Plantar Fasciitis

In the bottom of the foot there is a thick fibrous tissue known as the plantar fascia. The plantar fascia provides stability for the foot and also works as a shock absorber. Injury to the plantar fascia can lead to an aching sensation on the bottom of the foot when walking, especially after long periods of rest. The term plantar fasciitis refers to inflammation on the sole of the foot.

Plantar fascia injuries are most common in individuals who do lots of exercise such as running, jumping and dancing, involving lots of impact on the bottom of the feet. Treatment methods such as massage and rest can help alleviate the painful symptoms. Painful symptoms may ease on their own but if they still remain after 2 weeks, consult a professional.

Anatomy

The plantar fascia is a long, thick fibrous tissue connecting to the calcaneus (heel bone of the ankle) it runs along the bottom of the foot and divides into five digital bands, along the heads of the metatarsals (toes). It covers the sole of the foot.

The function of plantar fascia is to provide support to the foot when standing and shock absorption when running.

Inflammation or degeneration of the tendon where the fascia originates can cause heel pain.

Symptoms

The symptoms of plantar fasciitis will be aggravated by continuing activity on the sole of the foot such as walking/running and will get worse over time. Some of the symptoms of plantar fasciitis include:

  • Pain on the bottom of the foot, around the heel and the arch (main symptom)
  • May be tenderness/pain under sole of foot and under heel when pressing in
  • Eases pain when exercising, but painful once rest
  • Difficult to raise toes off floor
  • Pain occurred gradually
  • Pain worse first thing in morning/when walking after long periods of rest
  • Pain eases off only to return later
  • Pain directly under the heel
  • Flat or overpronated feet
  • Tight calves

Causes

Plantar fasciitis is directly caused by damage to the plantar fascia running along the sole of the foot.

Some examples of causes/links consist of:

    • Overuse
    • Recently started exercising on hard surfaces
    • Exercising with a tight calf or heel
    • Overstretch the sole of your foot during exercise
    • Recently started doing a lot more running, walking or standing up
    • More common in sports involving running, dancing or jumping
    • Foot biomechanics
    • Overpronation (foot rolling in/flattening too much when running or walking which stretches plantar fascia more than normal)
    • High arch – unable to absorb as much shock so increased strain on plantar fascia
    • Footwear – very flat and unsupportive shoes increase likelihood of developing plantar fasciitis
    • Bodyweight – overweight individuals or those that do lots of heavy lifting causes increased load on feet increasing chances of developing heel pain

Flexibility – if have tightness in the calves or plantar fascia this can alter the biomechanics in the foot causing strain on the fascia

Diagnosis

During your visit to your local GP or Sports Therapist / Physiotherapist, they will assess..

      • History- how long the pain has been occurring for and when its most painful
      • Physical examination- check for tenderness in foot, pain during palpation
      • Gait analysis- analysing feet and how they function when walking and running- if overpronate or feet flatten

Treatment

Aims to decrease pain and inflammation, identify and correct possible causes, improve flexibility, gradually increase strength and return to full fitness levels.

  • Rest- rest from activities causing the pain reduces initial pain and inflammation
  • Massage – can help stretch and relax the plantar fascia. Massage also helps to stimulate blood flow and loosen tight tissues underneath the foot which cause pain
  • Stretches – for calf muscles and plantar fascia
  • Night splint – compliments plantar fasciitis exercises by preventing the tissues from tightening up overnight. Wearing a night splint is more effective than stretching exercises alone.
  • Taping- supports the arch of the foot and reduces strain on the plantar fascia
  • Shock Wave Therapy – method of therapeutic treatment for soft tissue injuries- works by passing shock waves into the tissues
  • Ultrasound – transmits high frequency sound waves into the tissues- has a micro massage effect and can reduce pain and inflammation
  • Footwear – wear comfortable trainers with good cushioning- avoid hard, flat soles
  • Cold therapy – ice massage or application of an ice pack for 10 minutes every hour for the first day- reduce to 3-5 times a day as symptoms ease
  • Medication – doctor may prescribe NSAID’s (Nonsteroidal anti-inflammatory drugs) e.g. ibuprofen in the early stages – always check with a doctor before taking any medication
  • Orthotics (shoe insoles) – for overpronated feet if feet roll in or overpronate it can cause strain on the foot should be worn at all times, not just when training
  • Surgery – rarely needed but is used when all other treatments haven’t helped. 

Exercises

The best way to treat plantar fasciitis is firstly to rest. If pain allows, some stretching exercises can help improve symptom’s and alleviate some pain.

  • Foot rolling – rolling the foot over a round object such as a ball, weights bar, rolling pin or can of soup can stretch the plantar fascia. Roll the foot repeatedly over the object, applying increasing downward pressure. You can also apply an object that can be cooled in the freezer (bottle or metal can) to apply cold therapy at the same time – 10 minutes per day until walking in the mornings is pain-free.
  • Calf stretches
  • Soleus stretch
  • Stretching on a step – stand with toes on step and heels off the back, lower heels down below the level of the step until a stretch is felt- hold for 15-20 seconds- further stretches calves and Achilles
  • Towel Scrunch – While sitting, place a towel on the floor with your foot on top of it. Try scrunching up a towel with your toes like you are trying to pick it up off the floor

No running!

Try to maintain fitness by swimming or cycling & you can begin to start walking again when there has been no pain for at least a week, slowly increase the distance and speed.

Prevention

  • Stretching – make sure to keep up the stretching of the lower body to prevent strain on the fascia
  • Footwear and Insoles – try to wear shoes that are supportive for the sole of the foot and absorb shock with cushioning
  • Ease into more intense exercise gradually – start by walking and gradually increase the amount as time goes on, then eventually ease back into running when pain is eliminated
  • Keep a healthy lifestyle and your weight under control as excess weight can increase the amount of stress on the foot

Frozen Shoulder

Frozen shoulder (also known as adhesive capsulitis or periarthritis) is used to describe the condition where the glenohumeral joint of the shoulder is stiff and painful. It occurs in about 2-5% of the general population, with a higher prevalence among elderly individuals and those with diabetes. Frozen shoulder is a benign and self limiting condition, usually lasting for 1-3 years, in 20-50% of patients the stiffness and pain only partially resolve, which leads to long lasting effects of shoulder mobility impairment and reduction in sleep quality. Commonly patients who suffer persistent symptoms (over 4-5 years) only suffer mild long term effects.

Anatomy

The hallmark pain and stiffness are caused by the formation of adhesions or scar tissue in the glenohumeral (GH) joint. The GH joint is a ball and socket joint between the scapula and humerus, connecting the upper arm to the trunk. Under normal conditions this joint is one of the most mobile in the human body, allowing for a large range of motion in multiple planes. In the case of frozen shoulder the adhesions limit this range of motion and make movement painful.

Symptoms

There are 4 recognised clinical stages of the condition:

  1. Painful stage- moderate pain and reduction of movement lasting less than 3 months
  2. Freezing stage- severe pain and reduction of movement lasting 3-9 months 
  3. Frozen stage- pain may be present but stiffness predominates lasting 10-14 months
  4. Thawing stage- minimal pain and gradual improvement in movement lasting 14-24 months

Causes

The cause of frozen shoulder is still unclear. Historically researchers into the aetiology of the condition have shown that it is characterised by a thickened, tight capsule with chronic inflammatory cells and fibroblasts found in the joint capsule. It can occur as a primary idiopathic condition or secondary to medical conditions or trauma.

Diagnosis

Frozen shoulder is diagnosed by testing positive to three characteristics:

  1. Insidious onset of severe pain over a period of months, night time pain is a common feature 
  2. Shoulder stiffness with markedly reduced external rotation 
  3. Negative radiographic findings

Some patients describe the pain as a deep ache, poorly localised and non specific without any point of tenderness. In others it presents as a pain which refers to the deltoid origin and radiates down to the bicep area. Manual testing will often return normal rotator cuff strength but a greatly reduced passive and active range of motion. 

In some cases laboratory tests may be carried out to identify or rule out underlying conditions. Radiographs of the shoulder will also return normal with a patient suffering from frozen shoulder, but may be carried out to exclude conditions such as shoulder dislocation, GH arthritis or calcific tendinopathy.

Treatment

There is no universally accepted intervention which is viewed as the most effective treatment for restoring motion and reducing pain. 

Non-surgical or conservative management is preferred with most patients improving in 6-18 months. This includes analgesics, oral steroids, physical therapies and supra-scapula nerve block. Physical therapy, from a sports massage and remedial therapist or physiotherapist, has traditionally been the first choice of treatment for frozen shoulder. The therapist can work to reduce pain, mobilise the joint and provide the patient with a supervised  stretching and strength maintenance programme.

Exercises

Exercises should be carried out under the direction of a qualified therapist and vary according to the stage of the condition. 

  1. Early freezing stage: gentle and short duration stretches e.g. pendulum exercises, passive external rotation and supine passive forward elevation
  2. Later frozen stage: strengthening exercises e.g. isometric external shoulder rotation and posterior capsular stretching 
  3. Thawing stage: combined strength in and stretching exercises with increased frequency 

Prevention

As the aetiology of the condition is still unknown advising on how to prevent an incidence of the condition is difficult. Research has suggested that prolonged immobilisation or limited use of the shoulder joint may contribute to the likelihood of developing frozen shoulder. With this in mind regular balanced exercise and stretching can help to maintain the structural support and mobility of the GH joint.

Exercises to help with lower back pain

Exercises to help with lower back pain

Stretching

Child Pose:

  • Begin on your hands and knees, with your knees hip-width apart and your feet together.
  • Lower your hips back towards your heels while stretching your arms out in front of you.
  • Rest your forehead on the ground and hold the pose for 30-60 seconds, breathing deeply.

Cat/Cow Poses:

  • Begin on your hands and knees, with your wrists under your shoulders and your knees under your hips.
  • Inhale and arch your back, lifting your head and tailbone towards the ceiling (Cow pose).
  • Exhale and round your spine towards the ceiling, tucking your chin to your chest and bringing your tailbone towards your knees (Cat pose).
  • Repeat the sequence several times, moving smoothly between the two poses.

Knee to Chest with Rotation:

  • Lie flat on your back with your legs extended.
  • Bend your right knee and bring it towards your chest.
  • Keep your left leg extended on the ground and hold onto your right knee with both hands.
  • Rotate your right knee to the left, keeping your right shoulder on the ground.
  • Repeat on the other side.

Both Knees to Chest:

  • Lie flat on your back with your legs extended.
  • Bend both knees and bring them towards your chest.
  • Hold onto your knees with both hands and breathe deeply, feeling the stretch in your lower back.
  • Release the pose and repeat several times.

Figure 4 Stretch:

  • Lie flat on your back with your legs extended.
  • Bend your right knee and place your ankle on your left knee.
  • Reach through your legs and hold onto your left thigh.
  • Pull your left knee towards your chest, feeling the stretch in your right glutes and hip.
  • Repeat on the other side.

Sitting Spinal Stretch:

  • Sit on the floor with your legs crossed.
  • Reach your arms up overhead, interlocking your fingers and stretching your spine.
  • Keep your back straight and hold the pose for 30-60 seconds, breathing deeply.

Hamstring Stretch with Towel:

  • Sit on the floor with your legs extended in front of you.
  • Loop a towel around the sole of your right foot and hold the ends of the towel with both hands.
  • Keeping your knee straight, lift your right foot towards the ceiling until you feel a stretch in your hamstring.
  • Hold the stretch for 30-60 seconds, breathing deeply.
  • Repeat on the other side.

Strengthening

Dead Bug:

  • Lie flat on your back with your arms extended overhead and legs in the air, bent at a 90-degree angle at the knees.
  • Lower your left arm and right leg toward the floor at the same time, keeping your lower back pressed into the floor.
  • Return to the starting position and repeat on the other side, lowering your right arm and left leg.

Bird Dog:

  • Begin on your hands and knees, keeping your hands directly under your shoulders and your knees under your hips.
  • Simultaneously extend your right arm and left leg, keeping your back flat and your core engaged.
  • Hold for a few seconds and then return to the starting position.
  • Repeat with your left arm and right leg.

Forearm Plank:

  • Start in a push-up position, but instead of resting on your hands, rest on your forearms.
  • Keep your body in a straight line from head to heels and engage your core to maintain stability.
  • Hold for 30-60 seconds, or as long as you can maintain proper form.

Lying Windshield Wipers:

  • Lie flat on your back with your arms extended out to the sides.
  • Raise your legs until they are perpendicular to the floor.
  • Slowly lower your legs to one side, keeping your lower back pressed into the floor.
  • Bring your legs back to the center and then lower them to the other side.

Slow Mountain Climber:

  • Start in a push-up position with your hands directly under your shoulders.
  • Slowly bring your right knee toward your chest, then return to the starting position.
  • Repeat with your left knee.
  • Continue alternating knees, keeping your core engaged and your back flat.

Hanging Knee Raises:

  • Hang from a pull-up bar with your palms facing away from your body.
  • Engage your core and raise your knees toward your chest.
  • Lower your legs back down and repeat for the desired number of repetitions.

If you want to know more about correct technique or would like professional advice from one of our personal trainers then please get in touch. Furthermore, if you are including lower back exercises into your regime and they are causing you some aches and pains, then we can help there too with our specialist sports massage service. For more information on how these types of massage could help you, contact us on 07939 212 739 or drop us an email at info@livewellhealth.co.uk