INTRODUCTION
Achilles Tendonitis and Plantar Fasciitis are two of the most common overuse injury in sports. I have seen a number of kids at practice this year with these diagnoses and thought I should share some tips with everyone. These conditions affect many athletes in running and training.
Achilles Tendonitis is an inflammation of the tendon that connects the calf muscles to the back of the heel. Pain typically occurs about 2 cm above the insertion of the tendon to the heel.
Plantar Fasciitis is pain on the bottom of the foot at the inner side of the heel. The plantar fascia connects your toes and forefoot to the heel and supports the arch. You may feel pain on the first step after getting out of bed in the morning.
OVERTRAINING
One common feature of these conditions is that they often result from overtraining. In addition, new exercise routines or new motions that the body is not used to can exacerbate these conditions. As a general rule, athletes who increase their training stress more than 10% weekly will run a 50% risk of these two conditions in the first 4 weeks.
Achilles Tendonitis occurs in ANY level athlete who may have increased speed workouts, running, jumping, or total training volume and time. The calf is the major muscle tendon group responsible for the push-off that leads to the airborne or leaping phase of running and jumping.
Plantar Fasciitis can affect ANYONE, but is more common in older athletes, those that are overweight, those new to exercise or those involved in prolonged exercise.
TREATMENT
The principle of treatment is the reduction of inflammation. Icing helps reduce swelling and inflammatory changes and is most effective right after activity. One should ice for no longer than 20 minutes every 2 hours to the affected area.
Icing can be accomplished by compressed ice in a ziplock bag with an ace wrap, an ice bath or bucket or a cold or frozen soda can.
Non-steroidal anti-inflammatory medications(NSAIDS: advil motrin naproxen aleve ibuprofen)help these treatments. In general the treatment with these meds should not exceed 7 days continuously. Intermittent treatment when pain is present or prior to activity is also recommended.
REHABILITATION
Specific rehabilitation exercises help restore the strength of supporting muscle groups and allow you to return to full activity without pain. In general, these exercises need to be done daily and prior to all activity. You need to work on contracting(concentric) and lengthening(eccentric) strength exercises.
For Achilles and Plantar fasciitis problems, conduct heel raises on a step by slowly lowering the heels below the level of the step. This produces both concentric (on the way up) and eccentric(on the downward motion) stress to the affected calf muscles and foot tendons. You may start with just your own body weight on one foot and then progress to a backpack with increasing weights to gradually increase strength while stretching. Wringing out your foot in the am prior to putting your feet on the floor will prevent the tearing and ripping that happens every morning. This is done by crossing your leg over your knee and by placing opposite hand on heel of foot and same side hand on arch of foot. The heel hand moves away from the body and the arch hand moves up. Doing this as hard as you can for 15-20 reps will give you the best results. Prior to activity you can take a towel in the seated position with your legs out in front of you and wrap the towel around your toes while leaning backward and pulling the towel up the leg. Holding it for 30 seconds for 3 reps.
FINAL THOUGHT
Returning to sports from an overuse injury means you have rehabilitated enough to perform without compromising good form. Athletes who limp, change running or jumping form or favor one leg will ultimately get another injury and lose additional time on the field. While you may not be 100% pain free, the ongoing practices and competition should not prevent daily progress toward recovery. To prevent chronic problems, arch support shoe inserts need to be used along with post activity icing and continued stretching may be needed for weeks or even months.