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Heel Pain: 5 Top Tips to Ease Plantar Fasciitis

Plantar fasciitis is an inflammation of the thick band of fascial tissue that connects the heel bone to the toes on the sole (plantar aspect) of the foot.

Plantar fasciitis is most common in runners particularly those who run on hard surfaces but also occurs in people who have to stand for long periods of time; those who wear poor footwear, such as shoes with little cushioning or arch support; people who pronate as the stand or walk; sudden weight gain, such as pregnancy; tightness, overuse or poor biomechanics in the calf and Achilles tendon.

Foot pronation, where the arches collapse and put pressure on the medial aspect of the foot and plantar fascia

Symptoms include a sharp “stabbing” pain in the heel on standing or walking, particularly in the morning or after long periods of sitting, a “burning” horseshoe ring of pain in the back of the heel, and tension in the Achilles tendon and the calf, all leading to limping while walking. The pain is likely to ease on movement throughout the day.

One of the most common foot complaints it effects 10% of people at some time during their life. While men can get plantar fasciitis, it’s more commonly reported in women, those with very high or low foot arches, pregnant women and those with poor biomechanics while walking or running.

A physiotherapist or podiatrist can make a diagnosis based on your symptoms, although if it has been present for a long period of time (6 months or more), a bone spur may have developed and will require an ultrasound for diagnosis.

Plantar fasciitis is considered a chronic issue and should be treated as soon as possible. The longer it goes on for, the worse it will be come and the harder it will be to treat.
A combination of different treatments may help; 
1. Rest- ease off the running and switch to swimming or a low impact exercise to rest the feet; 
2. icing the sole of the foot and elevation at the end of the day will help ease the inflammation – keep a bottle of water in the freezer for rolling on the bottom of the foot;
3. wearing appropriate footwear such as shoes with good cushioning and appropriate arch supports – be fitted for running shoes that support your arch and cushion your heel, put away the high heels and switch to comfortable flats, orthotic supports from a podiatrist or heel pads inside shoes can also help ease the pain;
4. stretching to the calves and hamstrings, before and after exercise or a day on your feet, rolling the sole of the foot over a ball to stretch the fascia are all good at home treatments;
5. massage, acupuncture and electro and dry-needling are very effective treatment options.

While needling the sensitive areas of the foot can be a daunting prospect there is good evidence it can be used as a good alternative option before proceeding to more invasive therapies of plantar fasciitis.

Shock wave therapy for heel pain

If the condition goes on untreated, it can lead to complications such as spurs in the heel and may require more invasive treatments such as steroid injections, shockwave therapy or surgery.

There are certain things that you can do to try to prevent plantar fasciitis, especially if you have had it before. These include:
• being fitted for, and regularly updating training shoes used for running or walking;
• wearing shoes with good cushioning in the heels and appropriate arch support;
• reducing body weight, not always an easy option but it can take the pressure off the bottom of our feet;
• stretching the plantar fascia and Achilles tendon, especially before exercise;
• avoiding exercising or standing on hard surfaces.

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Four easy exercises to ease Achilles tendonitis

What is Achilles tendonitis?
Achilles tendonitis (also known as Achilles tendonitis, Achilles tendinitis, Achilles tendon pain, Achilles tendinosis, Achilles tendinopathy) is inflammation of the Achilles tendon. The Achilles tendon is a tough band of fibrous tissue that connects the calf muscles to the heel bone (calcaneus). The Achilles tendon is also called the calcaneal tendon. The gastrocnemius and soleus muscles (calf muscles) unite into one band of tissue, which becomes the Achilles tendon at the low end of the calf. [1]

Anatomy of the heel

How do you get Achilles tendonitis?

Achilles tendonitis is an overuse injury that can occur with over training or poor biomechanics due to anatomy or poor footwear.

Common causes of Achilles tendonitis include;

  • Over-training or unaccustomed use – “too much too soon”
  • Sudden change in training surface, such as grass to bitumen
  • Flat (over-pronated) feet
  • High foot arch with tight Achilles tendon
  • Tight hamstring (back of thigh) and calf muscles
  • Toe walking (or constantly wearing high heels)
  • Poor footwear
  • Hill running
  • Poor eccentric strength [2]
Excessive high heel wearing can lead to Achilles tendonitis

What are the signs and symptoms of Achilles tendonitis?
The main signs and symptoms of Achilles tendonitis are pain in the Achilles area, particularly on walking/running and swelling around the back of the heel and Achilles tendon. Other symptoms include tight calf muscles, poor range of motion in the calf and ankle and the feeling of heat or burning in the heel.

Who gets Achilles tendonitis?
Achilles tendonitis is a very common runner injury . It can however, also affect athletes, basketballers, dancers, or people who put a lot of repeated stress on their feet.

Those with an over-pronating gait due to high foot arches can often be inflicted with chronic Achilles tendonitis and have to manage the injury for life.

How is Achilles tendonitis treated?
Most cases of Achilles tendonitis can be treated at home before it gets too severe.

Use the RICER formula:

  • Rest: Don’t exercise for a few days, or try an exercise that doesn’t stress your feet, such as swimming.
  • Ice: Apply an ice pack wrapped in a towel or a cold compress to your tendon for 10 minutes or more after you exercise or if you feel pain in the tendon.
  • Compress: Use tape or an athletic wrap to keep swelling down and help support and immobilise the tendon.
  • Elevate: Lie down and raise your foot above the level of your heart, and if possible, try to sleep with your foot elevated. This will help keep the swelling to a minimum.
  • Refer: See a physical therapist, such as a podiatrist and a massage therapist for treatment
  • Take anti-inflammatory medications. Pain relievers like ibuprofen can help ease pain and reduce swelling in the short term.
  • Stretch and exercise your ankles and calf muscles while you recover. Keeping your muscles, tendons, and ligaments strong and flexible will aid in your recovery and help you keep from re-injuring your Achilles tendon. A physical therapist can help you come up with a good exercise program.
  • Prescription orthotics. Orthotics can be helpful if you have poor biomechanics. Talk to your GP or a podiatrist to find out if they might work for you.
  • Massage. Remedial massage can help manage the muscle tension in the hamstrings and calves and help reduce swelling around the Achilles tendon [3]

What stretches should I do for Achilles tendonitis?

Calf Stretch: Place your hands on a wall with one leg straight and the heel to the ground. Place the other leg, with the knee bent, in front of the straight leg and push your hips toward the wall. Stretch your calf to the point where you feel a strong pull but no pain. Do not let your heels come off the ground. Hold the position for 20-30 seconds, and then relax. Repeat 3 times on each foot in a slow controlled manner.

The same stretch can be repeated, with both front and back knees bent.

Straight Leg Calf Stretch

Seated Heel Raises: Sit on a chair and raise your toes up as high as you can without pain. Slowly lower your heels. Do 5 repetitions, 4 times a day. You can gradually increase the intensity, as you get stronger by holding a weight on your thighs.

Seated Calf Raise

Following are some other exercises you can do, but they should be done under the supervision of a physical therapist, at least initially, because they could damage the Achilles tendon if they’re not done correctly:

Bilateral Heel Drop:  Stand at the edge of a stair or a raised platform that is stable. Put the front part of each foot on the stair. This position allows your heel to move up and down without hitting the stair. Hold on to a railing or support to help your balance.

Slowly lift your heels off the ground and slowly lower your heels to the lowest point possible. Be sure to do this in a controlled manner 20 times. You can also do this starting on the floor rather than the stair.

Unilateral (Single Leg) Heel Drop: This is similar to the bilateral heel drop except it’s done on one leg while the other leg is bent. Raise your heel off the ground and slowly lower it down. Do it in a slow controlled manner. Then switch to the other leg. [4]

Unilateral Heel Drop

 

 

 

 

 

 

 

 

 

 

 

 

 

[1] https://www.webmd.com/fitness-exercise/picture-of-the-achilles-tendon#1

[2] http://physioworks.com.au/injuries-conditions-1/achilles-tendonitis-tendinitis

[3] http://m.kidshealth.org/en/teens/achilles.html#kha_11

[4] https://www.webmd.com/fitness-exercise/stretch-achilles-tendon

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Magnesium: what is it & what does it do for you?

I regularly recommend my clients use magnesium, either in the form of a supplement, topical cream or oil, or as salts dissolved in a warm bath.

But what is magnesium, and what does it do for our body?

The Science

Magnesium

Magnesium is a chemical element. It is the fourth most common element on Earth, and the third most common dissolved in seawater. Magnesium is the eleventh most abundant element by mass in the human body and is essential to all cells and some 300 enzymes.

The important interaction between phosphate and magnesium ions makes magnesium essential to the basic nucleic acid chemistry of all cells of all known living organisms. More than 300 enzymes require magnesium ions for their catalytic action, including all enzymes using or synthesizing adenosine triphosphate (ATP).

Now I don’t want this to turn into a boring chemistry lecture, but ATP is a complex organic chemical that participates in many processes, including providing energy for nearly all of the body’s metabolic processes and muscular contraction. 20% of the body’s magnesium is for skeletal muscle function.[1]

Magnesium is also an imperative part in;

  • Nerve conduction
  • The production of energy from carbohydrates and fats
  • The production and maintenance of healthy bones, including the synthesis of bone matrix, bone mineral metabolism and the maintenance of bone density
  • Maintenance of healthy heart function and normal heart rhythm.[2]

Where can we source magnesium?

The Source

Nuts, Greens, Cocoa & Spices

Spices, nuts & seeds, cereals, cocoa (W00T!) and leafy green vegetables are rich sources of magnesium. [3]

Thankfully, if we are not getting enough magnesium in our diet, or are experiencing symptoms of magnesium deficiency alternative methods for magnesium intake is readily available.

Bath salts

Magnesium chloride

Magnesium chloride is extracted from seawater and is more readily absorbed through the skin than other forms of magnesium, so it’s perfect for bath salts. It is not for ingestion.

Magnesium sulfate

Magnesium sulfate is more commonly known as Epsom salts. A great source of magnesium and available in most supermarkets and chemists, Epsom salts have been popular since it was discovered in the British town it was named after, in the 17th century. [4]

Topical creams and oils

As both magnesium chloride and sulfate are absorbed through the skin, they make great topical applications and are available in creams and oils that can be rubbed directly on the sore or cramping muscle. Great for carrying in your sports or travel bag and cant get to a bath.

Topical spray, supplements, bath salts

Supplements

Magnesium itself cannot be absorbed and needs to be bonded to another molecule to be absorbed. The most common bonding agents are oxide, citrate, glycinate, sulphate or amino acid chelate.

This is the least absorbed form, but also has one of the highest percentages of elemental magnesium per dose so it still may be the  highest absorbed dose per mg. This is a great general purpose magnesium if really Mg is all you need.  It makes a simple muscle relaxer, nerve tonic and laxative if you take a high dose.

This is one of the most common forms of Mg on the commercial market. This is Mg bonded to citric acid, which increases the rate of absorption. Citrate is a larger molecule than the simple oxygen of oxide, so there is less magnesium by weight than in the oxide form. This is the most commonly used form in laxative preparations.

In this form, Mg is bonded to the amino acid glycine. Glycine itself is a relaxing neurotransmitter and so enhances magnesium’s natural relaxation properties. This could be the best form if you’re using it for mental calm and relaxation.

Magnesium amino acid chelate is usually bonded to a variety of amino acids. In this form there is less magnesium by weight but the individual amino acids could all be beneficial for different things. Every formula is different so if you need both Mg and a particular amino acid, then this could be the way to go. [5]

Recommended daily intake of magnesium is;

  • 400 mg/day for men aged 19-30 years, increasing to 420 mg/day for those aged 31 and above,
  • For women aged 19-30 years, the RDI is 310 mg/day, increasing to 320 mg over the age of 30,
  • Depending on their age, the RDI for adult women who are pregnant is 350-360 mg/day.
  • The RDI for breastfeeding for those who are breastfeeding is 310-320 mg of magnesium each day. [6]

What happens if I don’t have enough magnesium?

The Symptoms

If you’re not getting enough magnesium in your diet then you may be experiencing symptoms such as;

  • Muscular cramp

    Muscular problems such as cramps, twitches, slow to recover from injury, aches and pains,

  • Fibromyalgia is sometimes linked to magnesium deficiency,
  • Migraines and headaches, including tension headaches,
  • Period pain and symptoms of premenstrual syndrome, including mood swings , fluid retention, premenstrual migraines,
  • Stress, irritability, insomnia and anxiety,
  • Fatigue, which may be a symptom of magnesium deficiency.

It may also play a role in helping to maintain cardiovascular health and healthy bone density.

What could be causing my magnesium deficiency?

The Seed

  • Stress (especially when prolonged or severe),
  • Inadequate sleep,
  • Profuse perspiration,
  • Excessive consumption of caffeine, salt, sugar and alcohol,
  • Heavy menstrual periods,
  • Eating large quantities of processed and refined foods,
  • The use of some multiple pharmaceutical medications,
  • Gastrointestinal disorders such as short-term diarrhoea or vomiting and conditions that affect your absorption of nutrients,
  • Getting older. [7]

Can I have too much magnesium?

Doses less than 350 mg daily are safe for most adults. When taken in very large amounts, magnesium is possibly unsafe.

Symptoms of magnesium overdose include;

  • diarrhea
  • nausea and vomiting
  • lethargy
  • muscle weakness
  • irregular heartbeat
  • low blood pressure
  • urine retention
  • respiratory distress
  • cardiac arrest. [8]

 

The best way to ensure you’re getting enough magnesium is to maintain a healthy diet of whole foods and steer clear of processed and refined foods. If you are getting regular cramps or muscular pain it might be a good idea to get some advice from your physical therapist.

Maintaining muscular health can be as easy as regular gentle exercise and stretching, fresh air and water each day, a 20 minute magnesium bath a week, some leafy greens and nuts in your diet and regular massage.

If you think you have a serious magnesium deficiency you should consult your doctor.

 

Have you ever used magnesium? How did it work for you?

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Runners Knee, it’s not just for runners


 itb-syndrome-mWhat is ‘runners knee’?
Runners knee, or iliotibial band friction syndrome (ITBS) is when iliotibial band irritates the lateral (outside) of the knee to cause knee pain.
The band is thought to be a type of tissue with little or no elasticity, similar to a tendon, that runs from the hip joints along the femur (thigh bone) and works with the quadriceps (thigh muscles) to provide stability to the outside of the knee joint during movement.
What are the signs and symptoms?
Pain on the outside of the knee, particularly during activity such as running. Pain is likely to get worse until the activity is stopped, only to start again once activity resumes. Running downhill or on banked surface is likely to cause more irritation.
Who gets iliotibial band friction syndrome?
Most common in runners particularly women but can occur in anyone.
Poor posture and/or poor biomechanics such as over-pronation of the foot may increase risk of irritation. Also weak hip flexors and gluteals can increase risk of developing the injury. Overuse, increase of training too fast, returning from injury too soon can all lead to ITBS.
How is iliotibial band friction syndrome treated?
• Rest
Take a break from running. Try an alternative such as swimming that does not put pressure on the same structures.
• Ice & heat therapy
In the initial stages of inflammation use ice or cold packs for 10-15 minutes every hour until the pain has eased. Then repeat 2-3 times per day or after exercise until the pain does not return. Once the initial inflammation has eased, the muscles around the ITB may require heat to ease tension. Apply a heat pack for 10 minutes a day to keep the joint from stiffening at times of rest.
• Stretching and foam rolling
Stretches to the quadriceps, hip flexors, hamstrings, TFL and gluteals will all help take the pressure off the ITB (see below). Using a foam roller to self massage is always a great way to treat any injury at home.

TIP: rolling directly over the ITB can be quite painful. Try rolling the quadriceps and hamstrings, and then then the hip flexors, just below the front hip bone instead.

ilotibial-band-foamroller • Physical therapy including massage, acupuncture and electrotherapy can be very effective for ITBS
• Strengthening exercises
Strengthening the gluteal muscles and the hip abductors, on the outside of the hips will help take the pressure of the ITB
For example
Heel drops, clam exercise and hip abductions

ClamShell
Clam Shell exercise
HipAbd
Hip Abductions
Heeldrp
Heel Drops

 

• Modification to training, footwear and biomechanics

How can massage help?
Massage will help release the tight muscles around the ITB to, in turn, help release the ITB. This may include the muscles that feel weak like the gluteals.
Are there any complications?
Typically there are no long-term complications of iliotibial band syndrome but without taking proper steps to reduce the pain and correct any biomechanical problems, the pain may persist.
How can I avoid getting iliotibial band syndrome?
Running on a flat or soft surface. Wearing arch support and having adequate footwear for training. Adequate warm up and stretching each time you exercise and modifying your training routine will help.
References
http://sportsmedicine.about.com/od/flexibilityandstretching/qt/IT-Stretch-B.htm

http://www.sportsinjuryclinic.net/sport-injuries/knee-pain/iliotibial-band-syndrome

Stretches for ITB

itb_stretch
Standing ITB stretch
PigeonPose
Pigeon Pose

 

 

 

 

 

Stretches for runners from “Stretching” by Bob and Jean Anderson

Stretches 3, 4, 5, 7 are recommended for ITBS

Screen Shot 2015-06-15 at 5.39.11 pm

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Shin splints or Compartment Syndrome

Shin Splints

Shin splints, a common term used amongst the athletic community, describes chronic shin pain resulting from overuse.

It occurs in two regions of the leg.

imageWhen it occurs in the front outside region of the leg, it’s called anterior shin splints. Shin splints is also regularly seen in the lower inner region of the leg, where it’s called posterior shin splints or medial tibial stress syndrome (MTSS).  Anterior shin splints is routinely confused with another overuse condition of the lower leg called chronic extertional compartment syndrome.image

Anterior shin splints usually result from overuse of the muscles the flex the foot down, for example, the muscles used when running downhill.  The condition usually occurs after continual repetitive use or sudden onset or increase of use. Most complain of the pain occurring at the beginning of exercise and then easing with use, only to return after stopping, even hours after.

What causes shin splints?

Anterior shin splints is usually an imbalance of the muscles of the calves and muscles of the front of the leg, usually afflicts beginners or runners who do not stretch enough. It is more likely to afflict the foot of the dominant side. For example, right handed people are more likely to suffer shin splints in their right leg.

Frequent cause of MTSS is over pronation, inadequate stretching, worn shoes or excessive stress placed on one leg from running in one direction, such as on a track.

It is suggested that during overuse the muscle separates itself from the shin bone, which results in inflammation and pain.

How to treat shin splints?

Rest

Firstly you need to rest. Stop what is causing the pain, ice your shin to reduce the pain and inflammation. Start some rehabilitation such as stretching and strethening exercises after you have rested. Over-training or not addressing the issue as it arrises, may lead to serious injury.

exercise-to-treat-shin-splints

Exercises

Ankle flexes, with bent knee and straight knee
Seated on the floor, use a thermoband wrapped around the foot to flex the ankle forward. Do this first with a bent knee, and then with a straight knee

Toe flexes
Seated on the floor with a straight leg, wrap the thermoband around the toes and flex forward

Ankle rotations
Seated on the floor with a straight leg, wrap the thermoband around the sole of the foot and rotate the foot. Do this in both directions.

Heel & toe walk
First walk on your heels on a soft surface (carpet) for 25metres. Then walk back on your toes.

Standing calf raises
Standing on a step, raise up onto your toes and hold for 10 seconds. When you come down, go past the level of the step so your heel dips down. Do ten of these.

Standing toe raises
Leaning against a wall, raise your toes up, so you’re on your heels. Hold for a few seconds.
Or you can perform a simple toe tap, this can be done anywhere, anytime.

Glute, core and pelvic strengthening
Any glute, core or pelvic strengthening will help take added pressure of the legs.

Stretches and massage

Stretching can increase range of movement and help reduce any tension that may be causing your pain. It’s not always the cause but is an important part of recovery process.

Front of shin stretch
Kneel on the ground and sit back on your heels. Stretch the front of your shins. Hold for 15 seconds. If this is too strong, stand, with the top surface of your toes on the floor, stretching the front of your shin

Calf stretch
Keep your knee straight and place your toes to the edge of a platform. Feel the stretch in the calf and the bottom of the foot. Hold for 15 seconds.

Achilles stretch
Follow the same steps and bend your knee to target the stretch to achilles and lower calf. Hold for 15 seconds.

Hip flexor stretch
Start by standing straight, bend your knee forward and step straight back to the ball of your foot. Keep your hips even and hold the stretch for 20 seconds.

Knee to chest
Laying flat on your back, bring the right knee toward the chest as far in as possible. Hold for 15 seconds. Repeat with the other leg.

calf-foam-rollFoam roller techniques for calf and shins (go easy on the foam roller, as this can be quite painful)

When treating shin splints I will use a combination of myofascial release, with both cupping and dry needling, and some deep tissue massage. Releasing through the longitudinal fascial lines from the lower back, the hamstrings, calves and bottom of the foot. Warming the tissue of the calf with some massage and then muscle stripping of the individual muscles of the calf and shin. Then treating any remaining trigger points through the major calf muscles with deep ischemic pressure. I would then have the client turn face up and treat any remaining trigger points in the front of the shin, either with deep ischemic pressure or dry needling.

Wear the correct footwear

Being fitted for the correct footwear for you can make all the difference.

Avoid hard running surfaces

Hard surfaces have greater impact on your body and can cause trauma to the shins. Dirt, grass or unpaved surfaces are better than the footpath or road.

Also add variety to your training, as repetitive motion, such as running on a track in the same direction can add stress to your body.

Strengthen core and glute muscles

This will take further pressure off the muscles of the lower leg by being able to balance and control your legs more effectively .

There are various other supportive methods for shin splints such as, tapping, compression sleeves, ice and heat treatments. It’s best to see your physical therapist to help you with these treatments, to learn the best techniques on how to use them.

Compartment Syndrome

Fascia surrounds all our muscles and groups of muscles in compartments. Compartment Syndrome is increased pressure of fluid within the body’s compartments that contain muscles and nerves. Most commonly occurs in the lower leg and can often be misdiagnosed as shin splints. Chronic Exertional Compartment Syndrome is what most runners experience. It is induced by overuse and exercise where the pressure in the muscles increase to extreme levels. This creates a decrease in blood-flow and deprivation of oxygen to the muscle.

Symptoms include sensation of extreme tension in the muscle and burning increasing through exercise.  The pressure usually decreases after exercise has stopped and the pain will be relieved.

Chronic or chronic exertional compartment syndrome are not emergency situations but can cause permanent damage to the muscle and nerve function of the limb.

Treatment

Calf-massage-300x200Conservative treatment to reduce the pressure include rest, anti-inflammatory medications and manual decompression such as myofascial release. Do not elevate the limb or apply pressure to the area. Instead lie with the limb at the level of the heart. Massage can help once the inflammation has gone down.

Invasive treatment such as surgery can be an effective for sufferers of compartment syndrome.