♪ Bob and Brad, the two most famous ♪
♪ physical therapists on the internet. ♪
- Well hi there folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And we are the most famous
physical therapists on the internet.
- In our opinion of course, Bob.
- Today Brad, we're gonna talk about a perineal tendonitis.
That's how I say it anyway, I don't know, perono.
Side of the foot pain basically, outside of the foot pain.
Causes and self treatment.
This is very timely by the way
because my wife has been getting some pain there.
- Yes.
- And I never thought of perineal tendonitis.
- Well Bob, well actually
my sister-in-law is complaining about this.
She says what do I do?
And I says, I gotta do some homework.
I haven't had anybody with this for quite some time.
This is for you Chris, gonna show you everything,
all the ins and outs about your pain
and how you can correct it.
So there you go, just pay attention though.
- That's right, focus.
- The actual treatment is at the end of the video.
But we really want to make sure you understand it
because it makes a big difference
if you know what's goin on and why it hurts there.
- And even how to treat it.
- There you go.
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- Oh that's right.
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This thing is awesome.
This thing penetrates, the heat penetrates.
I gotta show this Brad.
- Oh yes, get the yard stick.
Oh it's upside down, wow.
- So this represents normal heat.
- [Brad] Skin deep basically.
- It only penetrates skin deep.
Thermotex Far Infrared Heating System, UV light right?
Not UV light, what am I, I'm talking about something else.
This is infrared light. - Infrared light.
- Penetrates 2.36 inches, so quite a difference.
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- There you go. - Let's go to work Brad.
- So if anybody's still listening,
we're gonna go on with the show here.
- All right.
- So the perineal tendonitis, pain on the side of the foot.
But what is there, why is there pain there?
And there happens to be, I've got a little red mark here,
we're gonna show on Sam too.
But where the red line is here there's a tendon,
actually there's two tendons, the perineal muscles.
Perineal is a Latin word for side of the leg.
That's how the name gets.
So the muscle belly's up here
and that's what does the contraction, the work.
But the tendon that offers the transfer of the force,
goes right underneath,
behind the ankle bone, the lateral malleolus.
And connects up right to the bone there.
That's the brevis.
The longus goes around
and actually connects up under by the big toe.
The function of these muscles is
to keep your ankle stable so it doesn't roll this way.
So if you've had an ankle sprain,
there's a good chance that
you strained your perineal tendons.
If you had an ankle sprain and you recovered it
and you didn't strengthen those muscles well,
that could lead to perineal tendonitis.
- Gotcha.
- As well as walking on uneven surfaces, overuse.
Runners get this a lot, walking a lot.
Walking on the side of a road that has a camber.
- Sure.
- And you're ankle wants to roll out that direction,
stresses that tendon as well.
- Yeah, every step or every running step
you're putting stress on that.
- Right, right.
- Cause it's working to stabilize the ankle.
- But wait Bob, there's more.
- All right, let's see more.
- Let's look at Sam.
Now if you look at.
- This is his left foot.
- Yep, at the bony structure here.
I've made his muscle green so it shows out better.
But here you have, I just went one piece of tape
cause I didn't want to show both muscles.
It's really not that important.
But because the locations' very similar,
it goes around the back of the ankle bone
and that acts like a little pulley system,
connects up to here.
And it connects up to the bone that you feel
from your little toe about half way back your foot.
So if we pull the tendon off,
we're gonna have a little rupture here.
Whoops, sorry Sam.
You can see right there.
And there's actually called a Haglund's fracture.
I believe I've got that right.
Where the bone here sometimes breaks right off.
Now I don't think you have that Chris,
cause that'd be a little bit different symptoms.
But again, stabilizing that ankle.
We wanna really look at that as part of our treatment.
Keep that in mind.
- Thank you for the anatomy lesson Brad.
- Wow, now the other thing is
is sometimes the shoe, just the footwear.
If the outside of your shoe is wore out,
look at the bottom of the shoe,
and if it's wore on the outside under there.
If you get new shoes, could be a part of the problem,
may even fix the problem.
Sometimes they say really soft shoes allow the foot
to roll without you knowing about it,
can be part of the problem as well.
- I think even tight shoes Brad, too.
If it rubs against that tendon.
- Yeah, yep too tight in there.
- Yeah, and that's what my wife
seems like she was up against.
She actually liked cushioned shoes.
The ones that were too hard
gave too much pressure against that area.
- If you get different shoes
and you notice one pair is worse,
that's an indication that you gotta get rid of those shoes.
Uh, so treatment, how do we make it better Bob?
- How do we make it better Brad?
- Okay, Bob.
Here's what we're gonna,
for some reason I keep thinking, oh this is my sock.
What we have here is if it's really sore
and you get up and you walk and you limp
and it's just tender to the touch
and it's driving you crazy,
you're just gonna need to cool it down.
Get off of it.
- [Bob] Gotta get it calmed down.
- Right.
Cold pack, a nice gel cold pack
over that for 15-20 minutes is gonna help.
You know if you respond well to anti-inflammatories,
ibuprofen anything of the over the counter
that works well for you.
Combine that with a cold pack and then staying off of it.
Don't do the things that irritate it.
I know sometimes you really cannot do that
because you have to work.
- You have to go on living.
- Right, exactly.
- But you certainly don't need to add to it.
You don't need to add your walks into at this point.
- One thing you can do,
cause one of the symptoms is pain with weightbearing,
or if you've been sitting for a while
and then you get up and walk
and those first steps you're walking limping.
And after you start walking a while,
it's kinda like plantar fascitis, it feels better.
- Sure.
- So before you get up actually do some exercises.
You can do ankle pumps but for this
you're probably better off
going right to left like a windshield wiper.
- Ins and outs basically.
- Yep, yep ins and outs, or the windshield wipers.
Do that about 10 times
and that's gonna help loosen up
those tendons and those muscles.
- Yeah, warm them up so they're ready for action.
- Right, what did I say?
- You said loosen up, that's fine too.
- Yeah, so warm, loosen.
Now the next thing is the muscles up in here,
and this is a really nice treatment.
If it works really well,
it's really fun because it's easy to do.
And it just is really effective.
The muscles are up in here.
If you start palpating or just push around,
you gotta go deep.
And you may find a knot or a tender point,
okay a trigger point we call it.
And once you find that, let's say I find one,
I got a little one right there.
Now I don't have any symptoms but usually you'll get,
if you feel around your muscles you'll find a trigger point.
If this is associated with your lateral foot pain,
it's probably gonna be really tender
and it's gonna be tight.
- [Bob] The muscle's been overworking.
- [Brad] Right, there you go.
- [Bob] You need to calm it down.
- Right, the easiest way to do it is a positional release.
Strain-counter strain.
- We've been having good luck with this.
- Right, exactly.
Now the best way to do this,
we want to get this tendon and muscle on slack
and take all the pressure off.
The best way to do it, I'm gonna lay down
cause I think it's probably the best.
- Lye down.
- Lye down, sorry.
Yes, we do wanna have, we're gonna become English majors.
You can do this on bed or on the floor.
And what we need to do is take the foot up and dorsiflex it.
And I'm gonna pull it this way to the right side.
And I really need, you should have a pillow.
I'm gonna pull it up here.
- [Bob] Puts that muscle on slack.
- There you go Bob, exactly right.
Now with the other hand I'm gonna go to that trigger point.
Can you see that Mike?
I'm gonna palpate that before I do the treatment.
Let's say oh it hurts, that's up about a seven over 10.
10 being the worst pain.
And then I'm gonna pull this over.
Now when you get your foot in the right position,
you kinda have to wiggle it back and forth.
Oh thanks Bob.
Now I know he cares about me.
- [Bob] I care.
- Wow, hold on, what a guy.
The position of the most comfort
is where you're gonna hold it.
You're gonna look at yourself
follow your watch on your hand,
and for 90 seconds minimum you're just gonna hold it.
You're gonna sit there and relax,
listen to the birds or the music,
or whatever you have goin on.
Or just silence and allow that muscle to relax.
That trigger point will relax
and circulation will become more prevalent there.
- [Bob] So if you can't see it from this angle,
he's pulling this way, is what he's doing.
- Right.
- [Bob] Up and out that way.
- Exactly, thanks Bob.
After the 90 seconds, if feeling good
you can go longer than 90 seconds, just slowly let it back.
You can wiggle it around a little bit slowly.
Nothing happens fast after positional release.
Then go back to that trigger point and palpate it.
Chances are it's gonna go from a seven over 10,
go down to a one or a two over 10.
Then you know you've made some progress.
It's gonna feel better.
- Yeah, if that muscle's relaxed
and it's not acting up on you,
it's not gonna pull on the tendon as much.
- Right, exactly.
- And the tendon won't get as sore then.
- Sure.
- So it's just a good start to make sure
the muscle's not being part of the culprit there.
- And if you have success with that,
you're gonna do that three times a day.
Probably within a couple days
you're gonna notice notable improvement.
If that doesn't work, we're going to plan B.
- Sure.
- We're gonna do a cross friction massage over that knot.
So the fibers go up and down this way.
We're gonna go on there.
Now with my sister-in-law Chris,
I did this to her wrist once a long time ago.
And I, it was about 10 years ago, 15 years ago.
I was little rookie at it at the time.
She didn't respond to it, I think she got mad at me.
So Chris if you don't remember
just cancel that from your memory.
So be careful when you do this.
You get on that ropey spot and you go back and forth
and you push in deep.
Now I can feel my little ropey spot right there.
And it's uncomfortable.
And you do that and after 20-30 seconds
if it doesn't clearly start feeling better,
like oh boy it's better now.
Then you keep doing it,
but if it's just feeling worse, then you stop.
- Would you do cross fiber down here too Brad?
- That's an option.
You could go right down here on the tender spot
and work the cross fiber over that.
You're gonna push in deep.
Again, you're only gonna do this after 20-30 seconds
it clearly feels better.
Sometimes it feels numbish better, that's good.
If it just feels better, that's good.
You do it for a couple, three minutes
until your fingers get sore.
That can be a really quick way to get things moving.
- Yeah, I would absolutely check that out as an option.
Cause I think that's what my wife's gonna have to do.
I think that's the one because the irritation is down here.
I think there might be some micro-tears down there.
- Sure, yeah.
- And that's where we wanna treat.
So both areas you want to check out.
- Right, again these should feel good when you're done.
And as you're doing them
or like I said into it with the cross friction massage.
Now, we've got one more thing is
to strengthen that tendon or the muscle.
So, there's some really nice ways to do this
that you don't have to buy
any special equipment or whatever.
Okay, I need to stand up.
- Oh sure.
- So I call this the ziggy-zaggy.
It's a nice way to strengthen your ankle muscles.
Typically I'd have shoes on.
I'm not gonna go put my shoes on for this,
it's the same motion.
We're gonna go like this and like this.
And when you do this, you're lateral muscles
or the muscles on the sides of your ankles
are working quite aggressively.
- Right, you're working hard.
- Yep.
When you have shoes on the grips offers better resistance.
And you just go back and forth like this,
until you get fatigued.
Usually it's back and forth three or four times.
- You could play a little music if you need to.
- Yeah, music.
- The thing is don't expect results
from this in one week even.
You're gonna have to do this for a couple weeks
before it starts to get stronger
and you'll notice the difference.
- Exactly, do it once or twice a day.
Get to the point of fatigue then let them rest.
If it hurts and creates pain
and it's setting you backwards you gotta stop.
It's not ready for it yet.
- This is something that needs to be done
once the foot is ready for it.
- Right, when it's feeling better,
you're not experiencing that sharp pain,
no more ice pack, no more ibuprofen,
the tender spots are gone or pretty close to it.
- Well show the one you can do just sitting down Brad.
- This is a nice one.
Say this is the side I wanna strengthen, my right leg.
You take your other foot over the top
and you offer resistance with your blue sock.
So you have to put a blue sock on Chris.
I'm just kidding.
It works good for instructions though.
I'm pushing outwards with my sore, or the injured foot,
and I'm using this foot.
All you have to do is relax this foot
and it really works like a nice resistance doesn't Bob?
- [Bob] Right so, basically you're gonna push out.
You're not gonna allow the resistance.
Or you're gonna give some resistance isotonically.
Brad is that what you're doing?
- I'm pushing out.
- [Bob] I mean you could do it isometrically
where you don't even allow it to move.
- Oh I see, yeah right, yep.
But I think you're better off.
- [Bob] Yeah I think so too.
Getting some motion along with it.
So it's giving some resistance.
It's like if I was resistance on my bicep,
I'd be going like this.
- Right, oh Bob, you strong like bull.
But yeah, so I'm offering resistance that's moving.
I'm not trying to do an isometric.
- Sure, gotcha.
- You could do an isometric if you'd like.
I think you'd be better off.
- I was surprised how well this works Brad.
- Yeah, it really is.
- It really is a simple thing that you can do at your desk.
And like I said, do that for a couple weeks
and you're gonna notice a difference.
The ankle's gonna be more stable
and less like to injure itself.
- Exactly, so you know you've got,
I'd say 10-15 reps, two or three times a day.
So very good, I hope anybody who has
their perineal side of the foot tendonitis pain,
this is gonna help you out
and get you back on your feet again.
No pun intended.