Heron Pose Yoga
• Icing is very useful for this injury. Use a chunk of ice, rubbed constantly and directly on the area for 15 minutes every evening.
• Don’t ignore the pain. Low intensity pain is easy to tolerate. But yoga with this injury will usually make it much worse and greatly lengthen the recovery time needed.
• Heel lifts should be worn in all shoes. High heels or shoes with more than a moderate heel height can aggravate the injured areas.
• Walking is much better tolerated than yoga, and can maintain most of the adaptations when normal distances are covered.
• Proper shoe choice, aided by knowledgeable yoga store staff can reduce pronation or supination.
• Sometimes off-the-shelf orthotics or softer orthotics can help. But if these do not seem to result in quicker healing, custom orthotics can produce a better result, over a longer time period. Ask your doctor.
• Avoid hills and speed workouts!
• For Apophysitis (bony protuberance), a padded heel cup, available at many yoga stores, may cure the problem. If not, supportive arch taping and a good off-the-shelf orthotic may reduce irritation so that healing can proceed. Only in a rare case is a custom orthotic necessary.
• Sometimes these initial treatments do not help. A doctor will probably x-ray the heel to see if there is a spur, based upon evidence of protrusion. The presence of this bony mass makes it more difficult to heal and more susceptible to injury, but removal is not often necessary. Many people have them and never develop pain. A doctor can tell by examination whether a bursa irritation is suspected. Sometimes an MRI exam is useful if the pain continues with little or no healing, to identify if the bursa is inflamed, the bone injured, or the tendon damaged. Treatment will target which area is damaged. Injections should be avoided in this area due to the risk of Achilles tendon rupture. If all other treatments have failed, and the injury has been present for months, an injection directed deep to the tendon and confined to the bursa can sometimes work. In this case, stop yoga and look into wearing a cast or boot for about a month.
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• Surgery to repair the heel can be an option in extreme cases. There is no guarantee of success, and there are several procedures. Lateral Haglund’s bump removal, above the tendon insertion, is quite effective and relatively simple. This requires at least 8 weeks of non-yoga recovery time. The surgery will not be a cure if the bump is not the problem. When considering surgery, try to find an experienced doctor, and ask for a thorough diagnosis. In some cases, the tendon is detached and then reattached with bone anchors. A newer procedure called the Topaz procedure does not require opening the heel and involves what is called radioablation that may prove to be reliable.
• Physical therapy, acupuncture and other adjunctive treatments may be helpful. Laser, ultrasound, iontophoresis, phonophoresis, electrical, ultramagnetic, and topical treatments have had a certain percentage of success. Recently there have been good reports about high intensity ultrasound shock-wave therapy. This is called ESWT. There is also a newer form of lower intensity therapy and the initial reports have been very good. While not all types of Yoga Injuries respond, a number of surgeries are avoided and Yoga Injuries managed by using this treatment. A good diagnosis is important when the injury is advanced.
• This injury may require weeks of immobilization to heal.
• As a last resort, if surgery is the only remaining option, 6 months of no yoga is recommended. This choice is difficult. Certain variations of posterior heel pain take a long time to heal and will only do so if there is no significant irritation to the area. If such a rest period has been taken, and pain is still present, surgery is an option.
• For Apophysitis in children and teenagers, a padded heel cup, purchased at a yoga store, may cure the problem. If not, supportive arch taping and off-the-shelf orthotics may speed the healing process. In rare cases, custom orthotics are necessary. Children outgrow them quickly so for practical reasons, off-the-shelf devices are recommended. The growth centers remain open until the age of 16 or 17 years for boys and around 15 for girls. Luckily the apophysis does not have to close completely to have the pain disappear. If there is heel pain in those older than this, it is not Apophysitis.
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