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What is it?

Rotator cuff injuries are some of the most common shoulder injury. The rotator cuff is comprised of four muscles: subscapularis, suprasinatus, infraspinatus, and teres minor. These four muscles are responsible for stabilizing the shoulder girdle throughout the shoulders range of motion. Pain or weakness in curtain range of motion can determine which muscles are hurt. Subscapularis creates internal rotation. Supraspinatus creates abduction. External rotation is created by both infraspinatus and teres minor. Common injuries are rotator cuff tendonitis, rotator cuff impingement syndrome and a rotator cuff tear. This blog will focus on rotator cuff tendonitis.

What causes it?

Rotator cuff tendonitis is an overuse injury due to poor shoulder mechanics. To learn more about shoulder mechanic, please read through our blog "Shoulder Mechanics". Rotator cuff tendinitis affects the tendons of the 4 muscles stabilizing muscles. Tendinitis means that these tendons are inflamed or irritated. Tendinitis of the rotator cuff can be caused from keeping the shoulder in one position over a period of time, sleeping on the shoulder every night, or participating in activities that require extending the arm over the head. Sometimes rotator cuff tendinitis can occur without any known cause. Most individuals with rotator cuff tendinitis are able to regain full function of the shoulder without any pain.

What are symptoms and how do you diagnosis it?

Symptoms of rotator cuff tendinitis tend to worsen over time. Initial symptoms may be relieved with rest, but eventually the symptoms can become constant. Symptoms of rotator cuff tendinitis include:

·         pain and swelling in the front of the shoulder and side of the arm

·         pain triggered by raising or lowering the arm

·         clicking sound when raising the arm

·         stiffness

·         pain that causes you to wake from sleep

·         pain when reaching behind the back

·         loss of mobility and strength in the affected arm

Through the physical examination, including history and special tests, the treating provider can determine if the patient is suffering from rotator cuff tendonitis. The exam may include movement of the arm, shoulder and neck to test mobility and strength.

Your provider may order imaging tests to confirm the diagnosis of rotator cuff tendinitis and rule out any other causes of your symptoms. An X-ray may be ordered to see if you have a bone spur. Your provider may order an ultrasound or magnetic resonance imaging (MRI) to check for inflammation in the rotator cuff and to check for any tearing.

How do we treat it?

Conservative treatment

Conservative treatment is always the first line of defense. Shoulder strengthening, corrective exercises, postural changes, proper stretching and soft tissue work can be used in conservative treatment. Severe cases way require the use of a sling to prevent excessive use of the shoulder during the healing process.

Steroids

If the rotator cuff tendinitis is not responding to conservative treatment, your provider may recommend a steroid injection. This is injected into the tendon to reduce inflammation, which reduces pain. This approach is used as a band-aid to the problem not a long term fix.

Surgery

If nonsurgical treatment is not successful, your provider may recommend surgery. The most non-invasive form of shoulder surgery is accomplished by arthroscopy. This involves two or three small cuts around the shoulder, through which your doctor will insert various instruments. One of these instruments will have a camera, so your surgeon can view the damaged tissue through the small incisions.

Open shoulder surgery is usually not required for rotator cuff tendinitis. However, this method may be used if there are other problems in the shoulder, such as a large tendon tear. Any type of surgery involves recovery that consists of rest and physical therapy to restore strength and range of motion.
 
 
1.       Drink at least half of your body weight of water in ounces a day. As your activity level increases so should you water intake. 
Your body need water to function properly. If your muscle do not have enough water, they become less pliable., similarly to a dried up rubber band.  If the rubber band is hydrated, you can stretch the rubber band with out it breaking. If you pick up a dried up rubber band and try to stretch it, the rubber band will pop in your hand. Your nervous system and brain also need water to function properly. Dehydration and alcohol consumption have similar effects to the brain. 

2.       Get in at least 30 minutes of physical activity 4-5 days a week. 
This can include walking your dog, jogging around the block, playing with your children outside. Anything activity to get you breathing harder and your heart pumping. For a long healthy life, your heart has to be healthy. When the hearl is surrounded by fat, the heart get suffocated. It has to work so hard every day to pump blood throughout your body. Decrease the fat around your heart and you can increase the years on your life. 

3.       Eat a healthy, well rounded diet. 
There is no such thing as a “quick fix” to weight loss. Stay away from pills and supplements that guarantee more than outrageous amount of weight loss in a small about of time. A healthy weight loss should consist of no more than 2 pounds per week. And always remember that muscle weighs more than fat. Do not get discouraged if you are working out and eating a well balanced diet but you don't see the pounds going down. Be comfortable with who you are and what you see in the mirror. 

4.       Stretch at least one time a day. Don’t neglect any body parts. 
A stretching routine should take about 10 minutes. Everyone can spare 10 minutes in their morning routine to make there life healthier and pain free. Some people might use a 10 minute yoga video or find some stretches on YouTube. Something is better than nothing. Check out our blog "dynamic stretches vs. static stretches" for more information on which stretches to use. 


5.        Don’t forget to RELAX. 
Sit in a comfortable position in a quiet room for 10-15 minutes to relieve stress by using one of many relaxation techniques. Find a relaxation technique that works best for you. Think about what your needs are while evaluating the techniques. i.e. mediation, deep breathing, progressive muscle relaxation technique. Taking time out of the day for yourself is important for you mental health and spiritual health. These along with physical health allow you to become a healthier person over all. 

 
 
Did you know a thorough clinical exam has been shown to be more accurate than MRI for properly diagnosing meniscus (Cartilage) injuries in the knee? Furthermore MRI shows meniscus (cartilage) changes in 24% of patients that are asymptomatic? Does this make you question what really is causing your knee pain? It should.

Although we've said it before, I'll say it again. Understanding the underlying cause of your injury and taking a look at your whole health and injury history are very important factors to ensuring you have adequate and high quality treatment.  Be sure your provider has given a thorough exam, is not only relying on MRI or other imaging, and that your treatment addresses the underlying problem not just the pain itself.

Here is a starter guide to knee pain, most likely causes and what to watch for.  Treatments vary by condition, but as a general guide: 
    • Active Release Technique, Graston and Guasha are 3 of the best techniques for many of these injuries. 
    • Rest, Ice Massage and anti-inflammatory cream at home will help control symptoms.
    • Proper rehab is a key to preventing reoccurence.
    • Additional, specific treatment options for some conditions are listed below.
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PAIN LOCATION

FRONT

(Anterior)


  • Most Common condition categories:  

    • Patellar Tracking Disorders/Cartilage irritation aka "The knee cap doesn't glide where it should" causing irritation of any number of tissues/structures around the knee.
    • Degenerative Changes- breakdown and irritation of cartilage, bone, and/or ligaments. May be the result of previous injury, or most commonly due to improper mechanics. 
    • Tendinosis- inflammation or tissue thickening of tendons (attaching muscles to bone)

  • Who: Most Commonly related to overuse. Runners, jumpers, activities require excessive starting/stopping, stair climbing, jumping or impact. 

  • What to look for:

      • Swelling- may indicate irritation/inflammation of a bursa (fluid-filled sac)
      • Popping/Clicking- may indicate damage/degeneration of the meniscus (Knee cartilage) or the presence of a plica, a band of tissue under the knee cap which can friction causing noise and sometime pain

  • Underlying Causes: Improper Mechanics. See knee mechanics article here. Overuse. Improper training regimen/progressions.

  • Diagnosis: Clinical Exam

  • Treatment Options: usually responds to properly prescribed homecare, rehab and conservative methods (ART, Guasha/Graston, etc)

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INSIDE (Medial)



  • Most Common condition categories:  

    • Medial Meniscus- cartilage within the knee may be degenerating, irritated, frayed or torn
    • Ligament Damage- Specifically MCL or the Medial Longitudinal Ligament. 
    • Tendinosis- Sartorius, Gracilis, Semitendinosus most commonly
    • Bursitis- Pes Anserine Bursa protects the three tendons listed above from rubbing on the underlying bone

  • Who: Soccer, Football, Basketball, Tennis and Racquetball players. People suffering from weak hips and/or feet causing the knee to "fall" inward during walking, running, stair climbing, etc. 

  • What to look for:

    • Swelling- may indicate irritation/inflammation of a bursa (fluid-filled sac) or the MCL
    • Popping/Clicking- may indicate damage/degeneration of the meniscus (Knee cartilage)
    • Feeling unstable/giving away: may indicate ligament damage, loose bodies, muscle weakness or meniscus injury
    • Pain unchanged by knee movement or that cannot be reproduced. Rarely, a problem in the lower abdomen can refer pain here. 

  • Underlying Causes: Trauma/Injury where the knee is forced inward (sometimes with rotation) Improper Mechanics. See knee mechanics article here. Overuse- most notably with weak hips, weak feet, and poor mechanics.

  • Diagnosis: Clinical Exam, possible MRI

  • Treatment Options: Possible surgical intervention for Meniscus or MCL damage. Meniscus tears are categorized by a number of factors. Surgical intervention is required for some types of tears, however many tears respond best to conservative care, rest and rehab. Proper diagnosis is very important in determining the best treatment methods.  

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OUTSIDE (Lateral)







  • Most Common condition categories:  

    • Lateral Meniscus- cartilage within the knee may be degenerating, irritated, frayed or torn
    • Ligament Damage- Specifically LCL or the Lateral Longitudinal Ligament. 
    • Tendinosis- Iliotibial Band (ITB), Biceps Femoris (one of the hamstring muscles), Popliteus (small muscle behind the knee)
    • Bursitis- protecting the ITB from the underlying bone

  • Who: Runners, Contact sport athletes

  • What to look for:

    • Swelling- may indicate irritation/inflammation of the bursa or the LCL
    • Popping/Clicking- may indicate damage/degeneration of the meniscus
    • Feeling unstable/giving away: may indicate ligament damage, loose bodies, muscle weakness or meniscus injury

  • Underlying CausesTrauma/Injury where the knee is forced outward (sometimes with rotation) Improper Mechanics. See knee mechanics article here. Overuse- most notably with weak hips, weak feet, and poor mechanics.

  • Diagnosis: Clinical Exam, possible MRI

  • Treatment Options: Possible surgical intervention for Meniscus or LCL injuries. Meniscus tears are again categorized by a number of factors. Surgical intervention is required for some types of tears, however many tears respond best to conservative care, rest and rehab. Proper diagnosis is very important in determining the best treatment methods.  

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BACK 
(Posterior)





  • Most Common condition categories: 

    • Medial or Lateral Meniscus- degeneration, irritation, fraying or tearing usually in the back aspect of the cartilage.
    • Tendonopathy- Hamstring, Gastrocnemius (Calf muscle). May indicate irritation, inflammation, thickening or tearing in one of the these primary muscles.
    • Capsule involvement- irritation or contraction of the capsule surrounding the knee joint
    • Radiculopathy or referred  pain from the low back, a pinched nerve or disc related injury

  • Who: Runners, Contact sport athletes

  • What to look for:

    • Swelling- may indicate a cyst which can be related to meniscus tears or damage to the Anterior Cructiate Ligament  (ACL) or Posterior Cruciate Ligaments (PCL)
    • Popping/Clicking or Locking- may indicate damage/degeneration of the meniscus or may indicate a "loose body" in the joint; these range from calcium deposits to chunks of bone which have broken away due to injury.
    • Feeling unstable/giving away: may indicate ligament damage, loose bodies, muscle weakness or meniscus injury
    • Pain unchanged by knee movement or that cannot be reproduced. Pain may be coming from the low back, hip or another area.

  • Underlying CausesTrauma/Injury where the knee is forced backward (sometimes with rotation), improper warm up prior to activity. Overuse and occasionally poor mechanics.

  • Diagnosis: Clinical Exam, possible MRI

  • Treatment Options: Possible surgical intervention for meniscus, depending on classification or location of injury. Chiropractic manipulation, McKenzie technique, rehab or additional techniques may be needed if the cause is related to low back concerns.


FINAL NOTES

Hopefully this has helped you understand the basics of knee pain and concerns. As always, be sure to understand the underlying causes of your injury, proper diagnosis, and appropriate treatment options. 


 
 
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Meet Ben and Shelby Offrink, alongside their daughters, Maeve (3) and Hazel (1).
This young couple is fighting for their lives, and for time with their little girls.

Shelby was diagnosed with a rare form of cancer, when doctors found a tumor on her spine.  This January, despite months of chemotherapy and radiation treatments, doctors found three more tumors - the cancer has spread to her brain.  

Meanwhile, Ben learned that his cancer, Hodgkin's Lymphoma, has returned for a third time. The first round of chemotherapy showed no change, so he will continue treatment until he can receive a bone marrow transplant. 


Join us, in their fight. For the month of February, every NEW PATIENT that is referred to us [by a current patient], Miller Sports and Wellness will donate $25 dollars to the Offrink family's YouCaring Fundraiser.  Donations will also be accepted, in office.
Read more about this brave young couple. 

Ben and Shelby: Your family is in our hearts. 

 
 
The knee is one of the most unstable joints in the body. The stability comes from the ligaments and muscles that cross the joint, opposed to the hip which is largely stabilized by the body structures. The knee is comprised of two joints, the tibiofemoral joint and the patellofemoral joint. The tibiofemoral joint composed of the femur sitting on top of the tibia to create the hinge joint that moves the knee. The patella (knee cap) sits in a groove of the femur to create the patellofemoral joint. 

The tibiofemoral joint’s job is to transmit body weight and forces from the femur through to the tibia allowing constant energy movement. Because the tibiofermoral joint is a hinge joint it can only move in the sagittal plane. This plane allows flexion movement (bending the knee) and extension (straightening the knee).  The tibiofemoral joint has a small amount of rotational movement due to the shapes of the contacting surfaces and a few of the soft tissues that connect the two bones. One of those soft tissue factors is the ACL (anterior cruciate ligament). This rotational movement is called the “screw home” mechanism. The tibia externally rotates 5 degrees in the last 15 degrees of extension.  So what that means is when the knee locks out into extension the foot points out away from the body. This mechanism happens to take load off the quadriceps (thigh) while standing.

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The patellofemoral function is to transmits tensile forces generated by the quadriceps to the patellar tendon. The patella glides in a groove of the femur as the knee bends and straightens. Common injuries include patella tendonitis, patellofemoral tracking issues, and bursitis. Injuries to the patellofemoral joint occur when too much load is being transmitted through it or the patella is not tracking properly because of muscular imbalance.

Some common knee injuries include either a sprain or tear to the ACL (anterior cruciate ligament), MCL (medial collateral ligament), or LCL (lateral collateral ligament). The ACL is the most well known sports injury. The ACL's job is to prevent anterior translation of the tibia from the femur. So the ACL stops the bottom half of the leg from moving too far forward. The MCL is commonly hurt by a valgus force to the knee. An example of a valgus force to the knee is when a lineman in football gets hit on the outside of his knee causing his knee to fall inward towards his opposite knee. A varus force causes injury to the LC, which is just the reverse valgus force. The blow is to the inside of the knee pushing the knee out. 


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Proper knee mechanics is important to living life with ehalthy knees. Using correct form while performing everyday life activities, especially weight lifting, can decrease knee pain throughout your lifetime.

 
 
Recap from Part I.... You experienced horrific pain from doing none other than scooping a sock up from your floor. You cursed and crawled to the couch to lay in agony. Unfortunately this hits you yearly and you are sick of dealing with ongoing low back problems. Here are some treatment options to explore.

Part II: Treatment Options

There are 2 goals to treatment (as always at MSWC): get rid of the pain then FIX the underlying problem.

Stage I: Pain Relief

  • SI Belt. Unlike a back brace, this supports the ligaments to allow healing without turning off or weakening your core muscles. Worn 24/7 (to help with that pain rolling over in bed) for several weeks, then gradually reduced. Think of this as the "cast" to help the ligaments and joint heal.
  • Stability, stability, stability. Unlike an ankle injury where a cast or crutches allow healing, SI joints don't have that luxury- they still have to work! SI Belts help, but improving stability from the muscles in the area reduces force in these joints truly allows healing to occur. Depending on your case, we prescribe any assortment of "spinal -sparing" core exercises to strengthen and activate core muscles.  This may be as "simple" (but HUGELY important) as breathing properly, activating your pelvic floor muscles or tensing your abdomen. As you progress it may include planks or more physically taxing exercises.
  • Don't forget the classics: Rest, Ice, Compress, Epsom salt bath, anti-inflammatory cream/oral supplementation.
  • Kinesiotape- Used to reduce inflammation.
  • ART, Graston and soft-tissue techniques. These become most beneficial in Stage 2. We can use these minimally to reduce pain and improve circulation to the injured area. These are great for reducing muscle spasms trying to protect the injured joint. We do want to be cautious here; too much tissue work may destabilize the area too far and take away the hard earned support your stability exercises are giving us. It's all about balance!!!
  • Adjustments- For the same reason as ART, Graston and soft-tissue treatments, adjustments have their place. Adjustments are great for stimulating the nervous system to reduce spasm, opening up these joints to allow better circulation and improved healing. They also create movement in an area being "casted" by muscles and the belt to allow healing. Some cases adjusting is a needed tool, some cases it is a better tool in Stage II.
  • Muscle Relaxants. Pros and Cons. Pros- provide very effective, fast relief. Cons- they destabilize  the area and effectively slow the healing process, they also may interact with other meds and carrying some side effects like drowsiness, dizziness and mental fogginess. In severe cases, these may be needed and thank heavens for modern medicine! In most cases, other techniques should be used first.
  • Cortizone Injections or Radiofrequency Ablation These more aggressive techniques have their place, especially in chronic cases or cases which aren't responding to conservative care. As always, start with the least invasive and least risky then progress as needed.
Stage 2: Fixing the "Why"

If you slipped on ice- don't do it again.....doctors orders. If you "didn't do anything-" keep reading.  

  • FOCUS: Movement Repatterning: Retraining how you put groceries in the car, climb stairs, unload the dishwasher or get up and down from your desk are integral parts of your treatment. Although you are feeling better, remember that years of bad habits have culminated in this horrible experience. An ounce of prevention is worth a pound of cure!
  • Kinesiotape- Used to activate muscles that aren't working hard enough or deactivate the overactive ones.
  • ART, Graston and soft-tissue techniques. After an injury, scar tissue is produced. Scar tissue is only detrimental when an excess is developed. These techniques promote healthy tissue (collagen) formation and encourage the new tissue to have improved strength and resilience to reduce risk of reinjury.
  • Adjustments- Adjustments are great in this stage. Encouraging the nervous system to function properly and ensuring that each SI joint and the surrounding joints are moving properly to reduce compensations.
The next time you hear this story from a friend, neighbor or loved one (it should no longer be you), help give them hope. Please share this article with anyone who can relate and encourage them to seek the prevention or treatment that will break the cycle!


 
 

 You wake up one morning, feling great. You bend over to pick up a sock and suddenly you can't stand up. Excruciating pain sears through your low back, just over the left hip. After remembering to breathe again, yelling for help, and quietly screaming expletives through clenched teeth; you hobble to the couch and lay in misery the rest of the day. Missing work, your kids hockey game and ordering take out because it is too painful to cook; you know this is just the beginning. Gradually your pain improves but for weeks you question every movement and twinge.

I hate to say it...classic.  We commonly hear a variation of this story and it often suggests injury to the SacroIliac (SI) joint. Sound familiar? This 2 part series gives you some background followed by treatment options.  

PART I: THE BACKGROUND
HOW LONG AM I STUCK WITH THIS?


The "lock up" is from muscle spasms which typically improve by 3-5 days, but leave your SI joint (the actual cause of injury) relatively unprotected. Without treatment, pain often reduces to a scale of 1-2/10 within 4-6 weeks. With proper homecare and treatment, we can often reduce pain to this level within 1 week.

WHAT IS THE SI JOINT?

A large joint in the lower back. You have a left and right joint where the pelvic bones meet the large triangular sacrum. These joints are tightly supported by ligaments but move with EVERY movement you perform from walking or climbing stairs to transitioning between sitting and standing.

DEVIL IS IN THE DETAILS...

These joints carry your entire upper body weight and transfer that weight to the larger hip muscles and pelvic girdle. They function throughout the day as a foundation for your spine but also as an anchor point for the most powerful muscles in the body- your glutes.

CAUSES?

One cause is trauma like slipping and falling on ice.

More commonly, repetitive strain. There are "good" and "bad" ways to reach into your dishwasher, put on your shoes and pick up that sock.  A tiny change in how you move can put excessive force through this joint and these ligaments. Over time, the tissues around this joint can't support the forces you are demanding of them and they begin to break down. This process takes a lot of time and you won't notice pain until it is far underway.

THE STRAW THAT BROKE THE CAMELS BACK...LITERALLY

By the time you picked up the sock, the damage and irritation in those SI joint tissues has already reached a critical stage. Although the act of picking up the sock was "nothing," your daily patterns, habits, strengths and weaknesses have caught up with you.

 
AS IF ONCE WASN'T ENOUGH, THIS HAPPENS TO ME ONCE A YEAR...

This is the single worst thing to hear. This is a red flag that you have never addressed the injury fully and only on very, very, very rare occasions should I hear this from our patients. If you had a severe traumatic injury (car accident, etc) or have something in your history affecting your healing process or tissues, you are excused (and make up 99% of the rare cases I am allowed to hear this from). Otherwise....

If treated properly, you should only have re-occurrences that are predictable: aka....."I decided to help move a washing machine down a flight of stairs and I KNOW  I didn't move properly."

Cases that have never been treated, or treatments that stop when the pain stops will have re-occurrences. It is not an if.....it is a when and it is a disservice to patients without treating and educating you about the underlying cause.




STAY TUNED FOR PART II: Treatment Options





 
 
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What is spondylolisthesis?

Spondylolisthesis (spon + dee + lo + lis + thee + sis) is a funny word to describe a condition of the spine when one of the vertebra slips forward or backward compared to the next vertebra. If not treated, spondylolisthesis can lead to a deformity of the spine causing complications like, central spinal stenosis (a narrowing of the spinal canal) or foraminal stenosis (compression of the exiting nerve roots).

What causes spondylolisthesis?


Spondylolisthesis can be hereditary if there is a family history of back problems. In athletes, a history of repetitive trauma or hyperextension of the lower back or lumbar spine is a common cause. Athletes such as gymnasts, weight lifters, volleyball player, and football linemen who have extreme forces applied to the spine during extension, are at greater risk for developing spondylolisthesis.

What are the symptoms of spondylolisthesis and how is it diagnosed?

The most common symptom of spondylolisthesis is lower back pain. 
In most cases it is not possible to see visible signs of spondylolisthesis by examining a patient. Patients typically have complaints of pain in the back with intermittent pain to the legs. Spondylolisthesis can often cause muscle spasms, or tightness in the hamstrings.

Spondylolisthesis is easily identified using X-rays. If the patient has complaints of pain, numbness, tingling or weakness in the legs, additional studies may be ordered. These symptoms could be caused by stenosis or narrowing of the space for the nerve roots to the legs. A CT scan or MRI scan can help identify compression of the nerves associated with spondylolisthesis. Occasionally, a PET scan can help determine if the bone at the site of the defect is active. 


What are the treatment options for spondylolisthesis?

The initial treatment for spondylolisthesis is conservative and based on the symptoms.
    ·         A short period of rest or avoiding activities such as lifting and bending and athletics may help reduce symptoms.
  ·         Rehab will include exercises like core stabilization and proper hip mechanics. Stretches and foamroller will be used on the legs, hips, and upper back.  

 ·         Anti-inflammatory medications can help reduce pain by decreasing the inflammation of the muscles and nerves.
  ·         Some patients with spondylolisthesis may benefit from a hyperextension brace. 

·         Patients with pain, numbness and tingling in the legs may benefit from an epidural steroid (cortisone) injection.

For patients whose symptoms fail to improve with conservative treatment surgery may be an option. The type of surgery is based on the type of spondylolisthesis. This option will be discussed with a surgeon. 



For more information about the diagnosis and conservative management of degenerative lumbar spondylolisthesis, please click here










 
 

Professional Care Options:

In Part I of this series, I discussed the many factors that may cause true Plantar Fasciitis as well as briefly mentioned that a number of other conditions may be similar- the most important step is to know EXACTLY what you are treating. In the second section of this article, I described 13 different variations of techniques that can be used at home to treat this nagging condition.

If you have been diligent for 7-10 days or are not sure if Plantar Fasciitis is your true diagnosis, then it is time to seek professional medical care. Although many people are hesitant to spend the money or keep thinking "it will get better soon," the reality is that the longer you wait, the longer treatment will take when you do finally go in. So it is cheaper and less hassle in the long-run to just bite the bullet and seek help!

When you seek professional care, treatment options will be dictated by your provider, their area of expertise, their certifications and your specific case. Initially I would recommend seeking treatment from a Licensed Athletic Trainer (LAT), Chiropractor (DC) or Physical Therapist(PT) for which you may or may not need a referral. From there, you may be referred to any of these providers as well as your primary care (PCP), Podiatrist (DPod), a pain management specialist (PM), an orthopedic (OR), an acupuncturist (LAc),  possibly even a massage therapist (LMT) depending on your needs. Each spectrum of healthcare offers different techniques within their scope of practice, so depending on your case, different techniques may be required.

Below you will find an overview of common treatment options. I have included which disciplines most commonly use these techniques in parenthesis, but please realize that not all providers within a given discipline practice using all of these items.

-"Soft-tissue" Techniques may be used to loosen up overly tight muscles. These may include a variety of options including deep tissue massage, myofascial release, Active Release Technique, Graston or other Instrument Assisted Soft Tissue techniques and many more depending on the preference and certifications of your provider and your specific case. (LAT, PT, DC, LMT)

-Taping may be used to support the arch. Kinesiotape is used to stimulate the muscles of the foot and provide some light arch support while reducing any inflammation in the area. More rigid taping techniques such as McConnell Taping or even athletic tape can be used to provide more support and help to distribute forces away from the Fascia therefore providing pain relief. (DC, PT)

-Ultrasound may be used as a deep heater to encourage increased circulation to the area and speed up the healing process. (DC, LAT, PT).

-Iontophoresis- a technique that uses ultrasound and a topical gel with a variety of medications to deliver the medication directly into the painful tissue. Shown to be very beneficial for short-term pain relief (2-3 weeks) allowing time to address the underlying cause so the pain does not return.  (PT under prescription from your PCP, OR, DPod, or PM)

-Orthotics have been shown to be very effective at short-term pain relief but are highly debated. The problem here is that many people get the pain relief then stay in the orthotic permanently (especially due to cost of custom orthotics)....failing to remember one of the biggest causes of the condition is weakening of the foot musculature. By the very nature of an orthotic, your foot will weaken because it relies on the external support from the orthotic- so always stop to consider the purpose of the orthotic and question the long-term plans with this treatment. For me, orthotics are typically a later step if other techniques aren't working. (DC, PT, DPod)

-Rehabilitation is hugely important and should be a piece of your treatment puzzle in some way. The focus for many people is strengthening the small muscles of the feet which reduces pressure on the fascia. This piece also likely includes improving your balance, stretching or ankle/toe mobility work or strengthening muscles further up in the leg. (DC, PT, LAT).

 -Manipulation which involves increasing mobility in joints which are not moving properly has been shown to benefit Plantar Fasciitis. By allowing the foot to move properly in all of the joints, the forces in the foot are distributed more evenly and not focused directly on the fascia alone. (DC and some PT)

-Other treatment avenues may include Acupuncture , Trigger Point Dry Needling,  and Anti-inflammatory diets however less research is available regarding the effectiveness of these treatments. Anecdotally and through some case studies, these show some promise as more research comes out. (LAc, PT/LAT and nutritionists/some DC respectively)

-As an absolute last resort there are a number of more invasive options from Cortisone shots, Oral anti-inflammatories, Shockwave treatments, and even surgeries.  These options should be considered in stubborn and chronic cases, but should be discussed thoroughly with your provider only after you have explored all of these conservative measures. (PM, PCP, PM, OR respectively).

Hopefully this series has helped you gain a better understanding of a chronic and often frustrating condition to treat. You should better understand why so many cases respond so differently to varying techniques, what you can do at home to help get the pain under control and what to expect/where to go if you do need to seek additional care.

 
 
Our Help Others, Help Yourself event is coming up fast! This year, we were lucky enough to have over $2,000.00 worth of services/products donated for our silent auction!  
Here is our full list of silent auction items: 

  • Chili’s of Franklin - $20 gift certificate
  •   Movida - $20 gift certificate
  •   Milwaukee Food Tours - $50 gift certificate
  •   Rosencutter Ultrafitness Performance – Free Assessmesnt, program and 2 weeks of training - $500
  • Gigi's Cupcakes - one dozen cupcakes ($15)
  •   Extended Hands Massage Therapy – 1 hour massage ($65)
  •   Oilerie – Private Tasting Party for 10 ($150)
  •   Keenan Wellness – One Hypnosis session
  •   Heaven & Earth Acupunture – Free Initial Consultation w/ 2 treatments
  •   Flash Images Photopraghy – Complete high school senior portrait or family portrait package ($350)
  •   Fresh Paradigm – One hour nutritional assessment, goal setting and counseling session ($150)
  •   Sunni Boehme - Life Transformation Coach for 28 years.
  •   Gift certificate for 1 hour session. ($100 value)
  •   Sprecher Brewing Company – Beer and cheese pairing for 4 ($80)
  •   Fred Astaire Studio (Brookfield) – 2 dance classes (for two) 
  • Moxie Fittness LLC – Indoor cycling/training ($50)
  • Arte – 2 hour class for two people ($70)
  •   YoMama! – Brookfield – two T-shirts, chocolate pretzel, gift card ($50)
  • East Town Spa – Gift certificate ($65)
  • Hot Yoga Milwaukee – One month Membership ($150)
  •   TNT Performance – One month unlimited kettlebell classes ($120)
  • Klein Hair Design – Gift Certificate for consult and style ($65)
Stop in and place your bid on some of these amazing items - you won't want to miss them!  All of the proceeds, will be donated to St. Ben's Community Meal Program. Help others, Help yourself!