-Top of the foot stretch- This addresses the balance between the tissues on the top of the foot and the bottom. The easiest way to perform this stretch is to sit on a chair as shown and tuck your toes and ankle underneath your leg. Be very careful not to allow your ankle to bend inward (as shown in photo 2). This causes additional strain on the ligaments that are often involved in ankle sprains- we don't need any stretching of those!. Hold for 20-30 seconds. You will find initially that the bottom of your foot will often cramp- that is a really great sign that you probably need this stretch as well as strengthening of the bottom musculature. Just stretch out the cramp and try again. Within a few days the cramping should happen less frequently.
-"Foot wiggles"- Not a commonly known homecare exercise. I send this home with patients who have very tight feet without a lot of movement in the foot joints. The key is to isolate the movement into each individual joint, not the entire foot. Using a firm grasp with each hand: use one hand to stabilize part of the foot closer to your heel- well call this the base hand. Use the other hand to "wiggle" the part of the foot closer to the toes, but just next to your "base hand." You can do circles in each direction, push the foot up and down or side to side or do figure 8s. After about 5 wiggles in that area, move your hands just a half an inch closer to your toes and repeat again. The whole process should take about 2-3 minutes. Although this is a little tough to explain via photos, it can be a great way to help restore movement to a tight foot.
-Correct Toes (or similar products)- When you look down at your foot, you should see light or space between each of your toes. Using the toe stretch below helps to restore this and strengthen these muscles, but for many reasons most people have lost this space and our toes are "stuck" on top of each other or squished together. Loss of this normal foot structure can be a big underlying cause of PF. There are many products on the market that can help stretch the toes, my favorite is called Correct Toes (find more info: https://nwfootankle.com/correct-toes). These can be used as a "splint" at night or inside your shoes throughout the day. The key is to work into them gradually (like any big change).
Home Remedies for Tissue Degeneration/Tightness:
-Golf Ball/LaCrosse Ball rolling- Using a small, hard ball on the bottom of your foot is a great way to loosen up the tissue and stimulate circulation into the area. Try using the ball seated or standing; put enough force into your foot that the area is tender but nothing should be painful. When you find an area that is more tense or tender, that is an area that needs some focus. Spend 1-2 minutes several times per day covering the entire bottom surface of the foot- from heel to the ball.
-Rolling with Toe Stretch- If you can tolerate this small addition to rolling the bottom of your foot, I would highly recommend it. By stretching your toes backward, you put the tissue on the bottom of your foot into a stretched position. You are able to get deeper as well as access other fibers of tissue. The plus is that this can help especially with stubborn cases; the down side is that it will make the tissue much more tender.
-Calf Stretch- There are 2 very important stretches shown above, and most people forget about the second. Hold each stretch for 30-60 seconds; these can be used several times per day:
-Night Splint- Although many people find relief using night splints I have mixed emotions. On the plus side they help keep the tissue along the bottom of the foot stretched overnight so the repair that occurs can occur over a "normal" tissue length. The downside is that they are bulky and many patients report difficulty/disrupted sleep with them. I typically recommend trying most of the other techniques first, then using these if your case continues stubbornly.
UP NEXT...PF Part IIB: FOOT MOBILITY PROBLEMS
PART II: HOMEWORK- the cheap and "easy" solution
Being actively involved in your care will drastically improve how quickly this nagging condition can be treated. In the last post, we reviewed the underlying causes of true Plantar Fasciitis; remember how every case has a different cause? It would stand to reason that every case will respond differently to each technique used. Not all of these are recommended for every case. Here are a few rules to follow:
STAY TUNED FOR SPECIFIC HOMEWORK TARGETED TO COMMON PF CASES....
WHERE IS THIS COMING FROM?
Did you ever think you may have something in common with big names like Kobe Bryant, Tim Duncan, Ryan Hall, Pete Sampras, or Scott Podsednik? "Walking on sharp glass" especially early in the morning is one possible symptom of Plantar Fasciitis. Sharp pain localized in the heel can be another symptom. The reality is that from basketball to tennis, running to baseball, even football to hockey does not discriminate when it comes to this condition.
What most people don't realize is that there are a number of conditions that cause pain in the bottom of the foot or heel; yet the term Plantar Fasciitis is often wrongly used due to its familiarity to many people. It is important to see a professional for a correct diagnosis and to determine the underlying cause of the condition causing pain (muscle, fascia or tendon tears, nerve entrapment as well as stress fractures are just a few of the other conditions that should be considered). Early treatment is very important to better long-term outcomes, so instead of "running through it," read up on this 3 part series for information about treatment options, tips for home remedies and what to expect if you do need to seek care!
Before we can discuss how to treat it, we need to take a step back to understand exactly WHAT it is and what may have caused it to begin with. True plantar fasciitis was once believed to be inflammation of the thick band of tissue on the bottom of the foot known as the Plantar Aponeurosis (Fascia) - hence the name ending in "itis." In recent years, a change in the cause of the condition has been recognized. Current research suggests that although inflammation may be present, the true cause of the condition may be atrophy or chronic degeneration of the fascial tissue (3, 4). The smaller and deep foot muscles (known as intrinsic muscles) are also sometimes affected by this degeneration or inflammation.
Since everything in the body is about balance, we have to consider all 33 joints, 28 bones and over 100 muscles in the foot. The plantar fascia has direct connections to the muscles in the calf while at the same time opposing the muscles and tissue on the top of the foot. Each muscle, tendon and joint is responsible for sharing the load during standing, walking, running and jumping. Improper fitting shoes, poor gait mechanics, lack of range of motion in any one of the foot or ankle joints, overly tight calf or ankle muscles are all possible causes, just to name a few.
Studies recently have used MRI imaging to link pain and chronicity to the size (and therefore assumed strength) of the small muscles in the foot which are used to support the inside arch of the foot (1, 2). Weak foot musculature and/or lack of endurance in these muscles can lead to changes in pronation and the ability of the foot to distribute forces evenly and smoothly. Increased tension on the fascia or very fast transfers of force to the fascia cause irritation and eventually inflammation.
Diet and hydration can always be culprits. "You are what you eat" is an old saying for a reason. The types of proteins, fats and carbohydrates you eat are the building blocks of your tissues. The quality of your tissue is largely dependent on the quality of food you eat; furthermore your general inflammation is higher when you eat poorly and will be more difficult to calm down after an injury. Drinking plenty of (quality) fluids keeps your tissues more pliable and helps your body repair more quickly.
Training schedules and of course general overtraining are hugely detrimental. As a general rule, intensity of your workout should be increased by no more than 10% each week. Many people also fail to give themselves the recovery they need to heal and stay healthy after each workout- it is important to listen to your body and give it ample time to recover so it can adapt and get stronger. Using cross training, or mixing up your workouts with different types of activities is a great way to give yourself recovery time while working different muscle groups which pays off in the end as well!
Any combination of factors may lead to the inflammation that causes Plantar Fasciitis pain. As part of the natural healing process, the body creates scar tissue along the areas of inflammation. Scar tissue is not like the healthy tissue that lies underneath it; reduced pliability and stretch as well as increased diameter of the tissue leads to changes in how the foot functions. Changes in foot function leads to changes in the amount of force distributed throughout the foot during activities which can increase the irritation in the original tissues. It is easy to see the vicious cycle that makes Plantar Fasciitis such a chronic problem for so many people.
Every case of Plantar Fasciitis should be treated differently because every case has a different underlying cause. Improper fitting shoes, poor gait mechanics, weak foot musculature, lack of range of motion in any one of the foot or ankle joints, overly tight calf or ankle muscles, are all possible causes, just to name a few.
The first step in treating this condition should be obvious: stop doing whatever caused the pain. Whether it was increasing mileage for running, standing for a long time, wearing high heels or jumping during training for you sport, the longer you keep pounding and aggravating the tissue, the harder it will become to treat and the longer it will take. Depending on why your pain has begun, varying treatments can be used to improve your outcomes.
Initial treatment can be performed at home with little to no equipment. Stay tuned for Part II of this article which describes many commonly used homecare techniques in more detail. If your pain has not improved considerably within 7-10 days of diligent homecare, then it is time to seek professional care sooner rather than later. Part III will discuss professional care techniques that are commonly used.
STAY TUNED FOR PART II: HOMECARE OPTIONS TO FIND OUT WHAT YOU CAN DO AT HOME TO HELP!
1. Chang R, Kent-Braun JA, Hamill J. "Use of MRI for volume estimation of tibialis posterior and plantar intrinsic foot muscles in healthy and chronic plantar fasciitis limbs." Clin Biomech (Bristol, Avon). 2012 Jun;27(5):500-5.
2. Chundru U et al. "Plantar fasciitis and calcaneal spur formation are associated with abductor digiti minimi atrophy on MRI of the foot." Skeletal Radiol. 2008 Jun;37(6):505-10. doi: 10.1007/s00256-008-0455-2.
3. Kaikkonen M, et al. "Treatment of Plantar Fasciopathy." Duodecim. 2012;128(17):1777-85.
4. Cornwall MW, McPoil, TG. "Plantar Fasciitis Etiology." J Orthop Sports Phys Ther. 1999 Dec;29(12):756-60.
Meet Ashton Romero. He was born on August 9th, 2013. You would never guess by his smiling face, but for him, every day is a miracle. He was diagnosed with pulmonary atresia while still in the womb, and at just six days old, he was placed on the national heart transplant list.
Pulmonary Atresia is a defect in the heart, where the valve leading to the lungs doesn't develop properly. Instead of opening and closing to allow blood flow from the heart into the lungs for oxygenation, the (pulmonary) valve is blocked by a sheet of tissue.
The Children's Organ Transplant Association (COTA) is currently sponsoring Ashton and his family. This national charity has made it their mission to provide support for families who are struggling with the financial and emotional burdens of transplant related procedures.
At MSWC, we feel that giving back to our community is of great importance. To show support for Ashton, we have put together a gift basket to be raffled off at our Open House, on 9/26; 6pm-9pm. Tickets will be available for purchase from September 15th-26th. All ticket sales will be donated to his family.
Stay tuned for raffle details!!
Follow Ashton on his journey at: http://cotaforashtonr.com/
Follow our social media pages for updates about the week-long Patient Appreciation Event!!
Resistance Band Workshop - with Amanda Roberson
Monday September 22nd 6:30-7:00PM
Resistance bands are a diverse tool that can increase strength, stability, mobility and overall function. When used properly, they can help promote healing of injuries and prevent future injuries from occurring! This workshop is not just for patients! If you're an intense athlete, a "weekend warrior", or simply looking to understand and improve your body - this is the workshop for you!
Soft tissue Self treatment - with Dr. Therese Miller
Thursday September 25th 6:30-7:00PM
Releasing tension in the muscles is an integral part of any warm-up or cool-down exercise routine. This hands-on workshop will help you learn to effectively use inexpensive tools at home to self-treat some of the most common conditions. This workshop will benefit athletes and non-athletes alike, who want to know how they can better manage common aches and pains.
Thai Massage - with Elizabeth Hoffman
Saturday Spetember 27th 1:00-1:30PM
Thai massage is a form of bodywork featuring stretching and traction traditionally practiced on the floor. Clients remain fully clothed, and no lotions or oils are involved. Thai massage works as the practitioner uses their feet, elbows, knees and hands to compress and stretch the client. Some people describe it as a passive form of yoga.
“It’s like going to a massage therapist, yoga class and chiropractor.” Jill Burynski
MSWC and Hands On have spent two years in our office on 103rd & Oklahoma, and welcomed Berry Family Chiro last year. Now it's time to celebrate! Our success would not have been possible without our patients. We want to use our anniversary to thank YOU, for supporting us!
September 22nd-26th, we will be hosting Patient Appreciation and Education Week! Throughout the week, there will be free workshops with Amanda Roberson, Dr. Miller, and Elizabeth Hoffman of Hands On Massage Inc. The main event will be the open house, on Friday September 26 from 6:00-9:00pm. There will be a clearance product sale, raffle prizes, drinks, snacks and good times all around! Dr. Berry will also stop in to introduce Baby Berry!!
Event details will be posted throughout the next few weeks. You can find details on our Facebook, Twitter or in our blog. As always, feel free to contact the office for more information!
Let’s start by defining both. Static stretching is the action of holding a muscle in a stretch for a certain amount of time (let us say 30 secs) while the body is at rest, no movement. Dynamic stretching is stretching the muscle while activating that muscle in a controlled manner, movement. Dynamic stretching is not the same as taking a static stretch and adding a bounce to the end range for your motion.
Newton’s first law of motion comes to mind. “An object at rest stays at rest and an object in motion stays in motion.” Now, let us take that law and apply it to stretching. When a muscle is being stretched without any activation, the muscle fibers are being pulled apart in a weak uncontrolled position. This is not always a bad technique but it should not be used before an activity or event. Static stretching should be used during the cool-down phase of exercise or after an event.
Before an event, dynamic stretching promotes an increase in blood flow, “warming up” the muscle. Because there is movement while stretching, range of motion and body awareness is improved. To help you out, I have attached a link at the bottom that outlines a full body dynamic warm up routine to get you ready for any workout.
-- Amanda Roberson, MAT, ATC, LAT
What is IT band syndrome?
The first question to answer is what is the IT band? IT band stands for Iliotibial band which is a large sheet of thick fibers that connect the hip to the knee on the outside of the leg. Various muscles and other kinds of soft tissues connect to the IT band. IT band syndrome is an overuse injury common in runners and cyclists. The distal (bottom) portion of the thick band crosses over the lateral epicondyle (outside bony part) of the knee. As the knee bends and straightens that portion crosses over the lateral epicondyle which can cause irritation and/or a popping sound.
How do I prevent IT band syndrome?
Athletes can help prevent IT band syndrome from occurring. Proper mechanics should always be used while exercising regardless of the intensity. It is important that our muscles and joints are used the way that they were designed to be used. Incorporating a dynamic warm up and cool down decreased the rate of injury. This allows blood flow to the muscles while stretching the muscles. IT band syndrome can be an effect of tightness of one or more of the muscles that attach to the IT band. Also, a number of soft tissue techniques could be used including ART (active release technique) and Guasha (a scraping technique). Most soft tissue techniques have the same end goal with different approaches. People react different to different techniques.
How do I treat IT band syndrome?
There are many treatments for IT band syndrome ranging from conservative care or surgery. It is common practice to begin with conservative care, working of proper mechanics, soft tissue techniques, and stretching. From there if no results are found then the injury would be re-evaluated and the case would progress from that point.
-Amanda Roberson, MAT, ATC, LAT
Athletes don't always look like this...
Most athletes look more like this...
Changing the way we, as a society, look at exercises, influences our goals and overall outcomes. If the end goal of exercise is to get bigger and stronger, then lifting at the gym in the traditional sense fits. However, if the end goal is to run faster, throw harder, or jump higher, incorporating a functional approach may be more beneficial. Our life is lived through functional movement; therefore we should train through functional movement to reflect out activities. The Grey Institute is centered on the philosophy of Applied Functional Science (AFS) which is a functional based approach to exercise and rehab treatment. Using AFS allowed providers to retrain the body to function the way it was designed. Functional training combined with traditional training optimizes our level of performance. But as always proper mechanics is the most important in any type of training.
Using the link below will direct you to an article that explains deeper the “Principles of Lifting” by Logan Schwartz FAFS.
-Amanda Roberson, MAT, ATC, LAT