Endurance Running: A Look at Anatomy, Foot Pain and the Plantar Fascia

Most of the the runners and running groups in my neck of the woods are training for the Whistlestop full or half marathon in Ashland, WI. As a massage therapist who specializes in pain relief and improved range of motion, many of my patients and friends who run ask what I would recommend for the treatment of foot pain, heel pain and plantar fasciitis. Left untreated or caught too late, many have had to dial back on their training because of unchecked pain and inflammation. I wanted to use this post to talk about the anatomy of the lower leg, and share some techniques that people can use.

One of the most common complaints I hear of in runners is pain on the bottom of the foot, near the heel, or plantar fasciitis. People are often surprised to hear that the problem isn't always where its felt. I mean, yes, the fascia is tearing off the heel bone, but it is usually started with a problem further up the kinetic chain. In fact, by working directly on the plantar fascia, the problem seldom goes away. While I do work on the foot, so much of the heel pain is improved by a serious calf treatment. I try to lengthen the gastrocnemeus and other calf muscles with very specific and precise manual muscle manipulation.

In the illustration, you can see that the more superficial calf muscles merge into the achilles tendon which in turn attaches to the calcaneus, or heel bone. (The deeper calf muscles also attach to the calcaneus after wrapping around the medial ankle.) You can almost see the big strong gastrocnemeus and soleus,  the deeper muscles, and the surrounding fascia, getting too tight and pulling up on the heel. What if over time, the soft-tissue of the calf became adaptively shortened or "gummed-up" and ended up in a tug-of-war match with the plantar aponeurosa  at the front of the calcaneus? The action of the calf muscles is to pull the heel up, but the action of the plantar fascia is to stabilize the arch. The next image shows the bottom of the foot and its muscles. You can see where the plantar fascia attaaches on the sole of the foot at the heel. If it was involved in a tug-of-war  with the calves, which muscle would win? Where is the most likely place for strain to occur? No wonder it can feel like its ripping apart off the heel!

Quite often, by restoring the posterior compartment (calves) of the leg to a more normal resting length, the strain is taken off the bottom of the foot. If you are seeking medical massage for treatment of heel pain, be sure to also have your therapist check your pelvic angle as a tight rectus femoris (one of the quadriceps) or other hip flexors may also contribute to this problem recurring (but that's another can of worms for another day). Right now, here are a couple of videos that you, both runners and other massage therapists, might enjoy watching. This first video is Douglas Nelson treating a patient who has plantar fasciitis. Doug is the founder of PNMT, the method that I use most often to treat painful conditions.
 http://www.youtube.com/watch?v=QDRMVGH33pQ

I also like Erik Dalton's anatomical description of the foot and plantar fascia in this one:
http://www.youtube.com/watch?v=8bh5I50q5ck

If you are involved with a running group in Ashland, Washburn, or Bayfield, WI, I teach a workshop covering anatomy of the foot and leg, as well as sports massage techniques you can do with a partner to help keep the calf muscles loose.

Run strong!
Gina

Different Strokes

As a massage therapist working in Washburn, WI, I have to say how wonderful it is to be surrounded by amazing colleagues. If you have ever been to the Chequamegon Bay or the Apostle Islands region of Lake Superior, you probably noticed the dense concentration of artists, musicians, and...massage therapists.

If you are looking for a damn good massage or bodywork session after your adventure at sea or on the trails, you’ve come to the right place. I’ve seen all kinds of massage from Accupressure to Zen Shiatsu offered between Ashland, Washburn and Bayfield, WI. They all have some similarities, but they are different, too. The method I use most is called Precision Neuromuscular Therapy, or PNMT.

That reminds me of something that happened to me a few weeks ago. I was giving massages to cyclists after the Superior Vistas Bike Tour.

Gina McCafferty giving a chair massage to a cyclist at Superior Vistas Bike Tour in Washburn, WI

A female cyclist approached me and told me about the neck pain, headaches and vertigo she had been experiencing as well as occasional pain and tingling down her arm. I noticed that she, like so many other cyclists, had some head forward position happening. She sat down and I immediately started to work on her sternocleidomastoid muscle, the SCM for short. For those of you who are curious about anatomy, that's a muscle that runs from the mastoid bone behind the ear diagonally to the clavicle and sternum. Clinicians sometimes use the angle of the SCM to determine head forward position. The shorter the angle of the SCM, the more forward the head position.

As I continued to work on her SCM, she suddenly exclaimed “That’s it!” “That causes the headache!” I had to clarify so I asked “When I compress this muscle in your neck, you feel the pain in your head?” “YES.” I told her that we were working with a common trigger point in the SCM that is capable of producing a headache. I continued to work on it until the “headache” dissipated.

Trigger points in the SCM can cause tension headaches and dizziness.

Then I worked on some other muscles in the front of her neck. I worked on her anterior and middle scalenes (after checking for arterial contraindications) and found a spot that seemed to refer the nerve-y tingling down her arm. Once that had been relieved, I finished up with a little myofascial streching over her platysma, another anterior neck muscle. Her platysma didn’t hurt. It was an effort to help restore her neck muscles and posture to a more normal resting length.

When her time was up, she told me that what I did was remarkable. In just 15 minutes, I found out what was causing her pain, thoroughly treated  it, and still had time to address her posture, her head forward position. She went on to say that she does get regular massage from a very good practitioner back home. She always leaves his office feeling wonderful, but said he has never touched the front of her neck. “Well”, I said, “the anterior musculature of the neck is often overlooked in traditional massage therapy because it’s not very relaxing.”  I also told her that he’s doing a great job of keeping her healthy and his gift is probably that he can really reduce stress. He's probably an expert in relaxation and stress management. Everyone needs that and more people should seek it for themselves.  She leaves (both of us) feeling wonderful and if her neck pain, headaches, vertigo, and arm tingling go away, that’s great news for her.

I guess my gift is pain relief.  I like to be challenged, solve the postural puzzles, and improve the quality of life for people with pain. Everything I do during a massage has to do with improving the condition of my patient. Everything. There’s really nothing “relaxing” about it. Sometimes it hurts.

I think its important for we massage therapists to remember that we all offer something different and unique to our clients. We’re offering a part of ourselves and different people will need our different types of touch at different times.