Plantar Fasciitis is a painful inflammation if the connective tissue in the sole of your foot. The fascia in your foot essentially forms a sheet of tissue, running from the heel forward to the base of the toes. This fascia can undergo damage by way of micro-tears from unsupportive footwear allowing your arch to drop, trauma to the fascia itself with injury, and poor mechanics of the foot during everyday activities and exercise. These small tears do heal, but if the original strains upon the fascia remain they can heal as small deposits of scar tissue, and over time cause shortening and tightening within the whole plantar surface.
The pain is classically felt in the sole of the foot, often around the base of the heel, and extending through the whole underside of the foot in time. It is worst walking without supportive shoes or on hard surfaces, and like many inflammatory conditions is worst in the morning and then again later in the day as it tires. Over time, without intervention the plantar fascia can become short and fibrotic and your symptoms often become worse rather than better.
Obviously the plantar fascia itself is isolated in the foot and is the source of the pain you feel. But, that is only part of your pain picture. One of the main actions of the foot is to transmit and disperse weight effectively up into the lower limb. If there are alignment or restriction concerns in the knee or hip for example, then the load is increased on the foot itself, including overload to the plantar fascia. It is very common to see plantar fasciitis develop after an ankle sprain or knee sprain, as the loading onto the plantar fascia is significantly altered with the injury related gait changes. Another common trigger is poorly fitting and unsupportive shoes, especially when combined with a new or increased exercise plan. The plantar fascia needs some degree of external support from a shoe to help it manage repetitive impact sports such as running.
The best success with home treatment is when you work out that you have plantar fasciitis early, and then start a consistent home management plan. Treating your plantar fasciitis with denial rarely works!
Start with the widely applicable piece of recovery advice – what feels good is good, and what feels bad is bad. If you can run for 20 minutes without pain then simply do that for now; don’t run for 40 minutes. Start with a stretching and strengthening plan that covers your whole lower extremity
1. Marble pick up. Practice picking up small marbles or stones from the floor by scrunching up your big toe and second toe. Aim for ten of these, and then start increasing to 2 sets.
2. Tissue scrunching. Place a tissue on the floor and scrunch the tissue up with your toes (keeping your heel on the ground). Aim for ten and then increase to add another set.
3. Prayer posture. Sit on all fours, tuck your toes under and then sit back on your heels. Remain in this posture for 30 seconds and edge yourself further into the stretch with each deep breath. Repeat.
4. Self massage. Use your thumbs (or the rubber end of an unsharpened pencil) and push into the sore points in the sole of your foot. Try holding that pressure until it starts to feel better, and/or wiggle your toes to help the tight spot release. Move around to the top of your foot and again push on any sore spots between your toes. Continue on looking for sore spots in your calf muscle and he muscle that runs along the front of your shin.
5. Stretch your calf muscles by standing on the edge of a step and letting your heel drop downwards. Hold for a good 20 seconds and then repeat the same stretch but with a slightly bent knee to get the deeper muscles.
6. Wear supportive shoes. Ditch the jandals, scuffs, high heels and bare feet for a while. No one will see you first thing in the morning in your dressing gown and sneakers!
If the above stretching and activity modification doesn’t resolve your plantar fasciitis symptoms, then it is time to seek further evaluation and treatment. Osteopaths are trained to identify the biomechanical issues in your body that may be contributing to overload on your plantar fascia. It is likely that your treatment would involve assessment, exercises, manipulation and soft tissue release. Surgery is a poor option for plantar fasciitis, so it really is a case of seeking help when needed, keeping up the home exercises and finding yourself a good pair of supportive shoes.
ITB syndrome is a common problem for runners and starts as pain on the lateral or outer side of the knee. It is caused by friction or rubbing of the ilio-tibial band (ITB) against the outer tissues and structures of the knee, and you guessed it, it causes a lot of pain when running.
The ITB itself stands for Ilio-Tibial Band and it is just that – a band of tight tissue that spans between the hip and the knee. It is not particularly elastic or flexible like a muscle as it is designed to be tight to stabilise the hip and knee function. So when you are told you have a tight ITB that is exactly how it should be. The problems come when it is too tight and is causing pressure on the exposed structures underneath. So whilst some stretching is helpful for your ITB, it is often not enough to fix this problem. Your ITB has become too tight for a reason, and it is in finding that reason that the key to removing your pain lies.
Get yourself a good diagnosis, and that’s not just being told you have ITB syndrome, but actually the reason why you have ITB syndrome. ITB syndrome often stems from a mechanical imbalance in the whole lower extremity. Foot, knee, hip and pelvis mechanics can all play a part, as well as the likely muscle imbalances that can precede and/or cause this injury. If your health professional just rubs your leg and tells you to roll on a golf ball or foam roller, ask for more. You need a full diagnosis of why you are getting the knee pain, and a good plan to solve it.
Over twelve years of clinical practice has shown us that one common cause of persistent ITB syndrome is a pelvic imbalance. A twist in the pelvis can make the stride length slightly reduced on one side, resulting in a muscle length imbalance in the upper leg and pelvis and overload of the joints in the opposite leg. Some of these muscles then end up working too hard, tighten up, generate pain and then undergo premature fatigue causing further biomechanical stress in all of the leg structures. When the ITB becomes tight it creates pressure and friction on the uppermost edge of your shin bone where it attaches into, and everything that passes beneath this part of the ITB gets a bit squashed. With everyday levels of walking this is often not too troublesome, but as your knee bends a lot more and has the impact strike with running, the structures at edge of the knee can become sore and inflamed underneath the pressure of the tightened ITB.
Please don’t let a non-resolving ITB Syndrome stop you running. This is a very treatable problem, and if whoever you are seeing is not fixing it quickly, consider shopping around for another form of treatment. Ask for more from your therapist – ask why this injury is happening, ask how long it will take to recover, and ask what else they could be looking at to speed things up and prevent it from coming back.
Runners knee essentially arises from an imbalance between the various muscles pulling on the patella (knee cap) – some get too strong and overpower their counterparts resulting in the patella moving or tracking incorrectly. This starts off being painful in and around the patella as it doesn’t slide correctly in the groove of the knee joint, but can quickly spread pain into other areas as the muscles continue to pull it off track and compensatory patterns begin in the leg.
The pain usually starts around the outer edges of the knee and patella, and may spread up the thigh or down into the shin. It is worse with running and cycling in particular, although all exercising may cause knee pain, and then it is usually fine with rest. If this sounds like your knees, and you lead an active life, you may just have yourself a touch of Runners knee.
Runners Knee is best diagnosed clinically, and by that we mean using the pain pattern and presentation, along with palpatory findings in the front of the thigh to confirm Runners Knee. It will not show up on X-Ray, as there is not a bony problem in this situation; it is simply a temporary malignmnent of the patella on the front of the knee. Ultrasound is an option for helping to diagnose Runners Knee, as the continued friction under the patella when it tracks incorrectly can cause inflammation in the bursa (a small fluid filled cushion inside the knee) which can be identified on ultrasound.
The main group of muscles that causes the trouble is the quadriceps group – 4 large strong muscles that primarily control the knee. What usually happens, is the outermost of the quads becomes significantly stronger than the innermost section of the quads, resulting in the patella being pulled slightly towards the outside. Sometimes, it can be as simple as strength training to isolate the inner quad and stretching to the outer quad to reset the balance and correct patella tracking.
Although Runners Knee usually arises from a fairly simple imbalance, we need to also consider why that imbalance has come about. If you are simply using one part of your quads more than the other, then the simple solution of stretching and strengthening may be enough. However, let’s say one leg is slightly longer than the other, or you are slightly knock-kneed, or perhaps you are running with plantar fasciitis as well, then the pressures on your knee will be altered and the muscles will be responding accordingly. Recovering form Runners Knee will require not only the strengthening and stretching approach, but also treatment to resolve the other musculoskeletal factors that are contributing.
Virtually all cases of Runner’s Knee respond well to osteopathic treatment, and within 2-4 treatments you can expect to be well in the road to recovery. The aims of treatment are to resolve the localised inflammatory response at your knee and identify and address any underlying postural and body alignment issues that may be contributing to the problem. Rest and ice can be very helpful, particularly in the first phase of injury, and appropriate use of Non-Steroidal Anti Inflammatory Drugs (NSAIDS) can also be a good option. The main concern around NSAIDS with this type of injury is that sometimes they work too well – if you end up with no pain then in all likelihood you will keep running on it, and although there is no pain in your knee there is still damage occurring to the underlying structures.
Sometimes, for a short period of time it is necessary to give your knee a break and step back from your running. Often however, with good treatment you will be able to continue training as long as you keep up your self-care with stretching and using ice therapy at home. It can be so discouraging to find yourself injured, and so often it is just when you are starting to enjoy running, or reaching a certain milestone with your training, and the last thing we want you to do is stop. The benefits of exercising are so wide ranging, from your physical to your mental health, and we will do everything we can to help you keep going. Don’t let a nagging knee pain stop you – this is very treatable and you can get back to running pain free in no time.
In our quest to write the perfect newsletter detailing Men’s Health, we seem to have missed the deadline and Men’s Health Week has passed us by! But the way I see it is that gives us a golden opportunity to talk more about men’s health and how important it is to men, their families and our community.
A common injury with distance runners is ITB syndrome. This is pain on the lateral or outer side of the knee. It is caused by friction or rubbing of the ilial tibial band (ITB) against the outer tissues and structures of the knee, and you guessed it, it causes a lot of pain when running. (more…)