Friday, January 20, 2012

Posterior tibial tendonitis: Lessons learned

After nearly six months, my foot is finally starting to return to normal. I still find that I'm 'babying' my injury. I'm very conscious of trying not to do too much activity too soon. But I think that mindset has been helpful in avoiding another major flare up. I wanted to share what combination of remedies already out there that have been working for me. This is by no means new information, but rather an account of my experience dealing with tendonitis.
1. See a sports medicine doctor as soon as possible after injury
I did a lot of Google research, and basically figured out what my injury was, but I wanted confirmation from a professional. Because my doc mainly deals with athlete injuries, he diagnosed me in all of five minutes. Not that a podiatrist wouldn't have been able to help, but I felt the sports med doc really understood my desire to run again and gave me suggestions on how to move forward with recovery to be able to return to running.
2. Take advantage of a physical therapy script Your doc will likely write you a script for a minimum of six weeks of physical therapy. If you're fortunate enough to have health insurance that will cover it, go to the sessions. You may not need a full six weeks, or you may need longer. I did two 1 hour sessions a week for 6 weeks. I learned some great exercises and tools to help return to running. Again, nothing I couldn't have found by searching on the Internet, but it's nice to work with a trained professional to make sure your doing the excersises correctly, answer questions, and get feedback. These will be skills you will take with you and use after your therapy sessions have ended (lessons 3-6).
3. Practice the same exercises performed in therapy after your script has ended. My biggest problem was not incorporating enough strength exercises with my running. My Physical Therapist was able to point out holes in my previous training and provide suggestions for exercises I should do going forward.
4. Massage your tendon (on non-activity days)
During my sessions after a short warm up on the elliptical (10 minutes) I would stretch, then my PT would manually massage my foot before we began strengthening exercises. Depending on your level of pain, manual massage can be painful, but for me it was a 'good' pain. Like the feeling of getting a back or neck massage when you're very tense. Since soreness may be increased, I suggest massage on days when no other activity is planned.
5. Ice immediately after activity for 15-20 minutes
Whatever activity you do, strength, running, massage, ice your posterior tib as soon as possible afterwards. This is crucial. The quicker you can reduce swelling, the better.
6. Use compression after icing I think the compression further reduces swelling. I use an ACE ankle sleeve from Walgreen's.

7. Do ankle circles before jumping out of bed in the morning and throughout the day My PT suggested I might also be suffering from plantar fasciitis as well when I mentioned I had more tightness in the morning than pain. She suggested 'warming up' in the morning. 30 second sets of ankles circles have really helped to reduce tightness in my foot and ankle.
8. Soak in epsom salt
Honestly, I'm not sure if this actually works. There is a lot of conflicting information out there on the effectiveness of Epsom salt. It may just be a placebo effect, but when I can after activity, I like to ice first then soak in a warm Epson salt bath, then ice again. Kind of OCD, but I always feel better the next morning.
9. Stretch gently after a warm bath or shower
We're taught to statically stretch muscles only when they are warm, like doing moderate activity for a short period to get your heart rate up, then stretch. Well, you know how you always feel relaxed after a warm bath or shower? Your muscles are warm and loose and this is the perfect time to stretch out.
10. Keep a detailed record of your pain level
This isn't necessary, by was it was very helpful for me. I used the typical pain scale to keep track of my activity and how I felt during and after. It was useful to look back at my activity and pain level to know when I over did my activity, and when I could increase activity.

So these are some of the things that I've been practicing to return to running. I'm sure as I continue on my journey, I'll have more suggestions.


Rebecca said...

This is a really great lessons learned list!!

The hardest part for me to follow through with is doing the exercises at home that the PT dude recommended.

Margaux Mays said...

Yeah, it sometimes hard to stay motivated without someone pushing you.

MS. Bad Mama Jama said...

This is a great post! I can relate to many of the points when I injured my knee and worked through physical therapy. I actually directly to calling a sports medicine dr....

Margaux Mays said...

Thanx! Yes, it was suggested to me to see a sports med doc first too.

Anonymous said...

I found your posting comforting and hopeful. I was diagnosed with PTTD 7 years ago. After rest and boot for a couple of weeks, I started extensive PT for a few months and wore an AFO brace which fit into my sneaker. I could even drive with it. I chose all of this instead of surgery. I was careful these past 7 years with shoes and did not do any sort of jumping motions with my foot. PROBLEM: I recently tripped and fell in a parking lot, landed on my knee, and broke two bones in my other foot While attempting to be non-weight -bearing on my foot with the broken bones for 4 weeks I have aggravated my PTTD in what is now, my good foot. I am hoping very much that PT and exercises will help me restore the OK outcome I had 7 years ago with this new flare-up. far- starting PT AND BACK TO WEARING MY BRACE.

Margaux Mays said...

Oh, sorry to hear about your re-injury! If PT worked before, hopefully it will work for you again. Glad you you found the post helpful.

Designed By Blogger Templates