Some Help With Foot Pain and Plantar Fasciitis

You don’t have to be a runner to experience foot pain, but 10 percent of runners this summer will at some point!

We have all heard of plantar fasciitis. It is the most common cause of foot pain in runners, after all. Surprisingly, it is also one of the most misdiagnosed and mistreated.

Pain on the bottom of the foot often gets the diagnosis of plantar fasciitis, but this diagnosis neglects to take into account literally every other structure in the foot as a potential cause of pain.

For those who begin to experience foot pain, beginning to fix the problem can be a bit overwhelming. Far too often rest, ice, stretching, and pain medication do nothing for the pain!

So where do you start? What do you do? Is it just a soft tissue problem or is it a bone and joint problem? In order to answer these questions, you need to start with some assessment.

A simple test used to rule out bone spurs or more serious joint complications is toe walking. Although, not 100 percent accurate, plantar fasciitis or soft tissue problems will be made worse by toe walking. Other assessments include testing dorsiflexion and plantarflexion. Muscles in the posterior and anterior calf insert on the foot. They cannot be ruled out as part of your foot problem.

In order to test dorsiflexion, stand by a wall a few inches away. Place your hands on the wall for support and bring the affected foot forward to the wall. Bring your knee to touch the wall without the heel lifting off the floor. Continue to slide your foot backward until you find the furthest place from the wall your knee can touch the wall while keeping your heel on the ground. Normal, healthy range is five to six inches.

To assess plantar flexion, kneel with both shins flat on the ground. Sit back until your buttocks touches the heels. The shin and anterior foot should be flat on the ground without pain. Any space between your ankle and the floor, or pain with the movement, is a positive test.

These two movements are great places to start. Most problems found with these assessments can be fixed. If you find yourself with any of the above assessments positive, you must return these assessments to normal, healthy movements.

Mobility techniques like basic calf stretching and foam rolling the anterior and posterior are great places to start. Rolling a golf ball on the bottom of your foot for a couple minutes also can be of beneficial. Using your toes to curl up a towel can add some strength to the bottom of your foot.

The above assessments should be used to measure your progress with these techniques. If these do not clear up and you continue to experience pain, the problem may be more severe.

Plantar fasciitis and many cases of foot pain are caused by overuse. The result of overuse injuries are microtraumas and tears that eventually lead to the formation of adhesion. Adhesion acts as glue to prevent further injury to the tissue, but it restricts proper movement and function, and causes weakness and pain for those who continue activity. In order to fix adhesion, the above mobility techniques may help, but treatment from a licensed professional is often necessary.

There are many different causes of foot pain and the solutions are never easy. If you’re struggling to get to the bottom of your foot pain, start with the above mentioned assessments. Work to improve and return these tests to normal. If pain or dysfunction persists, reaching out to your local health care provider is the next best step.

If you are in the Cedar Rapids area, and struggling with foot pain, I invite you to fill out an appointment request on this page or give our office a call at 319-423-0925 and get to the bottom of your problem!  

Is It Tendinitis?

Tendinitis and tendinosis. One you’ve probably heard before.  The other, probably not. While they both sound the same, in reality they are worlds apart.

Tendinitis is, by definition, inflammation of a tendon.  Tendinosis on the other hand is defined as chronic tendinitis and implies chronic tendon degeneration without the presence of inflammation. Basically, one is short-term with inflammation, the other long-term, without inflammation, though both are caused typically by overuse.

soccerTendinitis, the most popular diagnosis of the two, usually presents with swelling and tenderness at the sight of pain, often accompanied by stiffness, and less often by weakness. Tendinosis presents most often with stiffness, tenderness to the touch, and weakness–almost identical to tendinitis. Recovery of tendinitis lasts anywhere from days to six weeks, a relatively “quick fix.” Tendinosis recovery can last a few short weeks to a couple months or more depending on the level of degeneration. If left untreated, tendinosis often leads to “tear” injuries.

While both conditions are classically treated with conservative measures, the difference in care is absolutely critical to resolution of the problem. Conservative management stems around rest and anti-inflammatory medication for tendinitis, while conservative management of tendinosis aims to restore tendon regrowth and strength through manual therapy and eccentric exercise.

Both, occur most often in the Achilles tendon (ankle), patellar tendon (knee), proximal hamstring (high hamstring), common extensor tendon (elbow), and the supraspinatus tendon (shoulder).

With both of these problems being so relatively close, while treatment is vastly different, proper diagnosis is vital to the recovery process! So which one do you have? Let’s go to the research.

While tendinitis is the wildly over-popular diagnosis among general practitioners, it may not be the case. Most research coming out on this topic is now showing that at a cellular level, once believed tendinitis actually is, in fact, tendinosis.

According to Almekinders and Temple, “Most currently practicing general practitioners were taught, and many still believe, that patients who present with overuse tendinitis have a largely inflammatory condition and will benefit from anti-inflammatory medication. Unfortunately this dogma is deeply entrenched. Ten of 11 readily available sports medicine texts specifically recommend non-steroidal anti-inflammatory drugs despite the lack of clinical evidence.”

In light of this, chances are that if you have been diagnosed with tendinitis the diagnosis was incorrect. Furthermore, traditional, conservative treatment, of such, with the use of anti-inflammatories, corticosteroid injections, and/or pain medication may have left you worse off long term even though pain may have dissipated short term (but this conversation is for a different time). These methods were designed to eliminate inflammation, not regrow tendon. As mentioned above, treatment of tendinosis should be aimed at restoring tendon function and strength through manual therapy and eccentric exercise. Drugs will not help! Treatment should also include load management when deemed necessary.

With all this said, while we cannot assume a diagnosis was incorrect, lingering, worsening, or reoccurrence of pain would suggest that it may in fact be tendinosis. It is recommended that treatment plans geared toward tendinitis, in these cases, be reevaluated.

Tendinitis is one of the most commonly diagnosed injuries and all too many struggle to find relief. With the proper diagnosis and treatment plan, it doesn’t have to be that way!

At Thrive Spine and Sport, we specialize in the diagnosis and treatment of musculoskeletal injuries, including tendinitis and tendinosis.  Most patients have seen many different providers before finding relief in our office.  Fill out the appointment request on this page or call our office at 319-423-0925 to set up an appointment today!

Thanks for reading!

Struggling With Carpal Tunnel Syndrome?

Carpal tunnel syndrome, or CTS, is something you are probably familiar with.  Affecting approximately 3-6% of the general population, CTS is usually linked to highly repetitive tasks like heavy manual labor, or typing and desk work.  Characterized by numbness, tingling, or burning sensations in the thumb and fingers, carpal tunnel syndrome is the most common nerve entrapment found in the body.

While there is a lot that we do know about CTS, unfortunately it hasn’t made fixing it any easier.  Successful conservative treatment of carpal tunnel syndrome have been estimated between 3 and 70%!  That is quite a wide range of success to say the least!  The problem in successful treatment may lie in the diagnosis.

Most commonly, CTS is characterized as entrapment of the median nerve in the carpal tunnel of the wrist.  Often times this is not the case.

The median nerve forms in the axilla (armpit) by joining nerves that originate in the neck.  After forming, the median nerve continues its path through the upper arm, into the elbow, through the forearm, and finally through the carpal tunnel and into the hand.  Along this path, the nerve passes through multiple structures before arriving at the carpal tunnel in the wrist.

Median Nerve Pathway
Median Nerve Pathway

When healthy, the nerve glides along other muscles, tendons, and other soft tissue structures without problem.  With overuse and some other conditions, the nerve can become glued and entrapped by adhesion to these structures.  When nerves become entrapped, they cause tingling, burning, and numbness symptoms.  This is where the problem lies in most cases of classic CTS!

Overuse Cycle

While the carpal tunnel, itself, gets most of the recognition for this problem, the median nerve can become entrapped anywhere along its path to the wrist and hand.  The difficulty with treatment is finding where this entrapment exists.

Therapies like drugs, injections, and splinting may offer short term relief, but do nothing to actually fix the entrapment.  The same holds true for stretching and exercise.  Surgery should always be used as a last resort.

In order for resolution of CTS, the nerve must be freed from the entrapment, if present, in the soft tissues of the neck and arm. Fortunately, there are some at home movements for carpal tunnel to see where the entrapment may exist:

Cervical Flexion.  To start, stand with your back flat against the wall including the head.  Start by tucking the chin to the neck without moving the head off the wall.  Note any symptoms into the neck, shoulders, or arms.  Next move further into flexion by tucking the chin to the sternum.  Inability to tuck the chin to the chest, or symptoms into the shoulder or arm can be a sign of entrapment in the neck.

Healthy cervical flexion.
Healthy cervical flexion.

Shoulder Abduction.  Stand upright with the arms along the side.  Slowly bring the arms up to the ears by moving the arms in a motion similar to a “jumping jack.”  The upper arm should touch the ear.  Anything short of this motion or pain or numbness into the hands may be a sign of entrapment.

Shoulder Abduction
Shoulder Abduction with right side more restricted than left. (Note upper arm proximity to ears)

Wrist/Finger Extension.  Place the forearm flat along the wall with the elbow 90 degrees to the shoulder.   Pull back on the wrist until it is 90 degrees to the forearm.  Now, pull back on the fingers.  They should be roughly 65 degrees to the wrist.  Note symptoms. Any motion short of the noted ranges is positive, along with pain, tingling, or burning sensations can be a sign of entrapment in the forearm or wrist.

Wrist Extension
Healthy Wrist/Finger Extension

As mentioned earlier, most conservative treatment fails to diagnose properly, and thus, fails to provide proper treatment to fix carpal tunnel syndrome.  Manual therapy has been shown to be effective for treatment of nerve entrapment.  Carpal tunnel syndrome is progressive in nature, and ultimately leads to surgery in far too many cases where it could have been prevented.  For those suffering with CTS symptoms it is highly recommended to seek proper treatment as soon as possible.

At Thrive Spine and Sport, we focus on finding and fixing nerve entrapment!  If you have been struggling to find relief from carpal tunnel syndrome, call our office today to set up an appointment at 319-423-0925, or fill out the appointment request on this page.  If you have any questions, feel free to email myself at dr.cody@thrivespineandsport.com.

What’s Wrong With My Shoulder?

Raise your hand if you struggle with shoulder pain!  Well, at least, raise it as high as you can.

Shoulder pain is one of the most frequently hurt and injured extremities in the body.  If you were to survey 10 of your friends, how many of them would report a shoulder issue?  Seriously think about this for a minute.  While the research can vary greatly with incident rates of shoulder pain, you can expect on average 2-5 to report shoulder pain and problems!  That is an incredible stat right there!

When you look into the mechanics of the shoulder, it is no wonder why pain is so often found there.  The shoulder joint consists of 3 bones, creating 4 joints.  13 muscles are involved in the movement of the shoulder which is responsible for almost 360 degrees of motion.

While there are many different kinds of problems associated with the shoulder (dislocations, fractures, etc), most complications arise from overuse, or repetitive strain injuries over time.  Shoulder pain may start up overnight, but it took weeks, months, even years to get to the point of pain.  Manual labors and athletes alike are no stranger to shoulder pain.

In cases of shoulder pain where overuse, repetitive strain, or previous injuries are present, the shoulder pain is almost always due to a lengthening issue.  The joints have become stiff and the muscles have become tight.  The most frequent cause of this stiffness is from adhesion.

Adhesion is a build up of scar tissue through repetitive motion, prolonged position, or as a result of previous trauma or injury.  Think of adhesion as glue on a muscle.  It binds things together and prevents the muscles from moving correctly.  When the joints and muscle get stiff and tight, it creates friction, pressure, and tension in the area.  This then creates decreased blood flow and sometimes swelling, which promotes the body to lay down scar tissue, or adhesion, to help stabilize the problem area.  Adhesion is one of the most common problems in the human body and fortunately one of the most easily reversible with the right care!

To see if your shoulder pain could be caused from adhesion at-home, there is a very simple test you can do at home.

Stand upright, with your arms and hands to your side.  Raise your arms up to your ears by moving your shoulders in an arc similar to that of a jumping jack.  The bicep should be able to freely touch the ear without any increased tension or pain.  Anything short of this, adhesion is a strong possibility, and may be playing a large part of your shoulder pain.  Regardless of previous injuries, or even surgeries, adhesion needs to be removed.

Stretching and exercises do not correct adhesion unfortunately.  When adhesion is present, it only gets worse without proper treatment, and could lead to bigger issues down the road.

If you are struggling with shoulder pain, try the test right now.  Look in the mirror if you can’t get your arms up to your ears and see how restricted it is.  The further away from the ear you are the more likely you are to suffer a serious injury down the road.

If you are in the Cedar Rapids/Iowa City area and struggling with shoulder pain, call our office today at 319-423-0925 or fill out the appointment request on this page.  If you have any questions feel free to reach out to me at dr.cody@thrivespineandsport.com.

Thanks for reading!

Before You Start CrossFit in Cedar Rapids, Here Is What You Need!

If you are reading this, chances are you are thinking about getting into CrossFit .

Known for brutal workouts and “ideal” looking athletes, CrossFit has created a fitness revolution sweeping, quite literally, the globe. CrossFit appeals to the common person to regain functional strength and get back in shape by beating previous times, reps or weight used.

As with most fitness revolutions, CrossFit has come under some recent scrutiny. A study in the Journal of Strength and Conditioning Research found that 73.5 percent of CrossFit participants receive an injury that limits work, activity or participation. This is an alarming number, but also a number not too surprising when the average new member just came from the couch into doing Fran (Fran is the name of CrossFit’s most popular workout).

Overuse, as with any other sport, is the number one cause of injury in CrossFit. It demands that all, not just some, of your body is moving properly. If there are any restrictions in any part of your body, this will lead to injury at some point down the road.

In order to make Cedar Rapids CrossFit, safer we must know our body is ready.

Here are the top 5 assessments to do that:

1. Ankle dorsiflexion. Ankle dorsiflexion is vital to running, jumping and squatting. If your ankle is not working properly, neither will your knee, hip and low back. Check this by standing arm’s length away from a wall. Place a ruler against the wall and foot. Drop the knee to touch the wall without the heel coming off the ground. A healthy range of motion will be around five or six inches.

2. Knee flexion. To check knee flexion, stand supported against the wall or table. Grab the ankle and try to accommodate the back of the heel to the butt, while the quad remains in line with the opposite leg. The heel should easily be able to touch without pain.

3. Hip flexion. Lie on your back. Grab just below one knee and try to bring the knee to chest. The front of the thigh should be able to be pulled flat against the chest without difficulty or pain. A lack of hip flexion alters squat motion and can lead to low back, hip and knee pain.

4. Shoulder abduction. Proper overhead motion and strength is dependent on this motion. Stand upright with arms to the side. Bring your arms up to your ears as close as you can. This should be very easy and without pain. Normal range should find the arm no further than three inches away from the ear, ideally only one inch.

5. Wrist extension. Reduced wrist extension can make front rack position painful and hard. To test, place the forearm flat on the wall with the upper arm shoulder height. Extend the wrist by using the opposite hand to pull the fingers back. The hand and fingers should be able to break 90 degrees to the wall without pain.

To fix these assessments, start a routine of stretching, foam rolling and active mobility to improve these motions. If mobility exercises fail to produce results after a week or two, there are only two options left — avoid the problem or fix the problem!

If you have any questions, feel free to reach out to me at dr.cody@thrivespineandsport.com or call us at our office at 319-423-0925.  If you have been struggling with pain, fill out the appointment request on this page.

Chiropractic, PT, or an Educational Booklet: Which Is Better Treatment For Low Back Pain in Cedar Rapids?

Would you believe me if I told you that an educational pamphlet is just as effective as chiropractic care or physical therapy in relieving low back pain?

In 1998, a study published in the New England Journal of Medicine looked to compare the effectiveness of chiropractic, physical therapy, or an educational pamphlet for low back pain.  The conclusion of the study fueled a lively debate.  What the study found was that there was little difference in outcomes between low back pain patients treated with standard chiropractic manipulation, McKenzie exercises, or the educational booklet!  Not surprising, chiropractors and physical therapists alike were outraged from the findings.

While many previous studies done prior have shown chiropractic and physical therapy to be effective for helping with low back pain, why did this study show an educational pamphlet was just as effective?

To start, let’s look at the study design.  The patients were diagnosed with a regional diagnosis, low back pain, after pathology had been ruled out (herniation, cancer, etc.).  This would be no different than saying someone has shoulder pain.  Patients were randomly assigned to either chiropractic, physical therapy, or the educational readings.  This is where things got interesting.

Patients sent to a chiropractor were diagnosed with a sprain/strain 50% of the time, and another 30% of the chiropractic group was diagnosed with facet syndrome, or misalignments of the spine.  The same group of low back pain patients sent to the physical therapist were diagnosed with disc derangement 92% of the time.  This should raise some alarm!  The same group of randomly assigned patients sent to two different providers had significantly different diagnoses!

While it is entirely possible that the provider’s diagnoses were correct, it is highly unlikely that the difference was that dramatic.  It has often been demonstrated that nearly 70 percent of low back pain arises from 3 different sources; disc (39%), facet (15%), and Sacroiliac (SI) joint (13%).  This is where the study inherently failed.

While the study was not specific enough to sub classify low back pain patients into their respective groups, the providers themselves seemed to have classified patients based on what they can fix, not what the patient necessarily had.  McKenzie exercises have been shown to be effective in treatment of pain arising from the disc.  Likewise, chiropractic manipulation would be most effective in treating those struggling with facet and SI joint complications.

While this was not the intent of the study, this ultimately showed where modern day health care has gone wrong!  Too often, providers of any profession try to categorize patient’s problems into what they can fix, and not what the patient actually has.  It comes without saying that patient outcomes would be much higher if patients were given the treatment they need, and not the treatment the provider is certified to practice.   When providers try to fix patients by classifying them into what they can fix and not what the patient actually has, an educational pamphlet has just as much value as chiropractic and physical therapy.

Reference:

Excerpt modified from [Original DC article] by William Brady, DC. Used with permission. www.integrativediagnosis.com