Dietary changes are long-term solutions that address problems even longer in the making. Immediate results are possible with things like allergens, but it often takes a year or more to deliver the best results. Thanks for your patience. Let's take a look at more immediate concerns.


    Yes, it is true there is a great deal of conflicting information out there. Genuine differences of opinion are somewhat tainted by the amount of money riding on each therapeutic intervention. Barefoot is a trend out there, but it has its detractors. Harder to sell shoes that way, but there is one common-sense approach that works: the nature test. Is it natural to wear shoes? No. Do we spend most of our time on natural surfaces? No. Is it natural to stand, walk, and run on unnatural surfaces? No. Is it natural to counter an unnatural surface with unnatural footwear? Maybe.


    I think there is some redeeming logic in trying to re-create the feel of a natural surface with footwear. Beats bringing turf indoors. The MBT approach may be a bit far-fetched, but it could be more "natural" than bare feet on hard flat surfaces. I've been trying the bare on floor approach myself, and I am going to assume that my sore feet mean they will soon toughen to adapt to this harsh environment. Not sure yet if this is a good thing, but I have my doubts.


    The first person who told me not to stretch was Jeff Galloway (via his book, although I did get a couple chances to chat with him on other stuff). It took a while for the well-trained mainstream medical community to catch on to this concept, at least enough that the controversy was visible, but I think it is telling that Jeff did not base his opinion on medical training. He based it on experience. Many years later, actual, evidence-based studies are beginning to catch on.


    Galloway observed that there were more injuries among marathoners who stretched than among those who did not. He substituted the slow warm-up for the pre-workout stretch, and the gentle cool-down for the post-workout stretch, cautioning that if stretching were done, it should be of warm muscles, never of cold. He also said it was not a good idea to walk barefoot on hard floors, especially right after a run. Haven't seen any studies on this yet, but I trust the guy, despite his lack of scientific training. That leads me to Damien's comment.


    The term "evidence based medicine" seems to be taking a back seat to "science based medicine" lately, probably because folks like Galloway can cite evidence, but Science requires multi-million dollar double-blind trials. The trouble with that approach is that such science is limited by what we know, which is limited by what we choose to see. What we see, unfortunately, depends on what we spend a great deal of money looking for. Without a solid ROI, "science based" becomes "Investment Based." Following the money, over 40 years after Nixon declared war on cancer, we have no cure. The only cures claimed have little or no cost, so are not likely to ever be "science based." "Conventional" means major stake holders must agree. Anything else is "experimental" or "quackery," until the big money says otherwise.


    Science is a religion based on lack of faith. When science bothers to prove the existence of God, explain what life is, bring back the dead, or heck, cure the common cold, I'll consider becoming a believer. Until then, cold logic will never be enough for me. When it lacks the power to prove, it ignores too much evidence.


    I think your prospects are much better, Marie. The important thing to know, is that you would have been in a wheel chair years ago if you weren't doing most things right. A little tweaking with the shoes is a good idea. Trends have brought the drop down, but I'd be suspicious of too abrupt a change. When you mentioned ditching heels, it brings to mind the concept that muscles tend to shorten when they are kept that way, and sudden lengthening can hurt. The middle drop you mentioned would allow the orchestration of your running muscles to slowly re-train. Other thoughtful discussions of orthotics I have read provided for the same gradual transition. I have faith the closer you move toward the barefoot/minimalist approach, the better you'll feel, as long as the change is gradual enough. Think of the old heels as the stone age from which you are gradually evolving, lol.


    I am encouraged by your account of the brief winter training, and your prospects for returning to normal in this great weather. If you feel you overdid it, if by only a little, your prognosis should be very good. My right heel had acted up after a hot, plodding 8 miler mostly on concrete a couple weeks ago, but a 9 miler a couple days ago on rolling hills with mixed terrain did not bother me at all. In fact, it was the most pleasant run of the year so far. My heel only hurts if I bump it. Yes, healing does come from within, even if Osteopaths are criticized for saying so!


    Regarding the self-directed therapies you are using (massage, stretch, exercise, socks, boots, etc.), I won't argue with anything that was prescribed for you, because a treatment protocol can't be fairly evaluated if it is not followed to the letter. I think some clarifications need to be made, however.


    Our language is not very rich when it comes to words for stretching. Elongate is more of a result, pull is more of an injury. Stretch is not a very specific term. I believe in stretching, but more of the type a cat or dog might do upon arising, not against a voluntary or involuntary contraction. OK, there is a type of stretch called PNF that tires a muscle by flexing it against resistance, the object being to disable the muscle's ability to resist the following stretch. This is a therapeutic technique best done by a professional, but most stretching that is done out there is completely unsupervised. I don't think Big Brother should be watching every stretch we do, but there are times when a stretch can be very dangerous. When a muscle is cold, or doped up with endorphins after a run, or riddled with active or latent trigger points (the tight bands I discussed earlier). These conditions contraindicate a "stretch" as it is generally understood, because of the potential for microtears and the proliferation of scar tissue.


    I think the most important data to emerge about stretching, is that it is hard to prove that it helps performance. Some drop in performance has been observed after stretching, but this finding needs to be backed up before it really meets the science test. The nature test is easy: animals don't stretch the way we do. I read some research a while back that found greater concentrations of chemicals in fascia, associated with flexibility, in response to stretching. The question is, stretching of what? It is very hard to stretch a muscle without tendons and ligaments getting involved, so we may have a dual conclusion. Muscles may not respond favorably to stretching, whereas tendons and other tough fascia may benefit.


    Here is an example of a stretch that was cited in some academic research as being beneficial for PF sufferers in most cases. Some background first: when you flex a muscle, the law of reciprocal inhibition states that the opposing muscle group will automatically relax. It's the brain's way of avoiding head-on collisions of contractile forces. Problem is the concept breaks down in the presence of spasms, cramps, and trigger points, but we press on: Dorsiflex your foot, gently grab the toes and lift them up even further than you can voluntarily dorsiflex them, holding for several seconds. Release and repeat 10 times. Do this 3 times a day, starting before getting out of bed. As I recall, the numbers were overwhelming in favor of this direct stretch of the plantar fascia as beneficial to PF sufferers. So, there you go. Some stretches help, and others can harm. It depends on the location, intensity, involuntary inhibition, and condition of the components stretched.


    One thing I hinted at in earlier posts, was the resting state of muscles and joints, and its impact on joint health and pain. Many tissues in the body are built during our youth and simply maintained thereafter. Vascularization is key. Blood flow that is initially plentiful for tissue formation is later replaced by interstitial fluid in adulthood. Muscles need oxygen supplied to them, but other tissues will depend on fluids without red blood cells getting involved. Other components of the immune system continue to circulate in order to facilitate repair, and these fluids deliver enough nutrients and remove enough waste that non-vascularized tissues can continue to thrive. This changes when there is no movement, and is impaired in the presence of unrelenting pressure. Unlike the circulatory system, there is no heart to pump these fluids around, which depend on movement and lack of restriction. One thing massage does, is to continue to mobilize non-vascular fluids when normal activity is low.


    Massage also can promote or retard low-grade inflammation, depending on the pressure and duration, which in some cases can benefit the tissues involved. Many things can be overdone, and massage can be done to the point of counterproductive irritation. The reason why I champion self-massage, is that individuals who listen to their body can become very good at knowing when enough is enough. They don't need to go by the clock for billing purposes (one reason why we charge by the minute, but nobody takes advantage because they think it's more expensive that way).


    Another important thing to know is the variety of techniques available. While most massage is intended to relax muscles with a mind-body component, pre-event massage is done quickly with the goal of warming up the muscle without the wear and tear of an active warm-up. Not a replacement, but it can save time and energy (vasodilation before a race or workout requires exercise).


    A third type of massage is directed at trigger points. Called ischemic compression, it is designed to temporarily slow or stop blood flow to the target tissue, in order to release an involuntary contraction there. A trigger point is different from a cramp in that there may already be adequate circulation, even inflammation, but the muscle fiber is no longer responsive to voluntary control. Removing its supply of oxygen has the dual effect of stopping the contraction and causing an involuntary vasodilation after, the object being to increase blood flow to whatever damage led to the trigger point. Not all triggers require ischemic compression, but it is the nuclear option.


    Massage in general has other benefits not known until recently studied. Producing an effect on muscles similar to exercise, without the wear and tear, is why it is a helpful strategy for dealing with injuries. I applaud your efforts to help with your PF. Just remember that unlike many medical interventions, massage is part of a healthy lifestyle, like exercise. This fact alone makes it suitable for inclusion in the category of so-called Alternative Medicine, even though it has medical applications as discussed above. I hope the above link helps to dispel any doubts about its long term effects. We already know the short-term ones. By the way, the study shows how difficult it is to prove what we already know for "science based medicine," and to do it humanely. This is why so many tests are done on rabbits and rats. Ouch! You're not going to biopsy my leg muscles!


    If I were to advise you directly, I might say your work between and to the sides of the bones may be more fruitful. It's hard to get a foam roller into those nooks and crannies, but it can also be hard to apply enough pressure with your fingers to affect tissue three layers deep. The Tib Posterior muscle between the bones, and the Gastroc above, mimic achilles and PF symptoms, respectively. The Gastroc and Soleus share the achilles tendon, but this tension favors the Soleus when the knee is bent, since the Gastroc anchors on the femur. Getting the muscles into the ideal position without plantarflexion or dorsiflexion, is key to softening them enough to go deep. Use passive positioning aids like pillows to position the muscles neutrally with less risk of involuntary contraction.


    Don't restrict yourself to the symptomatic area, which is one of the frequent pitfalls of so-called medical massage. Your entire power train and fascial bands, from the top of your head to the PF, is an integrated system. For example, some find relief for PF by working on the muscles of the hip. This is where laying on a tennis ball to release tight hip or back muscles can be helpful. Restriction along this fascial chain leads to muscular compensation and overuse injuries, of which PF may only be a symptom, not an isolated pathology.


    Back to the diet, I have nothing yet to post on a direct link between flexibility and the diet I suggest, but would offer my observations of amazing flexibility among those who use such foods. As a body worker, I get to see, feel, and chat the differences firsthand. I have read that 20% of fitness is exercise, and the other 80% is lifestyle choices, including diet. Posing challenges to the body introduces the stimulus for change, but providing the raw materials gets the job done. Even more important than what goes in, is what gets absorbed, and a lot of well-intended foods go in one side and out the other. Intestinal efficiency and the resulting bioavailability of nutrients is the key, and very important for the lipids that keep our tissues supple. I'm sure you will be hearing more about this as time goes on. Stay tuned. helpful Gray's Anatomy diagram of arteries, showing the Tib. P. in the middle. The Gastoc and Soleus have been removed for clarity., from Gray's via Bartleby's. As you can see there is a sweet spot in the center calf with access to the Tib P. without any major nerves or arteries in the way. served by cutaneous nerves, via Gray's, Bartleby, Yahoo.

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