 |
|
More Problems from Runners
By Daniel C. Batchelor, D.C.
Editor’s Note: In
our last issue, Dr. Batchelor presented information about care for runners,
based upon his extensive experience as both a runner and as chiropractor who
often cares for runners. The last issue saw him specifically focus upon conditions
that tend to show up in the area between knees and the lower back. In this issue,
the second and final part of his article on chiropractic and runners, Dr. Batchelor
catches our readers up on common problems from the foot through the shin.
Arch pain/Plantar Fasciitis—The plantar fascia is a fibrous band that
extends from the front 5 metatarsal bones to the calcaneous bone. This fibrous
band acts much like the guide wires in a suspension bridge. These guide wires
hold the arch in the foot so that it can absorb shock as it flexes during walking
and running. If the plantar fascia is placed under too much stress from activities
such as running on your toes, too much hill running, too much body weight, too
much fast running, or even running on the beach without shoes, then the plantar
fascia can stretch. Since it is not designed to stretch, but is designed to
merely hold the arch in your foot, when the plantar fascia does stretch, sensory
nerves become stretched. These stretched nerve fibers then send messages to
the brain notifying you that you have arch pain. This over stretching is when
the symptoms of plantar fasciitis first occur. If the condition is uncorrected
and the plantar fascia continues to be stretched beyond its normal limits, the
body senses this stress and begins to deposit calcium at the point of increased
stress. This stress point is usually located where the plantar fascia attaches
to the heel bone.
Over time, if plantar fascia stress is uncorrected, a spur develops. When the
spur becomes pointed, then not only does the runner experience pain from the
plantar fascia microscopically pulling away from the calcaneous bone but pain
is also felt from the pointed spur sticking into the sensitive tissue as walking/running
impact occurs.
With PF, the runner almost always feels the worst pain in the morning. This
is due to the fact that the plantar fascia has had all night to shorten, rest
and begin healing. Then in the morning, the first few steps elicit the most
pain because these sensory nerves again are stretched.
Treatment consists of ultrasound/galvanic physiotherapy, a special taping method
that reduces the stress on the plantar fascia and prescription lightweight semi-flexible
orthotics to further reduce the stress on the plantar fascia. If a spur has
developed then a spur pad is built into the orthotic device. The patient should
also be instructed to wear stiff dress, hiking, or biking shoes that do not
bend. Use of a running shoe that bends like a V when you flex it is contraindicated.
A running shoe that bends like an L with the front part of the shoe flexing
slightly is recommended. This will decrease the stress on the PF.
I cannot count the number of times I have had patients enter my office with
painful plantar fasciitis that were told by their doctors to stretch their calves
during the healing phase of plantar fasciitis to correct the condition. During
the healing phase, stretching the calf is like hitting an open wound with your
fist. As the calf is stretched, the plantar fascia is also stretched and the
condition never heals. If this overstretching continues, the condition becomes
chronic. Stretching of the calf should only begin after the condition becomes
asymptomatic and not during this important healing phase.
Once the condition is asymptomatic, a rehabilitation program is to begin. Strengthening
the muscles of the arch to reduce stress on plantar fascia is paramount. Picking
up a washcloth or pencils with the toes as you contract and strengthen your
arch muscles will help eliminate the future stress on your plantar fascia.
Another option designed to strengthen your arch muscles is to wear soccer-type
sandals in your free time. To keep their feet in the sandals, your patients
must contract the arch muscles while they curl their toes a tiny amount. This
will help develop the muscles of the arch.
Achilles Tendonitis — Most Achilles tendon problems occur from having
short tight inflexible gastrocnemius/soleous calf muscles. The Achilles tendon
is not designed to stretch. When it does stretch, Achilles tendonitis is the
result. Inflammation of the Achilles tendon (the structure that holds the calf
muscles to the heel bone) can be palpated very easily.
Treatment involves raising the heels with heel lifts. In addition, physiotherapy
in the form of Iontophoresis should be used. Do not advise your patients to
stretch the Achilles tendon while the condition is present. Do not advise them
to run. If they’re cycling, have them ride with their heels on the pedals
as opposed to having the forefeet on the pedals; in other words, it’s
best to use improper biking form and not to use toe straps or clip in type pedals.
If the forefoot were used on the pedal, then the Achilles tendon would be placed
under too much stress during this critical healing phase.
There are several factors that can contribute to Achilles tendonitis. First,
you should know that the biggest contributor to chronic Achilles tendonitis
is when your patients ignore pain in their Achilles tendon and “run through”
the pain of early Achilles tendonitis. If their Achilles tendon, are getting
sore, it is time to pay attention to it, immediately.
Shin Pain (posterior tibial tendonitis)—When the calf muscle contracts,
the shin muscle must relax and vice versa. If the anterior shin muscle is very
weak when compared to the calf muscle then when the calf muscle contracts, the
anterior shin muscle can microscopically tear as it tries to elongate during
calf contraction. Inflammation of the posterior tibial tendon (structure that
holds a calf muscle to the back side of the lower leg bone) can occur and shin
splints result.
Treatment involves allowing the calf muscles to heal. The use of ultrasound
can hasten recovery. After healing has occurred, rehabilitation involving two
different stretches should begin. If the foot pronates or rolls in excessively
then this should be addressed also. Eliminate pronation if present with various
wedged lightweight flexible orthotics. Strengthen your front shin muscles by
walking with toes in the air or using toe straps on the bike pedal and lifting
against the straps on upstroke.
About the author: Daniel C. Batchelor, D.C., is a graduate of Wayne State
University and Life University College of Chiropractic. He has practiced in
Roswell, Ga., for 24 years, where he treats musculo-skeletal ailments of athletic
as well as non-athletic patients. Batchelor, a competitive runner, has been
a consultant for Runner’s World and Running Journal. He can be reached
at (770) 823-8186 or via drbatch@aol.com.
Provide your feedback on this
article.
© Copyright 2004 Today's Chiropractic