The Green Girl's Achilles Tendon Bursitis

Photo Credit: Sinew Therapeutics Achilles Tendon Bursitis Information

The Green Girl has been dealing with Achilles tendon bursitis (retrocalcaneal bursitis) since last spring.

The pain presented itself in the form of a constant, dull ache in my right heel. I initially thought I was suffering from heel spurs from plantar fasciitis.

When I visited my podiatrist, Dr. Richard Graves at Sol Foot & Ankle Centers, he diagnosed me with Achilles tendon bursitis (retrocalcaneal bursitis).

Visiting Dr. Richard Graves at Sol Foot & Ankle Centers

Retrocalcaneal bursitis is swelling of the fluid-filled sac (bursa) at the back of the heel bone (calcaneus), where the large Achilles tendon connects the calf muscles to the heel bone. This condition is also called insertional heel pain.

The bursa acts as a cushion and lubricant between tendons or muscles sliding over bone. There are bursas around most large joints in the body, including the ankle.

The Green Girl's Achilles MRI

An MRI confirmed Dr. Graves' diagnosis of retrocalcaneal bursitis and indicated there were no tears and ruptures.

Dr. Graves gave me heel lifts to use with my orthotics. He advised against footwear that aggravated the condition by further irritating my heel. He also encouraged me to continue 'babying' my heel - I explained how I had to cushion my heel during yoga to avoid pain.

Orthotics and heel lifts

We agreed that the bursitis was most likely caused by my chronically tight calves. I appreciated that Dr. Graves didn't tell me to stop running but instead recommended listening to my body, stretching, and icing.

After getting the diagnosis, I visited Dr. Sebastian Gonzales from The Performance Place for some Active Release Techniques (ART) therapy sessions to help loosen up my tight calves.

Dr. Gonzales recommended I start doing eccentric heel exercises to increase collagen and strengthen my Achilles. Eccentric training is the lowering phase of an exercise.

Here's video of Dr. Gonzales demonstrating Eccentric Heel Lifts:



I perform Dr. Gonzales' eccentric heel lifts on my yoga blocks.

The Green Girl's current tight muscle arsenal: Softball, ProStretch, and Stretch Out Strap

My current focus is loosening my hamstrings/quads and calves.

I roll daily on a softball to loosen the knots in my legs. At the moment, I prefer the firmness of the softball over the more forgiving foam roller. The smaller surface area also increases the amount of pressure applied on a given muscle.

Stretching my calf with the ProStretch

Post-workout, when my muscles are still warm, I stretch my calves with a ProStretch device.

I hesitate to use the ProStrech prior to a workout simply because of how deep the stretch can get.

I use the Stretch Out Strap to stretch my hamstrings and my adductors (inner thighs).

When I travel, I always bring my trusty softball, the Stretch Out Strap, and The Little Stick.

I also try to stretch whenever possible. For example, I frequently stretch at the gas station while I'm waiting for my car to fill up.

Whenever my heel is feeling sore or I have a long run, I will use kinesiology tape on my heel. After long runs or anytime my foot hurts, I ice my heel.

splint

Dr. Graves also gave me a Dorsal Night Splint. He explained he preferred this model because it allowed for walking and was fairly comfortable.

I'll be honest, I hated the splint at first. It was annoying and uncomfortable. I would kick it off in my sleep and every morning I'd find it lying on the other side of my bedroom.

As much as the dorsiflexion night splint irritated me, I quickly realized how much better my Achilles felt in the morning when I actually kept it on through the night.

Dr. Graves and Dr. Gonzales helped me through my posterior tibial tendonitis diagnosis so I am confident that with time, the Achilles bursitis issues will subside.

Second Active Release Techniques (ART) Session

The Green Girl made another appointment with Dr. Sebastian Gonzales at P3 Sports Care yesterday.

As I mentioned before, Dr. Gonzales is a Certified Active Release Techniques (ART) Provider. ART is a combination of examination and treatment. It involves evaluating the texture, tension, movement and function of muscles, fascia, tendons, ligaments and nerves. ART treats soft-tissue injuries by moving muscle fibers, tendons, and ligaments through a combination of motion and deep, targeted massage to release adhesions, smooth the movement of tissues, release entrapped nerves of blood vessels, and promote healing.

The purpose of this visit was three-fold. First, I wanted to get a second opinion on my right foot. I also wanted him to look at my left leg because lately I've been struggling with an unusually tight hip flexor and inner knee pain on that side. Finally, I needed him to loosen up my calves again. I also wanted to follow up with Dr. Gonzales on the results of my gait analysis but unfortunately, he informed me he had stopped using his video analysis resource.

Dr. Gonzales started with my left leg. He had me stand with my left leg straight and my right leg slightly bent with my right foot behind me. He instructed me to do a slow one-legged squat and then slowly straighten my leg back up. He observed that my knee was going inwards - just as it had in my gait analysis video.

He looped my left thigh through an elastic band and he actually pulled in the same direction my knee was going and told me to repeat the exercise. Instead of moving further inwards, my knee eventually started to resist and after a few iterations, it was noticeably straighter. He suggested I do this exercise once a day to reprogram my leg.

After he examined my leg movements, he did ART on my left hip to loosen it up. Once again, I had to focus on yoga breathing to endure the pain.

I let Dr. Gonzales know I'd made a lot of glute progress since our last session. After mentioning my glute weakness to my kickboxing instructor, he's made an effort to integrate butt work into every class - good for my glutes but maybe not so much for my Kickblast! popularity.

Dr. Gonzales mentioned I should also incorporate the Cook Hip Lift exercise into my glute work. He demonstrates this exercise in this video:



Next, he worked on my right foot. He said he didn't feel any tears in the plantar fascia so it was a relief to hear whatever damage I'd inflicted on myself didn't appear to be that significant.

He worked on my calves last. I focused intently on my breathing but it wasn't nearly as painful at the first time. I told Dr. Gonzales how much my calf tightness had improved and how they have remained considerably looser since my first ART session. He said he was surprised to hear this because he couldn't believe how tight they were but I assured him this was nothing compared to last time.

I felt really good as I walked out of his office. My left hip felt much lighter and my calves were all relaxed.

Say, 'Cheese,' Long Beach! and Sole Runners Run

The Green Girl has been on a bit of an emotional roller coaster the past couple of weeks.

After a successful 17 mile run a couple of weeks ago, I managed to twist my right ankle as I was doing household chores.

Instead of containing itself to a particular location, this injury would present differently each time. I would go an entire day without any pain or discomfort and then I would feel a sharp pain in a random location. Since it didn't hurt when I ran, I simply went on easy runs sans Mr. Green Garmin.

With 15 miles planned for this Saturday, I decided it was time to pay my podiatrist, Dr. Richard Graves a visit after work on Friday.

He patiently listened to me babble on about my poor foot and my inability to Internet self diagnose due to the fluidity of the pain. He said his best guess was that I managed to tear my plantar fascia. I was thrilled that he didn't think it was the posterior tibial tendonitis since that was one of the places I had been feeling some pain.

As a runner, he understood my need to get this mileage in. He asked me when was Athens. He said he would tape me up and I could see how I felt on Saturday and go from there.

He suggested I come by each week to get taped before my long run and just listen to my body. He said, if possible, to try to get in my long runs and then instead of tapering, rest as much as possible in the last three weeks leading up to the marathon so I can give my foot a chance to heal.

Friday evening, my Sole Runner friend, Michelle, joined me at First Fridays for the Say, 'Cheese,' Long Beach! photograph competition results.

I didn't end up winning in any of the categories but I was thrilled to see a number of my photographs featured in the exhibit.

When I woke up Saturday morning, I held my breathe as I stood up and put weight on my foot. I didn't feel any pain so I headed out to join the Sole Runners for my tentative run.

I talked to Coach Steve about my foot and he suggested I look into getting a plantar fasciitis splint to wear at night. He explained the importance of applying dorsiflexion at night so the fascia heals in a flexed position.

I gingerly headed out with Mentor Barb, and her dog, Sassy.

My right foot felt good but the inside of my left knee was hurting so I put on a patellar strap and the pain went away immediately. I had brought the strap because I'd been feeling a pulling sensation and thought I might need it.

A few miles in my left hip flexor tightened up and became sore.

At the marina, Barb pointed out the boat she sails on, the Yippee Kai Yay.

Mr. Green Garmin ran out of juice towards the end of my run so I'm not sure what my exact mileage was but I did around 14.5 miles. I didn't have it in me to try to do another half mile.

It never felt so good to sit down on my yoga mat and do post-run yoga. I felt so much better as I headed back to my car.

My right foot is feeling good today but my left hip flexor is still sore and very tight.

I will try and make an appointment for another Active Release Techniques session this week. I also wanted to follow up with Dr. Gonzales on the results of my running gait analysis video.

The Green Girl's Run Down Memory Lane

The Green Girl spent her Fourth of July holiday weekend up in Northern California visiting her family. I don't usually do long runs when I'm up here because it takes time away from my early bird niece but with the San Francisco Half Marathon less than a month away so I thought I'd make an exception.

There is something intensely liberating about runs where I have no route or destination in mind. This was going to be one of them. It was pitch dark out when I headed out with my trusty headlamp.

I ran past the Saratoga Parent Nursery School where my youngest sister attended preschool.

As I continued down Saratoga Sunnyvale Rd., I decided to run up and down the halls of my former high school, Saratoga High.

I finally got to see the mural on the outside wall of the school's Little Theater. The mural depicts the Little Theater's first-ever production, 'Our Town'. The image was created by students, Doug Leverich and Jim VanOver. Before the sketch for the mural was complete, Leverich was diagnosed with non-Hodgkins lymphoma. He finished the sketch knowing he would probably not live to see the completion of the mural. He was a freshman when he participated in the play, and in the mural, he is displayed as a graying figure.

From there, I decided to head downtown Saratoga. I followed Big Basin Way through The Village but had to turn around at Hakone Gardens when the road became too narrow for me to run safely on the shoulder.

As I was running back through downtown, I started scanning for possible bathroom options - a squat behind some bushes was not a option. I sprinted to Wildwood Park to find locked public restrooms. Luckily, I found relief at the The Inn at Saratoga.

Feeling like a new Green Girl, I decided to go along my old high school P.E. class running route. I laughed at the memory of me hitching rides with friends to avoid having to run the full distance. Feeling nostalgic, I decided to head over to my former junior high, Redwood Middle School.

I went south on Fruitvale Ave. until I reached a good halfway mileage point. I decided to cross over and ended up winding around the De Anza College campus. I followed the path my dad used to teach me to drive a car back when I was a freshman in high school. The empty parking spaces reminded me of the hours I spent learning to park in between the painted lines.

The run was emotionally satisfying for me. I was able to mentally work through some unresolved issues from my past that I had managed to avoid for well over a decade.

I was also pleased to see I was still feeling the positive effects from my ART session. My calves felt really good throughout the entire run. My only caveat would be to avoid ball pits after ART. Ha.

When I got back to my parent's house, I quickly showered and threw on my swimsuit to take my niece to the Aqua Adventure Waterpark. The cold water felt really refreshing after my long run.

The Green Girl Tries Active Release Techniques (ART)

The Green Girl made an appointment with Dr. Sebastian Gonzales from The Performance Place Sports Care after work yesterday.

Dr. Sebastian Gonzales is a Certified Active Release Techniques (ART) Provider.

ART is a combination of examination and treatment. It involves evaluating the texture, tension, movement and function of muscles, fascia, tendons, ligaments and nerves. ART treats soft-tissue injuries by moving muscle fibers, tendons, and ligaments through a combination of motion and deep, targeted massage to release adhesions, smooth the movement of tissues, release entrapped nerves of blood vessels, and promote healing.

The purpose of my visit was two-fold. First, I wanted to get some treatment for my posterior tibial tendonitis. Second, I wanted to get some advice on my tight calves, quads, and hips.

Dr. Gonzales started the session off with some range of motion and strength analysis.

He recommended I do some exercises to strengthen my glutes. He explained it's difficult to say if my psoas are tight due to weak glutes, or if my glutes are weak because due to tight psoas. He showed me how to isolate my glutes with some butt lifts to help re-educate my neuromuscular system.

Some aspects of the ART manipulation were similar to experiences I've had with Rolfing but I definitely appreciated Dr. Gonzales' holistic approach.

In the past I've mentioned that my plantar fasciitis sometimes manifests itself as an intense, burning pain in my arches and I would have a hard time differentiating the plantar fascia pain from the posterior tibial tendon pain. When I explained this to Dr. Gonzales and I pointed out the different pain locations, he explained my arch pain is actually a result of a sore flexor hallucis brevis muscle.

He spent a great deal of time showing me how to differentiate between the plantar fasciitis, the posterior tibial tendonitis, and the flexor hallucis brevis pain. He said it's easy to get confused because the tendons of flexor hallucis brevis run along the bottom of the foot, under the head of the first metatarsal bone, and attach to the small bone of the big toe.

I have a high pain tolerance but I must admit that the ART hurt significantly more than a deep tissue massage. Surprisingly, my left calf was much worse than the right side. He said my left posterior tibial muscle was extremely tight. I had to focus intently on breathing in and out to endure the intense pain.

After all that, I wasn't sure if I was going to be able to stand but my legs actually felt a lot better. He had me walk around a bit and I marveled at how my calves actually felt a little looser.

Next, Dr. Gonzales took me outside for a running gait analysis. He videotaped me running back and forth across the packing lot a few times.


It was both awkward and fascinating to observe the footage. My untrained eyes couldn't detect any abnormalities but Dr. Gonzales made the following observations (which immediately became glaringly apparent):

• I have some issues with my left gluteus medeus which are causing pelvic instability
• My spine rotation on the left side is restricted
• My knees cross
• My left arm hardly moves

He is going to have some more in depth analysis performed on my video and then he suggested I talk to my coach about techniques and ways I can correct these issues. In the meantime, he recommended I work on stregthening my glutes and do some exercises to improve my gluteus medeus stability.

I felt like my visit to Dr. Gonzales was really productive. I'm anxious to hear the additional feedback on the video.

Sole Runners Winter Training Starts Tomorrow

My running group, the Sole Runners, will start the Winter Full/Half Marathon Training Program tomorrow morning. I'm really looking forward to this. My Saturday mornings seemed so empty without the group runs.

Since my knee pain started, I've been faithfully applying heat and cold and resting it as much as possible. I also went ahead and purchased a patellar strap yesterday after my coach recommended I give it a try. He also suggested I look into Active Release Techniques (ART). ART is a method of soft tissue massage that treats problems with muscles, tendons, ligaments, fascia and nerves.

I am hopeful that I'll be able to complete an easy run tomorrow.