Plantar Fasciitis

December 2019 newsletter.

Sources: American Academy of Orthopaedic Surgeons & Runner’s World Magazine. Images: American Academy of Orthopaedic Surgeons.

The plantar fascia is a long, thin ligament that lies directly beneath the skin on the bottom of your foot. It connects the heel to the front of your foot, and supports the arch of your foot. Plantar fasciitis is the most common cause of pain on the bottom of the heel. It occurs when this strong band of tissue becomes irritated and inflamed.

Causes. Plantar fasciitis can be caused by biomechanical flaws, including flat, high-arched feet and tight calves muscles; excessive pronation and being overweight. In some cases, plantar fasciitis can develop without a specific, identifiable reason. Especially for runners, sudden increases in training mileage; beginning speed or hill work; wearing worn or inappropriate running shoes; running on hard surfaces, like asphalt or concrete; or wearing high heels all day before switching into flat running shoes can overload the plantar fascia and lead to plantar fasciitis.

Symptoms.  Plantar fasciitis sufferers feel a sharp stab or deep ache in the middle of the heel or along the arch. Another sign is the morning hobble from the foot trying to heal itself in a contracted position overnight. Taking that first step causes sudden strain on the bottom of the foot. The pain can recur after long spells of sitting, but it tends to fade during a run, once the area is warmed up.

Prevention and treatment of plantar fasciitis.  Plantar fasciitis can be a nagging problem, which gets worse and more difficult to treat the longer it’s present. To prevent plantar fasciitis, run on soft surfaces, keep mileage increases to less than 10 percent per week, and visit a specialty running shop to make sure you’re wearing the proper shoes for your foot type and gait. It’s also important to stretch the plantar fascia and calves muscles.

At the first sign of soreness, massage (roll a golf ball under your foot) and apply ice (roll a frozen bottle of water under your foot, 3 to 4 times a day). What you wear on your feet when you’re not running makes a difference. Arch support is key, and walking around barefoot or in flimsy shoes can delay recovery.

Rest.  Decreasing or even stopping the activities that make the pain worse is the first step in reducing the pain. Crosstraining (doing other sports, where your feet don’t pound on hard surfaces) is a good way to stay fit during your recovery.

Stretchings.  Plantar fasciitis is aggravated by tight muscles in your feet and calves. Ask your health care provider how to stretch these structures.

Ultrasound therapy.  Ultrasounds are helpful in reducing inflammation, increasing plantar fascia extensibility and in speeding the healing process.

Supportive shoes and orthotics.  Shoes with thick soles and extra cushioning can reduce pain with standing and walking. As you step and your heel strikes the ground, a significant amount of tension is placed on the fascia, which causes microtrauma (tiny tears in the tissue). A cushioned shoe or custom orthotics reduces this tension and the microtrauma that occurs with every step. Night splints. Most people sleep with their feet pointed down. This relaxes the plantar fascia and is one of the reasons for morning heel pain. A night splint stretches the plantar fascia while you sleep and is sometimes necessary to treat this condition.

Cortisone injections and surgery.  Cortisone is a powerful anti-inflammatory medication that can be injected into the plantar fascia to reduce inflammation and pain. However, it should be seen as a last resort solution, because multiple steroid injections can cause the plantar fascia to rupture (tear). Surgery gives usually good results. However, because it can result in chronic pain and complications, it is recommended only after all nonsurgical measures have been exhausted.

Lisfranc Injuries.

November 2019 newsletter.

Text from: Running doc’s guide to healthy running (Lewis G. Maharam).

Lisfranc foot injuries occur in the midfoot.  They’re named after French surgeon Jacques Lisfranc, who in the 1800s, as a member of Napoleon’s army, first described an injury sustained by mounted soldiers whose foot got caught in the saddle’s stirrup as they got thrown off the horse.  Nowadays, the injury happens when stepping into a pothole in the road, twisting the foot, or pushing off with force as a football lineman might do.  These injuries can be ligament sprains, dislocations of the joints between the forefoot and midfoot, or fractures of the bones in the midfoot complex. 

Anatomically, the Lisfranc joints are between the tarsometatarsal joints involving the cuneiform bone and metatarsal bones, as shown in the figure.  Only a small percentage of Lisfranc injuries are fractures or dislocations; most are sprains involving the ligaments. 

Diagnosis

After palpating the foot, twisting the midfoot and checking the pulse on the top of the foot (because the artery there can sometimes be injured, too), the health care provider will generally order standing and non-weight-bearing X-rays. 

Treatment

Treatment varies depending on whether the injury is a sprain or a fracture.  A sprain will usually be treated in a non-weight-bearing cast boot (meaning that you cannot walk on the cast and will have to use crutches) for about 6 weeks.  After removal, physical therapy and a very gradual return to sports usually take 8 to 12 weeks.  Fractures and dislocations will often require surgery.

Non surgical treatment

Rest – Rest is important to allow the inflamed ligaments to heal. Activities other than running which do not make the pain worse such as swimming or cycling should be done to maintain fitness.

Ice – Apply ice to reduce pain and inflammation. Ice should be applied for 10 to 15 minutes every hour until initial pain has gone then later 2 or 3 times a day and / or after exercise is a good idea.

Stretching and strengthening exercises – Your healthcare provider will prescribe you Stretching and strengthening exercises to enhance the healing process and prevent relapse.

Ultrasound – Use of electrotherapeutic treatment techniques such as TENS or ultrasound may help reduce pain and inflammation.

Train safely!

IT-band Syndrome.

October 2019 newsletter.

Text from: Sports Injury Clinic, The Sports Injury Clinic on the net.

Symptoms

Iliotibial band syndrome results in pain on the outside of the knee which is caused by friction of the iliotibial band on the side of the knee. It is also known as ITB syndrome.

Symptoms of ITB syndrome consist of pain on the outside of the knee, more specifically at or around the lateral epicondyle of the femur or bony bit on the outside of the knee. It comes on at a certain time into a run and gradually gets worse until often the runner has to stop. After a period of rest the pain may go only to return when running starts again. The pain is normally aggravated by running, particularly downhill. Pain may be felt when bending and straightening the knee which may be made worse by pressing in at the side of the knee over the sore part. There might be tightness in the iliotibial band which runs down the outside of the thigh.

Causes

Certain factors may make you more susceptible to developing runners knee or iliotibial band syndrome. A naturally tight or wide IT band may make someone more susceptible to this injury. Weak hip muscles, particularly the gluteus medius are also thought to be a significant factor. Over pronation or poor foot biomechanics may increase the risk of injury. If the foot rolls in or flattens, the lower leg rotates and so does the knee increasing the chance of friction on the band. Other factors include leg length difference, running on hills or on cambered roads.

Treatment

Rest – Rest is important to allow the inflamed tendon to heal. Activities other than running which do not make the pain worse such as swimming or cycling should be done to maintain fitness.

Ice – Apply ice to reduce pain and inflammation. Ice should be applied for 10 to 15 minutes every hour until initial pain has gone then later 2 or 3 times a day and / or after exercise is a good idea.

Stretching exercises – Stretching exercises for the muscles on the outside of the hip in particular are important. The tensor fascia latae muscle is the muscle at the top of the IT band and if this is tight then it can cause the band to be tight increasing the friction on the side of the knee. Using a foam roller on the IT band and gluteal muscles can help stretch the iliotibial band and remove any tight knots or lumps in the tendon.

Strengthening exercises – Improving the strength of the muscles on the outside of the hip which abduct the leg will help prevent the knee turning inwards when running or walking and therefore help reduce the friction on the ITB tendon at the knee. In particular strengthening exercises for the tensor fascia latae muscle and gluteus medius such as heel drops, clam exercise and hip abduction are important.

Ultrasound – Use of electrotherapeutic treatment techniques such as TENS or ultrasound may help reduce pain and inflammation.

Training modification – Errors in training should be identified and corrected. These can include over training or increasing running mileage too quickly. As a general rule a runner should not increase mileage by more than 10% per week. Running across a slope or camber in the road for long periods or poor foot biomechanics should be considered. Also avoid too much downhill running.

Train safely!

The Proper Running Form .

July 2019 newsletter.

Source :Text in part from Runnersworld.com, Ashley Mateo.  Image from Runtastic.com.

The better your form, the easier running feels — especially when you start to get fatigued. While everyone’s natural mechanics are different, here’s what you should be paying attention to when you run, from your head to your toes.

Your Head.  “Be sure to gaze directly in front of you,” says Kelli Fierras, USATF-certified running coach and ASICS Studio trainer. “Don’t tilt your chin up or down, which happens when people get tired,” she adds. “You want to have your ears in line with your shoulders.

Your Shoulders.  We spend so much time hunched over at our desks and on our phones, but it’s crucial to open up your shoulders while you run, says Amanda Nurse, an elite marathoner, running coach, and certified yoga instructor in Boston. “You should pull them back, almost like you’re squeezing a pencil between your shoulder blades,” she says.

Cadrée Runtastic

Your Arms.  “Your elbows should be at a 90-degree angle,” says Nurse. Your palms or fists move from chin to hip. Keep your elbows close to your sides. “If your elbows point outwards, that means your arms are crossing your body, which actually slows you down. Try pointing your thumbs to the ceiling to keep your arms in line or imagining an invisible line that runs down the center of your body—don’t let your hands cross over that line.

Your Hands.  Don’t forget to keep your hands relaxed. “I always think about pretending you have a potato chip between your index finger or your middle finger and your thumb so that your hands are really relaxed,” says Nurse “The more you squeeze your hands, the more energy that you’re getting rid of through your hands.

Your Torso.  In most forms of fitness, your core—which includes your back—is really where all your power comes from, and it’s also your center of gravity while running. “You always want to keep a tight core while running—it’ll prevent you from going too far forward or too far backwards,” says Fierras.

Your Hips.  When you’re running, you want lean slightly into the run versus running completely upright. “That lean should come from the hinge at your hips, not from rolling your shoulders forward,” says Fierras. That means your torso will be slightly forward of your hips.

Your Knees.  Your knee should be in line with the middle of your foot so that when your foot strikes the ground, it’s right under your knee. “You really want to focus of keeping that knee directly in front of your hips versus turning in or bowing out, which is very hard for people to train themselves to do,” she says.

Your Legs.  The easiest way to think about your lower body is to think about your shin being as close to perpendicular as possible when the foot hits the ground,” Mahon says. “If you land at that 90-degree angle, then you get to use your ankle, your knee joint, and the hip joint all at the same time to both absorb shock and then create energy.”

Your Feet.  There’s no right or wrong way for your feet to hit the ground, as long as you’re actually using them to push off (instead of just lifting them). That said, the idea is to aim to hit the road with the ball of your foot, Fierras says. Running on your toes or striking with your heel are both more likely to set you up for injury. If that’s how you run naturally, though, “rather than focusing on changing your stride, talk to an expert about getting into a proper shoe—maybe one with more cushioning—that will help you stay injury-free,” Nurse says.

Pack It Light. Wear it Right.

August 2019 newsletter.

Source : Canadian Chiropractic Association

It’s common for kids to lug around backpacks apprearing to be twice their body weight. Though it may seem cool to sling a heavy load over one shoulder – long-term head, neck and shoulder pain is not. Here are some helpful tips that will help your child carry their backpack with ease.

Backpacks can affect your child’s health

Carrying a heavy load can lead to poor posture and a distorted spinal column. Over time this can cause muscle strain, headaches, back, neck and arm pain, and even nerve damage.

A heavy backpack carried on one shoulder forces the muscles and spine tocompensate for the uneven weight. This places stress on the mid and lower back.

Choose the right backpack

  • Select a lightweight backpack in vinyl or canvas.
  • Pick a backpack with two wide, adjustable and padded shoulder straps, along with a hip or waist strap, and padded back.
  • Try the backpack for fit and comfort – ensure it’s not too snug around the shoulders and armpits, and that it’s proportionate to the wearer’s body type.

Packing it properly

  • Your child’s backpack should only contain what is needed for that day.
  • A full backpack should be no more than 10 to 15 per cent of the wearer’s body weight.
  • Place the heaviest objects close to the body and light or odd-shaped objects away from the back.

Putting the backpack on

  • Place the backpack on a flat surface and slip on the backpack one shoulder at a time, adjust the straps to fit comfortably.
  • When lifting the backpack use both arms and legs, and bend at the knees – give young children a hand.

 

Wearing a backpack

  • Backpacks should never be worn over only one shoulder – this can result in neck, shoulder and back pain.
    •Both shoulder straps should be used and adjusted so the backpack sits flush against the back.
    •Test the fit of the backpack by sliding your hand between the backpack and your child’s back – if you can’t slide your hand in, the backpack is too snug.

Digital x-rays.

The benefits of digital x-rays for chiropractic care

Since August 2019, our x-rays facilities are all digital.  Digital direct radiography (DR) produces images of outstanding quality. A flat panel detector directly converts the pattern of incident Xray energy into electrical signals. Imaging plates, cassettes and Xray scanners are no longer needed . The Xray images are available for diagnosis immediately after exposure. The advantages are numerous:

  • Use 70% less radiation than traditional film x-rays.
  • Take less time to take and are easier to take than traditional film x-rays.
  • Have better quality viewing capabilities than traditional film x-rays.
  • Take the waiting out of the development process allowing us to see what is going on immediately.
  • Prevent issues from going undetected and/or missed.
  • Are easily stored on a computer.
  • Can be easily transferred to your family doctor when referrals are needed.
  • Environmentally-friendly.

Runner’s knee.

June 2019 newsletter.

Source : Text in part from “Running Doc’s Guide”, by Dr. Lewis G. Maharam, MD.

Runner’s knee does not happen only to runners.  It is a condition with many names: chondromalacia patella, anterior knee syndrome, patella femoral disorder, and, of course runner’s knee.  It is seen every day by health care providers.  Understranding the real cause makes treatment easy and pain relief possible in a short period of time.

When it comes to runner’s knee, biology is destiny.  Anyone whose foot rolls inward (overpronation) during a stride is a candidate, but the real high-risk frontrunners are people with extremely flat feet; a large, pronating forefoot; or a Morton’s foot (a foot where the second toe is longer than the first), causing an exaggerated rolling in, or pronation.

Of all the aches and pains that one can get, this one’s probably the easiest to get rid of.  If you were doing some serious running mileage over the summer, maybe getting ready for a fall marathon, or pain came on “all of a sudden” without any apparent injury and your knee suddenly started to get sore when you walked up and down stairs, or you felt stiff when you were sitting in a movie, you most probably have it.  You could have come down with it when you were 12, or 65.  And the treatment, which is not complicated or extensive, is the same for everybody from kids to grandparents.

It all starts with the kneecap.  In a perfect world, your kneecap rides up and down in a V-shaped groove that sits just behind it as you walk, run or cycle.  More typically, however, your foot rolls in, or pronates, as you move from heel strike to toe-off, and the kneecap ends up scraping along one side of the groove instead of sliding smoothly up and down the middle.  The cartilage there doesn’t much like getting sandpapered down that way, nor does the back of the kneecap, which begins to weep fluid that in turn produces a feeling of stiffness. 

It a easy condition to diagnose: joint hurts, no particular injury caused it, worst going upstairs and downstairs or walking down an incline, stiffens after sitting a while, feels like it needs to be stretched. 

Despite what you may have read, arthroscopic surgery is not the immediate answer.  Surgery helps perhaps 1 out of 100 sufferers.  One favored operation consists of mechanically smoothing the rubbing surface of the kneecap; this treatment can give relief for six months or so, but unless your biomechanics have changed, it’s a borrowed-time fix. 

A proper orthotic is the single most important step because it will prevent the roll that caused the scraping in the first place.  The good news is that once you start wearing the orthotic, your knee cooperates quickly; the patella, cartilage that’s been rubbed down is able to regenerate and heal itself.  Just give it the chance.

But orthotics alone won’t do it.  You need your other ally, the medial quad, which is the muscle in the front inside of your thigh that’s supposed to hold the kneecap in the center of the groove.  The stronger your medial quad muscle is, the better it can do its job.  To strengthen it, you need to perform the “terminal” leg extension exercises (see image), which limit the motion to the last 6 inches of extension.  Do them daily until the pain disappears, then twice weekly.  And do both legs, please, even if only one leg hurts.  Your knees are a matched pair, and what’s already happened on one side is a good bet for the other someday.

Knee sleeves and elastic bandages are out.  Think about it.  If you compress the kneecap, every motion will press it into the groove.  Keep it loose and free.  So make these exercises a part of your weekly routine, keep wearing your orthotics and you can rid yourself of this unnecessary pain forever.

Limited quad extensions for runner’s knee.  1. Sit up on a desk or high surface, stick your leg out straight, drop it about six inches, and if possible support it with a chair or stool.    2. Wrap your ankle with a weight bag or strap made for the purpose.    3. Lift only the last six inches (about 30 degrees) to full extension, hold for three seconds, and then come slowly back down.  Do 5 sets of 10 reps each day, with just enough weight that you get to 5 or 6 on that fifth set and have to stop.

Achilles Tendinitis

Text from “Running Doc’s Guide to Healthy Running”, from Dr. Lewis G. Maharam, MD.

Any sport that keeps you on your feet and uses a pushing-off motion can produce Achilles tendon trouble. Orthotics are usually prescribed, but stretching is always your first defense.

The Achilles tendon, which is formed from your calf muscles, can be pushed beyond its limits and become inflamed. That’s the tendinitis to wich most athletes ascribe pain. There can also be some swelling tendinosis, or chronic tendinitis, above the upper heel. But every time the tendon gets inflamed, and certainly every time the pain comes from more serious microtears in the overused tissue that can easily be mistaken for tendinitis, the Achilles grows just a little weaker.

What brings the condition on besides simple overuse? The Achilles is vulnerable to misuse. Designed to do its job of guiding the heel in a vertical plane, it’s intolerant of the rolling of the ankle when it overpronates (rolls inward) or supinates (rolls outward). Stretching and an orthotic can help prevent the inflammation by biomechanically allowing the tendon to pull in proper alignment.

But a calf muscle routinely loosened by conscientious stretching every day and after a workout cuts the tendon some slack, particularly in stiffer athletes, reducing the tendon’s role as a shock absorber – for witch it’s not very well suited anyway.

So on those hectic days when stretching seems too much of a bother, remind yourself that a neglected and partially torn tendon needs to rest and heal in a cast for six to eight weeks unless you like courting a rupture.
And if that tendon does pop? The gulf between the two ends creates a hole you can actually feel. A clock has just started ticking, during which the tendon’s two ends will drift apart. As soon as possible you must decide if you want the rupture repaired by surgical reattachment of the ends – the best choice for most athletes. After the operation, you will have to wear a cast or cast boot at first and then undergo probably 9 to 12 months of therapy. The sooner the surgery’s done, the easier the repair. Or you can just go into a cast for maybe 8 to 12 weeks and accept whatever healing nature is able to provide – probably a weaker result and longer recovery. Given all this, a couple of minutes of prevention does not seem like such a bother after all…

So what do you do if stretching alone doesn’t work? The longer you take before you seek help, the longer the problem will take to fix. All structures in the body constantly remodel (at different rates). The Achillles tendon gets its strength by its fibers lining up in parallel. In its originating calf muscles are inflexible, living in an environment of overpronation and inflammation (tendinitis), remodeling proceeds with the fibers lining up every which way instead of parallel. This results in a weakened, swollen, painful tendon, which is the definition of tendinosis (instead of tendinitis). This tendon is more easily prone to tear, and you will need a full-length flexible orthotics (worn full-time instead of just when running) and physical therapy for eight or more weeks minimum.

Recreational activities to minimize stress and prevent back pain.

Source: Canadian Chiropractic Association.

Going to the chiropractor can help relieve pain and prevent injuries, but being active is also a great way to help keep your spine healthy. Just going for a brisk 10 minute walk each day is enough to help improve your health and prevent conditions of the spine, joints and supporting structures of the body. But there are also a few other recreational activities that you can incorporate into your daily routine to prevent back pain and reduce stress.

Here are a few suggestions and why you may benefit from them:

Yoga and Pilates:

Yoga and Pilates are forms of exercise that typically focus on moving the body while focusing on breathing and body awareness. The poses are purposeful and usually work a few areas of the body at once, including the back and leg muscles to build a stronger foundation for other movements. Also, the poses often focus on balance which can be important to prevent falls and injuries as we age. Compared to higher impact activities that cause added strain to the body, Yoga and Pilates are known to be ‘safe’ for healthy and even injured individuals. Yet, with most practices being keenly aware of your body is important and adapting movement to your skill level. However, regular practice has been shown to decrease back pain. The great thing about Yoga and Pilates is that there are several types of classes catered to your specific skill and comfort level.

Aquafitness

Aquafitness is a dynamic, low impact activity that usually involves the entire body in movement, including the abdominals, gluteal, and leg muscles. Since the movements are done in water, the water adds extra resistance to strengthen muscles but also minimizes impact on your joints. Aquafitness has been shown to be an effective management tool for those suffering from certain MSK injuries allowing them to keep active. Notably, people suffering from low back pain may particularly benefit from aquafitness or gently swimming in water.

Tai Chi

This Chinese martial art focuses on meditative, deep breathing combined with methodical practice of slow movement enhancing mobility and balance among those who practice the art. Tai Chi is known to have major health benefits – even for those with back pain. Tai Chi can improve pain and function, while decreasing likelihood of chronic pain. It is a safe and effective activity for those experiencing long-term back pain symptoms.

Other activities you may want to consider are low-impact cardiovascular exercises such as walking or striding on the elliptical machine. There are always alternatives to staying active, even when you experience pain. Some of these can even help relieve the pain.

If you’re looking for ways to stay active and relieve pain, meet with your chiropractor to discuss more options.