Wednesday, April 28, 2010

Eccentric Exercises for plantar fasciitis & patellar tendonitis (runners knee)

After six months and hundreds of dollars spent treating my running injury under a conventional doctor's care who proscribed solely the treatments paid for by my insurance company has failed, I'm trying unconventional methods. By "unconventional" I mean therapies that are not paid for by my insurance company.

To find these therapies I crowd sourced therapy advice from runners, cyclists and multisport athletes on Twitter. I coined the term "cloud care" to describe my new medical care system that involves free outcome-oriented advice from injury-recovered athletes. Basically, it's asking people what worked for them. The old "conventional" care system, based in large part on what my doctor figured that my insurance company would pay for,  I now like to call "crappy care." I posted the results of my survey on a previous post titled "5 Steps To Heal Plantar Fasciitis".

Since my last post, I've discovered three basic tendon/fascia healing principles:
  • Increase circulation: Rolfing, deep tissue massage, PRP,  and "tennis ball therapy"
  • Increase flexibility: Stretches specific for the injured tendon/fascia
  • Increase stress gradually: Stress the injured area to facilitate tissue repair and regrowth
    Notice how these principals do not include many of the ones proscribed by crappy care: Cortisone, immobilizing the injured area with a cast, daily intake of ibuprofen and icing. What I'm not saying is that these treatments don't work. They just didn't work for me and they cost me and my insurance company a lot of money. In defense of crappy care: the physical therapy and proscribed flexibility, stability and strength exercises did help my injury recover. However, due to poor management of my case, a stress fracture went undiagnosed and the foot pain became worse at month five of crappy care.  Also, I just could not afford more PT after over 20 visits at $40 co-pay each. Below are some links to online sources about some "unconventional" (e.g. not paid for by insurance) therapies that have really worked according to athletes. They are treatments you can do at home for free (with the exception of the deep tissue massage/Rolf Therapy and the PRP therapy).

    Cloud Care Healing Therapies for tendon/fascia injuries:
    1. Rolfing–Rolf Integrative Therapy
    2. Eccentric exercises and tendonopathy treatment research:
    3. Eccentric exercises and stretches that worked for by Sigfús Víkþörðson a cyclist who suffered from patellar tendinitis (runners knee):
    4. PRP (Platelet Rich Plasma) blood therapy to oxygenate fibers with little blood circulation such as tendons, fascia, ligaments to induce faster tissue repair and recovery:
    5.  (concerns about PRP)
    6. Eccentric exercises (strength training by lengthening muscles/tendons) for plantar fasciitis:  (scroll down half the page to "Problem: Plantar Fasciitis...")
    7. Stretches and more strength training with eccentric exercises for plantar fasciitis:

    Please let me know what works for your tendon injury by making a comment or sending me a tweet @multisportmama. I think more people should know what really works–even if it's not blessed by the insurance companies.

    Here's to hitting the trails, roads or courts again soon!

    :) A

    Monday, April 19, 2010

    5 Steps to heal plantar fasciitis: "cloud care" from running Twitter friends

    I'm still hopping around on one foot. After more than a year of painful plantar fasciitis heel pain in my left foot (since December 2009) and months of not running (since June 2009) and medical care, this cursed injury has still not gone away.

    It's hard to have an identity of "Runner" and not be able to run. Having a cheerful and fit ultra runner girl friend who moved in across the street recently just put salt in the would.

    Me: "How did your 50K training run go in San Diego last weekend?"
    Ms. Ultra Runner: "Oh fine. I'm really not very sore at all. *laughs * It was a tough run though. The wheels came off at about mile 20 but I managed to get it together and finish..."

    Dang! I so wanted to be her. Dang! She's so happy and looks so fit...Dang! I want to run again...Dang! Dang! Dang! (Can you tell I'm missing my daily running fix? :/ )

    So, out of frustration (and desperation) I looked for some sports injury advice from my @MultisportMama followers on Twitter. Here's their advice in a nutshell:

    5 Steps to Get Rid of Plantar Fasciitis That Worked
    1. Stretch (gastrosoleus/calves/hamstrings), wear night splint to take load off foot tendons/fascia
    2. Strength train (heal raises, towel pulling with toes, core workouts, etc)
    3. Increase circulation with deep tissue massage, ultrasound or rolling foot on tennis ball
    4. Wear custom orthotics (I'm waiting for a pair to get finished now)
    5. Swim or bike (Don't run and cross-train instead)
    How is that for some open source "cloud care"? It was free. It actually worked for other runners. It's based on first person evidence. It's current (meaning it is not based on some study done 20 years ago or a book). And, there is no financial incentive for them to sell me over-priced products and services that don't work.

    To give credit where credit is due, here are some of running Twitter friends who kindly gave me the advice (and agreed to share their tweet names in time for this post):


    Do you remember those $700 toilet seats from back in the 90s? That's how I feel about the insurance-inflated prices for stuff I have in my medical system. The $250 co-pay for the MRI, the $40 co-pay ($150-$212 cost to insurance) for "therapeutic exercises and ultrasound therapy" twice a week, the $20 ($53 cost to insurance) felt heel pad shoe inserts, and waiting 10 weeks for Anthem to approve the MRI so I was getting the wrong kind of treatment for months (getting PT for plantar fasciitis and not a stress fracture).  I think our medical system has some inherent conflicts of interest. I mean when my orthopedic surgeon foot specialist is part-owner of the medical and physical therapy clinic providing me with advice, products and physical therapy, it benefits him financially when I buy as much care as my insurance will approve. So, for example, the stress fracture in my heel-- the "calcaneal contusion"--that didn't show up in my X-Ray-- went untreated for three months before the doctor requested an MRI. Then it took 10 more weeks for the MRI to get approved (thanks Anthem). In the meantime I'm continuing with the same regime of physical therapy for plantar fasciitis and asked to walk on my foot--even though I had a stress fracture.

    The current medical system is a game based on wrangling profit from the patients by both the care providers and the insurance companies.  In this system I only get as much care as my insurance company allows my doctor to proscribe. My doctor only proscribes as much care that the insurance company will approve to pay. That care is not based on needs of my running injury. It's based on what each side can get away with. That is not good outcome-orientated care. That is not good medical care. That is crappy care.

    At this stage of the game, I'm sticking with my running Twitter friends' advice (see above). As far as I'm concerned, it's outcome-orientated care devoid from any profit incentive or conflict or interest.  I will do another blog post about their collective "5 Tips to Get Ride of Plantar Fasciitis That Worked" in mid-May. It will be a status report on how my new social media/sports injury "cloud care" system is working. If those "5 Tips..." actually worked for me.

    Hopefully, by then I won't have to hop on one foot anymore.

    Happy Trails!