So, You’ve Got A Nagging Pain…Now What?
It takes a lot to distract me from the nagging pain in my right leg that happens every time that I run. It started about 4 years ago in the 10th mile of a half-marathon and it has not stopped since. It pops up after 1.5 miles and causes an ache that slows me down, makes me angry, and gives me excuses not to run.
But I think most of us have that same story. There is something that we don’t do or avoid doing because of a nagging pain that won’t go away. The science behind it might belong to a musculoskeletal approach that includes the kinetic chain of strength, power, and balance that flows from the low back to the sole of the foot and back upward. Once some piece of that chain is interrupted, the whole group can be disrupted. Think about a time when you wore heels that were too tall or stood for a long time on a floor that was too hard. The effect on your foot likely caused pain in the back. That kinetic chain can be affected by (and also lead to) changing temperaments of our tendinous structure. We’ll get a little technical for a minute.
The tendons of the body connect the muscles to the bones so that when the muscles tighten the bone can move. The tendons most often cross joints and cause the joint to bend. Interestingly, because the joint goes through a wide range of motion, the stress on the tendon varies based on how much work the muscle is having to do to bend the joint and at what degree of motion the joint resides. Consider offering a piggyback ride to a small child when they are 1) standing on a chair, 2) sitting in a chair, or 3) sitting on the floor. To pick them up from the floor onto your back requires you to squat completely to the floor and then lift them up until you are completely erect. That motion is much harder on the knees and hips because of the depth of the range in which those joints started.
These kinds of motions are more likely to cause a strain that starts out as a tendinitis lasting for a few days. In most cases, the body’s inflammatory period lasts about 3-5 days and then the tendon has recovered. However, in some cases the injury is too great or is repetitive and the inflammation doesn’t completely resolve during that inflammatory period. Sometimes it continues to smolder beyond that period and the body stops trying to heal it and instead, starts to create scar. Well, scar in a tendon is like pouring super glue onto a piece of cloth and then trying to stretch it. It begins to impede motion, cause pain, and limit activity. That condition is called tendinosis and it can be chronic.
What can help? Number one suggestion is always to get to the root of the problem within that first two weeks after injury. That is a critical time to close up the inflammatory period and avoid the progression into scarring of the tendon. Seek out a physical therapist or occupational therapist and discuss the activity that caused the injury and what activities are currently being limited. We’ll work with you on at-home exercises and use of heat and ice to reduce the inflammation but we’ll also discuss modifications to your activity that can keep you moving forward.
My goal for 2021? To spread the word that life without pain is worth fighting for. Here are a couple of resources that I hope can help.
Bass E. Tendinopathy: why the difference between tendinitis and tendinosis matters. Int J Ther Massage Bodywork. 2012;5(1):14-17. doi:10.3822/ijtmb.v5i1.153. Retrieved 1.1.21 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312643/