Here is my feedback after performing the exercises you recommended to me:
I feel my calves more relaxed and I really appreciate. Some exercises I did not fully understand and I would need some clarifications:
1 Hip stretch: Do I need to stretch passively as in passive frog? When I stretch actively, I feel a bit of pain in the right hip.
2 Standing Quad stretch: You say "bend one Knee" Is it bend or lift or both may be. I don't quite understand your key. At the end, do I let my knee go backward or just let it in alignment with the other knee?
3 Calves raises: You say gently roll into the toes. The movement is up and down to the heel from the toes. I guess there is no rotary movement?
4 Do I continue the exercises given to me by my PT, stretching the achilles tendons?
Last week I visited my rhumatologist for a checkup. The peri-tendinitis is back and he gave me anti inflammatory tablets. He proposed cortisone, to which I refused. We talked about ultrasound therapy, and he recommended to me a maximum of 10 to 15 sessions, at the rate of 3 per week. He said not more because after 15 sessions Ultra sound is no more effective. I felt discouraged because I had high hopes in this therapy that you mentioned that I could use every day on a long term basis. He said that we still dont know exactly how ultra sound really acts on the tendons...What do you think?
I misssed some of these posts. Sorry I haven't responded sooner.
You have orthotics. Some people need them, some don't. Some who have them can do without them once they are healed. Since I can't see you, I can't tell you if you need them or not. As long as you are in pain, you need to wear them all the time. If you don't, you are re-injuring yourself. If its hot out, find a sandal you can put the orthotics in.
EXAMPLE: Lets say you need glasses to see clearly. What would happen to you if you decided you weren't going to wear them for the entire summer, because they made your face sweat more? Most people would have severe headaches after a while, maybe a little nausea, and eventually problems with balance.
Same with orthotics. If they aren't comnfortable, then go back and get them adjusted. If the doctor/therapist can't or won't adjust them, find someone who will.
If it hasn't all ready been mentioned, you need to do Vickies stretches for life (maybe not the same intensity). I've seen research that has shown complete relapse of muscle/tendon flexiblity within 2-4 weeks after quitting the stretching routine. This is really what preventative medicine should be all about, but in our society we are more interested in a cure after the disease occurs.
Odile, Sounds like you really have the spirit of consistency if you are already aware of reduced tension in your calves. It is the best sign that you will run this protocol to a fully successful outcome. Additionally, thanks for staying in the process with me. My private clients have the benefit of my clarifications and instructions and demonstrations when they see me two or three times a week. Remote training puts a good deal of the responsibility on YOU to ask for more help and clarity. It is the only way it really works. I’m not sure why most people who ask questions stop after the initial response to their request for physical assistance but I always appreciate the ones that do.
Here are the clarifications for the exercises, proving that you are really bringing the right attention to detail.
1 Hip stretch: Do I need to stretch passively as in passive frog? When I stretch actively, I feel a bit of pain in the right hip.
The beginning of the exercise is completely passive. Once you begin to rotate your hip to take your knee to the floor you are creating dynamic tension; which is stretching actively. So that is all perfect. However, you don’t want to have sharp, acute, pain in the process but you do want to be very aware of the tension, which can be described often as discomfort. So really we are trying to make a distinction between discomfort and pain. If you allow your back to arch a bit more as you rotate your hip you should be able to create a large motion and eliminate pain. This would be appropriate in the beginning and then over weeks you will find that you can keep your back down more and more as the joint realigns appropriately.
2 Standing Quad stretch: You say "bend one Knee" Is it bend or lift or both may be. I don't quite understand your key. At the end, do I let my knee go backward or just let it in alignment with the other knee?
I can see why you got confused; I’ll revise that immediately. Yes you will bend the knee and hold your ankle directly behind you. You want to be able to stand up straight on your opposite leg. If your shoulders and torso are inflexible you may find that you can’t full lengthen your body. In this case allow your bent knee to move forward but try to keep your thighs together (many people can’t bring their legs together and keep their body straight for a number of weeks). Once you can stand upright with your thighs together and knees aligned begin to push your bent knee back, increasing the intensity in the belly of your quad, the middle of your thigh. Don’t let your pelvis to tilt forward creating an arched back (as in a dramatic yoga pose) when you increase the stretch.
3 Calves raises: You say gently roll into the toes. The movement is up and down to the heel from the toes. I guess there is no rotary movement?
At this point there is no rotary movement, strictly linear, and we are working mostly the gastrocnemius calf muscle. You are presently doing primarily a concentric motion. I am adding a calf eccentric motion at the end of the post. I will want you to continue the original calf exercise and add this new one. Soon we will put them together and then move to the other calf muscle, the soleus.
4 Do I continue the exercises given to me by my PT, stretching the achilles tendons?
I would like to know what you are doing but don’t imagine anything would be contraindicated in conjunction with this work. The biggest risk will be simply ‘over working’ which will definitely create a conflict. Maybe you could send me a list.
In reference to your rhumatologist I need to defer back to the post by the doctors who share on this site. I have seen cortisone used effectively in severe achilles issues but it is never the first line of defense. I am concerned that your doctor would want to use this method again. I also wonder why and how he came up with the idea that the effects of ultrasound would be diminished upon a specific number of sessions. I would agree that the effects are’ felt’ more significantly in the beginning of treatment. But the effectiveness of this method to drive transdermal medication is on-going! I believe you even mentioned that you had some relief from each treatments. You asked my opinion so here it is. Your largest tendon with limited blood supply will be positively impacted by increasing the blood flow, getting the topical treatment directly on the injury, and relief from chronic pain and inflammation and a definite path toward healing. I am not against anti-inflammatory medications, although I prefer natural products, but when you take the pharmaceutical you are basically affecting your whole body. I like to know I can apply my anti-inflammatory agent directly to the source of the symptom. I know a runner that has benefited from use of ultrasound for many years. I agree that it would be expensive to purchase ongoing treatment which is why I slightly broke one of my rules of coming close to endorsing products. I learned about the benefits of this treatment, before I became a fitness tutor, after a very serious car accident. The physical therapist used ultrasound on my shoulders which had always been a recurrent problem in my life and were affected by the injuries specific to the accident. I can thank her for telling me that when the insurance ran out I could treat myself. We’ll I didn’t act on it and but it was the beginning of the work I do now everyday. I slowly but consistently corrected the origin of my problems. Years later I watched the relief a client experienced from pain and the subsequent enormous financial burden to obtain the benefits of the treatments. That’s when I went to work to see if there was an alternative and I learned that you could buy your own machine. That’s the long answer. I believe in ultrasound, that’s the short answer.
Now for another piece of the puzzle. The previous post regarding orthodics by our generous podiatrist are right on, no surprise there. You had already indicated that you were beginning to wear your heel cup orthodics daily but they need to be worn in every shoe. Heels won’t be in your future for some time, thank goodness they don’t make high heel golf shoes. I have not previously addressed your knee issues (loss of cartilage) but it is a definite piece of the puzzle and helped me to put together your exercises. Now, the good doctor mentioned that orthodics need to be adjusted from time to time. Basically they are compensating for a problem, I think we agree. As you do this work to correct the alignment problems, the orthodics could become a problem on their own. Remember they are designed to support and compensate for a specific measure of foot pressure. As you move the agreements between your torso, hips and feet they will need to be adjusted to support the new positive adaptations; making it so important to have a trusted and supportive resource. Orthodics may still be necessary in the long run because some of your condition could be permanent. Fear not, I have a great deal of permanent alignment issues but I suffer no pain. I wore orthodics for many years and now am free of them but if I thought they were necessary I would use them. Of the six clients who came to me in orthodics I have four that have been able to loose them and two that are still in some version of them and three other clients I referred to be measured for them’; I love good science. You won’t know where you fit in this formula for some time. For now . . . use what you have both in terms of orthodics and medical support and your own desire to reverse the origin of your symptoms.
Remember my earlier post where I said the natural process is long term. I was being honest. I encourage you not to become discouraged and celebrate even the smallest successes you experience. You are very holistic and I am not convinced your doctor is. And in Forrest Gump –ese . . . “That’s all I have to say about that”.
Till next time here’s your next step . . . literally. Vik
Declining Stairs
Stand at the top of a flight of stairs with hand rails on both sides, and use them.
Turn your back on the stairs so that you will be descending backwards.
Place the bridge of both feet (where the arch begins, big toe to little toe) at the edge of the step.
Slowly lower your heels keeping your weight over your heels (don’t lean forward).
Hold this stretched position for 20 seconds.
Bend one knee and lift your foot a few inches without letting your weight shift your hip over the other foot.
Bend your opposite knee as you deliberately place your foot down to the middle of the next step.
As your foot touches the step, roll from the bridge to the heel and repeat on the other foot.
Alternate your descending foot on each step
Work up from four steps to fifteen steps over a two week period.
Key: Keep your upper body alignment secure and check to be sure your abdominal muscles are engaged. If you don’t have stairs find a single location where you can allow your calves to stretch and then step down then just step back up and repeat. The stretch should not become so significant as to create pain but the stretch is profound.
Linear Mode
