Medial Epicondylitis (Golfer’s Elbow)

You may have heard of tennis elbow, but are you familiar with its counterpart, golfer’s elbow? Both are tendon injuries; the connective tissue that attaches muscle to bone. So what’s the difference? This problem in the outer elbow is known as tennis elbow (lateral epicondylitis), while golfer’s elbow (medial epicondylitis) is located in the inner elbow and forearm.

Read on to learn more about the causes and symptoms of golfer’s elbow, and how it is treated.

 

What causes golfer’s elbow?

Firstly, you don’t have to be an avid golfer to develop it! It’s an overuse injury caused by any repetitive movement of the wrist, hand and forearm.

Besides overdoing it on the golf course, what are the types of activities that may cause golfer’s elbow?

  • Racket sports like tennis or squash – gripping a racket that is too heavy or too light. Make sure you check your technique as well.
  • Weight training with poor technique causes you to overwork the tendons and muscles of the arms.
  • Ball sports: repeatedly throwing a ball in sports such as bowling, softball and baseball.
  • Manual labour: painting, plumbing, and construction work that involves forceful and repetitive movements cause golfer’s elbow. Doing repetitive work using tools like hammers or screwdrivers may also cause it.
  • Computer work: frequently typing on a keyboard and using a mouse with a poor ergonomic set up.

 

What are the symptoms of golfer’s elbow?

There are some common symptoms you may experience if you have golfer’s elbow. It’s worth noting that the pain develops over weeks or months, often starting out as pain in the inner elbow.

You might experience pain and tenderness that radiates from the inside of the elbow down the forearm. Your elbow may be stiff or difficult to move. Although rare, there may be numbness or tingling in your fingers, or weakness in the hand and wrist also.

 

How is golfer’s elbow treated?

Most of the time this condition is managed at home, following simple steps used to treat tendon injuries:

 

Rest your arm: this one’s important! You need to give the tendon a break for a few days so that it has a chance to heal. Avoid any activity that makes the pain worse. You can gradually re-introduce these activities once the pain is under control.

 

Apply ice: in the initial stages of injury, ice can help to control pain. For the first few days, apply to your elbow and forearm for 15 to 20 minutes, three to four times a day. Contrary to popular belief, you want to limit ice application because the cold temperature can inhibit the natural inflammatory process the body goes through when a new injury develops. We want to allow the body to do its thing, so use ice sparingly and only early on.

 

How can I prevent golfer’s elbow?

  • Take regular breaks from repetitive exercises.
  • Stop any activity that causes elbow or forearm pain.
  • Learn proper techniques for exercise and sport to avoid putting extra stress on your wrists and elbows.
  • Warm up properly before you begin exercise or sports.
  • Increase your arm strength.

 

How can osteopathic treatment help?

Your osteopath can help you to recover from golfer’s elbow. They may use soft tissue techniques such as massage and stretching to reduce muscular tension and increase blood flow to the tendon.

We can also treat golfer’s elbow with shockwave treatment , acupuncture and dry needling.

They will also help you to prevent the injury from reoccurring by conducting an assessment and diagnosing the root cause. Don’t be surprised if your osteo treats your neck, mid-back and shoulder to help with this issue. These areas often need attention too!

 

We’ll put together a treatment plan with you to see you gradually return to your former glory. Tendon injuries like these need an approach that focusses on strength and mobility and ultimately, time.

 

If you are experiencing elbow pain, we are here to help! Don’t let golfer’s elbow impact your handicap. Give us a call on (416) 546-4887 or email [email protected] to make an appointment.

Concussion

Concussion, aka ‘mild traumatic brain injury’, has been the topic of much research and discussion between health professionals in recent years. It is a particularly important topic amongst practitioners who treat sports people on the field and in the clinic setting. Although concussion in sport is a common occurrence, anyone with a head can get concussion… so that’s everyone then!

 

What is concussion?

Concussion is the word used to describe a minor head injury that is usually sustained by either:

  • A blow to the head (e.g. hitting your head during a fall or being hit on the head by an object)
  • Your head going through a sudden change in direction (e.g. during a car accident or a quick change in direction on the sports field)

During a trauma, the force sustained to the head causes the brain to move and hit the inside of the skull. This leads to inflammation and damage to the nerve tissue of the brain. This can affect the function of the brain in many ways and can lead to a wide variety of symptoms. The symptoms depend on what part of the brain and other body parts (i.e. the neck and other parts of the spine) are affected.

 

Who gets it?

Concussions are very common in sports people, especially those that partake in contact sports like boxing and football (any form), or a sport that leaves a person susceptible to a fall (i.e. cycling, skiing / snowboarding and horse-riding). Anyone who hits their head, or has their head thrown around during a sudden movement can become concussed. Car accidents are common causes in the general population where whiplash type injuries can lead to the brain being thrown back and forth inside the skull.

 

Signs and symptoms

Concussion can lead to a wide range of signs and symptoms, including any combination of:

  • Loss of consciousness (30 minutes or less)
  • Amnesia (i.e. an inability to recall what has happened / memory loss)
  • Persistent low-grade headaches
  • Dizziness, vertigo and loss of balance
  • Confusion
  • Brain fog
  • Nausea and vomiting
  • Visual disturbance (blurred vision or seeing stars)
  • Drowsiness
  • Light and noise sensitivity
  • A blank / vacant look on the persons face

 

In the majority of cases, symptoms will come on quickly or at least within the first few hours after the injury occurs.

 

Treatment

It is unlikely you will see an osteopath in the immediate aftermath of a head injury, unless you are a sportsperson who is under the care of an on-field osteo. After a head knock, if someone is suspected as having a concussion, it is normal procedure to see a medical professional (i.e. a GP or on-site osteo / physio) to be checked out. Severe impacts may require hospitalization. In mild cases, once the treating practitioner is happy that symptoms are stable, you will usually be sent home to rest and recover. Many people feel okay at this point and are keen to return to playing, but this should be avoided because the consequences of a second head injury can be much more severe. The best and only thing you should do at this point is follow your doctor’s orders!

 

A mild concussion usually recovers within two weeks, but symptoms can persist for some people for weeks or months following a head injury. If this occurs, this person is said to be experiencing post-concussion syndrome. These symptoms should resolve with time, but again, they can persist in some people.

 

Once you are in that stable stage of a concussion, it is fine to seek out the help of your friendly neighbourhood osteo. Osteopathic treatment has been shown to be an effective and safe treatment option for people suffering from stable concussive symptoms. A blow to the head can start off a chain reaction around the body and may have immediate effect on the function of the spine and shoulders. We can assess and treat these dysfunctions to get you through your concussion safely and in as little pain as possible.

 

Concussion? We can help you today! Please call and speak to us on (416) 546-4887 if you need more information on concussion or are unsure our treatment is right for you.

If you wanted to schedule an appointment to have your concussion assessed and treated click here

 

References

  1. Brain Foundation. 2021. Concussion. [Online]. Available from: https://brainfoundation.org.au/disorders/concussion/. Accessed 11 Sep 2021.
  2. Brain Foundation. 2021. Understanding concussion: a bump on the head or something more serious? [Online]. Available from: https://brainfoundation.org.au/wp-content/uploads/2021/08/Concussion-Fact-Sheet-Recent-News-1.pdf. Accessed 11 Sep 2021.
  3. Yao, SC. et al. 2020. Effectiveness of Osteopathic Manipulative Medicine vs Concussion Education in Treating Student Athletes With Acute Concussion Symptoms. Journal of Osteopathic Medicine. 120(9). 607-614. Available from: https://www.degruyter.com/document/doi/10.7556/jaoa.2020.099/html.
  4. Chappell, C. et al. 2015. Assessing the Immediate Effect of Osteopathic Manipulation on Sports Related Concussion Symptoms. Osteopathic Family Physician. 7(4). 30-35.
  5. Zwibel, H. et al. 2018. Concussion Evaluation and Management: An Osteopathic Perspective. Journal of Osteopathic Medicine. 118(10). 655-661. Available from: https://www.degruyter.com/document/doi/10.7556/jaoa.2018.144/html.

Lateral Ankle Sprain

How many of us have rolled our ankle and damaged a ligament at some point in our life?! The answer is many of us. Approximately 2 million ankle ‘sprains’ (the word used to describe a ligament that has been over-stretched or torn) occur in the US every year alone, which gives you an idea of how many happen worldwide! Whilst many of these sprains occur in the sporting world, there are surprising amounts that occur in the general population. This shows us that we don’t have to be an elite sportsperson to be at risk of rolling our ankles. It’s an injury that can literally happen to any one of us… Picture Joe Bloggs walking down the street and slipping unexpectedly off the curb. Ouch!

What is a ligament sprain?

Let’s start at the beginning… Ligaments hold bone to bone. Two bones held together become a joint. Ligaments are responsible for providing a joint with stability (along with the muscles and tendons surrounding it), ensuring the bones of a joint do not move away from each other and dislocate. Ligaments are thick, strong bands of tissue that can withstand the majority of the large forces that run through our bodies when we move. Sometimes the force placed upon a ligament is too great for it to withstand, and this is when damage (or a sprain) occurs. Ligament sprains are generally categorized into the following grades:

  • Grade 1: A mild sprain with only damage seen at a microscopic level and no joint instability.
  • Grade 2: A moderate sprain where some, but not all, of the ligament fibres are torn. There may be very mild joint instability (or none) associated with this grade.
  • Grade 3: A severe sprain where all of the ligament fibres are torn leaving the joint unstable.

 

Why is a sprain of the outside of the ankle so common?

The outside (or lateral aspect) of the ankle joint is one of the most commonly sprained regions of the body. The two leg bones (the tibia and fibula) run down the leg from the knee and slot in with the ankle bone, or ‘talus’ (pronounced ‘tay-luss’). The fibula bone runs down the outside of the leg and the tibia runs down the middle/inside of the leg. The very ends of these bones are enlarged lumps (known as malleoli… ‘mal-ee-oh-lie’). You can feel these lumps either side of the ankle. Where the malleoli meet the talus is where the outside (lateral) and inside (medial) ligaments are found. The medial ligaments are much stronger than the lateral ligaments which result in the lateral ligaments being injured more commonly. A simple roll of the ankle can cause an over-stretching or tearing of the ligaments here, depending on the force being placed on the ankle as it rolls outwards. In a normal healthy ankle, the ability to roll the ankle outwards is greater than that of rolling inwards… Another reason why lateral ankle sprains tend to occur more often.

 

Risk factors

One of the biggest risk factors for a lateral ankle sprain is having a history of ankle sprains. If you have done it previously, you are more likely to sprain it again! Other risk factors include:

  • Being hyper-mobile or having excessive range of motion at the ankle joint due to naturally looser ligaments.
  • Playing sports where turning, twisting and pivoting at high speed are a large part of the game (i.e. netball, basketball, football (any form), and racket sports)
  • Being taller and heavier in weight
  • Having wider feet

 

Signs and symptoms

Sometimes when you roll your ankle, the force placed on the ligament is not great enough to damage it. In these instances, you may experience no symptoms at all. For instances where the force is great enough to damage the ligament, you can expect to experience any or all of the following (depending on the severity of the injury):

  • Pain (possibly preceded by an audible click or pop) over and around the affected ligament
  • Swelling
  • Bruising
  • Limping on the affected side when walking
  • Reduced movement of the affected ankle
  • Instability of the ankle joint (i.e. excessive movement) if severe enough

After a severe injury you may not be able to walk immediately. The more severe the sprain, the more likely other structures in and around the ankle may be affected, including the possibility of fracture and/or dislocation (if the force is great enough).

 

Treatment

Most cases of lateral ankle sprains that enter our clinic are mild to moderate in nature. More severe injuries are often dealt with initially at an emergency department (i.e. if it has been necessary to rule out a fracture/dislocation), but may present to our clinic for ongoing management once the acute injury has begun to heal.

The first goal of treatment for lateral ankle sprains is to regain a normal walking pattern, whilst reducing the risk of further injury. This is likely to mean zero participation in your chosen sport to begin with, especially if pivoting and turning play a large part. We will work on reducing pain by massaging the muscles of the leg and foot. We may also need to work on muscles higher up the body, such as your back, glutes, hamstring and quad muscles. Any stiffened joints will be mobilized gently to restore range of motion. Any swelling can be dealt with using drainage techniques of the lower limb.

When normal walking has resumed, you can progressively load the ankle by adding in strengthening, balance, and more multi-directional agility exercises. The end goal for a sportsperson is to return to training followed by full match play. A non-sportsperson will look to return to their normal daily life without pain or dysfunction. A mild to moderate ankle sprain will take approximately 6-8 weeks to heal. More severe injuries can take months.

If you have sprained your ankle and need some help, look no further than your trusty osteopath. Call us today on (416) 546-4887 or book online to book your appointment and begin treatment immediately.

References
1. Mackenzie, MH. et al. 2019. Epidemiology of Ankle Sprains and Chronic Ankle Instability. Journal of Athletic Training. 54 (6). 603-610. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6602402/pdf/i1062-6050-54-6-603.pdf
2. Physiopedia. 2021. Ligament sprains. [Online]. Available from: https://www.physio-pedia.com/Ligament_Sprain. [Accessed 08 March 2021]
3. Beynnon, BD. et al. 2002. Predictive Factors for Lateral Ankle Sprains: A Literature Review. Journal of Athletic Training. 37 (4). 376-380. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC164368/pdf/attr_37_04_0376.pdf

Lateral Ankle Sprain

How many of us have rolled our ankle and damaged a ligament at some point in our life?! The answer is many of us. Many sprains occur in the sporting world, but there are surprising amounts that occur in the general population. This shows us that we don’t have to be an elite sportsperson to be at risk of rolling our ankles. It’s an injury that can literally happen to any one of us… Picture Joe Bloggs walking down the street and slipping unexpectedly off the curb. Ouch!

What is a ligament sprain?

Let’s start at the beginning… Ligaments hold bone to bone. Two bones held together become a joint. Ligaments are responsible for providing a joint with stability (along with the muscles and tendons surrounding it), ensuring the bones of a joint do not move away from each other and dislocate. Ligaments are thick, strong bands of tissue that can withstand the majority of the large forces that run through our bodies when we move. Sometimes the force placed upon a ligament is too great for it to withstand, and this is when damage (or a sprain) occurs. Ligament sprains are generally categorised into the following grades:

  • Grade 1: A mild sprain with only damage seen at a microscopic level and no joint instability.
  • Grade 2: A moderate sprain where some, but not all, of the ligament fibres are torn. There may be very mild joint instability (or none) associated with this grade.
  • Grade 3: A severe sprain where all of the ligament fibres are torn leaving the joint unstable.

 

Why is a sprain of the outside of the ankle so common?

The outside (or lateral aspect) of the ankle joint is one of the most commonly sprained regions of the body. The two leg bones (the tibia and fibula) run down the leg from the knee and slot in with the ankle bone, or ‘talus’ (pronounced ‘tay-luss’). The fibula bone runs down the outside of the leg and the tibia runs down the middle/inside of the leg. The very ends of these bones are enlarged lumps (known as malleoli… ‘mal-ee-oh-lie’). You can feel these lumps either side of the ankle. Where the malleoli meet the talus is where the outside (lateral) and inside (medial) ligaments are found. The medial ligaments are much stronger than the lateral ligaments which result in the lateral ligaments being injured more commonly. A simple roll of the ankle can cause an over-stretching or tearing of the ligaments here, depending on the force being placed on the ankle as it rolls outwards. In a normal healthy ankle, the ability to roll the ankle outwards is greater than that of rolling inwards… Another reason why lateral ankle sprains tend to occur more often.

 

Risk factors

One of the biggest risk factors for a lateral ankle sprain is having a history of ankle sprains. If you have done it previously, you are more likely to sprain it again! Other risk factors include:

  • Being hyper-mobile or having excessive range of motion at the ankle joint due to naturally looser ligaments.
  • Playing sports where turning, twisting and pivoting at high speed are a large part of the game (i.e. netball, basketball, football (any form), and racket sports)
  • Being taller and heavier in weight
  • Having wider feet

 

Signs and symptoms

Sometimes when you roll your ankle, the force placed on the ligament is not great enough to damage it. In these instances, you may experience no symptoms at all. For instances where the force is great enough to damage the ligament, you can expect to experience any or all of the following (depending on the severity of the injury):

  • Pain (possibly preceded by an audible click or pop) over and around the affected ligament
  • Swelling
  • Bruising
  • Limping on the affected side when walking
  • Reduced movement of the affected ankle
  • Instability of the ankle joint (i.e. excessive movement) if severe enough

After a severe injury you may not be able to walk immediately. The more severe the sprain, the more likely other structures in and around the ankle may be affected, including the possibility of fracture and/or dislocation (if the force is great enough).

 

Treatment

Most cases of lateral ankle sprains that enter our clinic are mild to moderate in nature. More severe injuries are often dealt with initially at an emergency department (i.e. if it has been necessary to rule out a fracture/dislocation), but may present to our clinic for ongoing management once the acute injury has begun to heal.

The first goal of treatment for lateral ankle sprains is to regain a normal walking pattern, whilst reducing the risk of further injury. This is likely to mean zero participation in your chosen sport to begin with, especially if pivoting and turning play a large part. We will work on reducing pain by massaging the muscles of the leg and foot. We may also need to work on muscles higher up the body, such as your back, glutes, hamstring and quad muscles. Any stiffened joints will be mobilized gently to restore range of motion. Any swelling can be dealt with using drainage techniques of the lower limb.

When normal walking has resumed, you can progressively load the ankle by adding in strengthening, balance, and more multi-directional agility exercises. The end goal for a sportsperson is to return to training followed by full match play. A non-sportsperson will look to return to their normal daily life without pain or dysfunction. A mild to moderate ankle sprain will take approximately 6-8 weeks to heal. More severe injuries can take months.

If you have sprained your ankle and need some help, look no further, our team can help you get back and running. Our osteopaths can help with treatment and rehab, whilst our chiropodist can help out with alignment corrections and shoe recommendations. Call us today on (416) 546-4887 or book online at beachealth.janeapp.com to book your appointment and begin treatment immediately.

 

 

References
1. Mackenzie, MH. et al. 2019. Epidemiology of Ankle Sprains and Chronic Ankle Instability. Journal of Athletic Training. 54 (6). 603-610. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6602402/pdf/i1062-6050-54-6-603.pdf
2. Physiopedia. 2021. Ligament sprains. [Online]. Available from: https://www.physio-pedia.com/Ligament_Sprain. [Accessed 08 March 2021]
3. Beynnon, BD. et al. 2002. Predictive Factors for Lateral Ankle Sprains: A Literature Review. Journal of Athletic Training. 37 (4). 376-380. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC164368/pdf/attr_37_04_0376.pdf

Gluteal Tendinopathy

Have you recently started to experience pain at the side of your hip? With the turn of the new year now behind us, maybe you’re embracing your new healthy lifestyle and have been going for a solid run several times a week to shift some of those festive kilos… Or it might just be that you’re getting a bit older, hitting the middle decades of life, and you’ve had a nagging hip for a while. There are a few structures in and around the hip that can lead to pain felt at the very outer aspect of it. Problems in the low back, the hip joint itself, and soft tissues that surround the joint can all be viable culprits.

Common culprits in the running and middle-aged populations are the tendons of the gluteal muscles. These muscles are responsible for movement at the hip (outwards, backwards and forwards) and stability of the pelvis and hip during movement. There are three gluteal muscles or ‘glutes’. The deepest muscle is the gluteus minimus, followed by gluteus medius, and finally gluteus maximus (which is the largest and most superficial of all three). Where the gluteus medius and minimus tendons wrap around the bony outer part of the hip and insert into the bone, are the areas most commonly associated with disease leading to pain in the outer hip.

Tendon disease

There are a few terms that can describe a diseased tendon. An acutely inflamed tendon is known as ‘tendinitis’, where ‘itis‘ means inflammation occurring at the tissue. A tendon which is chronically diseased (i.e. long-standing pain that may have been present for several weeks, months or years without the presence of inflammation), is known as ‘tendinopathy’. Historically the term ‘tendinosis’ was used to describe a chronic tendon problem, but tendinopathy is now the favoured term. The important thing is to think of a tendon problem sitting somewhere on a continuum between acutely inflamed and chronically degenerated and/or torn.

Let’s take our aforementioned population, a middle-aged female (females are more affected by this issue than males), who runs. What typically happens is they will start to run with the full intent of bettering themselves. Due to poor running technique, the tendon becomes overloaded and after a few weeks or months… Bang! Inflammation, pain, can barely walk! Once the initial pain settles and movement resumes, they start to run again. If they haven’t corrected the problem that underlies the initial acute episode, the problem compounds itself. The body will compensate, and further excessive load and compression are placed on the tendons and other surrounding structures. This might go on for a while with the hip grumbling from time to time. Eventually, the changes that have occurred to the tendon tissue result in widespread degeneration and derangement of the tendon fibres and you are left with a tendon incapable of dealing with the high loads required to do something like running. If left untreated, the tendon eventually tears and leaves you with a very unhappy and less mobile hip.

Signs and symptoms

The signs and symptoms of a gluteus medius and/or gluteus minimus tendinopathy include any or all of the following:

• Pain felt on the outside of your hip
• Pain that radiates down the thigh to the knee
• Pain that is worse before and after exercise
• Pain that improves initially with exercise (depending where on the disease process you are)
• Pain when lying on the affected side
• Difficulty walking up stairs or hills
• Difficulty standing on one leg (on the affected side)

Treatment

Your first port of call is to temporarily cease the activity that is aggravating your hip, and ring your osteo (ahem… 416-546-4887). This will help to de-load the injured tendon, and give you relief knowing soon you will be in the hands of an expert who is going to guide you through your recovery journey. We will assess your movement from top to bottom and work out where the root cause of your problem is. This is what osteopaths are great at doing. We look beyond the pain, take a picture of your whole life (occupation, hobbies, family life, etc…) and work out all of the contributing factors, so we can put a comprehensive plan in place to rid you of your problem forever.

For a gluteal tendon problem to occur in the first place, there will likely be mechanical issues to correct in the spine and/or lower limb (from the foot up). We do this with a combination of:

• Hands-on therapy to soothe your pain and improve muscle and joint health
• Re-training of poor movements into more efficient movements
• Strengthening exercises for the muscles / tendons
• Alterations to your daily life which may be contributing to your issue (i.e. increasing particular activities, decreasing aggravating activities, changing a work posture)

Over time, treatment will aim to progressively strengthen the gluteal tendons, so they are capable of withstanding greater loads again. Combined with correction of poor, inefficient movements, this will also decrease the compressive forces acting on the tissues in and around the hip, leaving you with greater strength and more flexibility.

We will be with you every step of the way. A gluteal tendinopathy doesn’t mean you have to give up running. We might need to change focus for a short period during rehab, but our goal will be to get you back to your pre-injury state… with a little extra in the tank so you’re not back with us for the same issue within two months.

Hip pain, was it? No problem. We got this! Contact us

Plantar Fasciitis

It’s morning, and the alarm clock has just told you it’s time to get out of bed. Another few minutes won’t hurt. You check your emails, social media sites, and you even ring your mom to see how the dog slept last night… basically anything to delay putting your feet on the ground and taking those first steps to get the day started. And it’s because of this pain you’ve been getting on the bottom of your heel every morning for the last few weeks. And it’s getting worse… Time to see your osteopath!

There are a few things that can cause pain on the bottom of the heel, but the most common cause is a condition named plantar fasciitis (also known as plantar fasciopathy).

 

What is plantar fasciitis?

Plantar fasciitis is an overuse condition affecting the plantar fascia. The plantar fascia is a layer of soft tissue that stretches along the bottom of the foot, from the heel bone to the metatarsal bones in the front of the foot. It helps to provide stability to the arch of the foot and is similar in make-up to a tendon (the things that attach muscle to bone). If too much stress is placed on this structure, over time the tissue can degenerate, weaken, and start to give you pain. The pain is commonly felt where the plantar fascia attaches into the heel bone.

 

Risk factors

Scientific research suggests there are a few groups of people who are more prone to developing plantar fasciitis. These include:

  • Runners
  • People who are over-weight and lead a sedentary lifestyle and/or spend long periods standing for work (e.g. a factory worker)

Important things to consider with these at-risk groups include:

  • Foot alignment and arch height: Having a very low or high arch or having excessive or not enough movement in the foot joints can lead to the development of this problem.
  • Amount of training: Increased levels of training can place greater stress on the plantar fascia more regularly.
  • Footwear: Wearing certain types of footwear when training can lead to an increased risk of plantar fasciitis (i.e. wearing athletics spikes, or the wrong footwear for your foot type).
  • Muscle strength and flexibility: Decreased strength in the muscles that control toe movement, as well as weakened and tight calf, hamstring and gluteal muscles are all associated with higher rates of plantar fasciitis.

 

Signs and symptoms

The signs and symptoms of plantar fasciitis include:

  • Pain at the bottom of the heel
  • Pain that appears as a gradual onset
  • Pain felt first thing in the morning (i.e. taking those first steps out of bed in the morning is classic!)
  • Pain that decreases with activity, but increases again afterwards (early stages)
  • Pain that increases with activity and pain felt at night (latter stages)
  • Pain felt after periods of prolonged rest during the day (i.e. being sat at your desk for 2-3 hours and then getting up again)
  • Tight calf, hamstring and gluteal muscles
  • Weak muscles that help to support the arch of the foot
  • Stiff or over-flexible foot and ankle joints

 

Diagnosis and treatment

First things first, if you have heel pain that sounds similar to the picture we have painted above, make an appointment with us now (you know what to do call us on (416) 546-4887). Once we have asked the relevant questions, performed the necessary tests, and are convinced that the issue stems from the plantar fascia, we will formulate a plan with you with short and long-term goals to reach within a set time.

 

Initial hands-on treatment will include a combination of massage, joint mobilisation and manipulation, and dry needling of the lower limb muscles with the aim of correcting any mechanical issues that are playing a role in this issue. Depending on the presentation, we may also use tape around the foot and ankle to provide support and reduce the stress being placed on the tissues. Other treatment will include advice on weight loss (if required), training regimen, footwear, and exercise prescription that helps to lengthen and strengthen tight and weak muscles. Some cases of plantar fasciitis may require a foot orthotic or in-sole to provide extra support to the foot whilst wearing shoes. This would be best recommended and assessed by our Chiropodist (foot specialist) at Beachealth.

 

Plantar fasciitis is a tricky condition to treat which may require ongoing treatment for several months. We will endeavour to get you pain-free in the shortest time possible, so we recommend following all advice to a T, which may include a reduction in the amount of training you are doing at present. When you start to hit goals and we see improvements being made, we’ll have you back up to your full training program before you can say “plantar fasciitis”.

 

Imaging?

 

People regularly ask if they need imaging for such an issue, but the majority of cases of plantar fasciitis can be diagnosed with a thorough case history and physical assessment. This is where we excel! Imaging is there for cases that do not respond to treatment and for those instances where we need to rule out a more serious problem.

If you need help with heel pain, please call us today on (416) 546-4887 to book your appointment. Let’s have you putting your best foot forward, ASAP! 👌

 

 

References
1. Thompson, JV. et al. 2014. Diagnosis and management of plantar fasciitis. Journal of American Osteopathic Association. 114 (12). Available from: https://jaoa.org/aoa/content_public/journal/jaoa/933660/900.pdf
2. Brukner, P. et al. 2017. Clinical Sports Medicine. 5th ed. Australia: McGraw Hill Education
3. Harvard Health Publishing. 2007. Easing the pain of plantar fasciitis. [Online]. Available from: https://www.health.harvard.edu/newsletter_article/Easing_the_pain_of_plantar_fasciitis. [Accessed 15 Jul 2020]
4. Orthoinfo. 2010. Plantar fasciitis and bone spurs. [Online]. Available from: https://orthoinfo.aaos.org/en/diseases–conditions/plantar-fasciitis-and-bone-spurs. [Accessed 15 Jul 2020]

Is the Empty Can Test A Good Rehab Exercise?

Over the past couple of weeks, I have been seeing a few more shoulder injuries, all which have started for many different reasons. There have been falls, sports injuries and others which have been there for a long period of time. However, with some of the presentations there has been a common factor and that has been a particular exercise or rehab that has been prescribed.


After spending some time with the clients going through their medical history and working out actions that may aggravate or relieve their pain, we are able to come to a clinical impression, which gives us an ability to determine a personalised rehab plan to the shoulder joint. The shoulder can be a complicated joint as there are lots of different muscles which attach around the area and influence its movement.
While I don’t like to call out another practitioner or say that one exercise shouldn’t be performed, I do believe that there are exercises that are better for people so that we are to strengthen an area while limiting pain.

The empty can/ full can exercise involves taking your arms out to the side (abduction) on about a 45-degree angle and turning your thumbs down (pronation) or as if you are pouring a can out and then turning the can upwards (supination) this exercise is done with weights being held and repeating the pronation and supination action.

This exercise has been proven to target the supraspinatus muscle, which is one of the four rotator cuff muscles. When you pronate your wrist, we decrease the amount of space our shoulder joint has to move and this is one of the many reasons that people may get shoulder pain. So you can imagine that if you have been given this exercise from a healthcare practitioner and you are getting a sharp pain in the front of your shoulder, your desire to perform the exercise is not going to be very good. So how do we target the muscle without placing our shoulder in a painful position?

There are a number of different ways, but to keep it simple, standing external rotations and lateral raises, should be sufficient enough to train the muscles. Each person is different and require slightly different instructions or cues to help them feel the activation of a muscle, but as a general sense these 2 exercises can activate the muscle correctly without putting the shoulder into a position which may cause more impingement pain.

If you think that this could be beneficial for yourself, please don’t hesitate to contact us at the clinic

Written By: Brendan Ashman

Ice or Heat

Heat v Ice to Treat a Sports Injury

Most patients ask ‘do I use heat or ice?’ Now the answer to this question generally is if it’s acute or chronic.

An acute injury, being one that happened suddenly, will show signs and symptoms of pain (usually intense), local tenderness, redness, warm to touch and swelling. These signs and symptoms are mostly the result of internal bleeding and inflammation, which is the body’s response to an injury occurring suddenly and usually the inflammatory process should last 48 hours. The best therapy for an acute injury in these initial stages is rest and iceIce is a vasoconstrictor (it causes the blood vessels to narrow) and limits internal bleeding at the injury site and would therefore reduce the swelling and pain. Apply ice (wrapped in a thin towel) to the affected area for 10-15 minutes at a time and generally repeat every hour (if needed). The main goal during these initial stages is that you want to isolate, decrease and prevent the inflammation from spreading further.

Chronic injuries, on the other hand, can be subtle and slow to develop. They sometimes come and go, and may cause dull pain or soreness. They are often the result of overuse, but sometimes develop when an acute injury is not properly treated and doesn’t heal. Chronic injuries generally do not have inflammation or swelling and that is when heat a good form of therapy. Heat is best to stimulate blood flow, increase the elasticity of joint connective tissues and help relax tight muscles or muscle spasms. Safely apply heat (i.e. wheat pack) to an injury 15-20 minutes at a time and use enough layers between your skin and the heating source to prevent burns. Because heat increases circulation and raises the skin temperature, you should not apply heat to acute injuries or injuries that show signs of inflammation, as this will generally make them worse. This is a common mistake made by a lot of people with acute injuries, so please use cold in the initial stages of injury.

Some exemptions to the rule are:

Heat is recommended in an acute injury once the inflammation has settled down (usually after 48 hours). This will encourage the blood flow to the injury site and promote the healing process.

If you have a chronic injury, but suddenly aggravate the injury and the pain greatly increases in severity, ice would be recommended for the next 2 days. This type of injury is also known as acute on chronic.

If you are unsure or the injury does not show signs of improvement within 48 hours please consult with your local doctor or osteopath.

 

Written by: Daniel Stasiuk

Ankle Sprains

The ankle is made up of 3 bones: The Tibia (the shin bone), Fibula (runs on the outside of the shin bone) and Talus (connects our foot to the shin bone). The bony bumps found on the inside and outside of the foot are called the medial and lateral malleolus.

The way the ankle is designed, its primary movement is dorsi and plantar flexion (up and down), while it is subtalar joint which produces eversion and inversion movements (turning foot in and out).

 

The ankle has a number of ligaments which holds the bones together and allow the ankle and foot to move. The two main sets of ligaments which originate from the malleolus are the Medial and Lateral Ligaments.

The Medial Ligament, or the Deltoid ligament is a strong, flat and triangular band which consist of four ligaments and fans out from the medial malleolus to the talus, calcaneus and navicular bones. The primary action of this ligament is to resist over-eversion of the foot or rolling the foot inwards. This particular type of rolling motion which may cause an ankle sprain is rare and is normally associated with a fibula fracture known as a Pott’s fracture.

The lateral Ligament has 3 parts to it, which we separate into 3 different names. The Anterior talofibular, Posterior talofibular and Calcaneofibular ligaments. They all originate from the lateral malleolus and attach onto other bones of the foot. These ligaments all resist over-inversion of the foot. This type of ankle sprain is the most common.

So how do we treat a sprained ankle?

As osteopaths, we have a number of special test that we can do to make sure that we are able to identify the exact ligament that is involved and rule out a fracture. If we are unable to rule out a fracture we may advise an x-ray to identify a break and possibly a cast if needed.

If no break is suspected, the first goal of treatment is to assist in getting the swelling down while keeping as much range of motion throughout the foot and ankle bones. Rehabilitation is extremely important with a ankle sprain and vital for getting the person back to their sport or daily task. We would start off with some advice which would include rest, ice, compression and elevation (RICE). Then followed by basic ankle and foot range of motion exercises such as the ABC’s (which is just moving the foot to the letters of the alphabet).

Once the person’s pain and swelling has decreased and their range of motion is better, we can start to add in some harder exercises like balance exercises, theraband ankle work and increasing their range of motion exercises. The very last step is to make the persons rehab a little more sport specific to them, such as hopping, jumping and changing directions. Whether it is basketball, running or just getting back to playing with the kids.

 

Written By: Brendan Ashman