Injury Flare Up

My posterior tibial tendonitis flared up again.  

The tibialis posterior is a little tendon imbedded around the ankle area that helps support the arch.  It supports that rolling motion as you walk or run.  My pobre tendon is stressed to the max trying to support my flat feet and sometimes it just gives up and goes on strike.  I spent a good chunk of 2014 in physical therapy to address the issue.  I remember my PT saying it would be something I would deal with again in the future but I was unprepared for how quickly it hit me again.  

No warning. Just wham.  One day I'm fine and am running 11 miles and the next I"m peg leg Sue, hobbling up to my bus stop.


As soon as I could feel pain, I began scanning my mind over the preceding couple of weeks trying to pinpoint exactly "where it all went wrong".  I can't think of ANYTHING.   

Queue the injury mind games


If being injured isn't bad enough, try being injured in a city where EVERYBODY runs.  Seeing other runners bounding along Comm Ave, makes me feel like "what's wrong with my body"?  Why can't I just run and be fine?  This thought spiral of death is by far the greatest struggle with being injured-- having so much restless energy and trying to steer it away from feelings of defeat.  2014 was hard mostly because I originally didn't know what my injury was but, once I was diagnosed and I started PT, things smoothed out.  

Remembering that encouraged me.  "Our momentary struggles are only temporary".  In 2014, there was a game plan and it worked.  I came back to run over 700 miles in 2015.  I like game plans.  Schedules help me keep hope alive.  So, I decided that the only way to stay sane during this flare up was to "get to work". 

Recalling my old PT exercises, I made a schedule for myself.  It has been about 2 weeks of working 3-4 days a week and I can already see some progress.

Here are some of the rehab exercises  I have been doing to strengthen my leg and foot.  


DOUBLE LEG HEAL RAISE/LOWER ON SINGLE LEG 
A tell-tale sign that you have issues with your tibialis posterior is not being able to do a single leg heel raise.  Raising up on both feet helps the injured leg complete the motion with minimal stress.  Lowering down on the injured leg is to help strengthen the foot and calf muscles.  Gravity helps so lowering down is much easier than raising up.

Repetition:
3 x 15 reps on each side

Eventually I should be able to raise up and lower on one leg at a time without pain.  This will take some time to be strong enough to do.

SINGLE LEG STANCE
Balancing on one leg is probably my most favorite exercise.  I've once heard running described as a series of single leg stances.  Essentially you are just bounding from one leg to another in succession down the street.  I'm finding that my ankles need more lovin' than I have been giving.  The goal of this exercise is to stand as still as I can on one leg.  I'm golden on the left side but super wobbly on the injured right side.  

Repetition:
3 x 1 minute on each leg

Eventually, I'll be able to modify this such as balancing on a bosu and maybe even a wobble board.

PICKING UP MARBLES WITH TOES
This is a funny little exercise.  I'm not very good at it yet.  The marbles seem to have minds of their own.  The exercise is supposed to strengthen the little intrinsic muscles in the foot and also to help with any stiffness in my toes by forcing them to move around.  For an added challenge, I move the bag around to stretch the foot in different directions and I try to pick up the marbles with the smaller toes (kinda hard).

Repetition:
Pick up all 50 marbles twice

DOMING WITH FOOT
Doming is a very subtle movement that has taken me a while to master.  I tighten my foot muscles ever so slightly and then release and repeat like a hundred times.  This exercise is also one that works the intrinsic muscles of the foot and ankle.

Repetition:
3 x 30 times on each foot

Exhibit A: my super flat foot

PULLING A TOWEL WITH FOOT
This is my least favorite exercise. Sometimes, I'm scrunching and scrunching and the towel goes nowhere. Quite annoying.  The video below caught a good session.  Essentially, I am pulling the towel towards me using my toes.  For added difficulty (when I get stronger), I will add a weight (a can of soup or something) to the far end of the towel and scrunch.  This exercise is one that also works the tiny intrinsic muscles in the foot and ankle.  There's also some lower calf action happening.

Repetition:
2 X 30 with each foot (or whenever I decide to give up)

SINGLE LEG SQUAT WITH SLIDER
This is just a jazzed up single leg squat.  I place the slider under my passive foot and lower on the stationary leg while sliding the passive leg out sideways.  This is a fun one working my whole leg, glutes on down!

Repetition:
2 X 15 on each leg 

SQUATS WITH BAND
Squatting with the band helps stabilize my legs which in turn engages the posterior and anterior tib in keeping the leg straight.

Reptetion:
2 X 15 squats

I also do a lot of ankle mobility exercises with the exercise band:  dorsi flexion, plantar flexion.  I can post a video if you really want to see :) And, lots of stretching: calf stretches with knee extended and bent 3 times a day.


I addition to the active exercises, I am icing regularly twice a day and applying heat.  Heat application: right before evening exercises and at bed time.  I have poor circulation in my limbs so my hands and feet are always cold.  Since, blood flow aids in healing, I figured I would try to keep my feet warm at night and see if it would help things along. 

Again, it has only been two weeks since and I've started to see progress.  I went out for 1 mile run/walk this morning with minimal pain.  Strong muscles in the leg and foot will take some of the pressure off of my overloaded tibialis posterior.  And believe me, it has its work cut out supporting my flat feet.


Please note: I am not a personal trainer or registered dietician.  I have no degrees or certificates of any kind in physical training, nutrition or fitness.  Ideas expressed in this blog are a means of communicating my personal experiences and should never be taken as medical advice.  Always consult your doctor before beginning any new dietary or fitness plan.