Is It Tendonitis Or Referred Pain, And Either Way What Can You Do About It?

 

Hi folks!

Matthew, a friend and relative, asked me on Facebook about his running injury, as follows [with minor edits]:

“after agreeing with your sentiments about barefoot running, I promptly picked up a foot tendon injury and haven’t been able to run since. [ ] I can’t for the life of me recall which tendon is damaged [ ] its outside the arch…possibly one of the peroneus tendons in this picture

Peroneus tendon location in foot from http://goo.gl/eVF3o

I suggested water running for maintaining fitness level while he addresses the foot issue, in response to which Matthew said:

Haven’t really been doing water running…I suppose I should. Can you do it without a belt? Although I guess it’s a bit late now. I’ve mostly been going to the gym, as it’s something I’ve never really liked but my last couple of coaches have recommended strength work to help my running (being a vegetarian, my frame is rather lightweight).  Just been to see the physio and he wants my next couple of runs to be 6*1 min running (he told me to forget about jogging) off 1 min walk, then 3 days later 5*2 min off 1 min. He seems to think it needs a bit of trauma to aid the recovery process. Worth a try as resting it for weeks on end hasn’t done much good!

What should I recommend that Matthew might do?

This is essentially the same issue as that posed by my friend Bryon a few weeks ago, and the same general approach is appropriate. I will repeat this advice here, with square brackets containing my comments with respect to this injury, which may be a foot injury and it may not.

  1. Carefully define the problem: (a) where it actually is (referred or not), (b) what it is, (c) when it occurs, (d) how long it has been going on, and (e) what seems to help. [Comment: you have to be really sure that it is tendonitis and not referred pain from the relevant muscle. I find that strained muscles can become tight and produce referred pain proximal or distal to the point of strain. Here is a quote from a Chez Ollie that supports this idea: “The implication of these facts is that foot pain may not be coming from the feet themselves, but may be referred pain from trigger points in muscles of the lower leg. You can waste a lot of time rubbing and soaking your feet, if your foot pain is coming from somewhere else.” You can test this idea by loosely shaking your foot and if it is referred pain from a tight muscle the pain will diminish or vanish to return a little while later. If this test is positive the problem becomes encouraging the muscle to relax. There are lots of ways to go about this, but it can take minutes to years to achieve! Feldenkrais has been the most effective approach to this issue in my experience.]
  2. Generate a differential diagnostic list for cause, such as overuse, poor mechanics, genetics (e.g. Dad had the same problem!), poor equipment, and so forth. [Comment: generating such a list resulted in my finally diagnosing my aortic aneurysm before it killed me, which it very nearly did. This is a standard approach to disease diagnosis in pathology.]
  3. Develop a multifaceted approach to treatment, starting by addressing symptoms to calm things down and then attack the cause, which can be challenging and interesting. [Comment: beware of doctors as they tend to rush into treating the symptoms and then rush to the next patient as they don’t have time to think anymore!]
  4. Remind yourself that we are all different and what works for one person may not work for another. [Comment: this is extremely important, just see the Four Hour Body, mentioned below.]
  5. Keep a record of this process, as we often forget the mistakes we make and do it again a few years later! [Comment: I recommend this but I never do it myself!]
  6. Use your injury as an opportunity to learn and improve, and try to take a positive attitude as this can also promote healing. [Comment: this turns a negative situation into a positive one, and it really works!]

Try the ‘foot shake’ and let me know what happens. Keep up your training with water running, which is nicely addressed in the running book by Earl Fee (cited in a previous post), and no, you don’t need a floating aid, just use your hands for uplift until you get the hang of it, at which point even that becomes unnecessary. The problem with water running is that it can become boring, but that is good mental training so you still win.

I strongly recommend that you consider reading The Four Hour Body, by Tim Ferriss, as it may change your approach to training dramatically. Injuries are an opportunity for change and improvement. You have a good reason to go back to the drawing board. I wouldn’t run on that foot until I worked out how to fix my problem.

You may simply need more arch support in your shoes, as “people with higher arches are at risk for developing peroneal tendon injuries,” apparently. Remember that injury leads to guarding, or psychosomatic tension, which can lead to abnormal biomechanics, which can lead to further injuries or exacerbation of the one you have. Finally, ‘the bit of trauma’ recommended by your physiotherapist contains the logic of ‘Chez Ollie,’ which is a tried and true approach to some chronic conditions, including post-partum bovine metritis (did hundreds when I was a veterinarian, and it worked great!) and tendon injuries in horses. I would be very skeptical of this approach as it comes with some risk, but it might be just right for you, who knows?

Don’t be discouraged, and don’t look for easy answers from so-called ‘experts.’ It is your body and you have to work it out for yourself, but with their assistance as you deem appropriate!

OK Matthew! Please go through this thought process and then report back on progress as a comment to this blog. Then we can all learn from each other, and between us we may be able to get you back on track and on the trails sooner rather then later.

-k Your Medical Mind

 

Comments

  1. – What should I recommend that Matthew should do? – You have two shoulds here. I would say “What should I recommend that Matthew do?” or “What should I recommend to Matthew?” or “What recommendation should I give to Matthew?”
    – comments specific for this injury, – specific to (?)
    – You can waste a lot time rubbing – the original quote has the “of” missing too.
    – what works for one person may not for another. This is correct but I would put another “work” in, i.e. what works for one person may not work for another.
    – Use your injury as an opportunity to learn and improve, and try to take a positive attitude as this can also promote healing.  – I would put that comma in there otherwise it sounds as if you are saying “Use your injury as an opportunity to learn and improve and try . . . “
    – recommended by your physiotherapist. In the USA, physiotherapy is usually referred to as Physical Therapy. Is It Tendonitis Or Referred Pain, And Either Way What Can You Do About It?
    What should I recommend that Matthew should do? – You have two shoulds here. I would say “What should I recommend that Matthew do?” or “What should I recommend to Matthew?” or “What recommendation should I give to Matthew?”
    comments specific for this injury, – specific to (?)
    You can waste a lot time rubbing – the original quote has the “of” missing.
    what works for one person may not for another. This is correct but I would put another “work” in, i.e. what works for one person may not work for another.
    Use your injury as an opportunity to learn and improve, and try to take a positive attitude as this can also promote healing.  – I would put that comma in there otherwise it sounds as if you are saying “Use your injury as an opportunity to learn and improve and try . . . “
    – recommended by your physiotherapist. In the USA, physiotherapy is usually referred to as Physical Therapy. http://thephysiosite.com/, but Matthew is in Australia so I don’t know what you would put here.
    – so-called ‘experts’.

  2. It got copied and pasted twice.

  3. Matthew Morgan says

    Thanks for the advice Kevin.

    I tried the foot shaking test, and the pain did very briefly subside. It quickly returns though…and is always present when I stretch my foot – raising up on my toes for example. Rest, Ice and anti-inflamatoires do help.

    Before I visted the physio, I did a couple of 20 minute runs which aggrevated it, and it hasn’t stopped aching since. Pysio seemed to think the problem was around my lower back area…he said I had a lazy bum! The short runs he advised did no help at all. But I do wonder if they would have helped if i hadn’t done those 2 runs a few days previously (it took 20 mins of running before my foot hurt and I’m thinking stopping before pain might have helped!!). I’m going back to the physio tomorrow.

    The root cause may well be poor mechanics. For the past few years I’ve worn stability shoes (Brooks Adreneline) – after previous foot pain. Brooks Adreneline were my shoe of choice.
    But I had spent the past few months moving to lighter shoes (and experimenting witrh barefoot running). Simultaneously, I had also increased my average weekly mileage.

    By the way, I tried the water running and it was great to do some pain free running. The sea was a bit rough and I was freezing when I got out, but I’m glad I did it – and I will be doing more.

    Going forwards, my main worry is how to go from rest to running. My previous attamptes were obviously too much too soon as they both ended in failure.

    • Hi Matthew,

      Me again! I am dealing with the same issue, except I have Lake Placid Ironman in six weeks. I am returning to my very ‘arch supportive’ shoes for this one. Here is a good site to check out:
      http://www.livestrong.com/article/62613-importance-arch-support/
      Many of the articles are pretty good at LiveStrong.com.

      Make a plan, adjust as you go along, learn about your peroneus function and adjust your approach accordingly. Keep in shape by water running and using this as a chance to work on neglected areas. For me it is always my core that I neglect, which can translate to many problems elsewhere.

      Best of luck to both of us on this! Keep me posted and enjoy Australia.

      Cheers,

      Kevin

  4. Kevin Morgan says

    Hi Matthew,
    Lots of stuff here, so I’ll blog the answer as part of my post today! I think I know what you should try as we have a kind of similar issue, all of which started with changing shoes and mileage. I have a tendonitis in my soleus tendon, and it came about in the same way. The problem is that light shoes feel so good. I would strongly recommend Feldenkrais rather than your physiotherapist, as this is the real way to explore poor biomechanics. I have no idea if you can find someone there, but you should at least explore the idea. Lazy bum (gluts) is definitely an issue for all of us, and that can be fixed with a very simple exercise. I’ll find the name of the book for my post.
    Hang in there.
    Cheers,
    Kevin

Speak Your Mind

*

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Disclaimer: As a veterinarian, I do not provide medical advice for human animals. If you undertake or modify an exercise program, consult your medical advisors before doing so. Undertaking activities pursued by the author does not mean that he endorses your undertaking such activities, which is clearly your decision and responsibility. Be careful and sensible, please.