Running Injury-Free by Joespeh Ellis

Author:Joespeh Ellis
Language: eng
Format: epub
Publisher: Rodale
Published: 2013-04-15T04:00:00+00:00

The “Protective” Reaction

I now see runners quite often who come to the office with a multitude of other symptoms but who, in fact, have tarsal tunnel syndrome. Formerly, these runners would have received traditional treatments for their primary complaints—and then would have suffered recurring injuries because we had failed to solve the real problem.

We now know that tarsal tunnel syndrome can cause a multitude of abnormalities. And probably the least common complaint is pain in the nerve that’s responsible for this whole mess.

Tarsal tunnel syndrome shows how pain is not a primary sensation like sight, smell, and hearing. Pain can be blocked out or altered—or your body can seem to “choose” one injury over another.

It’s as if the body has a priority system that says, “Protect the nerve at all costs.” So your body will sacrifice muscles, tendons, and joints and sometimes even bones to protect certain nerves. You can get shin splints, knee or Achilles tendon problems, or plantar fasciitis without even knowing that your tarsal tunnel nerve is injured.

Imagine having a little pebble under your heel inside your shoe. It irritates the bottom of your foot, and you naturally start limping. That’s a natural and almost involuntary reaction as you make every effort not to put full weight on that pebble.

After a while, your heel might not even hurt, but you probably will develop pain somewhere else—such as the other leg—because you are now overusing it. The protective mechanism has gone astray.

Now let’s say the pebble is removed after several days. Believe it or not, you will still limp because your brain still thinks that it needs to favor that foot. Physical therapy, however, can help you retrain your body to function normally.

Before we can accurately and completely diagnose tarsal tunnel syndrome, we run special nerve-conduction tests. Standard nerve-conduction testing isn’t particularly valuable because it generally doesn’t show an injury to the nerve until it is pretty far gone or shows actual pain, numbness, burning, and tingling.

The state-of-the-art nerve-testing methods include somatosensory evoked potential (SSEP), which tests your sensory nerves, and the more common nerve conduction velocity (NCV), which stimulates the motor nerves. The good news about this testing is that no needles are involved: The nerve is stimulated by a surface electrode.

The feet must be tested in three different positions: neutral, flexed upward, and flexed downward. Those are the motions you go through when you are running, and commonly only one of the positions causes the problem. If testing is done in only one position and it’s the wrong one, the diagnosis might be missed.

When the test is interpreted by a qualified neurologist, it becomes apparent whether or not this condition exists. If it does, we can use this information to interpret the symptoms and actually cure conditions we could only treat symptomatically before. This means that both the patient’s and my frustration levels are decreased.

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