The plantar fascia is a band of connective tissue that runs from the heel to the ball of the foot. Its main role is to support the arch and joints in position, act as a shock absorber and allow us to push off with our big toe. Plantar fasciitis or fasciopathy is now considered to be a degenerative condition of the plantar fascia due to repetitive microtears. Initially there can be an inflammatory reaction, but it is now understood that it is not an ongoing inflammatory process. There is usually not one specific cause of plantar fasciitis but is usually due to multiple factors. Some of these factors include spikes in load, age, suboptimal biomechanics, delayed healing and obesity (Luffy, 2018).

Pain is usually felt on the underside of the heel, and is often most intense with the first steps of the day or after rest. It is commonly associated with long periods of weight bearing or sudden changes in weight bearing, load or activity.

Prevention
• Start activity slowly and increase load slowly with a new exercise or program.
• Choosing the right shoe, both supportive and minimalist shoes can be helpful. Large heels should be avoided. Replace shoes when they are worn out.
• Allow adequate recovery time between workouts or training sessions. Stretch your calves regularly and strengthen your foot and toe muscles.
• Maintaining a healthy weight to minimise the stress on the plantar fascia.

Management
• Physiotherapy treatment includes soft tissue treatment of the plantar fascia, stretching and strengthening program for the calf muscles and small muscles of the foot, footwear advice.

References:
Hasegawa, M., Urits, I., Orhurhu, V. et al. Current Concepts of Minimally Invasive Treatment Options for Plantar Fasciitis: a Comprehensive Review. Curr Pain Headache Rep 24, 55 (2020). https://doi.org/10.1007/s11916-020-00883-7

Plantar Fasciitis

Luffy, Lindsey MSPAS, PA-C; Grosel, John MD; Thomas, Randall DPM; So, Eric DPM Plantar fasciitis, Journal of the American Academy of Physician Assistants: January 2018 – Volume 31 – Issue 1 – p 20-24 doi: 10.1097/01.JAA.0000527695.76041.99

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Neck pain – what to do?

Most of us experience neck pain at some time in our lives.  It is in fact, one of the top 5 chronic pain conditions worldwide (Cohen et al, 2017).  It can be the result of trauma, for example, a whiplash injury following a car accident or due to our everyday function such as work or exercise.  Usually our neck pain will settle with some exercise, over-the-counter medications, the odd hotpack and we get on with our lives.  But, occasionally our neck pain does not settle, niggles on and becomes a literal pain in the neck to our function.  What do do?  Who to see?

As musculoskeletal physiotherapists, we have the education and experience to assess and treat your neck pain and to help you treat and manage it into the future.  It is important that the mechanism of injury and contributing factors to your pain are established early and addressed so your neck pain resolves and doesn’t flare up episodically.

Treatments such as massage, dry needling, mobilization can help to settle your pain and exercise therapy (Cox et al, 2019) and ergonomic assessment and management can give you long-term relief.  Ongoing exercise is important and has the strongest evidence in the literature for managing neck pain (Cohen et al, 2017).

References:

Cohen, SP, Hooten, WM, 2017. Advances in the diagnosis and management of neck pain. BMJ

Cox, LG, Kidgell, DJ, Iles, RA, 2019. Neck-specific strengthening exercises and cognitive therapy for chronic neck pain: a systematic review. Physical Therapy Reviews 24 (6), 335-345.

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After the highs of 2016 saw him win a second Wimbledon title, a second Olympic gold medal and finish the year as the No 1 player in the world, it went downhill the following year.

He missed the second half of the 2017 season due to his long-standing hip injury.

He finally had the “Birmingham hip” surgery at the end of January this year (2019). After making a tentative start to singles in August this year (2019), it finally clicked for Murray during the European Open (October 2019) as he won his first title since March 2017.

A standard hip replacement replaces the acetabulum (hip socket) and the top section of the femur (thigh bone).  Hip Resurfacing or “bone conserving” procedure replaces the acetabulum (hip socket) in the same way but resurfaces the femoral head (ball). This means the femoral head has some or very little bone removed and essentially has a cap over the worn bone.

Resurfacing procedures may be indicated in the young patient (usually less than 55 years) who has osteoarthritis and wishes to maintain an active lifestyle. It is a more conservative and less traumatic alternative to a Total Hip Replacement

.

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The Iliotibial Band (ITB) has a poor reputation in sports and sports medicine. Mention your ITB and knowing nods and shakes of the head abound. The ITB is often associated with sports injuries and problems such as iliotibial band friction syndrome and anterior knee pain: and we all know…it hurts !

The ITB is, however, connective tissue, it doesn’t contract, or relax and you can’t directly strengthen it or lengthen it.

So what it the ITB ?

The ITB is actually a thickening of the lateral (outer) soft tissue that envelops the entire upper leg. The thickened band is called the ilio-tibial band (ITB). The muscles that insert into the proximal (upper) portion of this band are the Tensor Fascia Latae and a portion of the Gluteus Maximus and Gluteus Medius muscles. At its lower section the ITB splits medially into the ilio-patellar band and laterallyinto the iliotibial tract. The ITB is also anchored to the femur (thigh bone) via the intermuscular septum (tissue between the lateral quads and the hamstrings).

Iliotibial band anatomy:

So, basically, the ITB is a passive structure that is influenced by the muscles around the region – the TFL and Glute Max muscles that attach to it proximally, and the quads and hamstrings that can pull and tug on the fascia latae which in turn can create stress and tension on the ITB. Weakness and/or asymmetry in any or all of these muscles, combines with repetition (eg: running and cycling) can contribute to ITB issues.

The most common treatments for “tight ITB’s” is usually massage, dry needling and using a foam roller (ouch !!!). These treatments will often work; however the main reason for this improvement is due to reducing tone/tightness in these adjacent muscles the contribute to ITB tension and not by stretching or releasing the ITB itself: remember the ITB is connective tissue that can’t really lengthen (0.2% max).

In the end weak muscles get tight – so the main issue is usually strength defecit, sometimes biomechanical, sometimes overuse, sometimes a combination, rarely flexibility. So here are some basic self help tips for treating your ITB Syndrome.

*Strengthen your hip abductors (gluteal muscles especially the glute medius).
*Side Stretching
*Regular remedial massage for those tired and tight muscles
*Gentle foam rolling (not too hard and not too painful)
*Avoid crowned surfaces or too much track running.

If you require any assistance with treating your ITB please make an appointment with Martin or Sandy.

References:
Randall Cooper –  Sports Physio; Melbourne. “The Ilio Tibial Band and it’s treatment”.
Stephen M. Pribut, D.P.M. ITB Syndrome: “Cause, Cure and Your Core”
Brian Fullem, D.P.M. “Treating ITBS”

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This term was first introduced by Richard Hayward, a consultant neurosurgeon in an article in the British Medical Journal in 2003

• VOMIT (victims of modern imaging technology) – an acronym for our times. BMJ 2003;326:1273:

“…The history of imaging since the discovery of x rays has been one of an exponential rise in the volume and accuracy of information, acquired against a background of firstly increasing and then reducing invasiveness—and rising costs … It is small wonder that the flood of information from these investigations and our knowledge of how to deal with it may be several years out of step … So where does this leave us doctors? We adapt to a world in which we must accept VOMIT as a reasonable price for our technological advances. But it’s also a world in which that well tried and tested concept, the doctor patient relationship, exists to help us translate the anxiety provoking generality into, we hope, the reassuringly individual.”

It is very important to remember that there is NOT a linear association between scan discovered changes and pain.

SO – just because there is pain and there is a scan change, it does not automatically create a causative relationship. This is particularly the case in persistent pain and especially in spinal pain.

Technology remains a very useful tool when used and interpreted correctly. It remains true to always treat the patient – not the scan.

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