Sciatica is one of the most painful, common and debilitating nerve pains there is. Luckily, an effective treatment method is right at your fingertips.
Half the patients we see in our clinic our back pain patients and sciatica is a common issue, causing a lot of pain and limitation.
But there is something else that we have noticed as well, often, a patient with sciatica has come in for a follow up significantly better after using an Inversion Table of a friend or family member. The nerve pain has improved markedly afterward.
Due to this, we started looking into it further, and even though there isn’t any high-level solid research showing that it works every time, there is both theoretical and anecdotal evidence to say that it really does help relieve sciatica and low back pain.
Note: Various forms of lumbar traction has been used for the relief of pain since the time of Hippocrates. So this is in no way a new thing. It is now just far more accessible!
Sciatica is not a diagnosis
Sciatica is a symptom of an underlying back pathology. That helps a lot in understanding how traction and inversion tables help relieve back pain and sciatica.
The nerve pain that people with sciatica feel are pain referral due to nerve irritation or compression somewhere higher up in the low back by the real cause. This underlying cause is what needs to be treated.
Often sciatica and other forms of back-related pain are due to a number of underlying pathologies, including:
Stenosis – Narrowing of the spine, where the nerves travel through
Spondylosis – This is effectively Osteoarthritis of the spine
Herniated or prolapsed discs
Note: You do not need to have sciatica or nerve pain for this to be relevant to you.
How Inversion tables actually helps sciatica
By inverting your body, your spine is tractioned. This improves the space around the nerves as well as stimulating healing and flow of fluid.
Traction of the vertebrae changes the position of the nucleus pulposus. This is the gooey part of your intervertebral disc. Tractioning the vertebra has been shown to improve space and reduce pressure on the disc. This also increases the area of the lateral foramen where the spinal nerves exit.(1) It isn’t known how well this maintains once full bodyweight is back on your spine though.
We often get asked for recommendations, so here is a quick link to the most popular, most affordable Inversion table on Amazon:
Are inversion tables safe to use
When instructions are followed, yes they are.
The main things to remember are to have someone with you to help if needed and check with your GP first to ensure there are no medical issues that may not be able to handle the change in position, such as a cardiac condition.
How far should you tilt on an inversion table
Studies show that you need to have at least 26% of your body weight force on your spine to achieve an effect on your low back.
Maitland suggests 30-45kg weight to be ideal on average, so it does not need to be your entire body weight and often just part of half way can achieve the required effect.(2)
The evidence is inconclusive on traction and inversion tables but anectdotally and theoretically that can be beneficial in helping relieve low back pain and sciatica. If you have had experience with low back pain and inversion therapy, let us know how it helped you.
An ankle sprain is one of the most common injuries, making up a quarter of all sporting injuries. But luckily, whether in sports or just in everyday life, there are two fantastic ways that are scientifically proven to reduce ankle sprains and protect ankles.
Millions of ankle sprains worldwide
In the Netherlands alone, they see a massive 580 000 ankle sprains a year and the US it is estimated that there are 628 000 per year! And keep in mind that half of those are from athletic participation, so it is just as common to injure your ankle off the sporting field in day-to-day life. (1)
Given this high occurrence of ankle sprains, one would think that everyone knows just what to do to rehab them back to 100% and prevent them happening but it seems that it is almost the opposite. It seems that because ankle sprains are so common – they are brushed off as “normal” with comments like:
“It’s alright, my ankle rolls all the time, it’s just an ankle sprain”
“I’ve got weak ankles”
But really, there are proven ways to prevent ankle injury that are cost-effective and they work and given that the risk of re-injury is DOUBLE in the first year after injury – why would we not do more to prevent this?
That’s where a couple of great recent studies come into play that shows what non-surgical options help heal an ankle sprain well and help prevent re-injury:
And don’t worry, they are just brief summaries, not a big write up!
Study 1: An earlier study (systematic review – the highest level of evidence) in 2010 found that taping, bracing and neuromuscular (balance) retraining are each individually linked to a 50% reduction in ankle sprain risk. Who could say no to a 50% less chance of reinjury right? (3)
Study 2: Following on from this study some researchers went a step further to figure out actually what was MORE effective between bracing and neuromuscular retraining.(2)
This is what they found:
Bracing is superior to neuromuscular training for the prevention of self-reported ankle sprain recurrences.
Bracing is associated with an added 47% reduction in risk of recurrence versus neuromuscular training.
bracing was proven effective when prescribed during sports for 12 months, the prescription period of brace use in athletes needs to be extended, instead of being phased out.
So if you had sprained your ankle in the past 1-2 years or have issues with ankle instability, our evidence-based advice would be to keep a good ankle brace and massively reduce the risk of reinjury.
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
The 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.
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)
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
The best Plantar Fasciitis Treatment
Now 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
De-load the fascia through alteration of exercise or load
Support the foot and fascia
Improve strength of the calf muscles for better control and shock absorption
Reduce the pull on the plantar fascia by
Improving flexibility in the calf and plantar fascia
Improving ankle dorsiflexion range if needed
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
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
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.
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:
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.
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!
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.
Rathleff Et al. 2014
And that’s it – all the information, treatments and tools that help fix plantar fasciitis.
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.
This is fairly straightforward:
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
Rehab injuries fully – challenge you dynamic balance until both limbs are even at least
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:
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.