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

Tour de Cycling Anatomy

Are you coming to Washburn, WI for the Superior Vistas Bike Tour? As an avid cyclist and Licensed Massage Therapist I’m very excited to be providing post-event massage at the tour finish in Thompson’s West End Park in Washburn, WI.

If you’ve never ridden up here, you’re in for a stunningly beautiful and deliciously hilly treat. But as I’m sure you’re aware, sometimes our sport causes muscular pain and postural imbalance.  Too often, our cycling associates have pain. They go in for an x-ray which turns out clear, but the pain is still there. The lack of results can be frustrating. This is where a qualified bodyworker such as one who understands “neutral balance alignment” can be a great help. Read on, and we’ll go on a mini Tour de Cycling Anatomy.

When we ride, we use the same muscle groups over and over, to the exclusion of other muscles (their antagonists) which creates a postural imbalance or structural shift. The quadriceps, for example, can get tight/short from overuse. The shortening of the rectus femoris muscle,, especially since it crosses both the hip and the knee, has the ability to rotate the pelvis forward or downward creating a structural shift that can cause low back pain. If we aren’t in neutral balance alignment, the way we sit on our bikes can also create an imbalance that may lead to pain.

A couple of weeks ago I provided therapeutic massage for a different bike tour came through Bayfield, WI. Like most people, they drooled a little with the back and neck work, but what they were really taken with was anatomical specificity with which I worked. Cyclists are very smart. They could tell when I was working on the specific tight/short muscles that needed to be restored to a normal resting length. Any ideas which ones I am talking about? The Hand, Wrist and Forearm of course!

Seriously. We all do it... We get a little tired and we start to put our weight on our hands and handlebars instead of using our core for support. The muscles that flex our wrists get all stretched tight/long. The wrist extensors are contracted (tight/short) for the entire ride.  Here’s what I did to help: First I applied a technique called myofascial release (MFR) to the flexor and extensor retinaculum. Think of that as the roof and floor of the carpal tunnel. I created more space in there for the tendons of the carpal tunnel to pass through. Then I used some deep gliding strokes in between the extensor muscles to check for any “stickiness” that would prevent their ease of movement. I used deep gliding strokes along the extensor carpi radialis longus and brevis, the extensor carpi ulnaris, and the extensor digitorum. I squeezed and sifted and kneaded the “wad of three” and then used more MFR to  pin and stretch the muscles. Working up the arm, I acknowledged the biceps, the triceps and deltoids. At the chest I stretched the pecs a little and then lastly I worked under the clavicle where the scalene insert on the first and second ribs. This is very important as sometimes the pectoralis muscles and scalenes can entrap nerves causing numbness in the fingers and hands.

Both avid cyclists and those who enjoy leisurely riding can benefit from bodywork that strives for neutral balance alignment because it decreases pain and improves ease of motion. Pain free ease of motion is necessary for building strength, endurance and flexibility. A qualified bodyworker can help with that by addressing the structural, functional and neural aspects of pain and by treating the pain referred by trigger points.

I hope you’ve enjoyed your Tour de Cycling Anatomy! Have a stellar, injury-free Superior Vistas Bike Tour and be sure to say hi after your ride!

Gina McCafferty, L.M.T.