Treading Lightly
Treading Lightly

Exercises for Posterior Tibial Tendonitis

Posterior tibial tendonitis is frustrating. You feel it in every step you take, and it drives you insane when you are sitting on the couch instead of out for a run. I’ve been there, and I never want to be there again.

I am a firm believer that injuries are your body’s way to alert you to an imbalance or weakness, and mine has spoken loud and clear.

I have spent the past year scouring the Internet and talking to every specialist I’ve met (the amazing people at the RunSafe clinic, doctors, physical therapists, massage and bodywork therapists, other PTT athletes) to find the best exercises to treat my PTT and prevent it from ever (EVER!) coming back.

There are three main areas you need to strengthen if you are suffering from PTT (or any other ankle/foot injury) the feet, ankles/lower leg, and the hip. Instead of trying to explain how to do all of these exercises myself, I linked each one to more information and instructions.

Here are some exercises I’ve been doing, from the bottom up:

Feet

Dynamic Calf Warm-up for Runners

Whether you start with flat feet or PTT causes your arch to fall, chances are you are in need of some serious arch support. Realign your arch and reduce the stress on your plantar fascia with these exercises.

Toe curls with a towel

Toe squeeze and spread (rubber bands are great for a little resistance)

Doming

Standing on one foot/balance work
Without shoes, stand on one leg for 30 seconds or so and focus on maintaining an arch while keeping your balance. Once the 30 seconds gets easy, add time/sets, try it with your eyes closed, or really challenge yourself by standing on a Bosu or another uneven surface. Be careful with this one! Balance work can really irritate my tendons. Be sure to work up to it very slowly. I mean it when I say to start for just 30 seconds on each side.

Ankles/lower leg

posterior-tibial-tendonitis-exercises-ankle-strengthening-theraband

For all exercises that you do with a band, you can buy a TheraBand (or any other therapy band) online.

Calf raises
Watch out! This is another one where you really need to ease into it. These irritated my PTT when I first started doing them. I had to start doing these sitting in a chair, just lifting the weight of part of my legs. Once I was able to do that, my physical therapist had me set a bit of weight on my knees (a heavy book works great if you don’t have access to hand weights). I did three sets of 10 reps (both legs at the same time) with the weight on my knees for about a week. Once I could do that easily, I moved on to leaning fairly heavily on a counter and lifting part of my body weight for three sets of 10. I’m currently doing three sets of 10 with my full body weight, but both legs at the same time. I’m going to progress to doing them mostly on one foot until I can do them one leg at a time with all of my body weight. If you are super advanced and you have gone through the whole progression, you can add weight, but do it slowly!

Ankle dorsiflexion with a band

Ankle inversion with a band

Ankle eversion with a band

Hips

Your hips are critical for keeping your gait balanced and even. Recent studies have shown that the hips are linked to everything from knee pain to ankle pain. These very well might be the most important exercises on the list. Don’t skip these! (Curious about where your hips are the weakest? Try this test.)

Side step with a band

Glute bridge
Weighted, unweighted, one leg, two legs – any and all variations are great!

Single-leg deadlift
Way less scary than they sound.

Squats

Side leg raises

Hip hikes

Living with posterior tibial tendonitis

What do you call a runner that can’t run? Depressed.

Junior year of high school I went from being the starting point guard to the score keeper in a cast days before the season was set to start. With half the basketball season out of the question, I sat on the sidelines and watched my team move on without me. I spent more time crying and feeling sorry for myself than I did practicing.

Now it’s years later, my team is just me, myself, and I, and yet being forced to stop doing what I love feels an awful lot like that ruined basketball season. I spend my time obsessing over all of the things I can’t do and wallowing in jealousy over everything everyone else is doing without me.

Almost exactly a year ago I had my first inklings of pain in my feet. As my injury progressed, I spent two months unable to run (and  losing my mind). I didn’t know what to do with myself, and the thought of losing all of the strength and endurance I worked so hard for for years just wasting away while I had to rest physically hurt almost as much as my feet and ankles. I tried running and not running, doing yoga, going for a swim, riding my bike, but no matter what the pain followed (and often worsened). Meanwhile the weeks ticked by and my half marathon grew closer and my mileage goals for the year more impossible.

Trying to undo all of the training mistakes I made this week with some #yoga and #mobility. #PlantarFasciitis

A photo posted by Mandy Ferreira (@treading_lightly) on

With each doctors appointment, new shoes, new inserts, etc. I got a sense of hope and would finally start to feel my mood lift. But days or weeks later when there wasn’t any improvement and I couldn’t sit still without thinking about the pain in my feet, I was right back under my dark cloud that rains all over me. I was desperate for a turning point and for some real hope. I started to throw myself into my PT exercises, contrast baths, and everything else I could do to heal faster. I stayed away from sugar and other foods that are taxing on my body. I pushed through some pain and pulled back before I made things worse. I listened to my body (and hopelessly ignored it). And it worked. I slowly got better. I got stronger. I ran a half marathon. And then another eight weeks later. All the while I lived in fear that my pain would return, that I would be broken again. Sidelined. But after a while the fear faded, and with it went my adherence to my exercises, the contrast baths, the self-massages, the intuition to listen to every little twinge in my body.  

 

I’m still flying on my Nike Women’s SF finish. #tbt #runchat #werunsf

 

A photo posted by Mandy Ferreira (@treading_lightly) on

 

I got careless.

And I paid for it.

It’s a year later, and my PTT is back. Another flair-up. Another setback. Another frustration.

But this time I know. I know I need to be doing my exercises. I know my shoes aren’t going to be a magical fix. I won’t suddenly wake up one morning able to run 13 miles.

Comeback’s are a struggle. But they are worth fighting for. I have four weeks until I run my first race since October, and I am sure as hell going to be at that starting line strong. I am going to strengthen my hips, my ankles, my feet. I will create a solid base that will keep me going through the summer and into the fall. I am going to have months without pain, without limits.

Instead of feeling sorry for myself, I’m looking forward to being set free, to being stronger than before.

Posterior tibial tendonitis management

I have a glaring track record with injuries. They all start the same way. I feel amazing. Unstoppable! And then I push too hard and I am completely stopped by an intense, slow-healing form of tendonitis. I’ve done it again and again, and yet I clearly haven’t learned.

The week after the Nike Women’s Half I felt great. My legs felt strong and I was flying high on a great race. I wanted to run further, faster, more often. I started planning how I would up my mileage this winter and all of the great speed workouts I would do. I was so ready to go.

running-shoes-asics-gel-2000

Except that I wasn’t. I forgot the most important part of training – rest. I pushed too hard, too soon after my race and I aggravated the injury I spent four months battling this year already.

Now every step is a reminder of how big of an idiot I am. Instead of doing all of the amazing running I had imagined in my mind, I’m back to doing what feels like endless PT exercises and wanting to cry every time I see someone else running (how dare they run when I have to rest. I want to run!).

Every step is a very real, painful reminder that I need to rest and take care of myself. I don’t have time for denial or trying to push through. (I wish I would have realized that before I played Ultimate Frisbee with my coworkers for an hour. Ouch.) I am going to do all of my exercises. I will rest and treat my ankles and feet with care. I will do contrast baths and hours of mobility work to break up all of the tight, irritated tissue in my calves, ankles, and feet.

But most importantly, I will stop doing this to myself. I will learn to hold back when I want to push 12 times as hard. I will get my legs strong and ready for all of the running I am desperately dreaming about. I will accept where I’m at when I finally get to run again, and I will ease back into everything when my body is ready.

Posterior Tibial Tendonitis

I think it’s fair to say that injuries bring out the best and the worst in us. For me, they bring out bitterness, jealousy, and depression, but they also reinforce my tenacity, dedication, and focus. I have my flight paid for, hotel booked, and participant shorts waiting in my dresser. I will run in August.

But for now I have Posterior Tibial Tendonitis, and it’s time I accepted that.

After not running for more than two months, I have shed enough tears for the rest of the year. Instead of feeling sorry for myself (which I have done plenty) and snapping at everyone who is just trying to help, it’s time to refocus and make my goal happen.

Asics GT-2000 gell women's black, purple, neon green 2014 treading lightly

How I’m healing:

1. My barefoot-loving, five-finger-vibram-wearing self has accepted my new shoes (in the picture above). I will wear these for the next year while I strengthen my feet and ankles and work on my gait. If it means I can run, I will just about anything at this point. For now I’m wearing the Asics GT-2000 anytime I’m out or I’m walking around (even in the house). I just keep telling myself I don’t care what they look like (which is true until I wear them out with a skirt and people look at me oddly), as long as they are helping.

2. I added inserts. My podiatrist wanted me to get custom orthotics, but those are on the back-burner for now. Instead I have been wearing Superfeet inserts, and they seem to be helping, especially when I have to stand for extended periods of time.

3. Contrast baths. I’ve never loved cold, but increasing the circulation is a major part of healing my PTT. I alternate three minutes in hot water with epsom salts and 1 minute in ice water. The 50 degree temperature swing is miserable, but it usually feels better after.

4. Rest. No really, rest. As much as I hate it, I am staying off my feet. With two weeks until I start my new job (more on that soon), I am making it my full time job to heal my PTT. It’s just about as exciting as it sounds. I still can’t do my usual CrossFit class, and I do a lot of arms and core (all I need is a cut-off tank and a protein powder shaker and I could be a full-fledged bro). No running, no cycling outside, no spin classes, no heavy lifting, etc.

5. Modify. I can swim, but I have to only use my arms and do the saddest, slowest, gentlest flip-turns known to man. My high school swim coach would cry if he saw my new turns.

6. I finally got to go to physical therapy. It’s been making an enormous difference. I tried to doing exercises on my own for PTT, but the next day my pain would always be worse. It has been incredible to have someone walk me through exercises, give me a better understanding of what I can and can’t do, and help me increase blood flow to the area. Plus, my physical therapist’s positivity has been slowly chipping away at my debbie downer, ‘I’m never ever going to be able to run again’ attitude.

7. In an effor to loosen up my muscle fibers and break up scar tissue, I got a much needed (and painful!) deep tissue massage and body work. I wasn’t able to miraculously run the next day (I knew it was a long shot), but it definitely helped relax my lower legs.

8. Just say no to sugar and gluten. Sugar is a known inflammatory and gluten just doesn’t make me feel very well. I tend to break out fairly excessively when I am not careful and I eat too much of either. Since PTT is inflammation and small tears, I’m doing everything I can to turn my body into a healing machine.

9. I’m sleeping as much as I can to increase the amount of time my body spends repairing itself.

While the goal of starting to run again has been pushed back over and over again, I’ve set my sights on mid-June. I’m secretly hoping it will be long before then, but it’s less mentally and emotionally draining to aim for a date so far away than to push it back week after week.

8 Months Post Injury

Two months ago I thought I was going to be full on running by now. My progress was shooting forward and I was getting stronger and stronger. Until I wasn’t.

At the beginning of May I got hit with posterior tibial tendonitis and plantar fasciitis. The old injury was a one-two punch that knocked me out for weeks. I’m still not running, but I am finally working back towards picking up the pace on my walking again.

It didn’t help that at the end of May I sprained my ankle again. Nothing close to the severity of last time, but enough to leave me holding my ankle in tears on the sidewalk. I now fear the 28th of every month since I’ve sprained it twice now on that day. Bad omens.

rolling-out-tight-calves-on-barbell-8-months-post-ankle-injury

8 Months

Eight months. It’s hard to take in just how long it has been. Just how many times I’ve gone to PT. How many TheraBand exercises I’ve done. How many rounds of cupping my body has endured. How many times I’ve seen someone running and thought ‘one day that will be me.’

It still shocks me every time I flip through my photos and my huge smile after my half marathon finish is quickly followed by pictures of a massively swollen and bruised ankle. How did we get here?

Still Going

Not the prettiest, I but had so much fun playing with plank to pike. #fitness #trx #yoga #handstand

A video posted by Mandy Ferreira (@treading_lightly) on

I’m still going. I’m doing ever more PT exercises all while trying to stay motivated instead of enraged. I’m still trying to heal faster and get strong. And in so many ways, I am. My squat is probably stronger than it was before my last half, and I’m rapidly closing in on my old PR. Lifting three times a week and being able to follow a consistent program has lead to huge progress.

My physical therapist seems optimistic, despite the fact that he can’t seem to get rid of me. Last week he told me that Steph Curry and I just had really severe sprains, but we’ll be back. One heal raise at a time. 

Massage and Bodywork for Athletes

Relax, improve recovery, and heal? Count me in!

In a fit of desperation with my tendonitis last year, one of my friends recommended a great place to get massage and bodywork. I can’t thank her enough. While there is no silver bullet for most injuries, getting the fascia released in my feet and ankles has been a huge help with my posterior tibial tendonitis.

feet-soaking-in-a-pool

I won’t lie to you, this is not a relax with cucumbers over your eyes sort of experience. I have found myself breathing like a woman in fake labor on TV. I have laughed hysterically while trying not to cry. I have wondered what is wrong with me that I paid for pain. But it’s always so worth it (and really not that painful. At least not for long).

One of the best parts of getting massage and bodywork for me has been having someone else give me feedback on what my body is trying to tell me. My massage therapist has also given me tons of great tips and exercises/stretches to make sure that when I’m not crying on her table, I’m not in pain and my body is functioning as it should.

Even if you don’t have a problem area or current injury, a session of massage and bodywork can do you some great good.

PS My massage therapist, Alex B. works at Psoas Massage and Bodywork in San Francisco. She’s amazing!

Training update 3/23-29

My comeback is starting to feel awful real…

Monday

After months of squatting on and off (and feeling like I’m beating myself into the ground for no progress), I PR’d by back squat… and didn’t even notice. Despite the fact that I failed (twice) to get a squat I am fairly certain I can make , I still grabbed a new PR. I thought my PR was 5 lbs. more than it really was, and I didn’t notice it until days later. I followed up my frustrating failures with this painful workout that includes 1 min ring holds. Ouch!

My nemesis for the day. #oly #crossfitgirls #LikeAGirl

A photo posted by Mandy Ferreira (@treading_lightly) on

Tuesday

Someday I am going to be running 12 miles and be dreaming of the days I only ran 2 miles. Right now I’m dreaming about the 12 miles and trying to stay focused on how great it is I can run at all.

Wednesday

This was one of those days where I felt like I was unstoppable. I hit heavy snatches over and over again. My form for once felt fluid and strong. And I even started to really pull myself under the bar. I’ve since deleted the rest of the workout from my memory (after I finally stopped being sore 4-5 days later).

Thursday

2.5 miles. Boom.

Friday

Instead of doing 15.5 days after doing thrusters (HA, no thanks), I lifted on my own. It was great to work on some weaknesses and do my own thing. I did some front squats and clean drills. And then a ton of exercises for my hips and ankles.

Saturday

I was terrified I wouldn’t be able to do this run. On Friday my body decided to give me shooting pain through my right ankle with no warning or cause (that I can figure out). It continued throughout the day, and after sitting in traffic for an hour, I had to hobble out of the car.

But I woke up Saturday morning feeling pretty good and decided to try it. I figured I could turn around and walk if the pain came back, but instead I made it through my longest run in months. Hello four miles. I sure did miss you.

Sunday

After a busy day walking all over San Francisco, I took the day off from yoga (and even called it a “rest” day ; ) ).

Numbers:

Ran 9.01 miles. Killin’ it
More than 2 hours of feet, ankle, and hip strengthening, stretching, and loosening.
Total 0.5 lb. (delicious) containers of guacamole eaten by me: 1.75  (I don’t know who ate all the ice cream though. Definitely wasn’t me.)

Training update 3/1-3/22

It turns out when my PTT flairs up, I give up on writing these updates. Which is sad because my life doesn’t stop, I don’t stop training, it just looks a little different.

So here it is, in all of its injury-interrupted glory:

3/2-8

I started March feeling pretty good. I had a solid plan for how I was going to slowly ramp up my mileage in time for the 10k I’m “racing” in April. I wasn’t worried about only having a month to go, and my body was handling the slow increase in mileage well.

Until it wasn’t.

Between a lot of balance work at CrossFit and the “extra” distance I was running, my feet fought back. I had started the week of 3/2 feeling strong with an accidental 3.5 mile run (I was shooting for 2.5-3). I followed that up with a CrossFit workout that had a lot of overhead work, and I never really bounced back. My short run on Thursday went alright, but after doing the 15.2 CrossFit Open workout that Friday, my feet were toast on Saturday for my “long” run. I had 4 miles on the schedule, but within a few steps my feet were killing me. I hobbled home after less than a mile and proceeded to feel sorry for myself for the rest of the day.

3/9-15

I accepted (mostly) the sate of my feet and took the week off from running. I did my best to reduce the strain I put on my feet at CrossFit by cutting out jumping and going a bit lighter on weights so I didn’t have to drive as much through my calves or struggle to stay balanced.

I also spent the time I would have been running working on my olympic lifts and strengthening my feet and hips to help stabilize everything when I run. Glute bridges, side steps with a band, ankle exercises with a band, and calf raises are all the rage these days.

I miss my morning run, but I can’t complain about starting the day with a nice quiet lift. #LikeAGirl #crossfitgirls #oly

A photo posted by Mandy Ferreira (@treading_lightly) on

3/16-22

I started hesitantly running again. I’m still playing around with pacing, distance, and even taping my ankle/arch to figure out the best way to move forward. I did another whopping 7.8 miles for the week, but I didn’t get pain while I was running, which seems like a win if you ask me. I made it through my “long” run of 3 miles without incident and even woke up feeling alright the next morning. I’m calling it progress.

The real bummer of the week was the discovery that yoga is definitely contributing to my PTT symptoms. All of the balance on bare feet kills me. My arch can’t support itself well enough, and all of that tugging on my tendons gives me pain that starts in my feet and keeps going up my ankles. I have been taping my ankle and arches when I go to class, but it’s still not enough. I’m going to take a few weeks off to let my body calm down before I try it again (modifying poses of course to reduce the tugging on my inflamed tendons). Fingers crossed it works and I can run all three days this week.