Tuesday, May 24, 2011

Hands-on Physical Therapy and Stretching Prove Effective for Treating Heel Pain

The most common type of heel pain is plantar fasciitis. You may have this dysfunction if you have a sharp pain in your heel with your first few steps in the morning. The pain is usually worst when first standing up after sitting or resting and symptoms often decrease as you walk around. It is estimated that 2 million Americans acquire heel pain each year and that 10% of all people will have heel pain at one point of their life.(1) Luckily, for the masses of people who suffer from these symptoms, there is new research from the Journal of Orthopedic and Sports Physical Therapy that just came out in February of 2011.

What did the study show us?

The study took 60 participants with heel pain and split them into two groups. One group did a couple of calf and foot stretches while the other group performed the stretches but also had hands-on manual physical therapy. The manual therapy mainly consisted of hands on techniques to decrease the amount to trigger points or “knots” in the calf and foot. The researchers found better improvements in pain and function in those who were in the manual therapy and exercise group. This suggests that treatment from a licensed physical therapist along with self stretching is more beneficial that stretching alone when it comes to decreasing heel pain.

My Advice

If you have heel pain, a physical therapist can instruct you on the proper stretching techniques to perform. The physical therapist can also determine if you are a candidate for trigger point soft tissue techniques (like the ones used in this study) or other manual therapy procedures. For more information on the management of heel pain, contact your physical therapist at Hayashida and Associates Physical Therapy.

Reference: J Orthop Sports Phys Ther 2011;41(2):51. doi:10.2519/jospt.2011.0501

Tuesday, May 10, 2011

Exercise Machines That You May Want to Avoid

There is often a general idea that if you go to the gym and use all the equipment you will have a great workout and avoid injury.  This is comparable to going to the grocery store and expecting that anything you buy will be good for you and make you healthy.  The grocery store analogy may be a little far off.  We instinctively know 2 gallons of ice cream and a bag of potato chips is not a healthy choice and would not be nutritious to consume.  But I would argue that roasted unsalted peanuts would be a healthy choice, so everyone should eat them, right?  No, many people have allergies to certain foods.  The gym is the same way.  Many can get away with using whatever equipment in the gym that they would like but this general guide will allow you to make smarter decisions when it comes to your workouts.  Some pieces of equipment that I would avoid include:
            Seated Leg Extension – This machine does a good job at strengthening the quadriceps (the main muscle group on the front of the thigh).  But this machine places increased stress on the patella (knee cap) since it makes you push a large amount of weight when in a disadvantaged position (90 degrees of knee flexion).  To obtain good leg strength a better exercise would be doing one-legged body weight squats.
            Seated Lat Pull-Down – This will confuse many of my patients since I give this exercise to almost all of them who suffer from neck, back or upper body weakness.  The main aspect that is inappropriate with this machine is that in the gym it often forces you to pull the weight behind the neck which can cause neck and rotator cuff (shoulder) problems.  This exercise can be completed better with a machine that allows you to pull to your chest.  The best way to achieve strength in the upper back and biceps would be to perform body-weight pull ups, if able.
            Seated Hip Abductor Machine – Again, my patients are questioning me.  I give hip abductor exercises to many patients with back, hip, knee, and/or ankle pain.  This machine is supposed to strengthen the abductors (one of the gluteal muscles).  My problem is that it does this in a very non-functional position since you are seated.  It would be better to place a resistance band looped around your legs and do “lateral squat walks” (sidestepping about 15-20 ft in a partial squatted position).
           Squats with Smith Machine – This machine restricts your movement during a squat that is supposed to strengthen your legs and chest.  The problem is that the bar is attached to a track which alters normal movements of the body and leads to a linear movement. You body very rarely moves in linear movements. A safer alternative would be to do a weighted or body-weight squat without a rack.
      Roman Chair Back Extension – I see many people at the gym doing this exercise with big weights across their chest, all trying to get “strong backs”.  The movement of this exercise only places pressure on the spine and increases the risk of damage to the lumbar discs (the structures that are supposed to help with shock absorption for the spine).  Other options for this would be the “bird-dog” or “quadruped reach.”  Do this by being on all fours (hands and knees) and extend your right arm and left leg making sure your back does not shift or arch.  Repeat 10x on each side.

Once again I will jump on my soap box and explain that exercises, like drugs, should be prescribed.  Would you go to someone with 3 months of education for a prescription to a drug for your heart condition?  This is equivalent to going to a trainer in your local 24 hour fitness and asking them what exercises you should do.  See a physical therapist for exercises that are safe for YOU and tailored to what your body needs.