Foot pain

Fasciitis Treatment: A Physios Guide to Fixing Heel Pain

December 15, 2017 • By

Do your heels hurt from a lot of walking or running? Or have you been told that you have plantar fasciitis or a heel spur? Well, you are certainly not alone!

We have developed this comprehensive guide to give you the what, why and how to help fix plantar fasciitis.

What does the plantar fascia do

fasciitis and heel pain treatmentThe plantar fascia is a strong band of connective tissue that starts at the bottom of your heel and runs along the bottom of the foot, attaching into the toes.Think of it like a big strong rope that supports your foot and helps you move.

It is important for:

  • Maintaining your arch when walking and running
  • Stabilises your arch: As you push off your big toe, the fascia is put on more stretch, which lifts up the arch into a more stable position so you can propel yourself forward. This is called the windlass mechanism. You can see in the diagram below how when the big toe is pushed up, that pulls on and tightens the fascia, lifting the arch up. For more info on the windlass mechanism, you can see this previous post.

plantar fasciitis treatment exercises

What is plantar fasciitis

In a nutshell: It is a thickening of the plantar fascia due to overload.

A massive 4% of the population over 20 have plantar fasciitis and it is a massive cause of loss of function. It is essentially an overload injury where multiple factors combine to increase the load/pull on the fascia. This overload combined with not enough time for the tissue adapt leads to mal-adaption.

Essentially, it adapts wrong and ends up getting thicker and dysfunctional.

Other common names of Plantar Fasciitis

  • Plantar fasciopathy or fasciosis
  • Plantar heel pain

Is fasciitis inflammatory?

No. There has been shown to be some inflammation early on in the pathology but on the whole, it is not an inflammatory injury after the first 1-2 weeks.

This is why over the last ten years, a lot of the medical profession and research down around this condition have been leaning towards calling in plantar fasciopathy, not fasciitis. For now though and the purpose of this article, we will continue to call it fasciitis for continuity. (1)

Fasciitis symptoms

  • Pain upon waking and taking your first few steps –This startup pain” is because your plantar fascia and calves have been in a contracted, shortened position all night.
  • Sharp stab or a dull ache in your arch or at the heel.
  • Pain after long period sitting.
  • Pain that eases gradually in a walk or run as it warms up

Risk factors for Plantar Fasciitis

  • Limited ankle or big toe range of motion
  • High body mass index/Overweight
  • Older age,
  • Prolonged standing.

The best Plantar Fasciitis Treatment

Nplantar fasciitis treatmentow that you know the what, why and how of how fasciitis can happen, we can move on to the main thing. How you can help your plantar fasciitis get better, faster.

These are the main things that need to covered in a comprehensive treatment of plantar fasciitis

  1. De-load the fascia through alteration of exercise or load
  2. Support the foot and fascia
  3. Improve strength of the calf muscles for better control and shock absorption
  4. Reduce the pull on the plantar fascia by
    1. Improving flexibility in the calf and plantar fascia
    2. Improving ankle dorsiflexion range if needed
  5. And last but importantly, we gradually load the plantar fascia to re-align the fibres and get rid of the thickening

Here are those steps laid out in far more detail:

1. Reduce load

Plantar fasciitis happens from the repeated load on the plantar fascia without enough recovery. So, simply, to help give it a chance to recover, we need to reduce the weight bearing load to a degree. It isn’t about stopping completely, that is barely ever needed.

For Plantar Fasciitis, it is all about the relative rest

This means resting the fascia, compared to what it has been doing and what overloaded it. For example, if you were running 5 or 6 days a week, you could cut that down to 3 times per week, every second day. There isn’t a set exact guide for this but the big thing is to listen to your body. If you have more morning pain the next day then ease off a bit more and don’t do quite as much.

Not satisfied with decreasing your running or walking or too sore to keep going? Then on the rest days or as an alternative, try getting on a bike or rowing machine and get your exercise in another way.

2. Support the foot

Helping support under the plantar fascia and encouraging good foot motion can be great for relieving pain when you have plantar fasciitis. There are a few options to help here including:

  • Orthotics – These help support the medial arch and cushion the heel and are recommended for up to 1 year
  • Gel heel pads – Great to help reduce impact and give a soft surface for your heel
  • Fasciitis compression sleeves – These great socks can mimick arch taping really well and we have found they can give patients great relief

3. Improve strength

Studies have shown that people with plantar fasciitis have calf weakness, as well as ankle and calf tension2. This can increase load and contribute to fasciitis as the calf is then absorbing less impact and there is less control.

Strengthening the calf is important but often when the plantar fasciitis is irritated, it can be too sore to do. Never fear though, we have provided a couple of different levels of strengthening for you to work at daily:

level 1: Theraband Calf Strengthening

As per the picture below, push your foot down again a resistance band (TheraBand for example) and then control back up.

Repeat this for 3 sets of 12 repetitions and adjust the tension of the band to make it easier or harder

calf stengthening for plantar fasciitis

Level 2: Heel raises

Starting on two feet, and holding onto a wall if needed for support, raise up onto your forefoot as shown and then slowly control back down over three seconds.

Do this for 3 sets of 12 repetitions and when that is easy, start doing them on one leg at a time.

Note, if there is more than a little pain then start with level 1.

Calf raise, calf exercise, heel raise

4. Reduce the pull

Both the calf and the plantar fascia attach onto the heel and some fibres of the Achilles tendon actually wrap around and attach to the plantar fascia. So it makes sense that any tension in the calf, plantar fascia or ankle can increase the pull at the heel and worsen fasciitis.

Here is a quick test t see if you have enough ankle range:


easy test to measure your ankle range

If you can’t get your knee touching the wall when your foot is 10cm (4 inches) without your heel coming off the ground then you have some work to do! Here are the top three exercises to regain ankle range and reduce plantar fascia and calf tension:

1. Ankle mobilisation

Improve the dorsiflexion range in your ankle if you failed the ankle range test above. See the video demo below for an easy ankle self-mobilisation at home. Alternatively, if you don’t have a band (you can get one here if needed), you can lunge your knee back and forth towards the wall for about 3 sets of 20 reps.

2. Calf stretch: Hang one heel off a step at a time to stretch out your calf and hold this for 30 seconds each side.

calf stretch , soleus, gastroc - self treatment for shin splints

3. Plantar fasciitis deep massage: Use a hard ball or a massage ball to roll out the sole of your foot. Do this between the heel and balls of your foot, NOT under the heel. Do this slowly and firmly for 1-2 minutes to relieve the plantar fasciitis – You can also use a small frozen water bottle!

plantar fasciitis treatment

5. Gradually load

The final aspect of rehab is to load the plantar fascia. The idea behind this and in some recent, successful research is to treat it like a tendon injury. In tendon injuries such as Achilles tendinopathy, the tendon is thickened and the fibres and dysfunctional due to overload. The big part of tendon rehab thing that helps this a lot is putting gradually more load through the tendon. This causes the tendon to adapt and change for the better.

Looking at it like this and treating the plantar fascia like a tendon (even though it technically isn’t) looks to be gaining good results in research and the clinic and is becoming a mainstay or plantar fasciitis rehab over the last few years.

If you want to read further about this, you can check out the main research paper here, with their main conclusion being:

High-load strength training may aid in a quicker reduction in pain and improvements in function

Otherwise, if you don’t want to read a research paper:

This is the main exercise that is used to load and strengthen the plantar fascia to ultimately help fix plantar fasciitis

The high load strengthening exercise is done as per the image below. A small towel is rolled up to raise the toe up (hence, putting the plantar fascia on stretch) while doing a heel raise off a step. Go up and down slowly (count 3 seconds each) and hold at the top for 2 seconds.

This can be started two-legged and progressed to one-legged as it gets easier. You can then add a backpack with something heavy in it to add a little extra load. Keep doing this until you are pain-free.

plantar fasciitis strengthening exercise

Rathleff Et al. 2014

 

Conclusion:

And that’s it – all the information, treatments and tools that help fix plantar fasciitis.

Unload, Support and Gradually strengthen

 


Health

How to Prevent Ankle Sprains in Basketball | Infographic

December 12, 2017 • By

prevent ankle sprains in basketball

 

More in-depth:

What is the most common lower limb injury? Ankle Sprains

What is the most common basketball injury? Ankle Sprains

With ankle sprains being as prevalent as they are, it’s handy for basketballers to know what helps and what hinders their continued playing. Luckily, there are some brilliant studies that have looked into just that and today we have summarised a large study from the BJSM.

Main study components:

  • 10 393 basketball players were observed for the study
  • 3.85 players injured per 1000 players
  • 45% were injured when landing

What are the risk factors for ankle sprains in Basketballers

A previous ankle sprain is a massive risk factor due to a couple of reasons:

  • Large sprains can leave some laxity on the ligament and joint
  • Athletes not fully rehabilitating sprains back to 100%

Ankle sprains are too often brushed aside with a week or two off sport and rest before getting back to it but the trouble is then that there is normally some muscle weakness that needs to be addressed.

It is very interesting to see a massive 4.3 X risk of ankle sprain in those that wear air cell shoes (can be the more expensive shoes) compared to those that don’t. This is part of the reason there has been less of these type of shoes on the market recently.(1) This could be down to the fact that the air cell makes you slightly higher off the ground and also the fact that it takes away feeling and proprioception, worsening you muscles reaction time.

In terms of a warm-up, we find a lot of people think they get injured because they haven’t stretched but it is actually more likely to sprain your ankle if you don’t warm up – with dynamic stretches or game-like drills.

 

Prevention

This is fairly straightforward:

    1. As you have probably guessed, an easy one is to warm up well. You can use a guide such as the FIFA 11+ which has been shown to be effective for basketball as well as football(2) or this one from Jeff Haefner at Breakthrough Basketball
    2. Rehab injuries fully – challenge you dynamic balance until both limbs are even at least
    3. Use a lace-up ankle brace for up to 12 months after injury such as the DonJoy Ankle Brace

 

Conclusion:

Rehab well, protect injured ankles and don’t take them lightely.


Ankle

The Top Sprained Ankle Treatment | Infographic

December 8, 2017 • By

Because sprained ankles are so common, every second person you talk to will have a different opinion on what is best and what you should do. So, to help you out we looked at the best research and summarized what is REALLY the best sprained ankle treatment so that there is no room for confusion.

Here is our infographic summary:

Ankle sprain treatment

Explanation:

As you can see, almost all research papers that this systematic review looked at, agreed that physical therapy (physiotherapy) should be trialled before surgery. This is relevant for grade 1, 2 and 3 sprained ankles – so even the high-grade tears. Of course, every injury is different so there is always the exception to this but your physio can guide you better with that after a thorough assessment.

What we found interesting was that ankle braces are now being recommended for at least one-year post injury. They have also been shown over this time to effectively lower re-injury rates and should be a g-to sprained ankle treatment. It is also worth noting that certain treatments that are used very commonly such as ultrasound and manual therapy show little benefit – this isn’t to say that they offer no benefit, they just haven’t been proven to give statistically significant improvements – for some people that can really help and we find manual therapy is very effective for the sprains and fractures (when out of cast) that are particularly stiff.

You can check out one of our most popular posts on ankle rehab HERE. It details some great basic rehab exercises to help guide your ankle back to it’s best as this is far more beneficial than just resting the ankle. Resting won’t get your strength back, it won’t get movement back as effectively and can just lead to more dysfunction.

Takeaway point: Active rehab is the key to successful sprained ankle treatment.


Ankle

Do Ankle Braces Prevent a Sprained Ankle? | Research Round-up

December 6, 2017 • By

Given the high frequency of ankle sprains in everyday life and dynamic sports such as basketball and volleyball, we decided to feature some summaries of research papers that show just how effective different sprained ankle treatments are.

Today we have a great infographic summarizing a systematic review (the highest level of evidence)  that helps answer the question of how to how well do ankle braces really help prevent a sprained ankle:

ankle brace for sprained ankle running

 

This study effectively shows that ankle braces – lace-up braces specifically – are incredibly effective in reducing the number of sprains that occur in basketball and this can be translated quite well to assume that it has similar effectiveness to prevent a sprained ankle in other sports as well.

You can check out the abstract to the mentioned study here and if you need an example of a good lace-up ankle brace, here is a good example on Amazon of the DonJoy Ankle Brace


Health

Knee Cracking: Noisy Knees are No Worry

September 28, 2017 • By

Knee cracking, popping and creaking are very common complaints but are actually nothing to worry about. Today’s post is an explanation of what causes the cracking in your knees, why it is no issue and what you can do to help it if it still gives you or a family member the heebie-jeebies…

knee cracking - what causes itWhat causes knee cracking?

Firstly, in the majority of cases, the cracking IS NOT FROM ARTHRITIS.

The most common cause of knee cracking or crackling are:

  1.  Gas bubbles within the main knee joint. We have a lubricating fluid within our joints called synovial fluid and within this can be gas bubbles. The change in joint pressures with movements of the knee causes these gas bubbles to move and pop – causing the cracking or popping noise
  2. Fluid movement behind the kneecap causes more of a fine crackling noise when bending the knee back and forth
  3. Another common cause of knee cracking is extra-articular (outside the joint) tendons or ligaments snapping back and forth over a knobbly bit of bone.(1)

Either way – these are not usually painful but if you are getting pain with you knee cracking then you should see a physio to get it assessed and treated.

The cracking can happen at any age but is more common as you get older and can be in one or both knees

 

Painful knee cracking

This is far less common but it can be caused by wear and tear (degeneration) of the cartilage and can be treated well with good treatment and rehab exercises – particularly if caught early, so if in doubt, go see your physio.

 

The video below gives a great explanation of crepitus and how it has no correlation to pain or pathology (Watch from 1 minute onwards)

 

How to decrease swelling and support your knee

For those that DO have painful knees, as well as seeing your physio, a compressive knee support can help a lot. There are two main types for you:

  1. A slip on compression sleeve with patella support. Having support for the kneecap at the front helps maintain alignment and compression of the support is key for helping keep the knee warm and decrease fluid from swelling.
  2. For those of you with large thighs, a wrap around knee support can be better fitting and more comfortable as the above braces and more cylindrical in shape and can slip or roll down.

Another great way to support the knee is to get the muscles around it stronger! A great place to start on that is some wall sits, which is a very safe way to lay a base of strength without aggravating any knee pain. Check out more on that here