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massaging/stretching the tarsal tunnel: good or bad?

Posted by elliott on 7/12/02 at 16:20 (089578)

Due to nerve irritation post-TTS release (couldn't even keep my shoes on for more than a few minutes), one year later I began doing aggressive dorsal-type stretching through some yoga poses such as down dog (and its three-legged variant) and also things like kneeling with butt sitting on medial heels (which makes it feel like the skin on medial ankle is going to rise up and tear away). Or I would massage vigorously the delicate area in question (temporarily generating severe electric shocks into my arch and big toe). For the next day or two after doing this, I would be even worse than before, sometimes in almost unbearable pain, after which the pain level would drop to lower than it was before I did it. Then over time the pain level would rise again and I would repeat the process (although I got better at how to do it). This went on for some time. Now, another year later, I am much better off than before (can keep at least wear some types of shoes for several hours straight), and I am convinced it was not just the passage of time, but rather the massaging/stretching. I know some will frown on something that initially makes you worse and might be damaging the nerve, but my theory is that maybe this slowly releases the nerve from its entrapment, at least when it's post-surgery. (Obviously not recommending this for someone whose nerve is snagged by a fractured bone.) I wish journals and one's surgeons would know all this and tell you the do's and don'ts.

Any evidence, or at least thoughts, as to the merits, or lack thereof, of massaging/stretching to long-term improvement?

Re: massaging/stretching the tarsal tunnel: good or bad?

cindyp on 7/12/02 at 21:22 (089587)

didn't need either.

Re: massaging/stretching the tarsal tunnel: good or bad?

Lara % on 7/13/02 at 07:25 (089596)

I've never heard of it, but chiros were initially not accepted, and it works (for some things). Neuromuscular massage hurts and it works (for some things). I'm about to try Trigger POint Massage Therapy and I understand it hurts, and works (for some things). How did you stumble across this? (I assume it was a stumble - how did you figure it out?). It must have been more than just enduring pain on a whim. Very clever.

Re: massaging/stretching the tarsal tunnel: good or bad?

Ed Davis on 7/13/02 at 10:26 (089605)

Elliott:

Good question! I don't think we have a very good answer.

I think that HOW the area is massaged may be more of a factor than anything else. One would want to massage the tissues on either side of the nerve vigorously without massaging directly over the nerve trunk itself.
Modalities such as ultrasound and iontophoresis can be used safely over the nerve trunk with reasonable power settings.

Some may disagree as there are a lot of different massage techniques-- ART, etc., all with their adherents who assign specific therapeutic benefits to those techniques ( in other words, take my answer unless you happen to live in California).
Ed

Re: massaging/stretching the tarsal tunnel: good or bad?

Janet C on 7/13/02 at 18:15 (089612)

Hi Elliott,

It sounds to me like you're de-sensitizing the nerves. One of the common symptoms of TTS, and RSD too, is that the damaged nerves cause the skin to be overly sensitive to touch - whether it be from clothing, or sheets, sometimes even a breeze, or a loved one's gentle touch, can make us hurt.

I've heard several people have been treated for this condition by their Physical Therapists, who tried to de-sensitize the nerves with deep massage, and by having the patient put their feet into bins of beans and rice... if I remember correctly.

I think that what you're doing sounds very similar, and it sounds like it's working effectively for you. Whatever steps like this that help to bring some relief and flexibility back to your life, are great to incorporate into your daily routine. Thanks for sharing your ideas; you never know how many people it may help who have a related condition.

With best wishes ~ Janet

Re: stumbled on it out of desperation

elliott on 7/14/02 at 10:39 (089625)

Pain was terrible, I was near to losing control, pain meds I tried (neurontin, Celebrex) didn't work, I was reluctant to go on pain mgmt cause it seemed to me like giving up hope (although maybe I should've for at least a while), so I tried self-massage to, in theory, loosen up the nerve. At first it was even worse, but a day or two later, felt slightly better (eureka!). Repeat process.

Discovered stretching while doing yoga for sciatica. Noticed some poses (intended for the back!) stretched the nerve and brought at least some temporary relief, so repeated that too. Kind of counterintuitive, since stretching of nerve is what brings about TTS in the first place. But I guess the idea is (I'm making all this up, of course) to stretch it to free it from its entrapment. Not sure if this would've worked for me before surgery, but I wish I would've tried it (or would that have made me permanently worse?). Maybe this is all more likely to work post-surgery, after the nerve has been given room to move and there are scar tissue issues and the like to address, and by so doing these things one can possibly improve and maybe avoid the need for a repeat surgery.

Re: well, I guess I'm doing it wrong :-)

elliott on 7/14/02 at 10:58 (089630)

I got that huge vein right over that nerve and I vigorously massage that area, certainly over the nerve too. When I do it and get those electric shocks, it feels like the nerve is pressing on or stuck in bone right in front of where I'm pressing. A shame all surgeons do is look at surgical results and totally ignore encouraging studies on things like this, which might at least aid as a criterion as to whether surgery is necessary. Massage performed different ways? Do studies both ways and compare. It's possible.

I had around 20 iontophoresis treatments, and didn't notice a damn thing (except maybe some slight temporary improvement lasting at most the next day), so I can't help saying that my personal experience is that that modality is overrated.

I had ART for my hamstring; maybe I'll post about that later on the Treatments board. I know there's people here who claim they've had ART for their TTS with some success, but the guy who performed it on me and who seems very knowledgeable claims that what they do on one's foot for TTS is not really ART, even though they may call it that, because to perform ART one needs to grab hold of a muscle, and there's nothing really big enough to grab onto in the foot as there is in the hamstring. So he claims it's really just a form of massage.

Re: beans and rice, eh? :-)

elliott on 7/14/02 at 11:00 (089631)

Thanks for the best wishes.

Re: beans and rice, eh? :-)

Janet C on 7/14/02 at 15:07 (089638)

Yeah, you know... the hard, uncooked ones... I think the theory is the stimulation will eventually de-sensitize the nerve endings.

Re: well, I guess I'm doing it wrong :-)

sherry l. on 7/15/02 at 08:00 (089660)

Elliot, Did the art make your problem feel worse about an hour after treatment? I've had 2 treatments that didn't really hurt while he was doing it but about an hour afterwards the burning and redness and heat radiated from the area,that doesn't sound like this treatment is going to work for me.Please tell me your experience with this technique.Thanks, Sherry

Re: well, I guess I'm doing it wrong :-)

elliott on 7/15/02 at 08:52 (089668)

To repeat, I had ART on my hamstring (maybe a slight burning afterwards, but nothing to write home about), not my foot. According to my practitioner, it's not really ART on your foot.

Re: well, I guess I'm doing it wrong :-)

Ed Davis, DPM on 7/15/02 at 13:40 (089688)

The goal of massage would be to mobilize the tissues around the nerve without irritating the nerve itself -- not that easy to do.

It has been a while since you have posted here. Do you have any further opinions on what to do with the vein?
Ed

Re: massage techniques/research

Ed Davis, DPM on 7/15/02 at 13:43 (089689)

Elliott:

There just is not enough research in the areas of physical medicine and biomechanics so one must rely on a lot of anecdotal evidence and the experiences of practitioners.
Ed

Re: For Sherry Re: well, I guess I'm doing it wrong :-)

Donna SL on 7/15/02 at 22:19 (089737)

Sherry,

Don't mean to interupt this thread , and I don't have time to write again about the ART, but had extreme success with it not only for TTS, and PF, but other areas of the body as well. Many people that I know have too. Do a search on my initials Donna SL. I wrote extensively about the subject from April 01, and forward from that point. You can also do a search on 'active release therapy', or 'active release technique' if too much stuff comes up with my initials. Even just 'ART' might work.

I had some irritation in the beginning too, but that goes away after so many sessions. It may happen on occassion after other treatments down the road too, but that doesn't mean it's a bad thing. Old adhesions, etc., are breaking up. If it's really severe let the ART practitioner know.

For example, after ESWT a lot of the times many people have pain, even more than before the treatment. That's just because the area has had a heavy treatment, and has been stimulated to heal. Many of them have great relief after ESWT, but had some temporary pain during, and after the treatment, but it eventually went away. There are other people that have no pain after. But regardless in the long run most of the time they all have great benefit from the treatment. Of course ART is a more gentle technique than ESWT so the same level of pain would not be experienced, but hopefully you understand my point.

Also, just like any procedure ie. ART, EWST, surgery, etc., it doesn't work for everyone, but I don't think you should give up so soon. Talk to the person performing the ART, and let them know your concerns. Also be sure they are certified in lower body ART. Sometimes the person you choose may not be that experienced, or have poor technique, and just trying someone else can help. Also call the ART institute, and ask them about other practitioners, if you continue to have problems.

It's not an over night cure it you've had this a long time, or if the problem has been buiilding up for many years. It may take many many treatments to get rid of it. I went for ART for close to a year, and still go on occassion, but the alternative treatments were terrible for TTS, so I stuck with the ART, and got better. I have terrible biomechanics, and haven't had much luck with orthotics, so I may have to go for maintenence from time to time.

Also, it was mentioned by a poster here the that ART isn't being perfomed in these areas. This is only one opinion, and many ART practitioners would absolutely disagree. At times certain areas of the body may need to be mixed with straight myofascial release, etc., but if the practitioner knows what they are doing they are certainly performing ART most of the time , esp on the feet. My foot is constantly in motion when my chiro is working on them. The same goes for the TTS area, etc. My chiro not only helped me with a severe case of TTS that I had, but also PF, tight calves, hamstrings, peroneal entrapment, back problems, etc. All of those areas had 'ART' on them.

Please stick with it a while and judge for yourself before you give up. Also, I don't know your history, but hopefully you have had diagnostic testing to make sure there aren't any space occupying lesions, etc, and other problems have been ruled out.

In the interim if you are experiencing irritation after treatments some medication like neurontin may help along with standard anti-inflammatories at least taken during, and after the treatment. Also, remember to ice the areas treated. Drink a lot of water too if you don't already, because so much junk is being broken up. Taking a short walk after the treatments, and stretching are important too.

Donna

Re: massaging/stretching the tarsal tunnel: good or bad?

sue m on 8/08/02 at 08:01 (091918)

going thru the same thing. can move my toes a little bit now.

Re: massaging/stretching the tarsal tunnel: good or bad?

cindyp on 7/12/02 at 21:22 (089587)

didn't need either.

Re: massaging/stretching the tarsal tunnel: good or bad?

Lara % on 7/13/02 at 07:25 (089596)

I've never heard of it, but chiros were initially not accepted, and it works (for some things). Neuromuscular massage hurts and it works (for some things). I'm about to try Trigger POint Massage Therapy and I understand it hurts, and works (for some things). How did you stumble across this? (I assume it was a stumble - how did you figure it out?). It must have been more than just enduring pain on a whim. Very clever.

Re: massaging/stretching the tarsal tunnel: good or bad?

Ed Davis on 7/13/02 at 10:26 (089605)

Elliott:

Good question! I don't think we have a very good answer.

I think that HOW the area is massaged may be more of a factor than anything else. One would want to massage the tissues on either side of the nerve vigorously without massaging directly over the nerve trunk itself.
Modalities such as ultrasound and iontophoresis can be used safely over the nerve trunk with reasonable power settings.

Some may disagree as there are a lot of different massage techniques-- ART, etc., all with their adherents who assign specific therapeutic benefits to those techniques ( in other words, take my answer unless you happen to live in California).
Ed

Re: massaging/stretching the tarsal tunnel: good or bad?

Janet C on 7/13/02 at 18:15 (089612)

Hi Elliott,

It sounds to me like you're de-sensitizing the nerves. One of the common symptoms of TTS, and RSD too, is that the damaged nerves cause the skin to be overly sensitive to touch - whether it be from clothing, or sheets, sometimes even a breeze, or a loved one's gentle touch, can make us hurt.

I've heard several people have been treated for this condition by their Physical Therapists, who tried to de-sensitize the nerves with deep massage, and by having the patient put their feet into bins of beans and rice... if I remember correctly.

I think that what you're doing sounds very similar, and it sounds like it's working effectively for you. Whatever steps like this that help to bring some relief and flexibility back to your life, are great to incorporate into your daily routine. Thanks for sharing your ideas; you never know how many people it may help who have a related condition.

With best wishes ~ Janet

Re: stumbled on it out of desperation

elliott on 7/14/02 at 10:39 (089625)

Pain was terrible, I was near to losing control, pain meds I tried (neurontin, Celebrex) didn't work, I was reluctant to go on pain mgmt cause it seemed to me like giving up hope (although maybe I should've for at least a while), so I tried self-massage to, in theory, loosen up the nerve. At first it was even worse, but a day or two later, felt slightly better (eureka!). Repeat process.

Discovered stretching while doing yoga for sciatica. Noticed some poses (intended for the back!) stretched the nerve and brought at least some temporary relief, so repeated that too. Kind of counterintuitive, since stretching of nerve is what brings about TTS in the first place. But I guess the idea is (I'm making all this up, of course) to stretch it to free it from its entrapment. Not sure if this would've worked for me before surgery, but I wish I would've tried it (or would that have made me permanently worse?). Maybe this is all more likely to work post-surgery, after the nerve has been given room to move and there are scar tissue issues and the like to address, and by so doing these things one can possibly improve and maybe avoid the need for a repeat surgery.

Re: well, I guess I'm doing it wrong :-)

elliott on 7/14/02 at 10:58 (089630)

I got that huge vein right over that nerve and I vigorously massage that area, certainly over the nerve too. When I do it and get those electric shocks, it feels like the nerve is pressing on or stuck in bone right in front of where I'm pressing. A shame all surgeons do is look at surgical results and totally ignore encouraging studies on things like this, which might at least aid as a criterion as to whether surgery is necessary. Massage performed different ways? Do studies both ways and compare. It's possible.

I had around 20 iontophoresis treatments, and didn't notice a damn thing (except maybe some slight temporary improvement lasting at most the next day), so I can't help saying that my personal experience is that that modality is overrated.

I had ART for my hamstring; maybe I'll post about that later on the Treatments board. I know there's people here who claim they've had ART for their TTS with some success, but the guy who performed it on me and who seems very knowledgeable claims that what they do on one's foot for TTS is not really ART, even though they may call it that, because to perform ART one needs to grab hold of a muscle, and there's nothing really big enough to grab onto in the foot as there is in the hamstring. So he claims it's really just a form of massage.

Re: beans and rice, eh? :-)

elliott on 7/14/02 at 11:00 (089631)

Thanks for the best wishes.

Re: beans and rice, eh? :-)

Janet C on 7/14/02 at 15:07 (089638)

Yeah, you know... the hard, uncooked ones... I think the theory is the stimulation will eventually de-sensitize the nerve endings.

Re: well, I guess I'm doing it wrong :-)

sherry l. on 7/15/02 at 08:00 (089660)

Elliot, Did the art make your problem feel worse about an hour after treatment? I've had 2 treatments that didn't really hurt while he was doing it but about an hour afterwards the burning and redness and heat radiated from the area,that doesn't sound like this treatment is going to work for me.Please tell me your experience with this technique.Thanks, Sherry

Re: well, I guess I'm doing it wrong :-)

elliott on 7/15/02 at 08:52 (089668)

To repeat, I had ART on my hamstring (maybe a slight burning afterwards, but nothing to write home about), not my foot. According to my practitioner, it's not really ART on your foot.

Re: well, I guess I'm doing it wrong :-)

Ed Davis, DPM on 7/15/02 at 13:40 (089688)

The goal of massage would be to mobilize the tissues around the nerve without irritating the nerve itself -- not that easy to do.

It has been a while since you have posted here. Do you have any further opinions on what to do with the vein?
Ed

Re: massage techniques/research

Ed Davis, DPM on 7/15/02 at 13:43 (089689)

Elliott:

There just is not enough research in the areas of physical medicine and biomechanics so one must rely on a lot of anecdotal evidence and the experiences of practitioners.
Ed

Re: For Sherry Re: well, I guess I'm doing it wrong :-)

Donna SL on 7/15/02 at 22:19 (089737)

Sherry,

Don't mean to interupt this thread , and I don't have time to write again about the ART, but had extreme success with it not only for TTS, and PF, but other areas of the body as well. Many people that I know have too. Do a search on my initials Donna SL. I wrote extensively about the subject from April 01, and forward from that point. You can also do a search on 'active release therapy', or 'active release technique' if too much stuff comes up with my initials. Even just 'ART' might work.

I had some irritation in the beginning too, but that goes away after so many sessions. It may happen on occassion after other treatments down the road too, but that doesn't mean it's a bad thing. Old adhesions, etc., are breaking up. If it's really severe let the ART practitioner know.

For example, after ESWT a lot of the times many people have pain, even more than before the treatment. That's just because the area has had a heavy treatment, and has been stimulated to heal. Many of them have great relief after ESWT, but had some temporary pain during, and after the treatment, but it eventually went away. There are other people that have no pain after. But regardless in the long run most of the time they all have great benefit from the treatment. Of course ART is a more gentle technique than ESWT so the same level of pain would not be experienced, but hopefully you understand my point.

Also, just like any procedure ie. ART, EWST, surgery, etc., it doesn't work for everyone, but I don't think you should give up so soon. Talk to the person performing the ART, and let them know your concerns. Also be sure they are certified in lower body ART. Sometimes the person you choose may not be that experienced, or have poor technique, and just trying someone else can help. Also call the ART institute, and ask them about other practitioners, if you continue to have problems.

It's not an over night cure it you've had this a long time, or if the problem has been buiilding up for many years. It may take many many treatments to get rid of it. I went for ART for close to a year, and still go on occassion, but the alternative treatments were terrible for TTS, so I stuck with the ART, and got better. I have terrible biomechanics, and haven't had much luck with orthotics, so I may have to go for maintenence from time to time.

Also, it was mentioned by a poster here the that ART isn't being perfomed in these areas. This is only one opinion, and many ART practitioners would absolutely disagree. At times certain areas of the body may need to be mixed with straight myofascial release, etc., but if the practitioner knows what they are doing they are certainly performing ART most of the time , esp on the feet. My foot is constantly in motion when my chiro is working on them. The same goes for the TTS area, etc. My chiro not only helped me with a severe case of TTS that I had, but also PF, tight calves, hamstrings, peroneal entrapment, back problems, etc. All of those areas had 'ART' on them.

Please stick with it a while and judge for yourself before you give up. Also, I don't know your history, but hopefully you have had diagnostic testing to make sure there aren't any space occupying lesions, etc, and other problems have been ruled out.

In the interim if you are experiencing irritation after treatments some medication like neurontin may help along with standard anti-inflammatories at least taken during, and after the treatment. Also, remember to ice the areas treated. Drink a lot of water too if you don't already, because so much junk is being broken up. Taking a short walk after the treatments, and stretching are important too.

Donna

Re: massaging/stretching the tarsal tunnel: good or bad?

sue m on 8/08/02 at 08:01 (091918)

going thru the same thing. can move my toes a little bit now.