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

What do you mean by "Pain Relief Specialist"?

Many people have heard me, a L.M.T., say “I’m a Pain Relief Specialist” or “I help people have less pain and more range-of-motion” and I get such varied responses that I would like to use my first blog to explain what more about I mean. I've been providing therapeutic massage and neuromuscular therapy for pain relief since 2005 and I’d like to answer some frequently asked questions such as what makes Precision Neuromuscular Therapy (PNMT) different? And what conditions can be improved with neuromuscular therapy?

PNMT founder, Douglas Nelson, sums up the former well in one of his texts. “Precision Neuromuscular Therapy is less a modality than it is an approach to treatment of musculoskeletal pain. Rather than being tied to a certain treatment technique, PNMT is committed only to the end result. We measure accurately, treat precisely and aim for stellar results. If the results are less than remarkable we switch strategies instead of doing the same technique harder or longer than the first time.  PNMT takes time and effort to master the palpation, anatomical mastery and clinical reasoning processes”.

My colleague, Nicole Ftacnik (a Certified PNMT practitioner in Cincinnati, Ohio) has this to say about the kind of work that we do: “PNMT is a treatment using soft tissue manipulation techniques for dysfunction and pain caused by misalignment of the body by the muscular skeletal system. Misalignment or distortions of the body may be caused by muscle imbalance, which are caused by poor posture, repetitive movement patterns, and/or trauma. Restoring weight bearing equality and symmetry are essential for good health, which is why it is so important to bring people into neutral balance alignment!” That is exactly right.

Most of the pain I treat comes from one of 5 causes. When a client comes into my office presenting with pain I have to decide which of 5 elements of pain it is before beginning the journey to neutral balance alignment. The 5 arenas that cause pain are:

• Ischemia: Lack of blood flow to the muscle.

• Structural : Any distortion of the optimal position and carriage of the frame will have a negative impact on the muscles, connective tissues and joint function.

• Functional: This category includes muscular strength, length, ability to relax/release and the ability to fire in the appropriate and/or optimally efficient order

• Trigger Point/Referred pain: Includes the various kinds of trigger points that disturb muscle function, refer pain, or reduce muscle length. Referred pain is often pain felt at a place different than the origin of injury.  Carpal tunnel symptoms, for example, can be caused by problems in the neck, shoulder or upper arm that misaligns the muscles and tendons down the arm. The pain may not be felt in the shoulder, but instead pain that is similar to carpal tunnel. When the “carpal tunnel syndrome” is treated directly, it never seems to go away.

• Neural: Neural pain includes both the ability of nerves to affect muscular function and the capability for muscles to influence or entrap nerves.

By now, you have an idea that precise treatment (as opposed to broad, general gliding strokes) can restore your muscles to a more normal resting length (optimally, neutral balance alignment) and you may be wondering what conditions NMT can improve. Some examples of common conditions that PNMT is successful with include, but is not limited to: Low back pain, neck and shoulder pain, headaches/migraines, TMJ dysfunction, whiplash injuries, frozen shoulder, sciatica, osteoarthritis, plantar fasciitis, tennis elbow, carpal tunnel syndrome' shin splints, tendonitis, bursitis, muscles spasms, cramps, strains, postural distortions, fibromyalgia... and many more!

Hope this helps you on your way to a pain-free lifestyle once again!

Gina McCafferty, LMT