Odile, The good doctors are reminding me of something I always hope people remember when they are writing on the site. Your condition is real, and in this case advanced, and good medical supervision is not only smart but required. To have a doctor you trust and who can follow your process is necessary to get the best advice; even if it's not always what you want to hear.
Likewise the doctors have pointed out the rare use, and often misuse, of cortisone; especially for this largest tendon in your body. In addition to potentionally weakening the tissue you are masking the pain on your feet, which are so consistently used and can be a recipe for disaster. You took five weeks away from your athletics which makes you a perfect patient but I'm guessing you didn't lay around with your feet up and eating Bon Bon's.
I have a man I worked with a few years ago with nearly the same symptoms you are suffering almost down to the detail but within a shorter time frame. His had rapidly deteriorated. however, and was being directed toward surgery to remove the degenerative tissue at the nodule site; I think it's called debulking, atleast that is what his doctor called it. He had already had a cortisone shot but was put on crutches for protection against his tendency to do to much activity with four sons under the age of 15. The next step could have been casting both legs; it has it's own set of problems. The doctor felt certain there was a surgical room with his name on it.
On the one hand he was almost ready to try anything, surgery included, but decided to put 100% into an alternative. And so we trained together for almost a year continuously and then saw each other about every four months to adjust his work over the next year. I called him yesterday to see how he was doing, two years later, and to be sure I had an accurate memory. Basically he is better than even when we stopped training as the healing process takes time and he continued to do the work necessary to perpetuate the progress. He said the most painful aspect of beginning a program of self healing was that it was so little in the beginning and he was feeling so motivated and also that he had to change doctors until he found one that respected his choices and was still willing to take his case and then treat him if a turn around wasn't possible. Sometimes good science is just necessary if a condition has reached an irreversible stage or if the patient can't follow a strict and consistent protocol. You have to go into self-healing with this thought or irresponsible choices can insue.
I am a big champion of natural remedies and have great respect for good medical science.The natural process is slower, as you are assisting the body in it's self-regineration. The natural approach takes more participation on the part of the patient both in terms of attention and time (mb6066 referred to this phenomenon). In a natural approach you have to look at the body as a series of systems that work together in perfect orchestration. If one system is down you can bet there are other systems effecting the process. In natural treatments it is ineffectual to isolate the treatment to the symptom, i.e. the affected area. The medical community can go to the symptom and make a near immediate correction with proper rehabilitation and the outcome can be very positive. But in these cases the rest of the systems should still be evaluated to see why one part of this perfect orchestration failed. This is the way nature and nurture can work together in perfect harmony.
If you catch it in time you may get to see the wonder of our human physiology. If the condition is too advanced, you may see the wonder of medical advancement. Just remember that nurture always incorporates nature; and visa versa. It's the law.
Wolfman, please do not refrain from sharing your expertise. This is not my site. I am strictly a moderator and can only share the experiences and learning that I have. I do not have a medical degree and your input is invaluable. I will always share my piece of the pie but we all benefit from each other. I was actually glad you put your alert on the cortisone. I was waiting to get a complete picture to provide a full post and your insight would have been shared by me.
I was in the process of writing my post when you submitted yours and just had to add yet another. My last post was inspired by your sharing along with Dr. Dave's. One of the things that I love about being on LBG is that there exists a respectful appreciation of everyone's improvement; both on the golf course and in our other life.
Great to have you on this thread. This is 'ME' inviting your valuable '2 cents'. Vickie
When I kneel on the floor, sitting my buttocks on my heels, I can do it, there is no big pain, a bit of discomfort in the back region of my knee...and no pain on my ankles.
Doing gym, I have noticed that my tendons at the back of my knees feel tight and painful when I need during exercises to keep my legs straight.
I dont wear my orthodics all the time, because I'm living in a tropical island and during the 6 months of hot season, I feel a great discomfort to wear closed shoes. But I always wear them in my golf shoes since 5 or 6 years. I dont wear heel cups as I said previously but rather custom fitted orthotic soles as recommended by my doctor. My legs feel tight, specially my calves. I feel it strongly at one point behind, the same as shown in the trigger point therapy book. When I sit in the evening, my legs often cannot relax, on the contrary, they start to contract spasmodically. I'm taking homeopatic medecine (zinc) at bed time because these unvoluntary contractions can appear during the night and affect my sleep. the medicine works well. I also take glucosamine and chondroitine since 5 years.
I can't say for sure if the orthodics give me relief because I dont wear them everyday, but I have decided to wear them every day as from now to improve my heels. We are now entering winter time and I can use closed shoes.
I usually prefer flat or 2 to 3 cms high heel shoes; Too high heel shoes give me knee-pain, and my cartilage are worn out.
I am doing pilate exercises and my PT gave me stretching exercises for the ankles: 1) Right Toe raised against the wall, heel on the floor, I push my hips and stretch with my left foot flat on the floor and vice versa.
2) In a sitting position, with my leg streched out I pull my foot towards me with a towel.
3)one foot forward, the other back, I stretch the back one.
Well that's about it Vickie. Thank you so much for your quick reply and your care. I am sending a few photos you requested by pm.
Yes, I am a podiatrist. Since this was originally addressed to
Vickie, I was going to stay out of the thread.
When I saw that she had been injected at least twice, I couldn't refrain from replying!
I will add my other 2 cents if asked. Although, I must say I am interested in Vickie's whole body evaluation and recommendations.
Steve
Dear Steve,
Please do send in your comments/advice. You are most welcome. Many thanks in advance. Odile
Odile, Thanks for being so thorough and for encouraging Steve to participate. I am pulling together some movements and will respond again when I get your pictures. Understanding the condition of your knees is very illuminating and helps me know where to go with a full plan. You are fortunate with the cartilidge loss that you can kneel. Any knee pain other than the tightness during exercise. Look forward to finally sharing some beginning to your recovery. Vickie
P.S. Isn't it great that we have medical doctors who will share on this site? I love it!
Odile, Thanks for being so thorough and for encouraging Steve to participate. I am pulling together some movements and will respond again when I get your pictures. Understanding the condition of your knees is very illuminating and helps me know where to go with a full plan. You are fortunate with the cartilidge loss that you can kneel. Any knee pain other than the tightness during exercise. Look forward to finally sharing some beginning to your recovery. Vickie
P.S. Isn't it great that we have medical doctors who will share on this site? I love it!
Could anybody help me posting photos by PM to Vickie? Do not know how to go about it. Thanks
Odile, I got your pictures and they are perfect for me to move into some direct instructions. I will take some time with this after my clients today and hopefully post completely by tomorrow afternoon. Sorry I don't have time this morning. Thanks so much for the effort, they told me much important information. Vickie
Odile, Thank you again for the perfectly designed pictures. Since I can’t do any muscle testing I am still somewhat limited in an interpretation (notice I didn’t suggest a diagnosis) but, as they say, a picture is worth a thousand words. The immediately obvious issues, relative to your lower extremities, are distinct hypertension in the fascia latae of the left leg along with other internal rotators, and a probable weakness of the right medial gluteal. You have a posterior tilt of your pelvis causing a flat back. Obvious, but not extreme, hypertension of your knees with a consequent constant engagement of your calf muscles, primarily the gastrocnemius, the muscle that causes the roundness we see in the calf, combined with an undervelopment of this muscle. Your foot pronation appears minimal but there is obvious strain on the anterior tibialis muscle which keeps your ankles distressed continually in its effort to keep the joint stable. That is the obvious visual interpretation.
You mentioned that you have a short left leg, corresponding with the most afflicted achilles tendon. It has been my experience that the leg is typically not shorter, as evidenced by the opposite hip being raised, but the tensions are imbalanced causing it to look and perform as though it is. This is a huge factor in your delimna and must be corrected in conjunction with the work to heal the damage to your soft tissue.
Before I proceed allow me to share that I had a similar, yet exact opposite condition, which set me on this path of healing. I spent most of my young adulthood in pain with a short leg and weak ankles and near constant discomforts that eliminated any opportunity to participate in sports. It was by shear good fortune after a very serious car accident that a kinesthetic chiropractor began to assist me in balancing the tensions around my hips and alleviating problems I thought were just a part of living in my body. With that said, I didn’t have the advanced condition you are experience (ahh, youth) so reversal was relatively swift. I got out of my orthodics and avoided surgeries that ex-rays still always inspire a recommendation from the medical profession. While there are things I cannot do I was able to resume a fully active lifestyle and pain free. Did I mention that my leg is not shorter? Again, with that said, you still need to have a reliable doctor in this condition.
I am going to recommend exercises to directly address the obvious conditions to correct your alignments and support the other good work you are doing. I will also recommend some rather unusual techniques for treating your tendons during this period where directly addressing the injured connections would only cause greater suffering and further aggravation to the site; which will only inspire more thickening and more inflammation due to the body’s super-compensation to the problem, we call it scar tissue.
If you have read any other posts you will know that I believe that less is more as you initiate any healing protocol; this applies to nutritional supplements and exercises as well. You have to begin to interact with your body’s intelligence and set the pace and implementation of expanding workload accordingly. The biggest error we can make is to do too much too soon. If you have the consistency and the patience and the trust that you are on a course of healing your outcome can be very successful. Because I always show up to see my clients I can keep tweeking the work to inspire continual progress and evaluate their work. Online we are limited to the fact that you have to stay in the process on your own. Just remember, as your body’s physiology changes so does the application of the work you are doing. Your level of rehabilitation is limited to the amount of work you are willing to continue to do. Many have responded to work we have done on line but the dialogue must be ongoing to continue a positive adaptation to full recovery. As your physiology improves so will the need for changes . . . if you want more change. It’s nature’s law; not mine.
So here are a few exercises to get you started on what looks like the origin of your problems. They will look disassociated from the symptom area and should not cause you any distress in terms of increased pain. If any one movement does, this it means we need to refine the way you align for the work or the exercise is contraindicated at this time; that’s the body communicating. Remember that the form of these exercises is really specific, which is why the explanation is so lengthy and it’s easier in words and demonstration. I recommend you read the exercise, then perform the exercise, then read it again while you are feeling the motion. Initially I would like for you to do these once daily. In three days I’d like to know how it is going and then increase the work; what ever that might happen to mean in this case. See, I too am at the mercy of your body’s knowledge.
Here we go:
Shoulder Stretch Deltoid / Rotator Cuff Joint
Lie on the floor on you back, with your feet flat and your knees bent, arms by
your side with the palms down
Your shoulders should be down and your lower back will have a natural
curvature, in some cases keeping your low back off the floor.
Do not allow your back to change position through out the movement.
Lift one arm completely straight up, around, and over the shoulder to lay it
along the side of your head with the palm facing the ceiling.
Keep your arm straight through the elbow and hand and only stretch as far as
the shoulder joint will allow. Never force it or just let the hand fall to the
floor.
In the early stages (or on tense days) your arm may not go to the floor but with
time it will comfortably rotate around.
Hold for 20-45 and then engage your shoulder to lift the arm around
to the starting position.
Check to be sure your torso is flat and relaxed. Repeat on the other side.
Key. Your goal is not to lay your hand on the floor, Your goal is to create enough flexibility capability in the shoulder joint that the arm bone can smoothly complete a 180 degree rotation that results in your hand being on the floor.
The Passive Frog Inner thigh /Adductor muscles / Hip flexors
Lie on the floor with your back relaxed, your knees bent and your feet flat.
Let your knees fall away from your center and press the soles of your feet together stretching
the inner thigh passively.
Bring your feet in toward your torso as your flexibility will allow.
Lie comfortably for 30-60 seconds.
Use your finger tips to give a hoist to the outside of the thigh and bring your knees together.
Key: This exercise can surprise you as the intensity increases in the first couple of workouts while you are learning to completely relax the hip joint. Some days will be easier to hold than others
Never stay longer than you can manage with your breathing and never forget to use you hands
at the end. Don’t worry if one leg is higher than the other. They will find their way.
Hip Stretch (abductor stretch / focus: outer thigh)
Lie on your back with your knees bent and your feet flat.
Open your knees to bring your feet and knees wider that your shoulders.
Relax your hips as they rotate your knees inward, toward one another.
don’t let your hips lift even when one knee rotates inward
more than the other.
Once you are warmed up, open your feet a little wider and repeat.
Continue to open your feet and repeat in small sets until you can no longer
comfortably touch your knees together.
Once you have reached your maximum foot placement move one leg down
toward the floor. Do this by rotating in the hip joint while trying to
keep your back from lifting. When the leg will rotate no further, then
allow just a little lift in your back.
Continue this in small increments until your have reached the floor with your
knee.
With time and practice you will find that you can rotate more in the hip without
compromising the length of your back.
To exit, relax your leg and just rock your hip to the floor which will lift your leg
passively.
Key: You can not rush this exercise. You have to learn to relax in the work to allow the stretch in your leg to happen, so it is counter productive to struggle. You have gone too far into the stretch if you feel discomfort in your knee. In this case either open your knees until the sensation is gone or bring your feet in closer and resume you work. Pain is not gain.
Psoas Lift
Lying on back with knees bent and feet flat on the floor.
Zip up the abdominal wall to firmly stabilize your pelvis.
Extend one knee continuing to keep your center of gravity in the core and avoiding
pressing on the opposite hip.
Rotate the leg from the hip joint to rotate your foot approximately 20 degrees.
Without compromising the stabilized back, lower the heel to the floor and return to start.
Your intention should be focused on the psoas, lower abdominal region/ groin area.
Key: Do not allow your hip to dip as you move your leg up and down to train the abdominals to support the work.
Periformais Stretches
Yoga Position
On all fours
Cross your left knee over your right knee and let it rest on the floor
Begin to stretch out your left leg which will stretch the right hip.
Slowly lower your elbows to the floor, increasing the stretch.
As the stretch happens, let your left leg stretch out even more.
Stay on one leg for 45-60 seconds.
Flex your left ankle and push yourself back to an all fours position.
Repeat on with the right leg.
Cross Crunches
Lie on your back with your knee’s bent and your feet flat
Hands behind your head but do not pull on your neck, just lay your head in your
hands.
Squeeze your abdominal muscles to curl your shoulders in toward your hips.
Bring your knees perpendicular to your hips with your shins parallel to the floor.
Rotate your right elbow toward your left leg as you bring your left knee toward the right
shoulder. You will be crunching up to bring your elbow on the outside of your
knee.
This will create a lifting motion in your rib cage and an internal rotation in the
hip.
Now from that high position, rotate back through the center and take your left
elbow high and toward the right knee.
Do not rest between each side.
As you go through the motions begin to stretch out the leg opposite of the bent
knee.
Keep your feet high in the beginning, slowly moving to a fully stretched leg.
Only stretch out your leg to the degree that you feel no discomfort or weakness
in the low back.
Key: This movement should be slow and deliberate use caution not to engage your back to create the action. It may take a couple of weeks to be able to rotate your knees appropriately and to stretch the opposite leg to full extension. That is appropriate in developing the complementary functions.
Torso Twist (Spinal Torque & Lengthener / Pectoralis & Hip Stretch)
Lie on the floor with your back comfortably and completely elongated.
Begin with your knees bent, feet flat, and your arms stretched out perpendicular to your
shoulders and your palms to the ceiling.
Lift your feet, one at a time, off the floor to bring your thighs perpendicular to the floor.
Keeping head straight and shoulders stationary, lift one hip to drop your knees off to the
opposite side feeling the back twist and stretch.
As the tension builds be aware of the opposing shoulder trying to lift off the floor.
Just as it begins to lift allow the bottom leg to continue to the floor but only slowly allow
the top leg to lower to an appropriately comfortable position.
As you hold this position and it becomes more comfortable, slowly allow the leg to twist
over more by lifting the hip and bringing the knees in line.
Key: Do not force this movement. It will improve weekly.
Bridge Lower Back Relaxer / Neutralizer
Lie on the floor with your knees bent and your feet flat.
Zip your abdominal wall, place your navel on your spine and distribute your weight
evenly on your heels. Tighten your buttocks (glutes) and lift your back off the
floor slowly in one motion to make a straight angle from the knees to the shoulders.
Hold for 10 seconds
Bend at the flexors and lower your back smoothly toward your heels until you reach the
floor. You will be arching slightly
This will bring your shoulders up to your ears if you relax into the stretch.
Now tighten the lats and pull both shoulders low on the floor toward the hips.
Feel how long your back and your neck feel.
Key: Create an opposing force against the torso during the lift and against the hips as you lower. Be purposeful and consistent. Visualization is a must for this exercise as may be a slower motion.
Central (Medius and Minimal glute) Squat
Stand with your feet just wider than shoulder width apart and your toes only
slightly pointed outward.
Keep your weight in your heels and slowly lower your hips back, keeping
your upper torso as vertical as possible.
Concentrate on creating the action from the top and sides of your hips. Imagine
your hands are on your hips as you look down the fairway.
Do not push up through your knees and keep your motion slow enough to feel
your focus.
You will add a single dumbbell after your get good at feeling the movement in
the desired area and know you are not in your knees.
Standing Quad Stretch
Standard form with your feet together.
Bend one knee and reach down with the hand on the same side and grasp at the
ankle.
Allow your knee to move forward of your torso as you stand erect in your posture.
Continue to lift your torso until your shoulders are level.
Slowly contract your quadricep and bring it back into line with the opposite knee.
Hold.
To end, bend at the waist to take all tension off the leg and the torso.
Slowly lower your leg and repeat on the other side.
Key: Do not stretch your leg and arch your back from the upright position. Even though this stretches the thigh it is not as profound as moving the leg from an aligned torso.
Standing Hamstring Stretch Back of the leg
Standard form facing any type of stable platform of at least 18 inches in height.
Lift one foot and place the heel of the foot securely on the edge of the platform so that
the foot can pivot to serve the stretch.
Stand on your support leg with your knee fully extended but not locked and your foot
only slightly rotated out.
Do not allow the knee to bend nor lock-out throughout the movement
Rotating off the hip, lower your straight back over your leg as if you are placing your
chin on your toes. Stretch your hamstrings just until the knee tries to bend.
This will feel more like pushing your hip back than leaning forward. Hold.
Round your back and let your nose come more down toward the shin. Hold.
Bend your stretched leg and stand back to ready to repeat on the other side.
Key: Think more of dropping the hip away from your foot than of leaning over and you will find that you keep the joints and muscles at their most full length.
Hold off on this one until the next time we communicate but I wanted you to read it.
Calf Raises
Stand on the floor with your feet flat and in a neutral position.
Slowly lift onto your toes to your fullest range of motion.
Gently roll into the toes more, allowing your knees to bend but keeping your
back straight and vertical over your heel.
Lift fully out of this position.
Slowly return your heels to the floor
Repeat.
Key: Don’t let your back arch and don’t over extend your knees. The action is inspired by the ability to roll into your toes.
Those are the exercises that you should do once a day in the beginning. The second recommendation I will place here is very unusual for me. I believe in the ultrasound techniques that increase blood flow to the tendon area. I have no relationship with a retailer but know that they can be purchased on line at a reasonable rate. If someone tells you that this is bad advice then I will tell you that I have seen really good results and the very first day I did my apprentice work in a rehab facility, without taking my first class, I was directed to administer this treatment on a patient. It is an adjunct to rehab not a replacement but very effective on tissue that is sensitive to work at this early stage.
So we have begun. You can be in complete control of this process. Please maintain good medical support and stay in contact as we refine the process. I will be happy to be in it with you.
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