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.
Scientific research suggests there are a few groups of people who are more prone to developing plantar fasciitis. These include:
- 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”.
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! 👌
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]
Introduction to Running
Strength & Conditioning for Runners
Warmup and Cool-down for Runners
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
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 ice. Ice 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
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
After a conversation with one of the Beach Integrated Health Clinics patients, the topic of concussions with kids in sports came up. It prompted me to write a little bit about concussions, what to look out for and how as Osteopaths we can help.
So what is a concussion? A concussion is an injury to the brain that results in temporary loss of normal brain function. It is usually caused by a bump, blow or jolt to the head or body. This force to the body or head may or may not involve a loss of consciousness. Often there are no specific signs of head trauma like bleeding or even a bump.
A person who has suffered a concussion often cannot remember what happened immediately before or after the injury and may act confused. Which is why it is important to know the type of questions to ask someone if you suspect a concussion has occurred. A concussion can manifest in different ways such as altered memory, judgment, reflexes, speech, balance and muscle coordination.
Who can suffer from a concussion?
Everyone has the potential to get a concussion at some point in their life. Studies have shown that concussions seem to effect women more than men. Which could be for a number of reasons, though researchers seem to think the main reason for that is because women are more likely to report it or at least mention it to their healthcare professionals. A person who has had a previous history of concussions, especially a history of 2 or more concussions, are more at risk for increase in symptoms.
Symptoms of a concussion may include:
• Prolonged headache
• Vision disturbances
• Nausea or vomiting
• Impaired balance
• Memory loss
• Ringing ears
• Difficulty concentrating
• Sensitivity to light
• Loss of smell or taste
There are also some post Concussions symptoms to be aware of, as some symptoms may not show immediately.
• Mental fog
• Mental slowness
• Memory loss
• Irritability (especially in children)
• More emotional
• Difficulty falling asleep
• Sleep changes
There are ways to decrease the risk of a player getting a concussion in many sports like encouraging kids to wear a helmet in sports such as hockey and rugby if it isn’t already compulsory, however, this will not 100% stop a concussion from occurring.
The treatment for a concussion is rest. However, we must take into consideration the severity of the concussion and other factors that might be inhibiting the individual to heal. For example: after a tackle in football a player may hit their head and get a concussion. After 72 hours they may still have some neck pain and a dull headache. Although the concussion may have settled down, the player may have some neck stiffness or pain, which is causing the headache to be persistent. This is where our Osteopaths can help. Having spent time as an Australian Football league Trainer 1 have seen my fair share of concussions and it is important to treat all concussions as a serious injury. While taking a medical history and we decide on techniques that are a little gentler, so we don’t expose the individual to a jolting sensation through the body, neck or head to our treatment.
If you come across a person who you suspect does have a concussion the rule that I like to follow is if in doubt sit them out. While they may be unhappy that they cannot return to the sport, it is always better to be cautious. If they subject their body or head to another heavy blow, it may increase the persons symptoms exponentially.
By Brendan Ashman
Manual Osteopathic Practitioner
Over the last three weeks, the Tour De France has been running. The Tour consists of 21-day stages over a 23-day period, and the riders will cover around 3,500 kilometres (2,200 mi). While not all of us are elite athletes, there has certainly been an increase in cyclist on the road with the nice weather.
Cycling can be a great form of exercise. We get a great cardiovascular workout and it helps improve the strength of the leg muscles. There are, however, many common injuries that can occur when we start to ride or with high volume riding without the correct recovery methods.
Some of the most common sites of pain in cyclists are the neck, shoulder, knee, lower back and sacroiliac joints (SIJs). There are many reasons in which a person might be experiencing pain. It could be related to a new hobby, a predisposing injury, muscle tightness, or it could even be the set-up of your bike. Just like a work desk, our bike set up can be incredibly important to ergonomics, decrease injury, aid in decreasing pain and keep you riding for a longer period of time.
Getting the correct set up on your bike will depend on what kind of bike you have, how tall you are, shoulder reach, as well as what feels comfortable.
Here are a couple of quick tests you can do:
To check your seat height get onto your bike with one leg straight and place the heel of your foot on the pedal at the lowest point, which should make your leg straight. If this does occur then your saddle should be at the correct height for you.
To find the best saddle position, you should sit on the bike with the pedal at 3 o’clock. Place your foot with the joint of the toes on the pedal spindle. In the perfect scenario an imagery perpendicular line should run from your knee-cap through the spindle of the pedal. If the line runs behind the spindle, then the saddle needs to be pushed forward. If the line runs in front of the spindle then the saddle needs to be pushed backwards.
There are a lot of measurements and angles to take into consideration when setting up your bike with an ergonomics assessment. My best advice is that if you are experiencing any pain before, during or after riding your bike, it might be worth a visit to your local bike shop or your local specialized practitioner and ask for an ergonomic bike set up. This will allow to can for longer with the correct posture and decrease your chances of dealing with some of the getting some of the common cyclist pain.
If you would like more information on ergonomic set ups on bikes. Please ask us for a bike set up hand out.
Written by Brendan Ashman
Did you know that Brendan recently did a certification course for bike fitting and setup. For more information please ask Brendan at firstname.lastname@example.org or call (416) 546 4887
The Toronto Raptors are in the NBA playoff finals for the first time in History and what an exciting time it is to be in the city of Toronto. With a current 2-1 lead, a championship certainly favours the Raptors. With certain key players like Thompson and Durant out with Injury, it has certainly made the Raptors job easier. Pivotal moments like this, where injury is a huge factor, it brings on a great topic of discussion – INJURY.
What makes basketball players susceptible to injury?
In basketball, there are a lot of quick pivoting moments such as jumping, running, cutting. You have people going in different directions at all speeds, playing offense and defense. Athletes today are stronger and more powerful with more explosive force than ever before, thanks to sports nutrition, sports performance and conditioning.
What can players do to prevent injury?
Maintain a good balanced workout, stretch daily and strengthen your core muscles. Flexibility is extremely important, but it’s not as much of a focus for young athletes. As you get older, flexibility becomes important to help limit injuries on the basketball court.
What are the most common injuries in Basketball?
- Foot and ankle injuries
Lateral ankle sprains are the most common injury in Basketball. With the quick movements, lots of jumping and especially big feet in some players, some injuries are bound to happen. You may see a player jump and land on another players foot, causing their foot and ankle land awkwardly, resulting in a sprain.
High ankle sprains, an injury to the ligaments between the two lower leg bones (tibia and fibula), can be more of a serious injury and sometimes require surgery to reestablish the relationships between the bones.
With a sprain, follow RICE: Rest – Ice – Compression – Elevation. A lot of these injuries don’t need surgery, but if you can’t put weight on it, get an X-ray to rule out a fracture.
- Hip and thigh injuries
An injury to the hips, such as a strained hip flexor, can result from quick pivoting movements. Getting a knee from another playing into the thigh can cause bruising and possible contusions. This may seem like no big deal, but it can be painful and keep you out of the game. For this, ice it for the first 24-48 hours, then switch to heat and stretching so the thigh doesn’t get too tight.
- Knee injuries
Basketball requires extensive stop and go and cutting maneuvers which can put the ligaments and menisci of the knee at risk. Injury to the medial collateral ligament is most common following a blow to the outside of the knee and can be often be treated with ice, bracing and a gradual return to activity.
An injury to the anterior cruciate ligament is a more serious injury and can occur with an abrupt change in direction and landing for the jump. Although this ligament tear is most commonly a season ending injury that requires corrective surgery, current techniques used to repair the ACL ligament generally allow the player to return to play the following season.
- Wrist and hand injuries
From jammed fingers to sprained, dislocated or fractured fingers, these injuries are very common among basketball players. The ball can hit it your hand or fingers at a fast speed and can cause a significant sprain or break. Sprained wrists can occur if a player falls and puts his hand down to protect himself.
- Head and face injuries
Concussions, bloody lips, and other head injuries are usually the result of getting elbowed accidentally or coming down from a layup and getting hit in the head. It’s common when a player is rebounding or fighting for position.
For concussion, players should always get out of the game and have an evaluation by a medical health professional that regularly manages concussions.
For an assessment, treatment and management of your Basketball Injuries our osteopaths, massage therapist and chiropodist at Beach Integrated Health Clinic can help you get back on the court. Feel free to contact us directly with any further questions on (416) 546 4887 or book an online appointment.
The most common elbow condition is tennis elbow, also known as lateral epicondylitis, is caused by overuse and excessive strain on the extensor muscles of the forearm resulting from wrist extension, such as in back hand tennis players, or occupations that involve repetitive wrist movement, such as carpenters or bricklayers. It may be provoked by any exercise that involves repeated and forcible extension movements of the wrist, like using a screwdriver or hammer.
Symptoms of Tennis Elbow
Tennis elbow usually has a gradual onset but it can also be sudden. There may be a constant muscular ache in the forearm and/or near the outer elbow. It is aggravated by movements that involve extension of the wrist, such as picking up bags or turning on taps and sometimes it may feel like there is less strength when grasping objects. The outer elbow can be tender to touch, is painful with resisted extension of the wrist and is painful when stretching the wrist.
Tennis Elbow Treatment
In the acute phase of the tennis elbow rest is vital. Apply ice 2-3 times daily to reduce inflammation and pain. Anti-inflammatory medication or gels can also work very well. Osteopathic treatment can help loosen and stretch the muscles involved and also reduce the amount of inflammation in the elbow. Your Osteopath will also check any other areas that may be affected, such as the shoulder or upper back and neck, and show you stretches you can do to reduce tension in the forearm muscles and also show you exercises you can do to strengthen these muscles.
Achilles tendinopathy or generally known as achilles tendinitis is a common condition characterised by localised pain and swelling at the achilles tendon. The achilles is a large tendon connecting the major calf muscles, the gastrocnemius and the soleus, to the heel bone. During a calf contraction tension is put through the achilles tendon and if this tension is excessive due to too much repetition or high force, damage to the tendon occurs, leading to subsequent degeneration and inflammation.
Signs & Symptoms of Achilles Tendinitis
Pain at the achilles tendon is most commonly felt either at the mid-point of the tendon or at the portion where it joins with the heel bone. The pain can either be sharp or a dull ache. There may also be limited ankle flexibility, redness or heat over the painful area, a nodule (a lumpy buildup of scar tissue) that can be felt on the tendon, or a cracking sound (scar tissue rubbing against the tendon) when the ankle moves.
Causes of Achilles Tendinitis
Achilles tendinitis commonly occurs in both recreational and professional sports athletes, usually involving running and jumping type activities. Occasionally, it may occur suddenly due to a high force going through the Achilles tendon beyond what it can withstand. This may be due to a sudden acceleration or forceful jump. It can also be caused by adverse lower limb biomechanics, tight or fatigued calf muscles, previous calf strain/ tear and ankle sprain, weak muscles, overtraining, increasing training load too quickly, excessive hill running or speed work, overpronation and inappropriate footwear.
Treatment, Management & Prevention of Achilles Tendinitis
If you start experiencing achilles pain, then stop doing the activity that started the pain and rest. Ice the area for 10-15 minutes multiple times a day, until the swelling subsides. Take some anti-inflammatory medication is the pain persists for more than 2 days.
Manual therapy such as osteopathy can help with the pain, muscle tightness, joint mobility, body alignment, inflammation and swelling. This may include techniques and modalities such as soft tissue massage, manipulation, dry needling, electrotherapy and taping.
Shock wave therapy has also shown to be effective, especially more for insertional achilles tendinopathies.
A strengthening program should be implemented once the swelling has gone down. This exercise program should consist of eccentric exercises, but also exercises such as concentric strengthening and other exercise to address possible functional deficits (ie. weak gluteals). One of the most useful strengthening technique for the achilles is the heel drop. This is where you lower yourself from being up on your toes and allow your heel to slowly drop down and off the level of a step. This exercise should be done slowly and it can be normal it feel some pain, but as long as it doesn’t stick around longer than the exercise (irritable). From this exercise once it becomes easier and less painful, load can be added (ie. a backpack), increased repetitions, increase in range, and increase in speed (much later). Although this is one exercise it is best if you consult your osteopath or physiotherapist to rehab your achilles tendon correctly.
If you are a runner, you can start running once there is no pain on calf raises, heel drops or hopping. Make sure that there is no speed or hill work in these run sessions and there is at least one rest day between each run. Once there is no pain during or between runs you can gradually increase your volume.