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How might orthotics help me?

Posted on 10th March 2018 by

Orthotics are prescribed and worn for a variety of reasons. They are also known as insoles, shoe inserts or orthoses.

The most common reasons orthotics are recommended are:

  • Arch and heel pain (Plantar Fasciitis)
  • Lower leg tendonitis (Achilles tendonitis and posterior tibial tendon dysfunction)
  • Shin splints
  • Knee pain, such as chondromalacia patellae, iliotibial band syndrome (Runners knee)
  • Leg length discrepancy
  • Low back pain

Orthotics work by improving foot efficiency, lower limb alignment, therefore reducing stress on the problem area resulting in pain relief.

Although some people adapt to orthotics very quickly, you should gradually adjust to them by wearing them for a few hours more each day. You should avoid using them for extended activity, including sports, until you feel fully comfortable.

They should be comfortable and used whenever you are doing the activity that would normally aggravate your condition. If you need orthotics, they can improve your overall comfort in your lower limbs and feet.

We are able tosses whether you’d benefit from orthotics by combining our knowledge & expertise of injury and how the foot and ankle works with a dynamic computerised foot scan. Following this we can make appropriate recommendations based on your individual case and circumstances.

Read More

What are orthotics?

Overuse injuries

Top 5 Running Injuries and How To Manage Them

 

 


Top 5 Running Injuries & How to Manage Them

Posted on 29th January 2018 by

The top 5 running injuries. In this blog, I will share with you some insider information built up over a lifetime of clinical practice in the sports injury sector, treating 1,000’s of active patient’s with overuse, lower limb injuries.

I’d like to shed some insider light on the 5 most common running injuries and debunk some myths, helping you understand these injuries better, and give you some guidance on how to prevent and manage them if they do occur.

5 Most Common Running Injuries

The 5 most common running injuries we see here at goPhysio are:

  • Plantar Fasciitis
  • Achilles Tendonopathy
  • Calf Tears and trigger points
  • Anterior Knee Pain
  • Gluteal / Piriformis syndrome

Interestingly enough, all these injuries can originate from a similar movement dysfunction.

Starting at the foot with flattened foot arches or over-pronation, there is often a chain of biomechanics events leading up the leg to the trunk. These are nicely illustrated in this diagram. .Biomechanics chain of events

 

Plantar Fasciitis

Plantar-fasciitis is a fancy, latin word for inflammation of the plantar fascia. The plantar fascia is a thickened sheet of fascia (connective tissue) on the sole of the feet, it’s elasticity gives us a spring in our step when walking or running. The cause of plantar-fasciitis is linked to it being on an excessive stretch for prolonged periods of time, when the arches in your foot are too flat. So on push off when walking or running it’s excessively overloaded and stretched and overtime micotrauma, inflammation, pain and injury can result. Read more about plantar fasciitis here.

Achilles Tendonopathy

Flattened foot arches results in an inwards collapse of the heel bone (calcaneum) into which the achilles inserts. Thus with each step the heel bone excessively moves side to side, in a side-to-side whipping type motion of the achilles resulting in a build of force, overuse, microtrauma, inflammation, pain & injury! Read more about achilles tendon injuries here.

Calf Tears & Recurrent Myofascial Trigger Points

Again a similar mechanism to above. Over time, the calf muscles become tense and tight, they tend top hold a long term dull background contraction in an attempt to control the inward collapse of the heel bone. This increased tone is aggravated by running (we take approx 1,000 steps per km, per foot), resulting in tense, tight, overactive and painful muscles, which worsen with running and can become a long term or chronic issue. It feels especially tight after hill sessions, when the calf or achilles is also on stretch. Read more about calf tears here. 

Read more about the treatment of calf tears here.

Anterior Knee Pain

Anterior knee pain is an umbrella term, used to describe a wide range of injuries causing pain in the front of the knee. Although everyone is unique, in runner’s it is often linked to flattened foot arches and the inward collapse of the heel with it’s knock on effects felt through the whole kinetic chain (as per the diagram above). This inward heel collapse causes the shin bone (tibia) to rotate inwards and the knee will fall inwards, resulting in an asymmetrical build of of forces in structures around the front of the knee and some of the most common running knee injuries, namely; Infra-patellar tendonopathy, Patello-femoral joint map-tracking and Ilio-tibial Band friction syndrome (ITB syndrome). Read more about runners knee here.

Gluteal / Piriformis Syndrome

So, as the heel collapses inwards, we get internal rotation of the legs and hips. Subsequently, the gluteal (buttock) muscles become tense and tight in an attempt to control the inward rotation and movement of the leg and hip. This increased tone over a run (approx 1,000 steps per km, per foot), can result in tense, tight, overactive painful muscles. This often worsens with running and can become long term or chronic, which often results in referred pain travelling down the leg mimicking sciatica. Over my career I’ve even seen patients with this condition that mistakengly have been operated on, (the Surgeon thought it was a disc injury causing the sciatica) when it was merely this “Piriformis syndrome” referring into his leg.

The Solution

With all of these conditions, it’s crucial to understand that……..

the injured structure is actually the victim, the true cause is the uncontrolled movement!

Effective management of such injuries therefore needs to address the following:

From the foot upwards – Fully assessing foot position and biomechanics, looking at incorporating custom orthotics to correct the foot positioning and alignment and control excessive movement and rotation from the foot up the whole lower limb.

From the spine / “core” downwards – This is a crucial and often forgotten element, improving muscle stability and movement control throughout the body. Pilates is great for this.

Reduce inflammation – Ice and non-steroidal anti-inflammatories are an effective way to reduce inflammation in the early stages.

‘Hands-on’ Physio treatments – In the early stages, massage and acupuncture to normalise muscle tone, taping to correct alignment and ultrasound to stimulate natural healing, can all be effective ways to help ease pain and discomfort to help you quickly progress into active recovery.

Selective rest – Means to just rest from the aggravating (pain causing) activities, whilst actively participating in non-aggravating activities such as swimming or cycling to maintain movement and fitness. As we’re designed to move, movement in itself is therapeutic. We can really help guide you on this, as many people think if they have an injury they just need to completely rest.

Running Rehabilitation – Specific exercises, training advice and a return-to-running programme are all crucial to ensure a positive, long term return to running injury free.

Preventing these Injuries

We are our own normal

I want to reassure you that we are all different. We all have biomechanical differences that our bodies cope just fine with, we are our own ‘normal’. So, if you have ‘flattened arches’ but are able to run a marathon with no issues, nothing needs to change! You don’t need to address this ‘just in case’. Pain or injuries, such as those above, often arise when we are demanding too much of our body too soon, without giving it time to adapt to the demands – so in running, increasing distance or speed too quickly, changing the terrain etc. So much of the skill in preventing these injuries comes down to our training technique and running habits, combined with our body’s own ability to adapt.

However, what we often see is that a small biomechanical issue such as those explained above, combined with demanding too much of our body too soon, results in the body complaining with one of these injuries. Runners then get stuck in an injury cycle, where they can’t run without getting pain. By fully understanding and addressing the combination of biomechanical issues and training, this is the most effective way to overcome the injury and continue to enjoy a lifelong love of running!

By Paul Baker MCSP, goPhysio Clinical Director

The Injured Runner Project
We are trying to find out more about what injured runners do to get back to pain-free running, and would love to hear from you! If you’re interested in helping us out, please take a few moments to answer a couple of questions by clicking on this image. Many thanks.

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Runners – The Importance of Footwear and getting it right!

Posted on 15th January 2018 by

For a runner, running footwear is the most important piece of kit you will have in your running career (well – joint-most important next to a good Sports Bra for you ladies!). You will fight together through tarmac and forest paths, from quick mid-week runs to the long, slow Sunday ones. Training and racing side by side – so, with the Hendy Eastleigh 10km around the corner, you need to a pair of shoes you’re going to get on with!

Running Footwear has evolved so much in the last decade, it would be naïve to attempt to choose your perfect shoe alone. There are so many variables such as cushioning, stability, heel offsets and durability across well over 20 brands, who have up 30 shoes each on the market. That’s a lot of shoes!!

So, as your Official Health Partner of the Hendy Eastleigh 10km 2018, we thought to give you 5 points to find your match made in heaven:

  1. Support your local shop. Don’t buy online – you can’t get fitted properly over a computer- not yet at least! Go in and talk to someone one-to-one and get a gait analysis done. A gait analysis helps identify any abnormalities in your running style and whether it can be corrected with a particular set of shoes. The main movement they will look out for is the term ‘pronation’ and other elements such as heel striking and lateral/medial rotation of the hip. From this information, they will be able to suggest the best solution for you.
  2. Be open minded – don’t judge a shoe by its colour or brand. Always try what the shop recommends and get the shoe which feels most comfortable. Not the one which matches your new sports top! A pretty pair of shoes won’t hide the pain on your face half way round 10km!!
  3. Be transparent! Talk to them openly about your current aches and pains, and also what you like/don’t like about each of the shoes they suggest. That kind of feedback maybe the different between getting a good shoe and the perfect shoe for you!
  4. Don’t be too limited on price. For a good pair of running shoes, you’ll be looking at spending around £110 for a decent pair. It’s an investment for sure, but the shoes will last you long time and can offset a lot injuries and pain in the long run – no pun intended! They will last ~450 miles for the higher mileage shoes before you need to consider replacing them. So for someone doing 10 miles a week, that’s about a year!
  5. Don’t leave it too late! Give it at least three weeks before the race. Trust me from experience – it will make you re-evaluate everything you thought you knew about blisters otherwise! Break the shoe in properly with about 5 x 5km runs. And then, if you have any issues, just talk to them. It does happen and they will usually be keen to rectify the problem. But be wary, most guarantees only last a month!

Good luck to all who are doing the Hendy Eastleigh 10km! Fingers crossed for good weather and we will see you there as your Official Health Partner for the day!

Cameron Knapp

goPhysio – Sports Massage Therapist

Read More 

How to warn up for running

Top tips for injured runners

Runners – how to maximise your training time


How to Foam Roll – The Art of Self-Myofascial Release

Posted on 12th January 2018 by

Here’s a quick, no nonsense guide for runners to help improve your warm-up, performance and prevent injury with some simple foam rolling! It’s all about the fascia!

What is fascia?

Firstly, fascia is a dense connective tissue that surrounds every muscle, joint and organ in the body.

There are 3 types of fascia; superficial, deep and visceral.

  • Superficial fascia lies just beneath the skin.
  • Deep fascia penetrates and surrounds muscle tissue.
  • Visceral fascia helps keep vital organs in place.

Everything in the body is connected through fascia, but some areas are more connected than others, forming thickened sheaths and bands of fascia. These are bundled together, inseparable from the muscle tissue (myo) and it’s accompanying web of connective tissue (fascia), forming a 3D myo-fascial web throughout the body. Think of a 3D spider’s web in the shape of your body & you’re getting close!

When working optimally, this myo-fascial web helps provide support, stability, movement dynamics, force transmission and optimises sporting performance.

Why should runners foam roll?

Trigger Point Grid Foam Roller Foam rolling
We like the Grid Rollers from Trigger Point Therapy
  • For warm-up pre running, as it’s far more effective that static stretching (5)
  • To increase nutrient-rich blood flow to muscles that need it.
  • To improve the mobility and flexibility of muscles and joints (4,6,7).
  • To increase athletic performance (8,9).
  • To recover from exercise faster (1,2,3).
  • To reduce inflammation and remove toxins/chemical waste products.
  • Longer term, to break down adhesions in muscle and connective tissue.
  • You can also successfully self-treat minor injuries such as muscle strains and trigger points.

When should runners foam roll? 

  •  MB1 MB5 Trigger Point Roller Ball
    A great alternative to a foam roller is the MB1 or MB5 ball

    Before exercise: when paired with a dynamic warm up to increase blood flow to areas that may be lacking it.

  • After exercise: used within a cool-down procedure to flush out blood that has pooled in working muscles and to allow fresh nutrients and oxygen in to kick start the recovery process.

Rolling for only a few minutes can have a dramatic impact on the quality of your training session. So, if you’re stuck for time, pre-exercise rolling would provide most benefit.

How to foam roll

Remember this easy guide and apply it to each muscle group that you’re working on.

  • 4 linear rolls (to search the muscle for areas of tightness, we call these ‘hot spots’).
  • 30 second holds on each hot spot.
  • 4 joint movements (to move the muscle underneath the roller).
  1. Underside of the foot (plantar fascia)

TrP Foot roller Foam rolling

  • Place the roller under the sole of the foot.
  • Apply pressure and roll slowly towards the heel and back to the sole of the foot, 4 times.
  • Hold pressure on any hot spots you may find.
  • Once this hot spot starts to reduce, maintain pressure and add in movement of the toes by flexing and extending them all 4 times.
  • Repeat the process 3-4 times.
  1. Calves (gastrocnemius and soleus)TrP Calf Roller
  • Zone A = achilles to mid-calf.
  • Zone B = mid-calf to just below the knee.
  • Roll zone A, followed by zone B.
  • Begin by sitting on the floor with the roller on your Achilles tendon.
  • Place your hands behind you and the other leg on top to add pressure.
  • Roll up and down searching for hot spots. If any are found, hold this pressure for 30 seconds.
  • You can also ‘span’ the muscle by turning your foot inwards and outwards whilst maintaining pressure on a hot spot.
  • Repeat this process 3-4 times before moving on to zone B.
  1. Thighs (quadriceps)
  • Zone A = front of the hip to mid-thigh.
  • Zone B = mid-thigh to just above the knee. TrP Quads
  • Roll zone A, followed by zone B.
  • Begin by lying on your front with the roller at the front of your hip just below the bone.
  • Support yourself with your elbows out in front and the other leg bent up to the side.
  • Roll up and down in search of hot spots. If any are found, hold this pressure for 30 seconds.
  • You can also ‘span’ the muscle by turning your foot inwards and outwards whilst maintaining pressure on a hot spot.
  • Now, once on a hot spot, bend and straighten the knee 4 times.
  • Repeat this process 3-4 times before moving on to zone B.
  1. Buttock (gluteals and piriformis)
  • Begin by sitting on the roller with your hands behind you for support.
  • Shift your weight onto one side as you bring that leg up and cross it over the other.
  • Aim to have the roller ‘in your back pocket’.TrP Glutes Foam Rolling
  • Roll along the length of your glute in search of hot spots. If any are found, hold this pressure for 30 seconds.
  • Repeat the process 3-4 times.
  1. Upper back (paraspinals, rhomboids, trapezius)
  • Lay on your back with the roller just below the shoulder blades.
  • Place your arms behind your head or cross them in front of your chest.TrP Upper Back Foam Rolling
  • Lift your hips off the floor and use your legs to roll up and down the spine.
  • Carefully extend your back over the roller.
  • Add in side bends to target various muscle groups.
  • Again, if any hot spots are identified, hold this pressure for 30 seconds before moving on.
  1. Chest (pectoralis major/minor)
  • Lay on your front and place the roller (or trigger point ball) just inside the shoulder joint, on the pectoralis tendon. Pec TrP
  • With the arm above the head roll up and down in search of hot spots.
  • If any are found, hold this pressure for 30 seconds.
  • Add in arm movements to manipulate the soft tissue underneath the roller. 4 straight-arm scoops should do it.
  • Repeat this process 3-4 times.
  1. Latissimus Dorsi
  • Lay on your side with one arm above your head for support.
  • Place the roller at a 45° angle just underneath your armpit.Lat Dorsi TrP
  • Shift your weight to roll up and down in search of hot spots.
  • If any are found, hold this pressure for 30 seconds.
  • Add in straight arm movements to release the tissues further, 4 movements followed by 4 rolls.
  • Repeat this process 3-4 times.

References

  1. Pearcey GP, Bradbury-Squires DJ, Kawamoto J, Drinkwater EJ, Behm DG, Button DC. Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. J Athl Train. 2015;50:5–13.
  2. Macdonald et al. (2014) Macdonald GZ, Button DC, Drinkwater EJ, Behm DG. Foam rolling as a recovery tool after an intense bout of physical activity. Medicine and Science in Sports and Exercise. 2014;46(1):131–142.
  3. Rey E, Padron-Cabo A, Costa PB, Barcala-Furelos R. The effects of foam rolling as a recovery tool in professional soccer players. J Strength Cond Res. 2017;
  4. Bushell JE, Dawson SM, Webster MM. Clinical relevance of foam rolling on hip extension angle in a functional lunge position. J Strength Cond Res. 2015;29:2397–403.
  5. Su H, Chang NJ, Wu WL, Guo LY, Chu IH. Acute effects of foam rolling, static stretching, and dynamic stretching during warm-ups on muscular flexibility and strength in young adults. J Sport Rehabil. 2016; 1-24.
  6. Kelly S., Beardsley C. (2016) Specific and cross-over effects of foam rolling on ankle dorsiflexion range of motion. International Journal of Sports Physical Therapy 11(4), 544-551.
  7. Macdonald GZ, Penney M, Mullaley ME, Cuconato AL, Drake CD, Behm DG, Button DC. An acute bout of self-myofascial release increases range of motion without a subsequent decrease in muscle activation or force. J Strength Cond Res. 2013;27:812–821.
  8. Peacock CA, Krein DD, Silver TA, Sanders GJ, von Carlowitz KPA. An acute bout of self-myofascial release in the form of foam rolling improves performance testing. Int J Exerc Sci. 2014;7:202-211
  9. Monteiro et al. Acute effects of different self-massage volumes on the FMS overhead deep squat performance. Int J Sports Phys Ther. 2017; 12(1): 94-104.
  10. Monteiro ER Correa Neto VG. Effect of different foam rolling volumes on knee extension fatigue. Int J Sports Phys Ther. 2016;11(7):1076‐1081.

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Breaking the injury cycle: Calf Tear in a Runner

Posted on 3rd November 2017 by

We were recently asked some advice from a regular recreational runner. It’s a story that we hear a lot of here at goPhysio (not always calf related, but the same principles apply), so we thought it warranted a little blog post!

The runner in question was concerned, as they’d picked up a calf injury when out for a run a few weeks previously. Nothing major, but felt a bit of a tug on the calf when they had to move suddenly during the run. The calf was painful, so they did what they thought they should and rested for a week from running. The calf then felt fine, so they went back to running. Since then, the calf pain comes and goes. They don’t only feel it when they try and run but can feel it driving, going up & down stairs and first thing in the morning.

The dilemma is……….what is the best thing to do? Carry on running (because they love it and it they were progressing so well!)? Stop running (because it’s making the injury potentially worse)? Exercise? Ice? Heat? Strapping? New trainers? Taping? See their GP? Have a sports massage? Ask a friend? Use a foam roller????????? So many questions?

This is a really common story that we hear a lot in physio. A simple calf tear should take 3-6 weeks to repair itself, however its easy to get stuck in a cycle of tear, rest, repair, tear again, making the recovery much longer and much more frustrating.

How do we break this cycle?

Whilst rest is important it is not enough to adequately repair our damaged muscle to take the strain of running again, which is why it keeps being re-irritated. If we continue to do this we cause a lot of scar tissue to form in the healing muscle. Scar tissue is neither as strong nor as flexible as normal muscle fibres which make it easy to re-tear when stressed by anything more than day to day activities.

In the early stages of recovery from an injury, relative rest is important to help with healing. What that means is avoiding any activity which aggravates the injury, but trying to do alternative activities or modified activities so that you aren’t resting totally.

However, the important thing is to rehabilitate the calf muscle during the ‘rest’ period – gently stressing it with progressive strengthening exercises and stretches to regain its normal strength and elasticity. Ready to run again!

Physiotherapists are experts at guiding you through this process, making sure you are exercising at the optimal level for your stage of healing. They will make sure you are doing the right exercises (technique, loading, reps etc. all carefully worked out) and that you progress them at the right stage – all tailored to you individually and your own goals.

A programme for a minor calf tear for an ultra marathon runner would look very different to a programme for a severe tear in a Saturday morning Park Runner. There isn’t a one size fits all approach and although ‘Dr Google’ or Joe Bloggs at running club who also had a calf injury can be useful resources, relying on such information won’t always give the best long term outcome!

In addition to a specific exercise programme, Physio’s can also carry out a range of other treatments such as hands-on therapy, ultrasound and taping which can help to speed up your recovery. They an also advise on treatments you can do at home, such as foam rolling. A crucial part of your recovery is obviously returning to running at the right time. We know taking time out of running can be very frustrating, so we limit this as much as possible, guiding you with your return programme so you don’t do too much too soon and risk re-injury. If you have a specific event or race coming up, this is factored in.

So, if you love running and are worried about a calf injury, don’t hang about, book in to see an expert to guide you out of the injury cycle and back to running!

Here are two great simple exercises for a calf tear

Calf raise exercise Heel raises – standing on both feet, slowly rise up onto your tip toes then lower back to the ground. If you can manage 20 or more of these try doing it just on the injured leg, holding onto a support for a little balance, remember slow and controlled is key!


Calf stretch – stand in a long stride position with the injured Calf stretch exercise leg behind. Bend the front knee and gently press the back heel down towards the ground until you feel a stretch in your calf. Take it to where you feel a mild to moderate stretch (but not pain!) then hold for 30secs.


More information

Treatment of calf pain in runners

Top Pilates exercises for runners

Top tips for injured runners

Get your running back on track

How to warm up for running 

 


Beware of the Flip Flop!

Posted on 16th June 2017 by

Today, 16th June 2017, sees National Flip Flop Day! (Yes, that really is a national day!!) With the wonderful weather this week and set to be beautiful over the weekend, flip flops are are common footwear of voice!

Flip flops are great for chucking on to get from the car to the beach and walking around the pool. But this footwear is playing havoc with our feet!

In the summer months we see so many people coming into the clinic with foot and ankle problems such as achilles tendonitis and plantar fasciitis. In many of the people with knee, hip & back problems that come to see us, we also find that a sudden increase in wearing flip flops for long periods of time has played a part in their problem.

Flip flops provide no support for your feet, they are often made of very flexible rubber with little additional structure to hold your foot in place. This causes considerable stress to your feet as you rely on your toes to grip with every step and the additional stress placed on your plantar fascia, achilles tendon and other structures in your foot.

National Flip Flop DaySo, if you’re going for a longer walk or going to be on your feet all day, ditch the flip flop and wear something more supportive. If you’ve noticed you’re suddenly getting pain in your foot ankle or other part of your leg or back and have been wearing flip flops more now the sun is out, try reducing how much you wear them and see if this makes a difference.

#NationalFlipFlopDay


Read More

Achilles teninopathies

Plantar Fasciitis

Custom Orthotics

 

 

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6 Days Until Opening – Win A Computerised Foot Analysis

Posted on 13th December 2016 by

goPhysio Foot AnalysisWith 6 days to go until our opening, here’s another chance to win a free computerised foot analysis. With so much going on in your feet, and such a crucial part to play in your day to day movement – seeing what’s going on with your feet can be really insightful. You can win a 30 minute session with one of our Physio’s. They’ll take a look at your feet and carry out a computerised foot scan. They can then discuss the findings with you. You can find out more here.


16 Days To Go – Spiky Ball Countdown Giveaway & Some Great Exercises!

Posted on 3rd December 2016 by

Today we are giving away one of our favourites – a spiky ball! This ball can work wonders for easing off tight, sore muscles and areas of tension.

Ball Back Release 

This is a great exercise if you sit at a desk or drive a lot. It really helps to loosen up a stiff back and counteract the affects of being hunched over.

  1. ball-releaseSit at the wall with the ball at the bottom of the stiff upper back curve, feet planted firmly on the ground. Place your hands on your breastbone to guide the lift.
  2. Keeping the chin tucked, lift up with the breastbone to lever up over the ball. The head should move towards the wall ball-relesae-2because of the lift, but not because the neck has arched back.
  3. You can use a bit of a push up through the feet to encourage the lift.
  4. After loosening one level, move the tennis balls up a level and repeat. You can continue up to the top level of the upper back, but not into the low neck.

Plantar Fasciitis Ball Massage 

We often recommend self massage for the common foot complaint, plantar fasciitis. It really helps release the tightness and ease discomfort. Heres how:

planatr-fascia-ball

  1. Stand up and step on a hard ball with the foot.
  2.  Move the ball under your foot to find tender spots.
  3. Once you are on a tender spot, hold the position while applying pressure. You can hold the position as recommended to release the trigger point.
  4. Next, move to another tender area.

 


For your chance to win a very useful spiky ball, like or follow us on social media and share this post!


Foot Pain: Could It Be Plantar Fasciitis?

Posted on 8th October 2016 by

We are seeing and hearing from an increasing number of people who are suffering with quite debilitating pain on the sole of their foot. This common complaint is often the result of a condition known as Plantar Fasciitis.

Interestingly, over the last week I’ve met 8 people hobbling about with this painful foot condition and not one of these people were aware of what physio could do for plantar fasciitis.

So today’s blog is to educate you about plantar fasciitis and help you banish it for good.

What is Plantar Fasciitis?

Fascia is connective tissue which is found all over the body in various forms for different functions. It’s most common forms are sheaths surrounding muscles and ligaments to compartmentalise and  protect these tissues or thickened fascial bands or sheets in certain areas of the body.Plantat Fasciitis

The plantar fascia is a thickened sheet of fascia on the sole of the feet, running from the inside base of the heel bone and fanning out into the base of the toes. It’s elasticity gives us a spring in our step when walking or running.

Plantar fasciitis is an overuse injury to the fascial sheet on the sole of the foot.

Causes of Plantar Fasciitis

The main cause of plantar fasciitis is caused by

the plantar fascia being put under excessive stretch for prolonged periods of time. This can happen for example when your foot arches are too flat, so that as you push off when you’re walking or running the fascia excessively overloaded and stretched. Over time microtrauma, injury and pain result.

The foot can also be termed the “rubbish bin” of the body, where asymmetries further up the body can result in compensations in the foot. The body will compensate up to a point, but due to the excessive forces during the propulsion as you move that go through your feet, the foot may adapt by stiffening up and thickening of the plantar fascia. So sometimes, it can be something going on further up the body that may put too much stress on your foot, that will in turn cause this problem.

Symptoms

Plantar fasciitis is normally felt as a pain on the bottom of your foot, sometimes going into your heel.

Unfortunately plantar fasciitis is often confused with another foot problem called calcaneal bursitis heel pain). Without a thorough examination, most plantar foot problems are diagnosed as plantar fasciitis.

So a quick test you can do yourself to indicate whether your foot pain is plantar fasciitis or not is to see which is more painful; walking on your tip toes or your heels.

If it is painful to walk a few steps on your heels, you may have an element of calcanea bursitis. If it’s more painful too walk on tip toes (stretching plantar fascia), it’s likely you havre plantar fasciitis.

Why is it so painful 1st thing in the morning or after I’ve been sat for a while and then get up?

Plantar fasciitis is usually painful after a period of rest. The reason being is that when you’re sat for a while or asleep in bed, the fascia is off loaded and re-tightens. When you get back up on your feet, you are re-stretching the tight, painful fascia. It may ease a little as you start to move around as it effectively ‘warms up’ and stretches.

What can affect recovery?

There are many factors that will affect the speed of recovery. Seeing an expert Physiotherapist who has a wide range of experience treating lower limb overuse injuries is vital to identify all the factors and work towards removing or modifying the triggers unique to you.

The most common triggers for foot problems such as plantar fasciitis are:

Biomechanics It’s crucial to assess whether your foot and leg biomechanics (e.g. flattened arches, knocked knees etc.) are contributing to your injury and may need correcting. Here at goPhysio, our Physio’s can do this quite easily as part of your initial session by combining their physical assessment findings with performing a computerised foot screen using our cutting edge Gaitscan system.

Training Patterns and Intensity If a runner or keen walker has the condition, it’s vital to look at the historical loading of the fascia and modify their training schedule to a level that allows the condition to heal. Without breaking the cycle, the tissues won’t be able to recover. However, we like to keep people doing what they love, so rather than advise complete rest, we try wherever possible, to modify your activity or suggest alternatives in the short term that will promote recovery.

Lower Limb Stability Often muscle imbalances further up your body in your knee, hip or pelvis, will have an impact on the foot. As part of your recovery we will always address these elements too to help prevent re-occurrences.

Age Research suggests that older people experience more severe and more prolonged episodes of inflammation and pain. So, if you’re 40 years plus and enjoy an active lifestyle, your pain is unlikely to settle with just rest. It will be easily aggravated when you resume normal activities, as the cause and actual injury hasn’t been addressed.

Footwear Unsupportive, flat, old, worn out shoes or trainers can both contribute to causing plantar fasciitis and will inevitably prolong the condition.

Physiotherapy

At goPhysio, with a condition like plantar fasciitis, we always treat the condition as part of the bigger picture. Not only will we treat your foot itself, but we will look from the foot upwards and from the hip downwards, ensuring we leave you with no issues that will contribute to a re-occurrence.

Having identified all the factors unique to your condition, we will then address and correct them in parallel with hands-on physiotherapy treatments and education. It’s crucial to manually release the tight thickened plantar fascia with a variety of release techniques. You will also be provided with a bespoke home exercise programme for you to self treat at home and speed up your recovery in-between physio sessions.

We can also asses you to find out if you’d benefit from orthotics. In most cases of plantar fasciitis there is a biomechanics component that needs addressing. This can be achieved with orthotics. As outlined above, fattened arches will lower your body’s ability to cope with loading either from day-to-day actives or sport. At goPhysio we use a technologically advanced system called Gaitscan, which uses computer scanning to analyse your moving foot Combined with a physical assessment, the physio can identify if you’d benefit from wearing orthotics and subsequently discuss the range of options available to you to get you back on your feet a quickly.

What next?

If you think you may be suffering with plantar fasciitis or you have foot pain and aren’t sure what exactly it is, just give us a call on 023 8025 3317 or book an initial physiotherapy appointment online.

We can also offer you a free computerised foot analysis to see whether you’d benefit from orthotics. These analyses are completely free with no obligation. Call and quote Free Gaitscan to take advantage of this offer and find out whether orthotics could help you.


Growing Pains? Knee Pain in Kids and Teens

Posted on 27th September 2016 by

Growing pains?

Many children experience aches and pains as they grow which are typically written off as ‘growing pains’, told there is nothing that can be done and that they will ‘grow out of it’.

There is some truth to this; during a growth spurt the bones will lengthen first and then the muscles adapt and lengthen to keep up and there can be a period of discomfort around the joints whilst this happens.

However in young sporty children these ‘growing pains’ may well indicate a traction apophysistis (growth plate injury) that needs to be carefully managed to avoid long-term problems and ensure a quick return to sport.

What is a traction apophysitis?

This happens when the muscles are pulling on the growing part of the bone that hasn’t fully fused yet Osgoods Schlatters – like a rope pulling on cement that hasn’t hardened. If this area is overloaded by repeated, forceful muscle contractions, inflammation, pain and microtrauma to the growth plate will result.

This usually happens in very active sporty children who typically play 10+ hours of sport a week – especially kicking, sprinting and jumping activities like football, basketball and gymnastics. It always occurs during a growth spurt and is thought to affect around 20% of 9-16 year olds.

The main areas affected are the knee (Osgood-Schlatters disease) giving pain below the knee cap, or the ankle (Severs disease) giving pain above the back of the heel. Both conditions are associated with tightness of the muscles surrounding these joints pulling on their respective growth plates.

What can be done about it?

Rest, ice and anti-inflammatories can be helpful but most kids won’t want to wait months and months for their bones to stop growing before they return to sport, particularly if they are a budding athlete.

Will stretching help?

If the muscles are tight why don’t we just stretch them?

Well this actually pulls on the area where the muscle attaches to bone, potentially making it worse, not better!

So in response to this dilemma the Strickland protocol has been developed by a Physiotherapist to address the cause of the pain (tight muscles pulling on the growth plate) and to help guide return to sport and activity.

What is the Strickland Protocol?

The Strickland Protocol involves:

  • Applying a specific type of massage towards the insertion of the muscle to improve a muscle’s length and reduce its tightness, which reduces the pull on the tendon attachment – this needs to be done for a minimum of 2 minutes a day.
  • Once underlying tension is taken out of the muscle, helping it to catch up in length with the bone, the attachment site seems to repair in double quick time.
  • Once the child feels no pain in stretch position, we replace massage with stretches, safe in the knowledge that it should be able to cope with the loading of stretches.
  • Massage is continued in parallel with stretches to speed up process of elongation.
  • Rest from aggravating activities is essential – for a minimum of 3 weeks we recommend nothing more strenuous than walking, otherwise this delays healing substantially!
  • An important aspect is the involvement of the parent / guardian as the protocol cannot be done without their help & cooperation, as it will be them that performs massage on daily basis.
  • This is followed by sport-specific rehab and addressing a biomechanical or technique issues as we guide you back to sport.

Does it work?

YES! It has a 95% success rate in 3 weeks when correctly adhered to!

How can goPhysio help?

If your son or daughter is suffering with knee pain (or pain at their heel), you may have been to see your GP who has advised you that there is nothing that can be done, your child just needs to rest. However, we have found that by using this treatment protocol we can effectively help children get back to what they should be – running round, doing sports and having fun!

What we can do to help you and your child is assess the problem thoroughly to make sure we’re confident with the diagnosis. We will then advise you on the best course of action. The great part is that the treatment is pretty simple, with our guidance you can carry out the programme at home – we’re here to provide extra support and advise on progress as and when you need it.

We also offer a specialist Young Rehab service, which provides guided specific rehab programmes for kids, you can read more about this here.