What is Plantar Fasciitis?

Plantar Fasciitis runners foot pain

By Reiss C Gridley, B.Sc. (Hons)

Plantar fasciitis (or fasciopathy) is a debilitating condition which can make people feel like they are walking on glass. The most common site of pain is underneath the foot or pain around the heel. It usually occurs with first steps in the morning or after long periods of sitting.

The plantar fascia is a band of connective tissue that runs from the calcaneus (heel bone) to the toes. The main reason the plantar fascia becomes painful is because the collagen (which makes up the connective tissue) degenerates.

The cause of the degeneration is repetitive micro-tears of the plantar fascia that overcome the body’s ability to repair itself (Young et al, 2001).

Although it is a common practice to use cortisone injections on plantar fasciitis it has many complications. Plantar fascia rupture which can lead to long term pain and can be extremely hard to treat. Or, fat pad atrophy which causes heel pain.

A cortisone injection is a strong anti inflammatory that eliminates inflammation to the area in which it is administered. The problem with this, is that modern research suggests that plantar fasciitis is actually a degenerative condition (fasciosis) without inflammation.

One study found that treatment regimens such as serial corticosteroid injections into the plantar fascia should be re-evaluated in the absence of inflammation and in light of their potential to induce plantar fascial rupture.
(Lemont et al, 2003)

From Tatli and Kapasi 2008

It mostly occurs in runners because of the repetitive stress and accounts for around 10% of running injuries (Chandler and Kibler, 1993). It can also occur in people with metabolic disease like diabetes which affects the body’s ability to heal itself.

How to treat plantar fasciitis?

Shockwave therapy

At Back to Life we use a well-researched method of treatment called radial shockwave therapy. Pressure waves emitted by the shockwave machine into the plantar fascia stimulates healing response. Not only does it stimulate repair of the degenerated collagen, it will stimulate the nerves to decrease pain.

In a review of 9 different studies by Lou et al. they found that shockwave therapy improved the success rate of reducing overall heel pain, reducing pain at the first step in the morning and during daily activities and reducing heel pain after application of a pressure.

Exercise

Very slow strength training seems to be the modern ‘Treatment craze’ when it comes to tendon injuries. Which is why a new study looked at applying its effect on plantar fasciitis.

A study by Rathleff et al. found that high‐load strength training may aid in a quicker reduction in pain and improvements in function.

We use strength training after the first session of shockwave so that we can stimulate the repair of the tendon as quickly as possible.

3 Tips on what to avoid with plantar fasciitis

  1. Do not wear high heels or any dress shoes that aggravate the pain – wear comfy trainers
  2. Do not do any aggravating activity like running or standing for long periods
  3. Runners do not start running again until the heel is pain free for 4 weeks and you can walk 10 kilometres without pain on the day, or the following day.

References

Young C C, Rutherford D S and Niedfeldt M W, American Family Physician. 2001, 63 (3): 467-475.

Lemont H, Ammirati K M and Usen N Plantar Fasciitis. Journal of the American Podiatric Medical Association. May 2003, 93(3): 234-237.

Tatli YZ, Kapasi S. The real risks of steroid injection for plantar fasciitis, with a review of conservative therapies. Curr Rev Musculoskelet Med. 2008;2(1):3-9.

Chandler T J, Kibler W B. A biomechanical approach to the prevention, treatment and rehabilitation of plantar fasciitis. Sports Med. 1993;15.

Lou J, Wang S, Liu S and Xing G. Effectiveness of Extracorporeal Shock Wave Therapy Without Local Anaesthesia in Patients With Recalcitrant Plantar Fasciitis: A Meta-Analysis of Randomized Controlled Trials. American Journal of Physical Medicine & Rehabilitation. 2017, 96 (8): 529–534

Rathleff M S, Mølgaard C M, Fredberg U, Kaalund S, Andersen K B, Jensen T T, Aaskov S and Olesen J L, High‐load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12‐month follow‐up. Scandinavian journal of medicine and science in sports 2015, 25 (3): 292-300.

Improving function of the spine to help pain.

By Reiss C Gridley, B.Sc.

One of the functions of the spine is its ability to be flexible. This is so that we can pick something up from the floor or rotate our head to check a blind spot when driving. Pain can sometimes reduce our spinal flexibility and sometimes our lack of movement can cause pain. So its essential that our spines move well not only to prevent pain but to help treat pain.

A study by Gordon and Bloxham highlights that ‘Improving the flexibility of the lumbar spine and hamstrings can significantly reduce chronic lower back pain by 18.5%–58%.’

John, is a current patient at the clinic, has had surgery in the past for his debilitating back pain and sciatica. Although he had back surgery, he still was having to take time of work for the pain.

His case highlights how effective improvements in flexibility can be at reducing pain. After one treatment using shockwave therapy and a weekend of doing 4 minutes of exercise a day. He could return to work on the Monday without thinking about the pain throughout the whole day.

If your struggling to bend forwards without pain or are having trouble looking over your shoulder whilst driving, please get book in to see if we can help you.

References

Gordon R and Bloxham S. A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain. Healthcare (Basel). 2016 Jun; 4(2): 22.

Does joint ‘degeneration’ cause pain?

By Reiss C Gridley, B.Sc.

Degeneration is ‘deterioration and loss of function in the cells of a tissue or organ’. Our bodies degenerate as we get older just like wrinkles appear on our skin. Here are 2 studies that look at joint degeneration and pain:

  • A study of 113 people by Finan et al that found a clear pattern of people with knees that look bad on a scan, but feel fine, and vice versa.
  • In another study professor Nikolai Bogduk explains that “‘Degenerative disc disease’ conveys to patients that they are disintegrating, which they are not. Moreover, disc degeneration, spondylosis and spinal osteoarthrosis correlate poorly with pain and may be totally asymptomatic.”

So, what does this mean to someone who has just had an X-ray on their arthritic knee or and MRI on their ‘degenerative’ spine? It means be sceptical when a health care professional says that it’s the reason for the pain. This is because most of the time it simply isn’t the cause of the pain but more of a symptom of aging.

From my personal experience with working for 3 years with X-rays, sometimes patients would have huge amounts of pain but no real sign of degeneration, even when older! The same happens when someone has very bad ‘degenerative disc disease’, but has a small amount of pain that goes away with one treatment.

The most likely reason for the joint pain, swelling and stiffness is inflammation. Inflammation can happen because of many reasons including rheumatoid arthritis or injury to the joint. One of the best ways to reduce inflammation is improving joint movement and function. At Back to Life we use specific exercises to help improve joint function and improve movement so we can tackle pain.

If you are suffering with arthritis, swelling, joint injury or pain. Please book in for a full 1-hour consultation so you can get to the bottom of what is causing the pain.

Does ‘bad posture’ cause pain?

By Reiss C. Gridley, B.Sc.

Does bad posture cause pain


Against popular belief the answer is no. Whether its slouching over a computer (like i am now whilst writing this) or having rounded shoulders, or too much or too little lower back curve. It doesn’t matter when it comes to pain.

In a review of 50 research articles the evidence does not support an association between spinal curves (posture) and spinal health including spinal pain (Christensen and Hartvigsen, 2008).

Its also VERY hard to measure peoples posture. An article by Schmidt et al. said that ‘It can be concluded that standing is highly individual and poorly reproducible.’ This means that everyone stands differently and the same person doesn’t stand the same way when tested again. Another study found that over a 24 hour period the same person can stand up to 8 degrees in difference. So its very hard to know what the perfect way to sit or stand is.

There are times when posture is important. An example of this is when someone is bending forwards to avoid back pain or leaning towards one side because of leg pain. If these ‘pain postures’ are left untreated it can affect the normal function and movement of the spine and body. This in turn can make the pain become long standing and chronic.

Scoliosis (side ways curve) of the spine could be seen as a ‘bad posture’ but it’s more of a medical condition. This needs to be treated early on in life but can still be treated without surgery later on in life.

If you’re suffering with pain, or have scoliosis, or just want a better posture. Please get in contact with us below.

References

Christensen ST, Hartvigsen J. Spinal curves and health: a systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health. J Manipulative Physiol Ther. 2008;31(9):690–714.

Schmidt H, Bashkueva M, Weertsa J, Graichena F, Altenscheid J, Maier C, Reitmaier S. How do we stand? Variations during repeated standing phases of asymptomatic subjects and low back pain patients. Journal of Biomechanics 2018; 70: 67-76.

Dreischarf M, Pries E, Bashkueva M, Putzier M, Schmidt H. Differences between clinical “snap-shot” and “real-life” assessments of lumbar spine alignment and motion – What is the “real” lumbar lordosis of a human being? Journal of Biomechanics 2016; 49(5): 638-644