Saw Dave - my Physical Therapist at Holland Hospital Rehabilitation Services today. I've seen him before, and he always got to the root cause of my pain. With two conflicting diagnoses, I was eager to hear what he had to say. After I described what happened, and he did an initial assessment, he agreed that I was dealing with a pes anserine bursitis, along with some lingering tendonitis. He said it was clearly an overuse injury. But the fact that it did not occur till I was ten days in, and then only after I had increased my mileage, suggested that there might be a bio-mechanical issue causing it.
A recipe for Tendonitis/Bursitis.
Dave said that injuries such as mine are often caused by issues in the either the knee, hip or ankle. He performed several assessments of the knee and hip, finding no issues with either. He then had me stand barefoot, and watched my feet as I bent my knees and rotated my body. He had me sit, and he started manipulating my heal and the ligaments surrounding it. He said that the subtalar joint between my talus and calcaneus was locked up, and that meant that my left foot, leg and knee was not getting the shock absorption that joint provides. It meant my foot would not pronate properly (wear patterns on my old shoes confirmed this). And it meant my tibia was probably not rotating to the inside during each step, resulting in each step causing stress to the tendons with which I'm having problems.
With manipulation of the heel, and stretching of the associated ligaments, the joint was working properly, walking was significantly easier, and pain was greatly reduced.
Then he suggested a treatment called friction massage therapy. With a disturbing sparkle in his eye, he described the process as rubbing the tendon perpendicular to the tendons such that the pain would be intense. That he would continue that process for about three minutes, at which point the pain would begin to go away. Desperate for relief, I agreed, and he started rubbing with his thumb directly over the inflamed tendon/bursa area. I writhed in pain. After an interminable length of time, he announced that one minute had passed, and that I should start feel ing the pain diminish in about another minute. Yikes! I endured.
After another minute or so, the pain did start to diminish, and all but disappeared by the three minute mark.
He promised to repeat those treatments, along with some other tricks to get me back on my feet such that I may be able to get back on the trail to do a southbound by June.