The Green Girl's Updated Motivational Collage

The Green Girl decided it was time to update her Motivational Collage.

The focus of my last collage was the amelioration of my mind, body, and soul.

A significant portion of last year's healing process involved a chronic case of Achilles tendon bursitis (retrocalcaneal bursitis) in my right heel.

The rehabilitation of my heel was two-fold: Active Release Techniques (ART) and strength training to reduce muscle imbalances.

In addition to being a Certified ART Provider, Dr. Sebastian Gonzales from The Performance Place also performs gait and stride analysis for runners. I went through the process with him a few years ago and Dr. Gonzales identified some muscle imbalances.

Plagued year after year with overuse injuries, I finally opted to enlist the help of a personal trainer. I started training with Chris Nelson from Beach Cities Mobile Fitness twice a week.

One of the benefits of working with a professional is the fact that they are able to quickly identify muscle imbalances or tightness based on the exercise posture of my body. Slight adjustments during workouts make a significant difference.

I credit the treatment, support, and guidance I received from Dr. Gonzales and Chris for the completion of my first ultramarathon last year at the Run Woodstock Freak 50k. While my Achilles bursitis is not completely cured, I am able to run. I support my heel with kinesiology tape on long runs or at the first sign of sensitivity.

My updated collage revolves around:

• Regular stretching and yoga
• Disaster/emergency preparedness
• Local exploration

I am going to get back into a weekly yoga routine and set aside dedicated time for stretching at home.

I want to continue educating myself about emergency preparedness. I don't want a zombie apocalypse to take me by surprise.

Finally, instead of hopping on a plane, I want to focus on exploring locally through trail runs, hikes, and road trips. I identified a number of places I'd like to visit in my 100 Things in 2014 list.

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.

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.