In our most recent blog post we reviewed 5 ways that physiotherapy can help treat heel pain related to plantar fasciitis. In this post, we are going to review commonly missed issues in ongoing heel pain (stretching tight calves or using orthotics are not always the best solutions!).

Plantar Fasciitis can be a common reason for heel pain. However, if you continue to have heel pain for more than two months or have already received treatment for plantar fasciitis with limited success, you may have to consider that there may be factors other than an 'inflamed' plantar fascia, that are driving your heel pain.

Here are four commonly overlooked issues that result in overloading the structures on the bottom of the foot.

1. Non-optimal weight-bearing
   1. Ask yourself – are you constantly bearing weight onto your heels? If so, you may need to address this first to help your treatments be effective.
   2. Test yourself by assessing whether you weight is:
   1. evenly distributed between the left and right foot
   2. spread through the four corners/tripod pattern in each foot

2. Muscle imbalances
   • Weakness in the back, hips, knees, ankles, and/or feet – this may result in the ankle collapsing inward causing the medial arch of the foot to be stressed.

   Have you had a previous injury to any of these regions? This may underlie the inhibition of stabilizer muscles of your lower leg.


3. Joint stiffness
   • Lack of mobility in the hips, knees, ankles and/or feet – can also result in the medial arch of the foot to be under stress.

   This too may be the result of a previous injury, like an ankle, knee or back sprain injury.


4. Nerve tension
   • Lack of mobility in the nerves (yes they need to move too!) – can also result in certain muscles being inhibited or overused.
   • A thorough assessment of neural tension will require looking at the spine as well as the lower leg. Please check out our previous blog about some nerves that can cause heel pain.

No matter the reason, heel pain is often the result of a repetitive strain injury (i.e., a structure that is irritated due to it being 'overloaded). So, if you have had heel pain that seemed to be resistant to recovery, you may just need to look a bit closer at one or more of the above commonly missed issues.

Plantar Fasciitis is a common condition that affects the ability to walk and run comfortably. It is characterized by pain at the front of the base of the calcaneus (heel bone), although it can migrate forward across the arch of the foot.

Possible causes of plantar fasciitis include:

• Poor flexibility of the calf muscles
• No arch support and poor footwear choices
• Sudden increase in activity level
• Excessive pronation of the ankle or repetitive stress

Plantar fasciitis-related pain can be reduced through physiotherapy. This treatment treats the underlying causes of plantar fasciitis rather than simply managing the symptoms through self-help techniques.

Here are 5 ways that physiotherapy can help:

1. Reducing pain with manual therapy and other modalities.
   Manual therapy and joint mobilization can help reduce pain and improve mobility. Laser therapy and acupuncture can alleviate pain and inflammation to speed your recovery.
2. Stretching and strengthening exercises for the calf muscles, intrinsic foot muscles and the plantar fascia itself.
   Targeted treatment via individualized exercises and stretches can address specific drivers of your symptoms. Knowing when to stretch and when and what to strengthen are keys to recovery.
3. Biomechanical corrections, including gait analysis
   Analyzing your gait will help to identify abnormal or non-optimal movement patterns that may be worsening stress on the plantar fascia. It is important to assess the body as a whole to understand why you've developed a repetitive strain injury like plantar fasciitis.
4. Education and advice regarding activity modification and return to activity
   To avoid delaying your recovery, it is essential to understand how to modify your activities to limit aggravating your symptoms. Gradual, supervised return to activity is crucial for preventing the recurrence of plantar fasciitis.
5. Functional and proprioceptive training
   Balance and coordination exercises help improve foot and ankle function and can help prevent further injury. These exercises and treatments go beyond simple strengthening and are designed to improve whole body mechanics. If you are having difficulty with standing on one foot, going up on your toes, or even moving your toes individually, please check out our blog about the "TOE-GA" test!

Don't forget to check out our next post where we discuss some commonly missed issues in ongoing heel pain!

With the fall season already upon us, many of us are starting back up our recreational/competitive sports, finishing up yard work before the winter season, or completing home renovations while the weather is still warm(ish). Often times, many of these activities require repetitive overhead motion of our shoulders. Over time, these repetitive movements can lead to over-use injuries of the shoulder, where eventually simply reaching up to put your purse in the closet or performing a movement you have done hundreds of times becomes painful. One of the reasons for your pain in your shoulder may be due to an inflamed bursa, called bursitis.

So you may be thinking, I’ve recently been diagnosed, but what is it and how did I develop it? To understand what bursitis is, we first have to discuss what a bursa is. A bursa is a sack of fluid found in different parts of the body that help reduce friction between tendons, muscles, skin and bones. Bursitis is the term used if the bursa has become inflamed due to irritation. Common areas where bursitis is found in the body are in the shoulder, hip, elbow, and feet.

There are a variety of reasons that an individual may develop bursitis, and although over-use injuries are often the most common, there may be other reasons as to why you may have developed pain in your shoulder. Some of those issues include:

• Direct trauma to the bursa
• Muscular imbalances including weakness or motor control dysfunctions causing shoulder impingement
• Decreased muscle flexibility or joint mobility
• Anatomical/structural variations
• Joint disorders such as osteoarthritis, rheumatoid arthritis or psoriasis

If you have recently been diagnosed with shoulder (subacromial, subdeltoid, subcoracoid) bursitis, contact us at EQ Physio, where we have developed a specialized program (Freedom to Move Bursitis Program) to help you recover from your bursitis and get you back to moving pain-free.

Simon Janik, Registered Physiotherapist, is a graduate of Western University. He has taken post-graduate courses in manual therapy acupuncture and has a special interest in working with athletes, having been a former NCAA tennis player.

Source:

Figure 1: https://physioworks.com.au/injuries-conditions-1/bursitis_shoulder

Have you ever wondered if you are running “correctly”? Is pain limiting your distance, time, or affecting your long term goals when you run? If so, it may be important to look at the different phases in your running cycle to help address these issues.

Contrary to popular belief, there is no one way to run correctly, but there may be one that is more efficient or safer for you based on factors such as age, previous injuries, and goals that you have set out for yourself. For example, if you suffer from hip pain when you run, or have osteoarthritis in your knee, it may be beneficial to look at your initial contact to toe-off (absorption phase) to help with load management of these joints. Performing a biomechanical assessment can help determine what changes in the running cycle, temporary or permanent, may be necessary to help manage these acute or chronic conditions in order to keep you moving without causing further harm.

Running can be broken down into stance phase, when the foot is on the ground, and swing phase, when the foot is in the air. Stride length is measured from initial contact of the foot, through the stance and swing phase, until initial contact of the same foot. Step length is the length between initial contact of the one foot to initial contact of the other foot. Cadence is the number of steps you take per minute. Understanding these terms is important to know when you are running, as modifying parts of the running cycle may help improve efficiency or reduce risk of injury. For example, by increasing a runner’s cadence, you can help decrease their stride and step length, which may be beneficial for runners who don’t have sufficient hip extension (see figure 1, take off and swing phase). This in turn can help prevent irritation to the hip joint.

Figure 1- Running cycle, stages are in relation to right foot

Because running is a complex movement that involves many different muscles in your body working in unison, often times it can be tricky to determine what is causing your pain when you run. At EQ Physio, we look at your technique through all stages to help tease out what part of the running cycle may need to be addressed.

If you experience pain while running, come in and see one of our health professionals here at EQ Physio to help get you back to running pain free and back on track to whatever you running goals may be.

Simon Janik is a registered Physiotherapist at EQ Physio. He has given multiple talks to running groups regarding biomechanics, injury prevention, and strength training in runners. He is an avid runner himself, having completed 10k’s and half-marathons. He is currently training for his first marathon in 2020.

Simon Janik, Registered Physiotherapist, is a graduate of Western University. He has taken post-graduate courses in manual therapy acupuncture and has a special interest in working with athletes, having been a former NCAA tennis player.

Source:

www.goodlifegr.com

With the U.S. Open Tennis Championships starting up this week, it's only fitting to discuss the importance of having good flexibility and mobility as a tennis player in order to play the game at an effective and injury-free level. Below I will discuss a few areas that you might want to focus on to help with your game as well as a few exercises to help increase your mobility.

If you are unsure whether these exercises are right for you, we would encourage you to come in for an assessment prior to trying these. One of our registered physiotherapists will perform an assessment and help diagnose any potential areas that you may need to work on. Our clinic is conveniently located at the corner of Dundas and Trafalgar in Oakville.

Simon Janik, Registered Physiotherapist, is a graduate of Western University. He has taken post-graduate courses in manual therapy acupuncture and has a special interest in working with athletes, having been a former NCAA tennis player.

Sources:

1. Hopman Cup, 2017: Roger Federer's Australian pleasure and pain

Acupuncture has been practised for centuries in China and surrounding countries for treatment and management of pain. Over the last few decades, there has been a growing amount of research conducted in Asia, North America and Europe in the area of dry needling and acupuncture which involves the use of thin filiform needles applied to various areas of the body.

In the case of chronic neck pain, nerve signals that were active during initial acute injury continue to send signals to the body that it is in pain long after the initial injury has healed - lasting anywhere from weeks to years. New research has suggested that it may be due to a malfunction in the way the brain maps sensory information. Not only can acupuncture modulate the signals to the brain through neuropathways, but it can improve blood circulation, reduce muscle tension and trigger points, decrease inflammation as well as increase body's own opioid production. Its ability to regulate sympathetic and parasympathetic nervous systems explains why acupuncture can also be effective for stress or anxiety related neck tension.

In a 2015 randomized control trial comparing 12 acupuncture sessions performed within 3-4 months plus usual care (prescribed medications and visits to GPs, physiotherapists and other healthcare professionals) vs. usual care alone for individuals with an average of 6 years of neck pain, found that the acupuncture group showed a significant reduction in pain and improved function at 12 months. It was also found that at 6 and 12 months, self efficacy was greater with the acupuncture plus usual care group compared to usual care alone.

Your therapist at EQ Physio can use acupuncture to treat your chronic neck pain. A detailed assessment carried out will determine if you are a good candidate for acupuncture. Typically, you will experience significant changes after the first two weeks (4 sessions) of acupuncture. This would follow with two more weeks of bi-weekly sessions and a gradual decrease in frequency with frequent re-evaluation of your condition.

If you are having problems with your neck, contact the clinic today so we can get you on a path to recovery as soon as possible. We're conveniently located at the corner of Dundas and Trafalgar in Oakville.

Juny Wu is a Registered Physiotherapist. She has an advanced certification in neuroanatomical acupuncture and is involved with teaching at a Neuro-meridian Acupuncture program. Juny has a passion for blending Eastern philosophy and techniques with Western evidence-based approaches in treatment and management of acute and chronic pain, drawing from various tools including manual therapy, acupuncture (body, scalp, auricular), cupping, laser, functional exercises and yoga therapy. She has experience in pre- and post-operative rehabilitation, and treating various conditions ranging from neuropathies (eg. sciatica, carpal tunnel syndrome, phantom limb pain, diabetic neuropathy, neuropathic pain, to musculoskeletal conditions (eg. acute sprains and strains, tendinopathies including but not limited to frozen shoulder, rotator cuff tendonitis, tennis elbow, neck and pain, trigger finger, plantar fasciitis, osteoarthritis).