According to Greek Mythology, Achilles was a great warrior who was brave, strong and loyal. He had the best armor on the field and a sword like no other. He was untouchable, or so the armies thought. He had one tiny weakness and that was his heel.
Don’t let this be the case for you! As the weather continues to improve so does our participation in the outdoors, marathons, soccer, tennis, cycling and hiking to name a few.
Everyone has the ligament named after this mighty warrior, the Achilles tendon. Three muscles feed into this tendon and attach on to the calcaneus (AKA heel). When we stand up onto our tip toes, we are using these muscles (Gastronemius, Soleus and Plantaris, just in case you were wondering).
Young Warriors: Ages 8 to 14
Let’s start with the 8-14 year olds – they are young, their whole lives in front of them, and some of these kids may have found a few sports that they are really involved in such as basketball, soccer and track. At the start of their sporting season, or during a growth spurt, these kids will notice that they have pain in not one, but BOTH heels. Even Achilles only had it on one side, so that means kids who experience this injury are actually incredibly tough. And to make it even more of a challenge, having shoes on will only make the injury worse. Swelling around the heel, avoidance pointing the toe upward and squeezing the calf muscles will cause enough pain to elicit a hefty “yelp” from your young athlete. The injury is called “Calcaneal Apophysitis” or inflammation of the Achilles tendon.
What can be done about Calcaneal Apophysitis?
Step one is going to your doctor to have a proper diagnosis done. From there, a massage therapist will address the inflammation by applying a massage above the injury, helping to open up the blood vessels and encouraging circulation that will help move the swelling and bring nutrients to the injured site. Ice friction is a process where we take a Styrofoam cup filled with water and freeze it, peel back the cups edges and then apply the ice directly to the swollen area in small circular motions. This will help slow down those pesky pain receptors and decrease excess swelling by narrowing the vessels in the area. We make sure NOT to exceed 20 minutes with cryotherapy (the fancy term for ice therapy), as going past the allotted time will reverse the therapeutic affects to the area. In other words, too much ice may cause an increase in circulation as the body tries to warm the area up. To summarize, your massage therapist will massage above the injury to open up the exit routes, and ice the area to close the routes.
What can you do at home to help ward off painful heels?
I recommend contrast baths, two buckets that are large enough for two feet to rest in. You fill one up with warm water, a nice “hot tub”, at a temperature that is comfortable to your little soldier. Have them place their feet in the tub for 15 minutes. Then pour cool water into the second tub and toss in a few ice cubes. As long as you have a cube or two floating your temperature is perfect. Have them place their feet into the cool tub, a bit shocking at first but they will adjust, and let them soak for 15 minutes. In the meantime, warm up the hot tub as it may have cooled. Do this back and forth 3 times in each tub. This will make them feel better and decrease the swelling. Avoid the contrast baths if your child has circulation conditions, fever, and diabetes. When in doubt you can check with your massage therapist or your doctor.
There are physical exercises that can help lengthen the muscle to decrease the tension where it attaches and stabilizes the joint, helping to rehabilitate your athlete back into top form. Depending on the level of competition and severity of the injury, the massage therapist may refer to a physical therapist to improve and strengthen the situations. This is very common and good practice to work with fellow professionals in the field.
Advanced Warriors: Middle Aged to Older Adults
In this group we have our athletes and overworked professionals that may be prone to overuse injuries, doing certain repetitive movements involving the ankle over a substantial length of time. This recurring movement creates a lot of force and friction on the tendons. In the Achilles tendon there are two fluid filled sacs that are made to decrease the friction that is created, but when they are put under too much pressure, they swell up and let you know that you have gone too far. The job of these fluid filled sacs are to decrease friction between two structures. These are referred to as Bursa, and when they are inflamed or swollen they are termed Bursitis. We have two bursae that are affected in the Achilles tendon:
- Superficial Calcaneal Bursa (located above your Achilles tendon)
- Becomes irritated by constant rubbing of the shoe
- Decrease in the heel pad will irritate this bursa as well
- Proper fitting shoes and placement of foot bones are essential to keeping those Bursae in the foot happy
- Retrocalcalcaneal Bursa( located under the Achilles tendon)
- The position of the heel bone (AKA calcaneus) can create irritation in this bursa
We see this complaint occur with a condition called Haglund’s Deformity/Disease, also referred to as “pump bump”. If you wear shoes that are too small you may be at risk for forming a bump at the back of your heel. “Pump bump” is a slang term for Haglund’s syndrome and a symptom of retrocalcsneal bursitis. Really cool, and commonly found with women wearing heels (hence “pump bump”).
If you have pain in the heel area, along with redness and swelling at the beginning of an activity with shoes on, your bursae may have been put in a “tight” position. You may notice that you are limping to avoid further pain.
What to do About “Pump Bump”
The first thing you are going to want to do is change your shoes! Yes, shopping in this case may be exactly what the doctor ordered. You will want a larger shoe to prevent squishing your feet, and proper insoles as well to make sure your foot is sitting properly in the shoe.
The second thing you can do is book a massage and give your feet the proper treatment they deserve. Along with massage application, the use of ice treatment or contrast baths may help decrease the inflammation and can be a wonderful tool that you can carry out in the comfort of your own home. The main objective is to reduce the inflammation and have you back doing the activities that you love in a timely manner.
When you see “itis” at the end of a word, it is indicating that the structure is inflamed.
10% of all runners will encounter Achilles Tendonitis. Dancing, gymnastics and tennis players have a history of this injury occurring in their sport. Even starting a new sport can put you at risk of encountering this irritation.
There will be inflammation above and around the heel, and sharp heel pain which will only intensify with high grade activity. However, a nice light walk will feel nice.
What to do About Achilles Tendonitis
Step one, go to your doctor and get properly diagnosed. If you skip this step and go to your massage therapist first, you will be assessed and, with positive finding, you will be sent to your doctor. Why? Massage therapists want to make sure you have the best access to recovery and the “okie dokie” to continue with massage treatments. Therapists also work alongside Physiotherapists and Athletic Therapists – remember that a medical note may be required prior to treatment.
Step two is rest and hot/cold compress therapy. Massage therapy would include elongating the muscle if it has shortened, applying ice friction and introducing exercises that would be beneficial to your stage of healing.
In all three of the conditions above, massage therapy works with the increased inflammation in the area, and helps to improve circulation above the injury and address pain. Massage will also help with re-entry into the activity by incorporating massage and exercises together with the assistance of the therapist, always monitoring the clients and the muscles in our care.
So go out and enjoy your summer! If you find you experience any of these conditions, don’t hesitate to call us at Physique Massage Therapy where we are happy to answer any questions or to book you in for a restorative massage.
Yours in health,