Illustration by Barbara D. Cummings from “Myofascial Pain and Dysfunction”
By Jon Hodges
Acihilleeeeeesssss!” The Achilles tendon, named after the popular Greek myth and made more popular when Brad Pitt’s anatomy was showcased in the movie “Troy.” Not that anatomy. Lower. Nope, even lower. There you go.
Achilles tendonitis may be one of the more common diagnoses we see at Nevada Physical Therapy, which is characterized by sharp pain at the base of the calf, just above the heel. A quick side note before we get into the meat of this (pun intended): People often ask what shoes to wear for running, and the jury is out. I love the minimalist shoes, but, like anything, you have to build up to it: Do a couple 400m repeats on soft earth, like grass, and then do your heavy work in running shoes. But which running shoes?
Look, I’m a 200-plus pound power-lifter — I thought cardio was Spanish until a few weeks ago. If you want a better answer, schedule a chat with my partner, Crista Jacobe, on campus, or pop into Reno Running Company. But here’s what I tell people: Inserts like Superfeet are worth their weight in gold. They cost $35 and replace the factory inserts your shoes came with. They are awesome and work for 83.33 percent of my patients. Start there. It’s usually the arch support — not the cushion of the shoe — that is the biggest problem.
Now, brass tacks. The Achilles tendon is actually where two of our calf muscles — the gastrocnemius (the bulky muscle we see) and the soleus (a flat muscle that sits just underneath the gastroc) — combine into a common attachment. The key difference is that the gastrocs cross the knee joint and the soleus (solei?) do not. So just hitting your conventional calf stretches probably isn’t cutting it. This brings me to our first point: The soleus is your problem. Well, technically that’s not true.
Here’s your actual problem: The plantar fascia. This is the thick connective tissue that runs from the front of your heel to the ball of your foot. This is the way Nevada PT looks at Achilles tendonitis: Fix your plantar fascia. Inversely, if you have plantar fasciitis, fix your soleus. See, we just fixed two problems in one column.
Are we done here? No? Let’s back up.
If you look at your heel as a wedge, your soleus extends up from the wedge to your lower leg, and your plantar fascia extends forward to the ball of your foot. So if one is tight, it tilts the wedge towards it and effectively puts the opposing muscle into a chronic stretch. Our bodies don’t like that and inflammation ensues. So a tight soleus complex will pull your heel towards it and chronically stretch the plantar fascia, and vice versa. Most physical therapists spend so much time on the painful muscle that they miss the problem. So, what to do?
Here’s my favorite test that we’ll revisit when we pick apart your terrible squat pattern (no offense): The soleus lunge test shown in Fig. 2.
Place your foot four to six inches from a wall. Drop into a lunge with your opposite knee on the ground. Without lifting your heel or twisting your pelvis, can you touch your knee to the wall? If you can, you’re better than most, but you’re not home free. If you can’t, here’s what you need to do.
STEP 1) CALF SMASH:
Get a lacrosse ball or pay three times the amount and order one of KStarr’s LAX balls from MWod.com. Sit with your legs long ways out in front of you, and put the LAX ball to work by finding the tender spots and rolling them out, being sure to hit from the meat just below the knee (stay off anything that is bony or tingly), and roll all the way to where your Achilles tendon starts. If you’re not making a weird face, you’re doing it wrong. Hit the Xs in the Travell picture above.
STEP 2) SOLEUS STRETCH (FIG. 3):
This is easier to show than to describe, but basically you should be bending your intended leg, remember the soleus doesn’t cross the knee, and you should feel the stretch at the heel in the Achilles tendon. No pain in the front of the ankle, my young padawans. Hold for 30 seconds to two minutes. Rinse, repeat.
STEP 3) PLANTAR FASCIA SMASH:
While standing, take that LAX ball and stand on it between your heel and ball of the foot. Now slowly roll back and forth, being sure not to roll over the heel or the ball of the foot. Roll slowly, I see people doing this quickly, and that just isn’t it. Roll slowly, extend your toes to the ceiling and make a weird face. Repeat.
This is lower extremity mobility 101. If your soleus doesn’t work well, you will likely develop pain, not to mention your squat is inherently jacked. These are the folks that can’t squat to parallel without falling over backwards. You know who you are, but all of us will benefit from improved lower leg function. These muscles are tough; you want to be aggressive, but not excessive.
Let’s bring it full circle, if you have Achilles tendonitis, it’s probably your foot, and if you have a heinous squat or plantar fasciitis, it’s probably your soleus. Go forth and spread the good news.
Jon Hodges PT, DPT is a physical therapist at Nevada Physical Therapy on campus. He can be reached at firstname.lastname@example.org.