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

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:

1.     

            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.

2.     

            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.

3.     

            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).

4.      

           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.

5.        

      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.

Posture and Sitting Series Article IV: Ergonomically Optimize Your Workspace

In this article I hope to give you as much information as I can to help you set up your desk, whether it is at your home or office.  As mentioned before your posture is a result of how you treated your body over the last 20, 30, or 40 years of your life.  If you are like 80% of Americans, you sit 80% of the day whether it is for work or for surfing the internet; if you do this sitting activity incorrectly you will create postural deficits ultimately leading to pain.  Let’s break down your desk space and see if we can make some changes.

                 Mouse and Keyboard:

Most people will take their mouse and keyboard and place it on the desk and think that is where it should be.  Also, people like things to be centered and clean (most of the time) and this will make people place the keyboard right in the middle of the desk lined up with the monitor.  In reality you should place your keyboard so the alphanumeric part is in the center; do not worry about the added number pad and arrow keys that are often to the right of the keyboard.  The “B” key should be right in front of you when you are sitting at the desk.   The mouse should be as close to your keyboard as comfortably possible.  This will limit the amount you need to reach for your mouse.  If you have a keyboard tray make sure the mouse is on the tray alongside the keyboard.  The ultimate goal is to have your elbows bent at about 90 degrees when you are using your mouse and keyboard.  This will decrease the amount of bend you will have to have in your wrist, decreasing overuse injures such as carpel tunnel syndrome. 

                Monitor:

It would be best if all of our monitors were adjustable or not attached to our keyboard in the case of the laptop.  If your monitor is not adjustable you will need to get creative with books, monitor stands, or wedges to have your monitor in the correct position.  There are many do-it-yourself (DIY) websites out there that have information on how you can accomplish this.  Your first goal is to have the monitor at an arm’s length away from you.  Secondly it is optimal to have your eye level to be about 2 inches below the top of the monitor.  Even though this article is about ergonomics it would be smart to follow the advice of an ophthalmologist and look at an object far away from your monitor each 30-60 minutes to help “rest your eyes.”

                Desk Height:

I can sit here and explain how each element of your desk should be set up but by the time I was done I would surely have a 20 page informational packet.  Measurements of correct height of objects on your desk can easily be found with this informational website.  Just enter your desk set-up (sitting or standing) and your height and the website automatically calculates desk height for you.  It even gives you information on your chair positioning.  Other chair information is to follow…

               Your Chair:

You chair should have a pair of sturdy arm rests.  Arm rest height is crucial so that you keep the correct length-tension relationships of your neck and shoulder muscles.  The height of your arm rests should be at a height where your shoulders can be relaxed and your elbows bent at about 90 degrees.  When looking at back rests on your chair you should have it forward enough so that you are not “slouching back” and it gives you support to sit up straight.  The back rest should have some sort of lumbar support built in and if this is not the case, a relatively cheap low back support can be purchased online or at many local stores.  Your low back should have a slight curve forward and this support helps you keep this position.  “Do-it-yourself” (DIY) options are available.  You can always roll up a towel and place it on your back rest to help support your lower spine.  A semi-soft breathable cushion on your chair will make you feel more comfortable while sitting at your desk.  If a cushion is too soft it can make your pelvis sit in an incorrect position which can put extra stress on your low back.  When adjusting your seat height you should aim for a position where your thighs are parallel with the ground while your feet are flat on the floor.  As you can see there are many different configurations and options for your chair.  It is always best to have a physical therapist or certified ergonomist take a look at your setup.  The information here is only a general guideline to your workstation. 

     General Rule:

You could have the best, most expensive, perfect set up and still fail when it comes to sitting correctly at work.  The most important piece to the puzzle is your brain.  It is imperative that you recognize how you are sitting at your desk and constantly fine tune your posture.  The human body is an amazing “cheater”.  Your body will find a way to slouch at your desk no matter what kind of equipment you have.   Set an alarm on your watch, computer, or calendar to remind you to think of your posture every 20 minutes so that you can correct any problem areas that may have arose when you were busy typing an email or talking on the phone.  It is also a good idea to get up every 40 minutes and take a short walk.  Patients always tell me “I can’t just get up and walk around; my boss would fire me.”  I can understand this.  At the very least you should stand up every 40 minutes to “re-set” your body.

As you can see there are many factors to think about as you begin to change your desk setup.

If any major problems arise or you need professional help with your set-up be sure to see your local physical therapist for the proper set up or treatments if necessary.

Reference: http://lifehacker.com/#!5755870/how-to-ergonomically-optimize-your-workspace

Posture and Sitting Series: Article III – How to Correct Your Posture

As we have been talking about your posture we can see how prolonged sitting especially with poor posture can lead to aches and pains in your legs, back, shoulders, and neck.  It can be hard to change these seated and standing postures; the way you sit or stand today is a product of years of incorrect muscle use.  The key is to be in positions that decrease the strain put on your body.  "Good posture involves training your body to stand, walk, sit and lie in positions where the least strain is placed on supporting muscles and ligaments during movement or weight-bearing activities."¹  Lets look into a couple ways we can do this.

The first key is to understand what needs to be changed.  This is hard to do.  It is difficult to see your posture and to be able to understand how it may be leading to your aches and pains.  The best way to understand changes would be to see a physical therapist for a biomechanical screen and receive a prescribed treatment plan.  Others may be able to have their friends or family observe their static or dynamic posture. 

I will break down my advice by first looking into standing posture and then educate you on sitting posture.

STANDING POSTURE

While standing your shoulders should be slightly back.  Many people have the tendency to lean forward.  While standing place your hands in your front pockets. Feel how your shoulders start to gravitate forward; this position will lead to strain on the shoulders, neck and chest.  We should also have our feet at about shoulder width apart.

SITTING POSTURE

While sitting we need to make sure that we have support to our low back (commonly referred to the "small of your back").   When your low back is in the correct position the rest of your spine will line up correctly.  Secondly make sure that you don't begin to gravitate towards your computer screen, this will place increased stress on your shoulders, upper back, and neck.  Make sure to keep your eye level even with the top of your monitor. 

As mentioned before seeing your physical therapist is the optimal way to make changes to your faulty posture.  Your physical therapist can use passive techniques to correct your posture including the use of McConnell® or Kinesio® Taping techniques.  An extensive and personalized exercise program can be prescribed to help with your postural problems.  Along with this, your physical therapist can apply manual techniques to loosen your stiff joints, stretch your tight muscles while strengthening your weak ones.  Many people think this would be the job of a Chiropractor, but many chiropractors do not address the muscles and will not give out preventative exercises, so their patients will need constant care to feel better.

1. http://lifehacker.com/#!5732064/how-can-i-improve-my-posture

Posture and Sitting Series: Article II – Sitting Too Much May Kill You

Posture and Sitting Series: Article II – Sitting Too Much May Kill You

As we have pointed out many times in this blogs history, it is important to meet certain requirements in order to be considered an active adult.  We can recognize that if a person is to work out for 45-60 minutes each day they receive many health benefits including but not limited to controlling weight, decreasing blood pressure, and relieving physical and mental stress. But the question that remains is "What are you doing the other 14-16 hours of the day?"

In the past we used to judge ones fitness level strictly based on the amount that they worked out.  "In simple terms, if you were exercising for 60+ minutes/day, you were considered physically active. If you were exercising 10 minutes/day, you were sedentary."¹  And by association those who were physically active where healthy and those who were sedentary sat too much throughout the day which made them unhealthy.  But in the true meaning, sedentary means any time that you are sitting.  So that person that is working out 60+ minutes/day may be sedentary if he or she is sitting for the other 16 hours of the day.  "Thus, to quote researcher Marc Hamilton, sitting too much is not the same as exercising too little."¹  This is a very important statement.

Multiple studies have shown that sitting too much, disregarding the amount of physical activity one gets can kill you.  A study by Katzmarzyk et al. (2009) showed that those patients with common illnesses who sat the most throughout their day were 50% more likely to die upon follow-up even when controlling for many factors such as smoking, age, and physical activity levels.  Another study by Genevieve Healy et al. (2008) found that "The greater the number of breaks taken from sedentary behavior, the lower the waist circumference, body mass index, as well as blood lipids and glucose tolerance."¹

 

Many more studies on this subject can be found at Scientific American.

Now just sit there for a second (no pun intended) and think about your daily activities.  Let me guess, you sit most of the day.  You are not alone, western society sits most of the day, it's how our lives are formed.  We sit at work, sit in our car, sit to read and write emails, and I bet your are sitting right now to read a blog on how sitting too much can kill you.  So for now, get up and move around.  You life depends on it.

1. http://www.scientificamerican.com/blog/post.cfm?id=can-sitting-too-much-kill-you-2011-01-06