Achilles Tendinitis Pain? Trigger Point Therapy Helps!

Previously I covered trigger pointing for plantar fasciitis and inner heel pain. Since then, I received a few questions about trigger pointing for pain in various parts of the body. (Thanks for all your questions!) One of the enquiries was how to trigger point achilles pain. This is pain in the back of the ankle/s.

Credit: 'The Trigger Point Therapy Workbook'

Target trigger point #1: Soleus
I would first target the soleus trigger point (see pic to the right). Use your thumb to feel along the soleus muscle, until you find the trigger point. It will feel like a solid roundish mass. It will HURT when you press on it. This HURT almost always seems way out of proportion to the pressure you apply to it.

Use the opposite knee to rub out the trigger point firmly. This means, for a trigger point in your right soleus, rub the right soleus on your left knee. Thumbs work fine too.

Or you can get someone who enjoys hurting you to rub on that trigger point with their thumbs.

It's more fun that way :p



Target trigger point #2: Tibialis Posterior
Next, feel along the tibialis posterior muscle for a trigger point (see pic to the right). This muscle is quite deep - under the soleus and gastrocnemius. You will find the trigger point along the vertical line between the two 'heads' of the gastrocnemius. That's kind of the depression in the middle of the calf.

The trigger point will feel like a solid roundish mass. It won't hurt when you press on it....

I'm lying - of course it will hurt.

How much Hurt?
Rub out these trigger points 6-12 times, every hour. It should be enough pressure to be a 'good' hurt. Expect to feel immediately relief from your achilles pain. And for stubborn trigger points, it could take up to two weeks to completely resolve. Keep at it!

Let me know if these worked for you and if you managed to find those trigger points! And keep those questions coming!

Next post: Trigger Pointing for Knee Pain, even 'arthrtiic' knees

Inner Heel Pain: Trigger Point Therapy

Previously: Plantar fasciitis Heel Pain
In a previous post, I described how to locate and deactivate trigger points for plantar fasciitis, which gives a sharp pain directly on the heel. Plantar fasciitis pain is worst upon waking up in the morning, and it comes right back after sitting down for a long time.

This Post: Inner Heel Pain
I'll tackle trigger pointing inner heel pain. I had both plantar fasciitis and inner heel pain, and found trigger points that made the pain go away. Runners unite against Heel Pain!

Where and What
The pain on your inner heel is on the Adductor hallucis muscle. The trigger points are in the 'belly' of that muscle.

Use your thumbs or fingers to feel along the adductor hallucis. You might find two trigger points.

Credit: 'The Trigger Point Therapy Workbook'

These trigger points will feel like a solid crunchy/mass/lump about the size of a pea that hurts like heck when you push on them. Actually, the entire area around the trigger point will also hurt, so it will hurt when you try to find the trigger point. But it is very important that you find it so you can directly deactivate it.

• Self massage: My second finger works better for me than my thumbs in locating the the trigger point.  I find one lump in my right adductor hallucis when I run my left second finger from arch to back of heel as hard as I can. 
• Helping hand: Thumbs work better when locating and deactivating trigger points on another person. Today I found a monstrous one on Ruth's inner heel, drawing my thumb firmly across the adductor hallucis (also from arch to back of heel). 

Heal Pain!
Firmly rub on the trigger point/s 6-12 times, in a rolling motion. You could also use a golf ball to get in deep.

It's okay to cry. Screaming is optional.

Repeat this every hour or two. I mean the trigger pointing. :p

What to Expect
I've found this inner heel pain more stubborn and persistent than my plantar fasciitis pain. I've found that I need to trigger point this regularly, especially after long runs. But it works. Once I find the trigger point and deactivate it, the pain goes away.

You? Pain?
Did trigger point help your inner heel pain? Any problems finding that trigger point? Would seeing a video tutorial help?

Where else do you hurt? Achilles tendinitis? ITB? I'm all ears!

Trigger Point Plantar Fasciitis Away Now: How To Ease Pain Fast

I'm going to show you exactly where to trigger point massage to get rid of that plantar fasciitis heel pain that you have been suffering from.

Don't be like me
I spent close to RM1000 before finding this free solution to my plantar fasciitis. I found it in the
The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief book, borrowed from my library.

If you have heel pain, this is definitely worth trying. It might save you a lot of pain and grief and needless icing and abstinence (from running). It might spare you the fruitless search for heel cushions, padded shoes, foot splints, custom insoles, bla bla bla.

So, please try this first. Don't be like me ya. :)

You will Need

• A golf ball
• Your thumbs 

Where Does it Hurt?
If it hurts directly on your heel it could be one of two trigger points, or both of them. If it hurts on the inside of your heel it could be a different set of trigger points. I'll cover the direct heel pain first. This is a sharp pain that feels like you stepped on a stone. Or a nail is being driven into your heel.

Find The Trigger Point

Credit: Trigger Point Therapy Workbook

Use your fingers and thumbs to feel along your: 1) calf muscle, and 2) your quadratus plantae, to find the trigger points.

As I explained in previous post, the pain in your heel can be 'referred pain' originating from a trigger point in your calves. It is usually located in the 'belly' of the muscle and is a solid/hard mass ranging from 'noodle' to 'pea' shape/size (read about my two guinea pigs here).

In Figure 10.29, the black dot marks where the trigger point will be. Feel very carefully along every inch around there, rubbing back and forth with your thumb with a rolling motion.

Q: How do I know For Sure I Found It? 
A: OUCH!
Ya. It hurts when you push down on it. You don't even need to push hard. Just firmly. It surprised me the first time I felt and found that trigger point. That pea-like mass hurt exquisitely - only when I pressed on it.

A Good Kinda Pain
Now that you've found this first trigger point, use your thumbs and firmly rub it out in a smooth rolling motion. Do this 6-12 times. It will hurt, but in a good way. :)

This should deactivate the trigger point, resulting in the muscle being able to relax. You may discover that the heel pain and the tightness in your calves has eased. At this point you can safely stretch.

It's Still There
Okay, let's find the trigger point in your quadratus plantae next (Figure 10.55). This trigger point is very deep, so you will need to apply monstrous pressure with your thumbs to find it. Mine felt like a crunchy mass the size and shape of a bison rump steak gristle.

It will hurt.

And I don't mean the gristle.

To make it hurt some more, roll that painful spot over a golf ball. Work out the trigger point for about 6-12 good rolls.

And... Repeat
Do this every hour or two throughout the day. Stubborn trigger points can take up to two weeks before deactivating, but you should feel relief quite soon. For me, the pain went away like, immediately. Now, if you have pain on the inside of your heel, that's a different set of trigger points and I'll cover that soon.

It's Still There
If it didn't work for you, I'd love to hear about it!


xo Gracie

Trigger Point Tennis Elbow and Head Pain

Since my last post I've been getting questions about trigger pointing various parts of the body that hurt - thanks everyone for your feedback and keep 'em coming! Here are two recent practise cases.

Trigger pointing Dy's Head Pain

I got the opportunity to practise on Dy the other day. He complained of horrible pain all along the left side of his head, like it was 'inside' his head. He also suffered muscle twitching and pain when he tried to turn his head to the right. I immediately suspected trigger points somewhere in his neck muscles were causing 'referred pain' in his head. 

Trigger points are apparently 'remarkably common' - perhaps contributing to up to 93% of pain seen in pain clinics (Gerwin 1995 in Davies' 2004 'The Trigger Point Therapy Workbook'). Dy is a prime candidate for trigger points because he is tense and on guard all the time. I mean like, all the time (more causes of trigger point given later). I flipped through the book and found under the chapter 'Head and Neck Pain', the diagram that showed a referred pain pattern that looked like Dy's. Notice that the central trigger points (those black dots) are located right in the 'belly' of the muscle (the biggest part of the muscle). 

As I felt carefully along the muscles of Dy's neck with my fingers, I found one nodule about the size of a jellybean, that was very tender and painful for Dy when I pressed on it. This was nodule exactly where the diagram pictured a trigger point might be found. So I firmly rubbed on it a few times with my thumb - sort of a smooth rolling motion. Dy said the pain went away! I told him to keep feeling at the back of his neck and rubbing it out every hour or two, just to make sure. It's been two days and so far so good! Sometimes it takes up to two weeks if the trigger points are really bad, but I guess in Dy's case, they weren't too bad. 

(Credit: The Trigger Point Therapy Workbook)  

Trigger Pointing Spencer's Tennis Elbow

Spencer has the worst case of tennis or golfer's elbow ever. I tried trigger pointing it a few weeks ago, but it didn't seem to help. I am still learning after all, and sometimes I have trouble figuring out the diagrams in the Trigger Point Therapy Book. 

Anyway, I had another good look at the book, practised locating the muscles and potential trigger points on my own arm. 

Then I took another shot at Spencer's elbow. 

Guess what? This time, I really did find the nodule - it was quite a large one - a grape-sized lump in the middle of his tricep, nearer his elbow. It was very painful for Spencer when I pressed on it. I firmly rubbed on it about 12 times. I also used my fingertips and thumbs to feel along the muscles around the elbow, trying to find any other trigger points. Didn't find any more though.  

By the time I got done with that, Spencer had already passed out on the massage table. :p

When he awoke from the nap later, he said the pain had eased tremendously. I'm so pleased about that!

What Causes Trigger Points?

Okay before I wrap up this post, I'll briefly go over the main causes of trigger points so you can see if you're a candidate too:

• Abnormal bone structure such as a short leg, Morton's foot (the second toe longer than the big toe), can strain the muscles.
• Bad posture while sitting and standing (especially for long periods of time) can cause muscle tightness.
• Repetitive movement such as typing, forces the muscles of the shoulders, neck and back to be still while the muscles in the arms and hands strain.
• Stress and subconsciously holding the muscles tight will also strain the muscles.
• Health problems especially those involving chemical, nutritional, glandular imbalances/deficiencies (eg. hypothyroid, hypoglycemia, anemia, uricemia) can predispose you to trigger points too.

Next post, I'll delve into the physiology of a trigger point and how to trigger point the vastus medialis to help with ITB (iliotibial band) pain. 

In the meantime, do keep your questions and comments coming. Do you think you suffer from trigger points? Any specific parts that you have bad pain? I love hearing from you!

xo Gracie

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Plantar Fasciitis: Cure and Pain Relief FAST with the Kitchen Sink Prescription

Those of you who know me, know that I'd been whining - it seems like forever - about not being able to run because of Plantar Fasciitis (henceforth referred to as PF). After over half a year of trying everything recommended by friends etc, with no apparent relief, I quite suddenly found the solution to my PF! It might be yours too!


How I got Plantar Fasciitis
As I weaned off the meds, as my body healed from half a lifetime's worth of major health problems, I rediscovered my love of Running - in a big way. I'd pack my Camelbak Skeeter with water, dodol ('Malaysian Gu Chomps'), a few ringgit, phone, and first aid kit, and take off into the FRIM Bukit Lagong forest behind my apartment, running for 6 - 7 hours at a pop (don't be impressed - I'm just really slow hehe). I never wanted to stop.

But I had to. (Dang you PF!)

In my eagerness to run more and more, I had done too much too soon. The over mileaging - even in the minimal running shoes that greatly helped my arthritic knees - had over-stressed my feet before they had the chance to adapt and and get stronger.

The run that 'broke' my feet was probably the MPIR run in Jan early this year, where I went out in a blaze of glory - I actually won something for doing something athletic, for the first time ever! That evening, the sharp shooting pain through the heel of my foot began, and it didn't go away for the next seven months. Plantar fasciitis? Bone or heel spur?

Most of you are already familiar with PF symptoms (e.g., heel pain especially in the morning and after periods of sitting/inactivity), so I won't go into detail here but will save that for another post.

I think I pretty much tried everything except steroid shots (cortisone injections), extracorporeal shockwave therapy (ESWT) and surgery. Below is what I felt helped and what hurt my efforts to recover. And also what gave me almost instantaneous relief and The Cure :)


What Not to do for Plantar Fasciitis
I was informed by the physio doc that I should lay off running because the PF would not go away otherwise. It seems my years on steroids predisposed me to PF because the steroids hastened aging and had caused the natural fat pads at the bottom of my feet to deteriorate. With no cushion, the plantar fascia is susceptible to bruising, damage and inflammation.

I stopped running (which I actually didn't need to - read on below).

I wore cushioned shoes 24/7 - from the time I woke up till the time I went to bed, even in the house (shouldn't have). This was supposed to protect my feet while giving relief from the heel pain. All that cushioning did help my pain, but the PF didn't go away. Interestingly, my lovely high arches disappeared. At the end of six months of practically living in my shoes, I had become flat-footed! I now understand that all the little muscles in my foot - when I was barefoot - work together to give that 'spring' to my step. Cocooning them in shoes made the foot muscles weak. The muscles supporting my arch no longer did, so my arch flattened out. (I understood this phenomena better after reading Born to Run).

I got custom insoles (hard and painful, PF stayed) and tried off-the-shelf insoles too (pain relief but PF stayed). The physio doc said those $100 hard insoles would provide support to my arch, taking pressure off my heel. They hurt my arch and my heel. My pain threshold is up there, but I lasted only a week in those things. The Dr Scholl's Pro Pain Relief insoles were nice and cushy (and muuuch cheaper), but didn't seem to be doing anything to make the PF go away.

Awful. Just awful. 

What To Do for Plantar Fasciitis (What I did anyways)

For the first six months I did things that I think helped, but didn't resolve the PF:

• I stretched. Especially calf stretches. The physiotherapist I saw at HUKM taught me a few good plantar fascia and calf stretches (will cover these in future posts).
• I massaged my feet and calves. This was well and good, but as I didn't really know what to do at that time, it didn't resolve the PF.
• I iced. This was torture. I'd soak my feet in a bath of really cold water to bring down the inflammation. 
• Night splints (the plantar fasciitis boots). This was really the most effective way to keep the PF pain manageable and at bay. It works by keeping the plantar fascia extended while you sleep. I also stopped sleeping on my tummy. Sleeping on the stomach results in the feet being pointed and the plantar fascia kept in a shortened state for long periods of time (baaaad).

At Month Six, I started seeing a chiropractor. This was Dr Scott Mills, who specializes in treating athletes. That was when things started to get better. 

The New Balance Minimus

• Barefoot exercises. Scott prescribed a series of exercises to strengthen my feet. These worked the little muscles in my feet, and I was to do them on grass. They took about 20 minutes everyday. (Will cover these in my next post). 
• I finally ditched my shoes and started going barefoot as much as possible. And I went back to wearing my beloved New Balance Minimus and other minimal shoes that allowed me to feel the ground. 
• Active Release Technique (ART). Scott used ART to perform a controlled break down of the scar tissue surrounding my plantar fascia. He applied pressure all along the plantar fascia while manipulating my foot at certain angles. The aim was to actually start some fresh inflammation in the area so that healing begin could occur.
• Icing. Icing was now done in the evenings, particularly on days I received ART treatment. It was to bring down the inflammation caused by the treatment (think of it as a 'controlled inflammation'). 
• Night splints. I continued wearing them.

After a month of all that, the scar tissue on my heel had dissipated for most part, and I was really pleased about that. However, I still experienced heel pain after periods of sitting down, and I still needed to wear the foot splints, else the morning heel pain would be present.

Fast Plantar Fasciitis Relief - Trigger Point Yourself

At the end of June, as my PF treatments with the chiropractor were wrapping up, and with heel pain still present, I read the "Trigger Point Therapy Workbook: Your Self Treatment Guide for Pain Relief" (2nd edition, by Clair and Amber Davies).

I applied pressure to and rubbed at the specified 'trigger points' in my feet and calves that the book said would help with PF. And the pain vanished. Just like that. I kid you not. I was stunned. It really worked for me. The next morning, I woke up for the first time in ages not wearing my PF boots - pain free.

It might help you too. It's easy to do, takes just a few minutes a few times a day (gosh, I'm sounding like a salesman but this book has like, 396 gushing reviews on Amazon ya know). The book contains helpful diagrams showing where the trigger points are in relation to the 'referred' pain, for pain in various parts of the body. I've definitely got more posts planned on this topic.

I think it is interesting and relevant that the book says to think of your calf muscles as extensions of your foot muscles.

"You may not have ever thought about it, but the eleven muscles of the lower leg are actually foot muscles. Anatomists call them extrinsic foot muscles, meaning they operate from outside the foot. The muscles in the foot itself are intrinsic foot muscles, meaning they work from inside the foot. The implication of these facts is that the pain in your feet may not be coming from your feet themselves. You can waste a lot of time rubbing and soaking feet if the cause of your pain is trigger points in your calves and shins."

Progress, Finally!
I'm back on the trails! I'm running again. No more pain. No more foot splints. In fact, I trigger point myself whenever I have knee pain or any sort of pain anywhere in my body. To say I'm sold on trigger point now is an understatement.

Do you have plantar fasciitis pain? Has anything worked for you? Would love to hear your PF tale of misery and victory. Leave a comment!

xo Gracie