3 Things You Probably Did Not Know About Plantar Fasciitis

1.Having a heel spur does not mean you have plantar fasciitis. Link here.
In this study, 50% of patients with plantar fasciitis have heel spurs. It also shows that 20% of people with NO heel pain DO have heel spurs. What all this really means is that a heel spur may develop due to the dysfunction of the entire foot over a period of time. This is why focusing on the dysfunction is much more important than focusing on expensive imaging.
2.High-load strength training may aid in a quicker reduction in pain and improvements in function, compared to stretching. Link here.. This study shows a positive effect of both stretching and strengthening, and a progressive approach to be best overall.

3. Chiropractic adjustments can improve foot alignment and therefore help decrease symptoms of plantar fasciitis. Excessive foot and ankle pronation (loss of medial arch) is associated with plantar fasciitis. Correction of this abnormal foot posture will improve foot function, and decrease the stress forces that lead to irritation of the plantar fascia.

You may be wondering why you should see a Chiropractor for plantar fasciitis. This is because a good chiropractor can see the connection between plantar fasciitis and low back pain. We can also see the connection betwen your knee pain last month, and your current hip pain. Going to a specialist may seem like a good idea, but they tend to put on blinders to what is going on in the rest of your body. There is no muscle, joint, or nerve that works in isolation. That is why it makes no sense to isolate your focus to just one area. It is often the case that the most dysfunctional areas are NOT painful. That's why you need someone with vision, and experience.

STOP THE POP!

There is much confusion around "popping" your spine. At least once per week, a new patient will ask "Is it OK to pop my back?" It is a fair question. It requires a fair explanation.

It would be wise to start with defining what exactly "popping" means. This noise happens when a stretching of a joint creates a vacuum. The vacuum pulls out gases from the synovial fluid. The release of gas creates a pop. This is called a cavitation. This is similar to what happens when you open a wine bottle (the cork-top kind, not the cheap screw cap). Improved range of motion is often felt immediately afterward. That is unless something goes wrong. And it could.

Stretching the joint to get a pop and re-aligning the joint are two different things. I can pop my own knuckles, but that does not necessarily re-align them. A real Chiropractic adjustment requires an assessment first. It requires that misalignments be identified before the adjustment, and checked afterward to see if any change occurred. Without this essential information, the chances of the joints moving in a "good" direction are minimal. Here is another curveball- the areas that are in pain are not always the areas that need to be adjusted!

Once in awhile, I see someone who has "popped" a joint in a bad direction, and they are stuck. The alignment is now worse, and sometimes painful. However, it more often happens that the person has popped their back numerous times a day, and have done so for years or even decades. When this happens, the joint tissues get stretched. It becomes difficult if not impossible to achieve any adjustment until the person STOPS THE POP. This patient is usually very disappointed on the first visit, because any further "popping" is unlikely.

It is surprising to me how many DIY videos there are on Youtube for those willing to try, but these are quite ridiculous. I will say that some of these movements are good as stretches. But there is a big difference between going for a stretch and going for a pop. If you are truly trying to stretch, and you feel a pop, there is no need to fear. Unless, of course, it was a button that popped off your clothes.

A pain by any other name

Being a good doctor means going further than a diagnosis. I remember talking to an acquaintance of mine at a backyard party. He was describing his recent development of neck pain and associated arm and hand pain. He had gone to his primary care physician for this very reason. He was relieved to have had a diagnosis after a very thorough exam and x-ray. He was told that he had "cervical radiculopathy". He was certain that he was on the right path to recovery, since he left the MD with a prescription for opiods.
I remember not being able to hold back a chuckle. My acquaintance asked why I thought it was funny. I replied "I knew you had cervical radiculopathy the very second you described it to me." He seemed astonished. I informed him that the phrase "cervical radiculopathy" only meant that you have neck pain and associated arm and/or hand symptoms. It is a way to classify a condition, and does not specify how one develops it. Nor what to do if you have it.
But I do understand where he was coming from. Sometimes doctors tend to minimize a pain or a problem when they feel that they don't have a good solution for it. They may suggest that the pain will go away on it's own, therefore any treatment beyond medication is unnecessary. The diagnosis of "cervical radiculopathy" meant that there was definitely something wrong, and that there was a good standard operating procedure for dealing with it.
What is even more important, however, is the reason that the person has the "cervical radiculopathy". Why this patient? Why now? Why on just this arm and not the other?

This where having a good doctor is helpful. Asking questions like the person's sleeping position, computer workstation setup, and exercise history are crucial. Looking at the entire body posture is also important. Assessing range of motion and core strength are essential.
After a few weeks of only slight improvement with the opiods, this acquaintance came to my office for the same reason. I was able to determine that his computer workstation did not have a pullout tray. This means that he had to lift his arm too much to mouse with the arm with the pain. Considering he spent 10 hours per day at the computer, this was significant. He also slept on this same side with his arm underneath his head. After a month of treatment, and improvement in his workstation and sleeping position, he was 75% better. His arm pain was completely gone.
I still see this patient periodically, as his 10 hr/day computer usage is still too much for his body to handle, even with improved ergonomics.

Just try it.

I am chronicling my experience as a newbie triathlete in an effort to motivate people to just get out there and do it. What is "it"? It is something. It is anything more than what you are doing now. It is a step in the right direction.

Ten years ago I had consistenetly hit 212 lbs and my blood pressure was climbing. I believed heart disease was just around the corner. I was weight training, but doing little to no cardiovascular exercise. I was stuck in the bodybuilding types of exercise that I always had done. I had been doing them for 20 years. So that's when I started running. And it felt good. It felt like a meditation. Like I could think more clearly. I decided to see if I could run a marathon. I trained way longer than anyone else I talked to. I trained for a year. And I did it. And I was satisfied with that.

Then I got bored again. I needed a change. I knew that I always stunk at swimming. So I challenged myself to do a triathlon. It probably sounded more absurd to me than to anyone else. In the eyes of some people, it seemed a natural progression. I was already considered "athletic" by some. But it certainly did not come natural to me. The first year I did not train long enough. I only gave myself 5 months. I did not come close to being able to do the swim. So I did not even register. The second year I trained for 10 months. But this still did not prepare me for shock that my lungs would go through. The 43 degrees air temperature was too much and I swam to a lifeboat. I decided it was not a good day to die.

This time I trained - well I don't know how long. If you count the previous attempts, you could say I trained 2 or 3 years. And I did it! I stunk at the swimmimg. NOBODY passed me on the bike! Three people passed me in the run, but I passed a dozen others easily.

But you do not have to do triathlons. You do not have to do marathons. Maybe you will one day. Never say never. You can start by walking around the block. Join a gym. They are alot cheaper than they used to be. And there are alot more options. Yoga. Pilates. Orange Theory. Fit Body Boot Camp. Spinning. Barre (ballet?). Maybe Jazzercise? Instead of just do it, I would suggest just try it. If you don't like it, try something else. What is the best exercise you ask? It's the exercise you LIKE THE MOST. Then again, maybe it's the one you hate the least.

Not every hurt equals harm

If I were to go the gym and perform 300 repetitions of a 25 lb. bicep curl, my arms would hurt the next few days. Lifting my coffee cup the next day would likely be painful. Probably very painful. Yet doing so does not create further damage.

This is a good example of "not every hurt equals harm". Many chronic pain sufferers get confused with this, and I can understand why. The medical system has in the past taught us that we are fragile. The "overuse " theory makes us believe that we should not exert ourselves. The problem is that exertion is what is needed to become stronger, and thus avoid the problem next time. Einstein once said "A clever person solves a problem. A wise person avoids it".

Most assurances that rest, along with other passive treatments like medications, ice packs, or hot packs will take of the problem fail to recognize why it happened to begin with.

That is why most new patients come to our clinic. They don't understand why they hurt. New patients typically don't come to see me because they are sore from obvious strenuous activities such as home projects, yard work, or a vigorous workout. They realize some soreness is to be expected. Yet when there is no obvious trauma, accident or overuse that they can point to, it stands to reason that there is a deficiency in the person's physical ability to perform daily activities. Working through some pain is usually required.

Having someone experienced helping you through these painful exercises is essential. Ignoring pain is tricky, but there is one general rule. That is if you are exercising and it hurts, continue the exercise. If the pain goes away the more you do the exercise, then the answer is obvious. If the pain worsens it is best to stop. Unchanging pain is a judgement call. If the pain is mild and you can tolerate it, continue. Again, it is best done with an experienced professional's guidance.

Third Try for a First Tri

Well, it's official. I have just registered for the Allendale Countryside Triathlon. I have been training Since January, so I have given myself enough time to develop my lungs and my swimming skills. This is the third year in a row training for a Tri, but I have not yet completed one. The first year, I did not give myself enough time to train. Three months was nowhere near enough for a guy like me. (At 205 lbs and 5'9", I am technically in the Clydesdale Division) I did not even register. The second year I trained for 6 months, yet my asthma proved to be the limiting factor on a unusually cold morning for a "summer" Tri. So, yes it's my third try for a "Tri" (Sorry-I couldn't help myself).

Much like my story last year the swimming is by far the hardest for me. While the training has been difficult, the experience has been priceless. It has been my intention to become better at identifying conditions related to this type of training. It also helps to know something about training schedules and equipment, as it relates to common problems.

One of the most common problems I see is running is TMTS or too much too soon. There should be no increase in mileage or pace by more than 10% per week. if you break this rule, expect to hurt. The pain can be anywhere, but most often seen is knees, feet and hips.

The second most common problem I see is neck pain from swimming. Any swim coach will tell you to breath every three strokes. This ensures that you alternate sides on which to turn your head to get above water. If you breath every two strokes, you will repeatedly rotate your head above the water on just one side. This will lead to overuse of the muscles on that one side, and the imbalance will create pain.

Bicycling has its own set of problems. The most common of which is the excessively rounded low back. The lumbar spine naturally curves a bit, and this is called lordosis. When this curvature is completely reversed, more pressure is created in the intervertebral discs. Some telltale signs are stiffness when you get off the bike, and stiffness and/or pain when you wake up the next morning. Considering that the discs are already loaded from being in the seated position, any additional load can prove to be very detrimental.

My other reason for completing a Tri is to help motivate my patients. Sharing with them my failures and successes helps them to realize it is not always the destination, but the journey that is important. Just get up and "Tri" ! (Last one, I promise.)

Core Coordination?

While there is no shortage of "core" exercises, there is a shortage of common sense. I still find many patients doing outdated exercises and still injuring themselves in the process. This effectively sabotoges their health and exercise ambitions, and sends them back to the drawing board. Frustration builds until they just give up, and quit exercising altogether. They hurt because they are out of shape and don't exercise, but if they do exercise they hurt even more.

So, for the record, I am suggesting that the "sit-up" or "crunch" are not a good exercises for most people. One big problem is that the body's "core" is designed to RESIST motion, not CREATE motion. This goes back to my previous post about firing a canon from a canoe. It just doesn't work. The canoe moves just as much as the cannonball. Strengthening your core muscles to resist motion effectively locks down your cannon to dry ground.

But there is another problem with the typical person doing a "core exercise". That problem is core coordination. Not only are the core muscles meant to stabilize the spine and resist motion, they are also inherently involved with breathing. The external and internal oblique muscles, the abdominus rectus, and the quadratus lumborum muscle are all involved with forced expiration. That is considered exhaling when you are NOT "at rest".

If you watch the average person doing the crunch or sit-up or any core exercise for that matter, you will likely see this person holding their breath. You also may have noticed this pattern in yourself when you bend down to tie your shoes. This is because your body senses that it should be firing up the core muscles, but these muscles are weak, so you just hold your breath to achieve the same effect of stiffening the spine. This is called the "Valsalva maneuver", and is often used by powerlifters to lift maximum weight. Whereas it may be useful in stiffening the spine during a maximum lift, it should be avoided in other situations. It is known to cause an unhealthy spike in the blood pressure. I feel that it is cheating (except in heavy lifts) as it allows you to avoid full activation of the core muscles when completing simple movements of daily life.

So to teach the body to coordinate the activation of the core muscles with active breathing is the goal. The more you can coordinate these the more you can exercise. Obviously if you are continuously holding your breath (Valsalva maneuver), then you will not able to accomplish much. You will be too out of breath. An example of this is holding a "plank". Count your breaths instead of seconds. This is the only way some of us will actually breathe. Yoga is another good way to go, but then again I have seen many people nearly pass out in class because they were not breathing properly. Make breathing the primary consideration when choosing ANY core exercise. As much as I would like to think we would just naturally breathe through them, I am not holding my breath.

Weak Core + Running = Low Back Pain

The diagram above represents the trigger points that arise from the superficial longissimus thoracis muscle. If these areas look similar to any pain you experience I would not I be surprised. The pain pattern was identified recently in a research study published in the Journal of Biomechanics as the most likely injured due to a weakness in the deep core muscles. Multifidus, quadratus lumborum, psoas, and deep fascicles of the erector spinae are considered part of the deep core for this study. Note that the "abs" were not included! Because the superficial LT was most often the muscle overcompensating for weak deep core muscles, it may be “most at risk for fatigue or injury” if deep core muscles are not functioning properly.

If you are a runner, and experience low back pain, you are in good company. Up to 14% of American runners experience it each year. "Muscular compensations may increase risk of muscular fatigue or injury and increased spinal loading over numerous gait cycles may result in damage to spinal structures. Therefore, insufficient strength of the deep core musculature may increase a runner's risk of developing LBP."

How do you know if your deep core muscles are weak? If you have a job that requires you to sit, it is very likely. The best you can do is seek the advice of a health care professional with experience in recreational runners. Call us at (616) 301-3000 and set up an appointment for a free consultation to find out for yourself.

STOP STRETCHING!

Just kidding, sort of.
There is alot of hoopla these days about how stretching is supposedly a waste of time.

It's funny how fads come and go. And often come back again. Is high intensity cardio or low intensity cardio better? What about barefoot running? Wasn't that the hottest trend 8 years ago? Why are there so few "barefoot shoes" in the stores now? So-called experts will often become insistent that the newest research study is the final word or any given topic. But when you've been around awhile you start to see the patterns. A new study is much more likely to get published if it contradicts existing beliefs.
If you have been around the fitness industry you may have noticed that the trend has been very anti-stretching lately. In reality, there have been a few recent studies to suggest that stretching is pointless or even detrimental to athletic performance. But these studies need to be looked at in context to be understood.
A few studies suggest that stretching BEFORE exercise decreases strength. These studies mostly focus on peak effort. If you are a legitimate competition athlete then perhaps this applies to you. And it even makes sense. A powerlifter is a good example. If I were a powerlifter, I would not try to completely stretch out my pectoralis major muscles BEFORE a single rep maximum weight bench press. Or perhaps a long jumper in track and field. If I were a longjumper, I would not stretch out my hamstrings fully before a long jump competition. Warming up with a lower weight bench press would make much more sense for a powerlifter, as would light running or jumping rope for a long jumper. In reality this applies to a small percentage of people, as most of us do not earn a living by bench pressing or long jumping. The net detrimental affect that was observed was so small, it would not be noticed much by the average person exercising.
Separately, there are more studies which looked at larger populations of non-professional athletes, and the relationship between stretching habits and injury rates. They could not find any direct connection to decreased injuries with those who stretched regularly. This surprised a lot of people. But consider that there was no instruction given to these people on how to stretch correctly. There are dozens of different ways to stretch, and hundreds of different muscles to stretch. So it is possible that a correlation may have been found if specific instructions had been given?
It important to keep in mind that these studies are in contrast to decades of research suggesting that stretching is beneficial, and that it could help prevent injuries. So where does that leave us?
In truth these new studies really matter little to me. My business is pain relief. These studies don't look at specific stretching techniques on specific muscles to decrease pain. Pain levels can most certainly be affected if the ultimate problem is due to a shortened muscle.
Notice I said shortened and not tight. "Tight" can also mean "taught", or "high-tension". "Shortened" means it needs to be longer. NOT ALL PAINFUL MUSCLES ARE SHORT! Pain in a muscle can result from being overused, being under-used, being too short, or being too long. That means that if stretching does not help the pain you are experiencing, stop stretching. There is a good chance the muscle that is hurting is not truly "short", and therefore stretching it will do nothing. AGAIN, NOT EVERY PAINFUL MUSCLE IS SHORT!
The take-away message here is:
1. Don't stop stretching if you feel like it is helping you.
2. Don't assume every painful muscle is short, and therefore needs to be stretched.
3. If you are stretching a muscle and yet it keeps hurting, consult a professional. A Chiropractor or a physical therapist with good knowledge of sports injury is a good start.