In this installment of our “injury of the week” series we’re going to be talking about neck strains/sprains. We’re going to keep the same format we’ve had all along. First we’re going to start off with a review of what the injury is and talk about if this is what you have and when you need to worry/consult your doctor. From there we’re going to take you through the steps of the A-T-A self treatment system.

“I woke up and couldn’t move my neck.” Sound familiar?

While a good portion of neck strains and spasms occur following a traumatic injury (i.e. fall, bike crash, car accident, etc), an even larger portion occur after the fact. The muscles get overworked and stiffen up after the actual “injury”. That can occur hours later, at night while watching TV, or even overnight. So what actually causes it when there is no specific “injury”?

The simple answer is postural abnormalities.

Good posture means: shoulders back, neck in neutral position. Most of us do not sit or stand like this. Sure, we do when we think about it but more often than not we fall forward into a more comfortable slouch position. By itself, that isn’t a bad thing, but over time, we can actually get stuck in that position. Ladies? We are even more at risk for obvious reasons.

Here’s a picture showing what I mean. It’s not the exaggerated slouch we all see and ignore because we aren’t that bad, right?

In this picture you’ll see that: 1) the chin and head are forward, 2) the shoulders/upper thoracic spine are a bit rounded, and 3) the humerus/upper arm bone is rotated in ( see how the bone sticks out in the front just above the yellow?). Why is that bad?

1. The muscles in the front of the neck get stuck in a short/tight position. Now they can’t move fully or contract fully.
2. The muscles in the back of the neck/upper back are now stretched out and have to work hard to hold us upright. Over time, trigger points and increased tension will develop in them. If they get tight enough they can even pull up on your shoulder blades.
3. As the the muscles in the back of the neck/shoulder get weaker, we actually stoop forward and the muscles in the chest get stuck in that short/tight position.
4. As the front of the shoulder gets tight, the humerus rotates in and the scapular muscles/stabilizers get pulled into the mess.

What do you NEED to know after reading that?

The cervical spine is a dynamic part of the body. It’s stability and muscle balance carries over into how our arms and entire upper body work and vice versa. To function properly the muscles on both the front and back need to be both mobile and strong. More often than not we get tight on the front and the back gets beat up as a result, hence the trigger points and muscle strains we get.

My neck hurts. Now what?

First things first. Like we’ve said all along. This site is not designed to keep you from your doctor and healthcare team. It’s designed to teach you the things that you can do at home to help alleviate symptoms and prevent them from becoming a full blown injury. That being said, the neck is a complex place. If you have any of the following, time to see your doctor. Numbness/tingling anywhere in your neck/shoulder/arm. Burning pain or pain in multiple locations (i.e. into the shoulder blade or into the arm). Weakness in your hand or difficulty lifting your arm over your head. If you aren’t making any progress? See your doctor.  Remember, the thing to keep in mind with nagging symptoms in the neck is that the pain/spasm don’t always have to be muscular in nature. It could be because a nerve got pinched in the cervical spine itself or in the muscles that run along it. Numbness/tingling/weakness are a big red flag for this, but so are continued symptoms that don’t improve regardless of treatment.

Be smart when self treating at home. If you aren’t getting better, get some help. I can’t tell you how many patients I get who wait weeks and even months before coming in for treatment. The longer you wait, the harder it is to get rid of. Here are some tips for finding the right health care professional:

• Find someone certified in soft tissue mobilization, whether it’s instrument assisted like Graston Technique or hands on like Active Release (ART). This is where you need to do your homework to see who’s near you. Follow the links to those sites to search their provider lists and read up on what each is all about. A tight neck will definitely benefit from some hands on/massage work. When looking for someone on the ART list you’re looking for spine certified. If possible, someone certified with nerve entrapments is also a plus. Might as well cover all of your bases right?
• Not every PT and chiropractor are created equally. Some do very little soft tissue work and rely mostly on exercise and manipulations, others do not. We all specialize in our own little areas. Frustrating right? Not really. Most of us have websites to tell you what we are certified in. If we don’t? Pick up the phone and call us. There’s nothing worse than wasting 8 insurance visits not getting better only to switch places and have them fix it in two.

How to treat it.

**download PDF with links, sets, reps, progressions, etc here**

Step 1- Symptom management 

When a new muscle injury occurs, the first and most important goal is always to decrease pain and any inflammation that may be present. Don’t short cut this stuff. It’s boring but it works, especially if your symptoms worsen as the day goes. It’s now easier than ever to smuggle an ice pack into the office fridge. Use that to your advantage when working to heal an injury!

Rest: This may sound obvious, but I’m going to say it anyway. An injured muscle will require a decreased activity level to fully heal. The severity of the injury will determine if this is a full rest or more of an active recovery. For the neck, avoid overhead activities and heavy lifts. If you can’t pick it up with your elbows glued to your sides, it’s too heavy.

Ice: Typically I firmly recommend ice in the first seven days following an injury. It’s hands down the better option for decreasing pain and an absolute must for swelling reduction. However…in the event of a muscle spasm, I change that advice. Alternate them. Heat the muscles 10-15 minutes before any soft tissue work/stretching and then follow it up with ice 10-15 minutes. Once the acute pain  is gone, switch over to ice only following your treatment sessions.

Step 2- Kinesiology taping:

The taping application for a neck strain/spasm is designed to help restore normal alignment.

1. Taping application. Click here.

Step 3- Getting mobility back:

The second goal is going to be to loosen up the injured area. Below I have the treatment techniques set up in levels. As a rule, you must be able to complete #1 without pain to progress to the next level. Be smart! Healing a muscle sprain/strain isn’t about no pain, no gain. The muscle needs to heal! Don’t overdo it in an attempt to speed up your recovery.

1) Rest/ice/heat + gentle stretching. There should be no pain with stretching.

2) Begin using the foam roller AROUND the injured area. The goal here is to start getting slack into the muscle without aggravating the injury itself. No tennis ball work or mobilizations. The order should be foam roll around injury -> stretch -> rest/ice/heat.

3) Begin using the foam roller over the injured area to tolerance. The order should be foam roll around injury-> over injury -> stretch -> rest/ice/heat.

4) Begin using the tennis ball/theracane for mobilizations. The order should be foam roll around injury -> over injury ->  mobilizations  -> stretch -> rest/ice/heat.

5) Begin using the tennis ball for cross friction + trigger point release. These are the deepest of the soft tissue techniques so you want to save them for last to target specific adhesions and restrictions. Consider this your fine tuning step.

How long do you need to rest/ice/heat for??? Until it’s 100% gone.

Here’s what it looks like for a neck strain/sprain. Use the guidelines above.

Step 4: Strengthening

We’ve broken the exercises down into three levels based on pain levels. This stuff should NOT hurt. If it does, go back a level or ease up on the resistance. Only progress as pain free.

What you’ll need: 1) To start? Nothing at all. 2) As you add resistance? Ankle weights/little dumbbells.

Video’s for each level are here. Please note, in the PDF download (above) you will find details for reps and difficulty progression, as well as, benchmarks you should meet before progressing to the next level. The number one thing to remember is that these exercises should be pain free. If you’re getting discomfort, go back a level. You can’t force this injury to heal, but you certainly can make it worse if you over do it.

Level One

Level Two

Level Three

In this installment of our “injury of the week” series we’re going to be talking about neck strains/sprains. We’re going to keep the same format we’ve had all along. First we’re going to start off with a review of what the injury is and talk about if this is what you have and when you need to worry/consult your doctor. From there we’re going to take you through the steps of the A-T-A self treatment system.

“I woke up and couldn’t move my neck.” Sound familiar?

While a good portion of neck strains and spasms occur following a traumatic injury (i.e. fall, bike crash, car accident, etc), an even larger portion occur after the fact. The muscles get overworked and stiffen up after the actual “injury”. That can occur hours later, at night while watching TV, or even overnight. So what actually causes it when there is no specific “injury”?

The simple answer is postural abnormalities.

Good posture means: shoulders back, neck in neutral position. Most of us do not sit or stand like this. Sure, we do when we think about it but more often than not we fall forward into a more comfortable slouch position. By itself, that isn’t a bad thing, but over time, we can actually get stuck in that position. Ladies? We are even more at risk for obvious reasons.

Here’s a picture showing what I mean. It’s not the exaggerated slouch we all see and ignore because we aren’t that bad, right? 🙂

In this picture you’ll see that: 1) the chin and head are forward, 2) the shoulders/upper thoracic spine are a bit rounded, and 3) the humerus/upper arm bone is rotated in ( see how the bone sticks out in the front just above the yellow?). Why is that bad?

1. The muscles in the front of the neck get stuck in a short/tight position. Now they can’t move fully or contract fully.
2. The muscles in the back of the neck/upper back are now stretched out and have to work hard to hold us upright. Over time, trigger points and increased tension will develop in them. If they get tight enough they can even pull up on your shoulder blades.
3. As the the muscles in the back of the neck/shoulder get weaker, we actually stoop forward and the muscles in the chest get stuck in that short/tight position.
4. As the front of the shoulder gets tight, the humerus rotates in and the scapular muscles/stabilizers get pulled into the mess.

What do you NEED to know after reading that?

The cervical spine is a dynamic part of the body. It’s stability and muscle balance carries over into how our arms and entire upper body work and vice versa. To function properly the muscles on both the front and back need to be both mobile and strong. More often than not we get tight on the front and the back gets beat up as a result, hence the trigger points and muscle strains we get.

My neck hurts. Now what?

First things first. Like we’ve said all along. This site is not designed to keep you from your doctor and healthcare team. It’s designed to teach you the things that you can do at home to help alleviate symptoms and prevent them from becoming a full blown injury. That being said, the neck is a complex place. If you have any of the following, time to see your doctor. Numbness/tingling anywhere in your neck/shoulder/arm. Burning pain or pain in multiple locations (i.e. into the shoulder blade or into the arm). Weakness in your hand or difficulty lifting your arm over your head. If you aren’t making any progress? See your doctor.  Remember, the thing to keep in mind with nagging symptoms in the neck is that the pain/spasm don’t always have to be muscular in nature. It could be because a nerve got pinched in the cervical spine itself or in the muscles that run along it. Numbness/tingling/weakness are a big red flag for this, but so are continued symptoms that don’t improve regardless of treatment.

Be smart when self treating at home. If you aren’t getting better, get some help. I can’t tell you how many patients I get who wait weeks and even months before coming in for treatment. The longer you wait, the harder it is to get rid of. Here are some tips for finding the right health care professional:

• Find someone certified in soft tissue mobilization, whether it’s instrument assisted like Graston Technique or hands on like Active Release (ART). This is where you need to do your homework to see who’s near you. Follow the links to those sites to search their provider lists and read up on what each is all about. A tight neck will definitely benefit from some hands on/massage work. When looking for someone on the ART list you’re looking for spine certified. If possible, someone certified with nerve entrapments is also a plus. Might as well cover all of your bases right?
• Not every PT and chiropractor are created equally. Some do very little soft tissue work and rely mostly on exercise and manipulations, others do not. We all specialize in our own little areas. Frustrating right? Not really. Most of us have websites to tell you what we are certified in. If we don’t? Pick up the phone and call us. There’s nothing worse than wasting 8 insurance visits not getting better only to switch places and have them fix it in two.

How to treat it.

**download PDF with links, sets, reps, progressions, etc here**

Step 1- Symptom management 

When a new muscle injury occurs, the first and most important goal is always to decrease pain and any inflammation that may be present. Don’t short cut this stuff. It’s boring but it works, especially if your symptoms worsen as the day goes. It’s now easier than ever to smuggle an ice pack into the office fridge. Use that to your advantage when working to heal an injury!

Rest: This may sound obvious, but I’m going to say it anyway. An injured muscle will require a decreased activity level to fully heal. The severity of the injury will determine if this is a full rest or more of an active recovery. For the neck, avoid overhead activities and heavy lifts. If you can’t pick it up with your elbows glued to your sides, it’s too heavy.

Ice: Typically I firmly recommend ice in the first seven days following an injury. It’s hands down the better option for decreasing pain and an absolute must for swelling reduction. However…in the event of a muscle spasm, I change that advice. Alternate them. Heat the muscles 10-15 minutes before any soft tissue work/stretching and then follow it up with ice 10-15 minutes. Once the acute pain  is gone, switch over to ice only following your treatment sessions.

Step 2- Kinesiology taping:

The taping application for a neck strain/spasm is designed to help restore normal alignment.

1. Taping application. Click here.

Step 3- Getting mobility back:

The second goal is going to be to loosen up the injured area. Below I have the treatment techniques set up in levels. As a rule, you must be able to complete #1 without pain to progress to the next level. Be smart! Healing a muscle sprain/strain isn’t about no pain, no gain. The muscle needs to heal! Don’t overdo it in an attempt to speed up your recovery.

1) Rest/ice/heat + gentle stretching. There should be no pain with stretching.

2) Begin using the foam roller AROUND the injured area. The goal here is to start getting slack into the muscle without aggravating the injury itself. No tennis ball work or mobilizations. The order should be foam roll around injury -> stretch -> rest/ice/heat.

3) Begin using the foam roller over the injured area to tolerance. The order should be foam roll around injury-> over injury -> stretch -> rest/ice/heat.

4) Begin using the tennis ball/theracane for mobilizations. The order should be foam roll around injury -> over injury ->  mobilizations  -> stretch -> rest/ice/heat.

5) Begin using the tennis ball for cross friction + trigger point release. These are the deepest of the soft tissue techniques so you want to save them for last to target specific adhesions and restrictions. Consider this your fine tuning step.

How long do you need to rest/ice/heat for??? Until it’s 100% gone.

Here’s what it looks like for a neck strain/sprain. Use the guidelines above.

Step 4: Strengthening

We’ve broken the exercises down into three levels based on pain levels. This stuff should NOT hurt. If it does, go back a level or ease up on the resistance. Only progress as pain free.

What you’ll need: 1) To start? Nothing at all. 2) As you add resistance? Ankle weights/little dumbbells.

Video’s for each level are here. Please note, in the PDF download (above) you will find details for reps and difficulty progression, as well as, benchmarks you should meet before progressing to the next level. The number one thing to remember is that these exercises should be pain free. If you’re getting discomfort, go back a level. You can’t force this injury to heal, but you certainly can make it worse if you over do it.

Level One

Level Two

Level Three

Hope that helps, and fire away with any questions in the comments section!

References

1) Capobianco, Dr. Steven and van den Dries, Greg. (2009). Power Taping, 2nd Edition, Rock Tape Inc, Los Gatos, CA.

2) Hammer, Warren. (2007). Functional Soft-Tissue Examination and Treatment by Manual Methods, 3rd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.

3) Hyde, Thomas and Gengenbach, Marianne. (2007). Conservative Management of Sports Injuries, 2nd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.

4) Kase, Kenzo, Wallis, Jim, and Kase, Tsuyoshi. (2003). Clinical Therapeutic Applications of the Kinesio Taping Method.

5) Muscolino, Joseph. (2009). The Muscle and Bone Palpation Manual. Mosby, Inc, St. Louis, MO.

In this installment of our “injury of the week” series we’re going to be talking about shoulder impingement.

What is Impingement Syndrome??

There are three bones and subsequently three joints that make up the shoulder. You have the humerus (upper arm bone) that connects to the scapula (shoulder blade) and both are then connected to the skeleton by the clavicle (collar bone). This gives you three separate joints to help move the shoulder. These joints are then reinforced by muscles that help support them and also work to hold the the scapula against the rib cage.

The big take away here should be that the shoulder is an unstable joint that relies on muscles to hold it in good alignment versus bones. This makes it particularly susceptible to muscle imbalance and injury. Muscles can get tired and tight. Bones can not. Essentially that is what happens with impingement. That alignment is lost and things get pinched. For example, lifting the arm overhead requires two things: 1) rotation of the scapula/shoulder blade and 2) elevation of the humerus (upper arm bone). When both of these things happen there is plenty of space within the shoulder joint and all of the tendons and bones are able to move through their full range of motion without problem. However, when they do not, this space is decreased and the larger muscles must force the movement through bad alignment. This can result in the smaller tendons in the front of the shoulder and the joint structures themselves getting repeatedly pinched and inflamed.

Most of you have probably known people who have torn their rotator cuff or injured the cartilage inside the shoulder joint (also known as the labrum). Impingement is one of mechanisms that can cause those kinds of injuries. When that damage occurs (like a rotator cuff tear for example or tendinitis), you have to heal the tendon/muscle/joint damage, but you also have to correct the impingement mechanism that caused it otherwise that damage can occur again.

An easy way to visualize that mechanism is to do a little test sitting there in your chair. Have you ever tried to lift your arm fully over your head while slouching? Try it. You can get it part of the way up there, but eventually the bones will block the motion. It probably looks something like this too:

Now try pulling your shoulders back first and then lift your arm straight over your head.

The arm goes much higher and motion feels easier to doesn’t it?

Good posture is key. This means the muscles on the back of the shoulder are working properly. When you start slouching forward, the front of the shoulder tightens up and then makes those muscles work even harder to hold that good position.
Okay, so now that we’ve talked about how impingement is the mechanism of injury that damages the structures of the shoulder versus an actual diagnosis, let’s talk about how to determine what the actual injury is. Did something just get pinched in the front and irritated or did something truly get damaged and you need a doctor? Like we’ve said all along. This site is not designed to keep you from your doctor and healthcare team. It’s designed to teach you the things that you can do at home to help alleviate symptoms and prevent them from becoming a full blown injury. If you have any of the following, time to see your doctor.

• Swelling
• Scary purple/black bruising where the pain is.
• Numbness/tingling anywhere in the shoulder/arm.
• You can’t pick your arm up or hold it up above shoulder height.
• If this a traumatic injury, meaning you fell on it or felt a pop/tear when the injury happened.
• If you aren’t making any progress on your own.

Impingement can cause a dozen different things including: bursitis, tendinitis, bone spurs, rotator cuff tears, cartilage/bone damage, etc. The signs/symptoms listed above warrant a medical evaluation. Period.

For the purpose of this post, we’re going to focus on a classic injury caused by impingement- a rotator cuff strain/sprain that starts gradually. By that, I mean that the ache/pain/difficulty moving the arm started without a specific injury. It’s limiting your ability to work overhead with the arm, but it’s pain free at rest and you can still perform all of your daily activities.
How to treat it.

**download PDF with links, sets, reps, progressions, etc here**

Step 1- Traditional R.I.C.E. treatment:

When a new muscle injury occurs, the first and most important goal is always to decrease pain and any swelling that may be present. In other words, we want to decrease inflammation. Don’t short cut this stuff. It’s boring but it works, especially if your symptoms worsen as the day goes. For example, it’s now easier than ever to smuggle an ice pack into the office fridge and wear compression gear under your dress clothes. Use that to your advantage when working to heal an injury!

Rest: This may sound obvious, but I’m going to say it anyway. An injured muscle will require a decreased activity level to fully heal. The severity of the injury will determine if this is a full rest or more of an active recovery. For the shoulder my advice is typically to avoid overhead activities and heavy lifts. If you can’t pick it up with your elbow against your side, it’s too heavy.

Ice: while heat may feel better on stiff and sore muscles, ice only during the first 7 days following injury. This will help to decrease swelling, inflammation and pain. 10-15 minutes is sufficient and you can perform every hour as needed. Avoid direct ice to skin contact.

Compression: thanks to the recent explosion of compression sleeves, tights, shorts, etc, you have several options in this department. Ideally you want something that is snug without being uncomfortably tight. Think tight under armor or CWX shirt. If it reinforces posture by pulling your shoulders back? Even better.

Step 2- Kinesiology taping:

The taping application for impingement syndrome is designed to help pull the shoulder back into better alignment and give the injured structures space to heal.

1) Taping application. Click here.

Follow the directions for skin prep and care. This can stay on 3-5 days easy. Any signs of skin irritation? Take it off.

Step 3- Getting mobility back:

The second goal of treatment is going to be to loosen up the injured area. Below I have the treatment techniques set up in levels. As a rule, you must be able to complete #1 without pain to progress to the next level. Be smart! Healing a muscle sprain/strain isn’t about no pain, no gain. The muscle needs to heal! Don’t overdo it in an attempt to speed up your recovery.

1. R.I.C.E. + gentle stretching. There should be no pain with stretching. With this type of injury, we will need to stretch out the muscles in the back of the shoulder as well as the front and upper arm.
2. Begin using the foam roller AROUND the injured area. The goal here is to start getting slack into the muscle without aggravating the injury itself. No tennis ball work or mobilizations. The order should be foam roll around injury -> stretch -> RICE.
3. Begin using the foam roller over the injured area to tolerance. The order should be foam roll around injury-> over injury -> stretch -> RICE.
4. Begin using the tennis ball for mobilizations. The order should be foam roll around injury -> over injury -> active mobilization with the tennis ball -> stretch -> RICE.
5. Begin using the tennis ball for cross friction + trigger point. These are the deepest of the soft tissue techniques so you want to save them for last to target specific adhesions and restrictions. Consider this your fine tuning step.

How long do you need to R.I.C.E for??? Until it’s 100% gone.

Here’s what it looks like. Use the guidelines above.

Step 4: Strengthening

We’ve broken the exercises down into three levels based on pain levels. This stuff should NOT hurt. If it does, go back a level or ease up on the resistance. Only progress as pain free.

What you’ll need: 1) resistance band/tubing. This is easy to find in any sporting good store these days. You can probably even get it in walmart or target.

Optional equipment: 1) a stability ball. Same guideline as above. Very easy to find and cheap these days.

Video’s for each level are here. Please note, in the PDF download (above) you will find details for reps and difficulty progression, as well as, benchmarks you should meet before progressing to the next level. The video’s show you the basics for each exercise and what they look like.

The number one thing to remember is that these exercises should be pain free. If you’re getting discomfort, go back a level. You can’t force this injury to heal, but you certainly can make it worse if you over do it.

Level One

Level Two

Level Three

Hope that helps, and fire away with any questions in the comments section!

References

1. Capobianco, Dr. Steven and van den Dries, Greg. (2009). Power Taping, 2nd Edition, Rock Tape Inc, Los Gatos, CA.
2. Hammer, Warren. (2007). Functional Soft-Tissue Examination and Treatment by Manual Methods, 3rd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.
3. Hyde, Thomas and Gengenbach, Marianne. (2007). Conservative Management of Sports Injuries, 2nd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.
4. Kase, Kenzo, Wallis, Jim, and Kase, Tsuyoshi. (2003). Clinical Therapeutic Applications of the Kinesio Taping Method.
5. Muscolino, Joseph. (2009). The Muscle and Bone Palpation Manual. Mosby, Inc, St. Louis, MO.

In this installment of our “injury of the week” series we’re going to be talking about shoulder impingement.

Welcome to week #2 of our “injury of the week” series. Last week we went through what plantar fasciitis was, what some of the causes for it were, and most importantly how to treat it before it gets out of control. We started off with fasciitis because it’s one of the most common injuries out there. This week we want to continue that theme and tackle another popular one- hamstring strains and sprains.

Why is it so common?

1. There are three individual muscles that make up the “hamstrings”, not just one. Click here to catch up on the anatomy.
2. The hamstring muscles cross two joints- the hip and knee. This means that one end it helps bend the knee and on the other it helps pull the leg back at the hip (also known as hip extension).
3. The hamstrings are a middle muscle. This means that for them to function properly, they need to transmit the impact from weight bearing in the front of the leg to the back of the leg. When they can do this correctly, the large glute muscles take over and finish propelling us forward. That last part is critical! Without the glutes, it’s only a matter of time until you have problems down in the leg trying to pick up the slack. The hamstrings are a common victim. If anything is off downstream in the ankle/calf or upstream in the hip or back, it can affect the hamstrings. The leg works by moving forward and backwards. When things start to compensate, it’s common for the leg to rotate and move in/out in an attempt to compensate.

So what causes the hamstrings to get caught in the middle and get injured?

1) Mobility Restrictions–

These can occur in either the muscles themselves or the joints. Sometimes both. Here are the most common muscle limitations:

1) Tight achilles, gastroc and soleus. Limitations here will shift the workload to either the posterior tib (inside calf) or the peroneals (outside calf). Over time, restrictions will lead to joint mobility loss in the ankle and foot. It can even lead to problems on top of the foot and in the toes.

2) Tight hamstrings. Limitations here will prevent you from straightening your knee. Both the gastroc and the hamstring tendons criss cross behind the knee. If one is tight, the other isn’t far behind.

We’re going to kick off our new “Injury of the Week” series with Plantar Fasciitis for a few reasons. The first is that this one gets all of us in some shape or form at some point. The second is that now is a popular time of year for it to start. Shiny new shoes, high motivation levels for the upcoming season, and aggressive training schedules can all contribute. The good news is that the earlier you catch this and address it, the easier it is to get rid of. If you wait months because it “really isn’t that bad” or “it goes away as the day goes” or “it’s not stopping me from training”, then you’re heading for some potential trouble.

So what is Plantar Fasciitis exactly?

The plantar fascia starts on the heel bone (calcaneous) and then moves up to the ball of the foot and toes (also known as the heads of the metatarsals, one for each toe). It is a thick connective tissue that supports the arch of the foot to provide support to all of the little muscles and tendons on the bottom of the foot. It is NOT a muscle. That means it does not contract and it’s so strong fiber wise that it barely even stretches (less than 2% under full body weight). It gradually takes on the weight of the body and uses that tension to help get the foot ready for push off.

So what does that mean exactly? It means that the plantar fascia is a structure that gets injured because something else is getting stuck during the gait cycle. It either is unable to lengthen fully and loses what little elasticity it has or it gets strained making up for restrictions elsewhere. Remember, the PF works in support of the muscles on the bottom of the foot. In particular, it works with the Flexor Hallicus Brevis (FHB) and Abductor Digiti Minimi (ADM), as well as, the longer tendons of the Flexor Digitorum Longus (FDL) and Flexor Hallicus Longus (FHL). The key take away when looking at the muscles is this. Some of the muscles are strictly in the foot, start to finish. Some are not and only exist in the foot as skinny tendons to our toes. These tendons are from muscles up in the calf. Hint hint. You’ve gotta take care of your calves! They may not hurt, but if you’re feet do, they are involved.

So what can cause plantar fasciitis?

#1 Abnormal rotation of the foot. Meaning that the foot is twisted too much or too little during the weight bearing process (i.e. overpronation or under-pronation). Sound weird? Here’s an easy visual. Think of the foot like a rubik’s cube.

The only way to beat the cube is to get all of the little colors lined up. In the picture above, the red is the toes, the yellow is the metatarsals, green is the five midfoot bones, blue is the talus which sits right under the lower leg bones, and orange is the heel/calcaneus. Each of these sections can rotate and cause problems. When things are straight and the cube is lined up, all of the force travels from the heel to the big toe to push off for propulsion.  When things are not lined up, the body needs to compensate somewhere. For example:

Looking down, this is a right foot with the cube idea. All boxes are lined up nicely throughout the foot. As the weight travels from the heel towards the toes, those boxes and colors all line up, allowing all of the small muscles on the bottom of the foot to maintain a good arch and rigid foot that is strong as the foot pushes off the big toe. When those boxes/colors do not line up, the muscles have to work harder than normal. Over time they will break down if this is not corrected and the next structure down the chain is the plantar fascia. Remember, it’s not a muscle so when this happens it can be overstretched and even torn.

In this picture, the cube is rotated in. Most of you know of this as over-pronation. It can occur in all four levels of the cube or just in a few. Likewise, it can rotate to the outside of the foot. This is known as supination.

Those are just two common examples. There are a dozen different variations of how the different parts of the foot can rotate and even more variations for how the body tries to compensate for them. This is why shoe selection is a huge culprit. If you are in a shoe that exacerbates these bad rotations or limits the normal rotation we need to weight bear efficiently, you’re setting yourself up for problems. Bottom line: not sure about your shoes and have foot problems?? See a pro. Not the high school kid selling shoes at your local sporting good/running store. These rotations occur during movement, not while standing still with wet feet to look at what your foot print looks like. Arch height is not a factor in who gets plantar fasciitis and who does not. It’s the amount of rotation and strain on the bottom of the foot.

Okay, so now that I’ve rambled about rotation evils, let’s move onto the other possible causes.

#2 Bunion/loss of big toe extension. In the event that motion becomes restricted in the this area, the foot will become unable to fully load the big toe in preparation for push off. Over time this will lead to compensation and rotation of the lower leg and ankle to allow the foot to fully flatten to the ground during full weight bearing. Typically this is seen as the foot pointing out  and push off coming off the side of the big toe. The problem here is that as the rotation occurs, the big calf muscles become less efficient and the smaller muscles of the lower leg must assist with forward propulsion. The foot isn’t designed like that and the “cube” and all of the bones/joints/muscles in it can get all twisted up.

#3 Ankle restrictions. In particular, not enough dorsiflexion of the ankle (being able to pull your foot up towards your shin). When this is limited, you’re stride is shortened and your push off decreased. The larger muscles will be unable to fully help and the workload will shift from the big toe to the mid-foot and arch. Sprain your ankle often or break it as a kid?  This is where old sprain/strain injuries and fractures can sneak back up on you.

#4 Restrictions up stream. Just like the ankle can be a huge factor, so can the knee and hip. I know we’ve all heard “it’s all connected”, and probably rolled our eyes, but it is very true. For example, the gastroc (large calf muscle) and hamstrings criss cross behind the knee. Restrictions in one, will affect the other. Period.

The bottom of my foot hurts? NOW WHAT?

1) The first step is determining if it is truly a plantar fascia injury or something else. Other possible injuries include bone spurs off the calcaneus (aka heel spurs) or a stress fracture of the calcaneus. Remember, the goal of this series is not to keep you away from your doctor so that you can self treat everything. It’s to teach you how to catch the early symptoms and take care of them before it becomes a full blown injury. That being said, Plantar Fasciitis starts as pain and stiffness in the arch of your foot. These symptoms are worse with activity/motion, better with rest. When the symptoms are close to the heel or hurt along the bone itself, then you should be thinking doctor. This would mean that actually standing on your heel hurts. A true fasciitis feels better standing back on your heel versus forward on your toes because it’s that loading phase that hurts versus just the contact of the heel to the ground. The reason I say doctor for heel pain is that you’re in spur territory. If the symptoms are sharp and not improving, it’s time for an x-rays. Calming down the inflammation around a spur is the only way to keep it from growing bigger.

2) If after reading number one, you fall into the fasciitis camp, then the good news is that there is a lot you can do to calm this down on your own. Be smart though. If you aren’t getting better, get some help. I can’t tell you how many patients I get who wait months and even years before coming in for treatment. The longer you wait, the harder it is to get rid of. Here are some tips for finding the right health care professional:

• Find someone certified in soft tissue mobilization, whether it’s instrument assisted like Graston Technique or hands on like Active Release (ART). This is where you need to do your homework to see who’s near you. Follow the links to those sites to search their provider lists and read up on what each is all about. Plantar Fasciitis requires some hands on/massage work. Exercise alone won’t cut it most of the time.
• Not every PT and chiropractor are created equally. Some do very little soft tissue work and rely mostly on exercise and manipulations, others do not. We all specialize in our own little areas. Frustrating right? Not really. Most of us have websites to tell you what we are certified in. If we don’t? Pick up the phone and call us. There’s nothing worse than wasting 8 insurance visits not getting better only to switch places and have them fix it in two.

How to treat it.

** Click here to download PDF Treatment Session Sheet with all of the links/directions you need all in one convenient sheet***

Don’t skimp on phase one. This is your chance to heal everything up so that it doesn’t get mostly better and sneak back to bite you later.  Let’s break it down.

#1 Ice.

Aim for at least twice a day for 5-10 minutes while still having pain. Not enough or you have to be on your feet for work? Bump up the frequency. Pack a ziploc bag of ice for the break room. Ice before and after work. If at home, shoot for 3x/day. If you go with the frozen water bottle, start off easy and use while sitting. Progress up to standing to apply more pressure. Wear a sock and avoid direct ice on skin. This part shouldn’t hurt if standing. Pain = back off.

#2 Soft tissue mobilizations.

During phase one, this is going to be the meat and potatoes of your game plan. The goal is to loosen up the muscles on the bottom of the foot and up into the calf. Let’s start from the ground up. These are the links to our self muscle massage posts. In each you will find detailed guidance for how to use a foam roller and tennis ball.

• Bottom of the foot.
• Calf muscles (gastroc, soleus, and posterior tibialis).
• Peroneals.

Time goal- 2 minutes with the roller on each muscle group. Go after the problem areas with the tennis ball as demonstrated in the video’s.

If you can’t seem to loosen anything up, try ten reps of these using the tennis ball. All the directions you need are in the video’s.

• tennis ball mobilization for the foot and plantar fascia. Click here.
• tennis ball mobilization for the posterior tibialis. Click here.

#3 Joint mobilizations.

Sometimes, the muscles have been tight for so long that they’ve caused the joints they move to stiffen up as well. In this case, we’re talking about the big toe and the ankle joint.

• Big toe using a resistance band.
• Ankle joint using resistance band.

#4 Stretching.

This is how you maintain the mobility you just got back with the foam roller/tennis ball. For an injury like plantar fasciitis, you want to stretch out the entire leg to loosen up the entire chain. The goal here is to loosen up the entire leg chain to find any “upstream” problems. Pay attention. If one stretch seems more difficult then the others or there’s a marked difference between your good and bad legs, put the roller to it and see if that helps even them out.

• These are my five go to stretches for leg injuries. Click here.
• Goal is 20 second holds, 3 reps of each.
• Follow the guidelines in the videos! This stuff should NEVER hurt.

#5 Kinesiology taping.

By now you’ve probably seen athletes covered in all kinds of colored tape. Some of you have probably even tried it out. Here’s my go to application for plantar fasciitis.

• PF taping. Click here.

Like I said before, the above is the meat and potatoes of healing this kind of injury. Soft tissue work and stretches should be done DAILY. No exceptions.

#6 Strengthening.

We’ve broken the exercises down into three levels based on pain levels. This stuff should NOT hurt. If it does, go back a level or ease up on the resistance. Only progress as pain free.

What you’ll need: 1) resistance band/tubing. This is easy to find in any sporting good store these days. You can probably even get it in walmart or target.

Optional equipment: a balance disc. Always good to add difficulty to your strength exercises. Affordable too at $20.

Video’s for each level are here. Please note, in the PDF download below you will find details for reps and difficulty progression, as well as, benchmarks you should meet before progressing to the next level. The number one thing to remember is that these exercises should be pain free. If you’re getting discomfort, go back a level. You can’t force this injury to heal, but you certainly can make it worse if you over do it.

Level One

Level Two

Level Three

To help put it all together, I’ve also created a PDF you can download to walk you through what a “treatment session” would look like. In it you will find everything you need including links to the videos and posts. Click here.

Hope that helps, and fire away with any questions in the comments.

References

1) Capobianco, Dr. Steven and van den Dries, Greg. (2009). Power Taping, 2nd Edition, Rock Tape Inc, Los Gatos, CA.

2) Hammer, Warren. (2007). Functional Soft-Tissue Examination and Treatment by Manual Methods, 3rd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.

3) Hyde, Thomas and Gengenbach, Marianne. (2007). Conservative Management of Sports Injuries, 2nd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.

4) Kase, Kenzo, Wallis, Jim, and Kase, Tsuyoshi. (2003). Clinical Therapeutic Applications of the Kinesio Taping Method.

5) Michaud, Thomas C. (2011). Human Locomotion. Newton Biomechanics, Newton, MA.

6) Muscolino, Joseph. (2009). The Muscle and Bone Palpation Manual. Mosby, Inc, St. Louis, MO.

Hello again and Happy Holidays! I know it’s been ages since we’ve put up new content, but here we are with a brand new series! From here on out you can expect a weekly post featuring a new injury.

What you can expect in these posts:

1. A review of the anatomy/structures involved.
2. An explanation of possible causes/contributing factors for the injury. Why? Let’s face it. As endurance athletes, most of our injuries are NOT traumatic. They are gradual and sometimes can take weeks and even months to build up to actual symptoms (pain, swelling, bruising, etc).
3. A game plan to start treating the injury. This will vary based on the injury, but you can expect guidance on which soft tissue mobilization techniques should be used, how to tackle the acute symptoms, stretching, taping, and strengthening to balance everything back out again.

What you will not find in these posts:

1. Guidance for traumatic injuries. Use common sense here folks. If you felt a pop/tear, your leg is giving out, you have numbness/tingling or bruising/swelling….CALL YOUR DOCTOR. Health insurance is there for a reason and avoiding a doctor to avoid a potential training set back can often set you back even further. The goal here is to teach you how to take care of the sore and tight muscles you will inevitably encounter during your training/racing. It is not to keep you away from your health care team.

When will it start?

• This Friday. Don’t want to miss it? Sign up for our newsletter.
• First injury? Plantar Fasciitis.
• Have something you’d like to see covered in this series? Comment here or on our Facebook page and we’ll add it to the list!

Train smart everyone! This time of year it’s easy to cook ourselves with new race calendars coming out and a list of goals and race splits we want to see in ’13.

If you haven’t had a chance to check it out, download our free Maintenance ebook (on the left side of this page). Inside you’ll find a worksheet that will take you through a series of steps to build your own routine catered to your personal injury history and your training schedule. It’s designed to show you when and what you need to do without taking up all your free time. The easiest way to cure an injury is to prevent it in the first place!