Tips From Advanced Rehab - Plantar Fasciitis

Plantar Fasciitis

Plantar fasciitis is a common, painful foot condition. Patients, and sometimes doctors often confuse the terms plantar fasciitis and heel spurs. Plantar fasciitis refers to the syndrome of inflammation of the band of tissue that runs from the heel along the arch of the foot; a heel spur is a hook of bone that can form on the heel bone (calcaneus). About 70% of patients with plantar fasciitis have been noted to have a heel spur that can be seen on X-Ray
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Who gets plantar fasciitis?
Plantar fasciitis is most often seen in middle-aged men and women, but can be found in all age groups. Plantar fasciitis is diagnosed with the classic symptoms of pain well localized over the heel area of the bottom of the foot. Often the pain from plantar fasciitis is most severe when you first stand on your feet in the morning. Pain often subsides quite quickly, but then returns after prolonged standing or walking.

Plantar fasciitis is sometimes, but not always, associated with a rapid gain of weight. Plantar fasciitis is also sometimes seen in recreational athletes, especially runners. In these athletes, it is thought that the repetitive nature of the sports causes the damage to the fibrous tissue that forms the arch of the foot.
Could something other than plantar fasciitis cause this pain?
Plantar fasciitis can be confused with a condition called tarsal tunnel syndrome. In tarsal tunnel syndrome, an important nerve in the foot, the tibial nerve, is trapped and pinched as it passes through the tarsal tunnel, a condition analogous to carpal tunnel syndrome in the wrist. This may cause symptoms similar to the pain of a plantar fasciitis.

There are also other less common problems such as nerve entrapments, stress fractures, and fat pad necrosis, all of which can cause foot pain. Finally, several rheumatologic conditions can cause heel pain. These syndromes such as Reiter's syndrome and ankylosing spondylitis can cause heel pain similar to plantar fasciitis. If your symptoms are not typical for plantar fasciitis, or if your symptoms do not resolve with treatment, your doctor will consider these possible diagnoses.

Why did I get plantar fasciitis?
Plantar fasciitis occurs because of irritation to the thick ligamentous connective tissue that runs from the heel bone to the ball of the foot. This strong and tight tissue contributes to maintaining the arch of the foot. It is also one of the major transmitters of weight across the foot as you walk or run. Therefore, the stress placed on the this tissue is tremendous.
When a patient has plantar fasciitis, the connective tissue that forms the arch of the foot becomes inflamed (tendonitis) and degenerative (tendinosis)--these abnormalities cause plantar fasciitis and can make normal activities quite painful.
Symptoms of plantar fasciitis are typically worsened early in the morning after sleep. At that time, the arch tissue is tight and simple movements stretch the contracted tissue. As you begin to loosen the foot, the pain usually subsides, but often returns with prolonged standing or walking.

Treatment
Treatment of plantar fasciitis is with short-term rest and controlling the inflammation. Here are the steps patients should take in order to cure their plantar fasciitis:
•Rest
•Ice
•Exercises and Stretches
•Active Release Technique

IT Band Issues

Iliotibial Band syndrome is due to inflammation of the iliotibial band, a thick band of fibrous tissue that runs down the outside of the leg. The iliotibial band begins at the hip and extends to the outer side of the shin bone (tibia) just below the knee joint. The band functions in coordination with several of the thigh muscles to provide stability to the hip and outside of the knee joint.

Iliotibial band syndrome (ITBS) occurs when there is irritation to this band of fibrous tissue. The irritation usually occurs over the outside of the knee joint, at the lateral epicondyle--the end of the femur (thigh) bone. The iliotibial band crosses bone and muscle at this point; between these structures is a bursa which should facilitate a smooth gliding motion. However, when inflamed, the iliotibial band does not glide easily, and pain associated with movement is the result. Sudden increase in levels of activity, such as runners who increase their mileage, often develop iliotibial band syndrome.

Treatment of ITBS begins with proper footwear, icing the area of pain, and a stretching routine. Soft tissue techniques, such as Active Release Techniques (ART), help to treat the muscles responsible for ITBS. These muscles include the gluteus medius, gluteus maximus, Tensor Fascia Latae and the lateral quadriceps muscle. Limiting excessive training, resting for a period of time, and incorporating low-impact cross-training activities may also help.


At Advanced Rehabilitation, your care and treatment is our utmost concern. Should you feel any discomfort, we encourage you to make an appointment. Preventative care is crucial to maintaining a healthy, active lifestyle.

Hip Flexors: What You Need to Know

The hip flexors are a group of muscles that move the hip forward when running and walking. A great deal of stress is applied to this muscle group when sprinting and kicking. A strain can vary anywhere from stretching to a complete tear of the muscle tissue. This injury occurs in runners, bicyclists, athletes who jump or run with high knee kicks, athletes like soccer players who do forceful kicking activities, and people who practice the martial arts.

The hip flexors are a group of muscles that move the hip forward when running and walking. A great deal of stress is applied to this muscle group when sprinting and kicking. A strain can vary anywhere from stretching to a complete tear of the muscle tissue. This injury occurs in runners, bicyclists, athletes who jump or run with high knee kicks, athletes like soccer players who do forceful kicking activities, and people who practice the martial arts.

The most common cause of hip flexor injury is acute trauma. You may experience one specific instance when you felt your hip flexor pull. This may have been when you broke into a sprint, made a cut, or kicked a ball. Tight muscles and poor flexibility will contribute to hip flexor injury. When muscles are tight, there is an increased amount of tension on the tissues. When this increased tension is added to by an explosive movement, injury can occur. This is very common when doing speed drills or hill workouts.

Preventing hip flexor injury focuses on good flexibility, as well as making sure you warm up before you go full speed. Warm muscles are much less likely to be injured. So take the time to warm up and start slowly before you go all out. A good flexibility program will also help to reduce the tension on the muscles, and reduce your likelihood for injury.

Other ways you can reduce your likelihood for injury:

* Deep tissue procedures (Active Release Technique) to free up soft tissue motion of the hamstrings and surrounding musculature

* Gentle manipulation to free up joint motion of the lumbar spine and hips.

* Ultrasound and electric muscle stimulation combo-therapy applied to the proximal hamstring tendons to break up scar tissue, restore normal muscle tone, and decrease pain.

* Implementation of a proper strength program

* Advice on how to progress training runs more appropriately

Prevention is always the best cure.
Come see Advanced Rehabilitation and we will help keep you in motion!

What's ART and Why Should I Care?

ART is a patented, state of the art soft tissue system/movement based massage technique that treats problems with muscles, tendons, ligaments, fascia and nerves. Headaches, back pain, carpal tunnel syndrome, shin splints, shoulder pain, sciatica, plantar fasciitis, knee problems, and tennis elbow are just a few of the many conditions that can be resolved quickly and permanently with ART. These conditions all have one important thing in common: they are often a result of overused muscles.

How do overuse conditions occur?
Over-used muscles (and other soft tissues) change in three important ways:

acute conditions (pulls, tears, collisions, etc),

accumulation of small tears (micro-trauma)

not getting enough oxygen (hypoxia).

Each of these factors can cause your body to produce tough, dense scar tissue in the affected area. This scar tissue binds up and ties down tissues that need to move freely. As scar tissue builds up, muscles become shorter and weaker, tension on tendons causes tendonitis, and nerves can become trapped. This can cause reduced range of motion, loss of strength, and pain. If a nerve is trapped you may also feel tingling, numbness, and weakness.


What is an ART treatment like?
Every ART session is actually a combination of examination and treatment. The ART provider uses his or her hands to evaluate the texture, tightness and movement of muscles, fascia, tendons, ligaments and nerves. Abnormal tissues are treated by combining precisely directed tension with very specific patient movements.

These treatment protocols - over 500 specific moves - are unique to ART. They allow providers to identify and correct the specific problems that are affecting each individual patient. ART is not a cookie-cutter approach.


What is the history of Active Release Techniques?
ART has been developed, refined, and patented by P. Michael Leahy, DC, CCSP. Dr. Leahy noticed that his patients' symptoms seemed to be related to changes in their soft tissue that could be felt by hand. By observing how muscles, fascia, tendons, ligaments and nerves responded to different types of work, Dr. Leahy was able to consistently resolve over 90% of his patients' problems. He now teaches and certifies health care providers all over the world to use ART.

Knee Pain: Risk Factors, Care and Why It's More Common in Female Athletes!

A.J. Zelinski, DC ART

Advanced Rehabilitation Director

Getting ready for Mother's Day, it is appropriate to discuss knee pain, as it is very common in female athletes. Women tend to be more prone than men with regards to knee pain and injuries. This is due to a difference in structure and the biomechanical relationship between the hips, knees and feet.

Knees are complex, weight-bearing joints (junctions between two bones) that provide your body with flexibility, support and a wide range of motion. Knees can be injured from trauma, arthritis or everyday stress and strain. Knee pain is therefore a common complaint. Depending on the type and severity of joint damage, knee pain can be minor or can lead to sever discomfort and disability. There are a number of common causes for knee pain, and it is important to have an accurate diagnosis of the cause so that appropriate treatment can be undertaken.

Risk Factors:..

• Overuse - can lead to muscle fatigue and excessive loading stresses across the joint. this causes an inflammatory response (increased blood flow and cell response) that damages tissues.
• Age, athletic activities, previous injuries
• Instability - tight or weak muscles offer less joint support.
• Mechanical problems - structural abnormalities, such as having one leg shorter than the other, abnormal alignment of the bones or flat feet can increase risk of knee problems.

Initial Care Guidelines:

• Rest - minor injuries may require only a day or two of rest but sever damage is likely to need a longer recovery time.
• Protection - a sleeve or brace to provide added joint stability and restrict range of motion.
• Ice - reduces pain and inflammation.
• Elevation of limb.
• Compression- a wrap around the knee prevents edema (fluid buildup within the joint).
• Medications - nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, napoxen, or ibuprofen

When to seek medical advice:

• Difficulty bearing weight on the knee
• Swelling of the knee
• Obvious deformity in the leg or knee
• Sever or persisting pain
• Locking - inability to bend or straighten the knee joint
• Infection - typically indicated by fever and a knee joint that is red, painful and swollen.
  

When is it Injured? When is it Sore?

A.J. Zelinski, DC ART
Director - Advanced Rehabilitation

Training for a triathlon and being active in general usually involves a moderate amount of soreness and even discomfort at times. It is often hard to tell if soreness and tightness is normal, or if is an injury waiting to happen. Often it is too late to treat an injury if you are only a few weeks out from an event, but hopefully these three simple tips will help you to identify when to get immediate attention and make it to the finish line.

Tip#1 – Typical signs of injury are redness, swelling, heat in the affected area, and even discoloration. This can include a swollen ankle the day after a long run, heat and inflammation around the knee after a long ride, or even severe tightness and restriction in your hip after a brick session. If you are experiencing any of these symptoms, especially during or immediately after activity, DO NOT waste any time in getting proper care and evaluation.

Tip#2 – Changing your technique due to pain can often signal an injury waiting to happen. Knee pain during a long ride may cause you to sit differently on the bike and the next morning your back hurts. These types of scenarios are prime examples of compensation injuries. These injuries occur when you slightly change your technique to lessen immediate pain, but the long term side effects can create a significant injury. If you notice a new pain, or that you are changing the way you swim, ride, or run, please do not hesitate to get it checked out.

Tip#3 – Tightness or stiffness that lasts more than 24 hours can actually be an injury as well. This restriction in range of motion can be due to adhesions, or scar tissue, that has built up in the joint or muscles surrounding the joint. This decrease in range of motion will lead to compensation injuries as well. The best way to identify these problems is to stretch gently on a regular basis to know when your body is just not moving like it should.

These are just a few tips to getting to the finish line. If these things are caught quick enough we can often work out a plan to decrease activities that cause more problems and increase activities that are safe for the pre-injury. The key is to not wait when you have an issue, but get it looked at if there is any question.