Entries by Tobias Hall

Are Custom Insoles Actually Worth The Money?

Are Custom Insoles Actually Worth The Money?

Intro

As you read this, there are literally millions of people going about their day with custom orthotics in their shoes. There are of course also millions of people wearing generic insoles in their shoes who paid a fraction of the amount. Without doubt there will be people in both camps experiencing great benefits. The majority of these people will have found themselves wearing orthotics or insoles because of some pain or complaint they developed at a certain point in time. The reasons people wear insoles and orthotics include everything from plantar fasciitis and knee pain through to back pain, ankle pain and hip pain.

It is very hard to say with absolute certainty who has less pain and greater benefit as a result.

Research.. What Research?

The question of ‘how much benefit’ when it comes to custom made orthotics is not always as easy to answer as you might think. This is because custom made orthotics are designed to reduce the strain of concrete and paving on your joints and soft tissues over long periods of time. It could be compared to attempting a study on the long term benefits of drinking 3 extra glasses of water a day across the full spectrum of health issues we face long term, not easy research to do because of all the other variables in each persons life.

 In order to study this comparisons between insoles and custom orthotics scientifically in a way that a firm conclusion could be drawn, you would need a lot of expertise, a lot of money and a lot of time. Then once you had results you would need to convince someone else to find at least the same resources and put them into verifying your results by repeating the study. That’s how the data game is, and sadly no one has done this kind of research at this kind of level for you… as yet. 

The simple but inconvenient truth is that it is not easy to quantify the difference in ‘tissue stress’ between one device for flat feet and another, especially over long periods of time, this is not an easy thing to measure. 

So rather than pretend that we have any comprehensive and reliable data to cover all the possibilities within this complex issue…  I am simply going to offer the thoughts and reflections I have developed over a lot of years of experience. 

Some Personal Observations

It has certainly been my experience that those who have a high quality custom made orthotics tend overwhelmingly to get better long term pain outcomes than those wearing generic insoles for flat feet. My observations over a couple of decades are not the same as offering scientific proof.. but they do count for something. 

The classic patient who typifies this pattern is the person who turns up in my office nearly on a daily basis wearing some generic insoles that they usually purchased in a shop or pharmacy. The conversation nearly always goes the same way word for word. I express that I assume they have helped and the patient responds with words to the effect of  ‘yes I think they have helped a bit‘ or ‘I think they might have helped‘. The general vibe is positive but one of very marginal improvements. These exact same patients at some later stage will usually express far more emphatically how great and how different their custom orthotics have made them feel, along with decisive reports of significant pain reduction.

Another near daily observation is a kind of ‘aha moment’ when people who have had insoles first put they’re custom orthotics in. It is a moment not unlike the one where the prescription sunglasses go on and things come into focus for the first time in a long time.

If these observations (and countless others like them I left out to prevent this becoming a somewhat cumbersome post) had been occasional happenings they might not count for much. The fact is they are very predictable and steady observations made on the majority of relevant cases over a long period.

All this being said  you can get lucky with the right generic insole. If a generic insole for flat feet is stiff enough and happens to have the correct amount of arch height for you it could in some instances be about as beneficial to you as custom made orthotics for flat feet. These cases are generally the milder instances of pain and misalignment.

are custom orthotics worth the money

Custom orthotics.. are they a waste of your hard earned cash??

The Worlds Greatest Bargain

It is my belief that the greatest bargain product in all of creation is the fire alarm. Bear with me here I do have a point to make…

Consider for a moment the fact that my friend Dave once spent $12 on a small plastic device containing some simple circuitry called a fire alarm. A year after Dave invested his $12, that device woke him to a house filling with smoke at 2am. His $12 investment saved his life, the lives of his wife and 3 children, his dogs life and his goldfish’s life. It also saved 3/4 of his worldly belongings from being burned and made the difference between the home he built needing repair or being burnt to the ground. I challenge you to think of a better value proposition per dollar spent on an item than that fire alarm. 

At the other end of the value spectrum Dave could so easily have passed on the expense of the fire alarm, and spent that $12 on 2-3 bad extracted cups of coffee in any number of cafes within walking distance from his lovely home. I believe bad coffee is one of life worst value propositions.

Now I am certainly not going to claim that custom made orthotics can compete with the value proposition of the fire alarm.. because virtually nothing can.  But I am going to say that in my experience, custom orthotics for people with significant knee pain, ankle pain, hip pain and even back pain are often way closer to the fire alarm end of the value spectrum than you might think. Like i said, I have developed this perspective slowly and cautiously over many years, observing changes in people under different conditions and with different interventions.

The significance of the fire alarm analogy is that there are few times in life where a single purchase that could be afforded by almost anyone can have long lasting meaningful positive repercussions at the foundational levels of a persons wellbeing. It has been my observation that custom orthotics are often one such purchase. They still can’t hold a candle to that fire alarm though .. not without it going off and trying to save the word for $12 again :)

One Undeniable Value Of Custom Orthotics – Wearability

One value aspect of custom orthotics that is pretty hard to debate is their wearability. The most useful orthotic or insole for flat feet is the one you are actually wearing. If I had the choice of giving you a decent insole that I knew you would wear almost 100% of the time vs giving you fancy custom made orthotics that you were only going to wear half the time I would take the generic insoles every time. This is because when it comes to orthotics consistency is king. Consistency generally becomes a lot easier for most people when they make the shift to modern custom orthotics, this is because they are designed to fit neatly in your shoes and provide support without taking up too much space.

the real value of custom orthotics

The ability to wear them in any shoe is a major benefit to custom orthotics.

Closing Thoughts

Cost is really only ever assessable relative to comparable spending activities and to tangible value added to a life. Custom made orthotics generally cost less than many minor dental procedures. So for about the price of 1 hours root canal work you now have a device in your shoe that reduces strain in your joints. A device that often lasts well in excess of 5 years and serves your feet for 10’s of millions of steps.

modern custom orthotics

Modern custom orthotics – fancy as!

The bottom line in this topic is really a question of what your gut tells you, once you have undertaken an investigation into what you can do for your pain. Remembering there could be a lot at stake of course.

Your investigation may need to include going to the trouble of reading further or even talking to others about their experiences with custom made orthotics or cheaper insoles for their flat feet.  One such investigation I would urge you to undertake is the act of pressing down on the arch of any given generic insole you are considering with the tip of your finger. As you do so ask yourself if it is going to support your entire body weight pushing down through your arch 10,000 times per day. Whatever orthotic or insole you end up wearing it should be capable of preventing your arch from collapsing. If you can squash it with your finger I would suggest it isn’t going to support your body weight. 

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Is Your Pain A Failure Of Our Species To Adapt To Hard Surfaces?

Is Your Pain A Failure Of Our Species To Adapt To Hard Surfaces?

Intro 

The progress of the ‘human world’ is often leads to changes that are way way faster than what our biology can keep pace with. It is fairly obvious that we have not had time to adapt to the modern western diet (if that’s even possible).

A tragic example is how difficult it has been for many indigenous groups to adapt to the ferocious pace of change our species sets for itself. Especially changes in diet   https://www.mja.com.au/journal/2007/186/1/nutrition-related-disorders-indigenous-australians-how-things-have-changed  As Europeans blazed across the globe, the changes that they imposed on the diet, disease profile and environment alone made for near extinction level events among some indigenous populations. This is a stark reminder of how our species can affect change that is hard for our biology to keep up with. 

For us, the evolution of our physical bodies happens at a snails pace, not only compared to ‘human progress’ but also relative to many of the life forms on the planet. Did you know for example that 15 generations of certain gut bacteria live and die their whole lives while you are asleep at night? That means that in their tiny world the equivalent of 2000 years of human evolution go by in a night. 

For gut bacteria a 100 years is tens of millions of generations and a great deal of evolutionary adaptation. For us humans they live inside of, 100 years is less than 2 generations, and the blink of an eye in evolutionary terms. 

150 years (a mere 2 generations) is about how long our bodies have had to try and adapt to living and walking on hard flat surfaces. By hard flat surfaces I mean the concrete, paving and tarmac that we live on in our homes, towns and cities After 20 years of treating pain and obsessively trying to understand its underlying causes I have come to believe that this is a major cause of back pain, hip pain, knee pain, ankle pain, ankle sprains and plantar fasciitis. I have come so far down this path that I believe hard flat surfaces like concrete and paving are as significant to joint pain, muscle pain and connective tissue pain as sugar is to dental decay. This is more than likely not something that you have considered so I will try and bring it to life with a quick visualisation for you.

Imagine you are stood on a seawall looking down at 2 metre drop onto soft sand, now imagine jumping down and with straight legs let your heels sink into the sand as you land. Now picture standing on a 2m wall somewhere near your house, jump down in your minds eye and again with straight legs let your heel contact the pavement first. If you are in possession of an imagination you should be able to get a sense of the fact that the second experiment was probably not a good idea. This is a small window into a world of massive life long microtrauma that is inflicted on your skeleton during a lifetime spent on very hard flat terrain. 

There are 2 key problems the natural terrain we lived on for millions of years when it is compared to the brand new urban terrain we now live on. 

Hardness 

When the human heel strikes hard ground the strain that occurs in the joints and soft tissues is many times greater than on soft ground. It is part of why running on pavement feels so different to running on grass or sand. On natural surfaces energy is absorbed whereas on concrete energy is deflected back into the tissues of the body. 

paving - is this the primary cause of back pain, hip pain , knee pain and plantar fasciitis

paving slabs are extremely hard and offer no natural support to human feet.

To be understood, this additional stress that occurs in a single heel strike on paving must be multiplied over millions of steps, in every year lived in the urban environment. The spread of pedometers and apple watches has shown us just how many steps we actually take, even the most sedentary of us sit around 10 thousand heel strikes per day. This is a supreme recipe for repetitive strain. 

Tissues that generate stubborn pain are tissues that are suffering from persistent strain. Knee pain, hip pain, ankle pain, foot pain and plantar fasciitis are to a large extent repetitive strain injuries inflicted by the unnatural hardness of our urban terrain. 

Flatness 

Take a moment to reflect about what the ground is like when you are in the big outdoors. When you are ‘off trail’ whether it be in forest, on grasslands, on beaches, in mountainous regions the ground is almost never dead flat. Even when there are no obstacles in the form of rocks, fallen limbs and vegetation it is almost never dead flat.. almost never. Salt flats, certain beaches and a percentage of dry river beds are flat but apart from the Mother Nature is constantly curvaceous. 

is this the reason for back pain and knee pain?

the flatness of modern urban surfaces leads to weakness in our knees, hips and backs.

If you live on a constantly shifting and changing terrain full of natural obstacle the amount of muscle activity in your hips, core and legs is many many times what it is if you just cruise around town. Mother Nature gave your ancestors a workout like no other, we are adapted to rely on that constant stimulation to maintain muscle mass in our hips and lower back. The legacy of all this flatness is muscle wasting in the lower half of our bodies. The reason that this is great significance is that it is the strength of healthy muscles that prevent pain and injury in our joints and connective tissues.

The AstroTurf Example 

One relatively niche example of a hard man made surface that is newer than most is AstroTurf. Within a very short space of time AstroTurf become globally notorious as a cause of sports injuries. Groups of professional soccer players have even filed a lawsuit for the right to play on natural grass in the 2015 Women’s World Cup.

astroturf has long been associated with knee pain and knee injuries

astroturf.. a recipe for pain and injuries?

This 2014 survey.  https://www.ncbi.nlm.nih.gov/m/pubmed/24581229/ of US Major League Soccer over 95% of the respondents said they had greater muscle and joint soreness playing on artificial pitches. 90% said it took them longer to recover; and 89% said they were more likely to get chronic injuries from playing on artificial turf as opposed to grass.

Fortunately for my theory there is sufficient interest and financial incentive for this area to be researched fairly extensively. The research data definitely makes for interesting reading, for those of us with an appetite for such dry biscuits. There is evidence that early hard styles of AstroTurf were a greater risk factor for injury, and that risks may have reduced as technology improved, with the addition of tiny rubber pellets. There is also evidence that certain kinds of sports injuries do happen way more often on modern artificial turf.

Some studies like this one  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5544152/ have suggested that the transition from in-rubberised AstroTurf styles to those infused with rubber lead to a decrease in injuries of the knee and ankle. 

Papers like this one   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590909/ which looked at numerous other studies, have  shown variable injury risks related to AstroTurf which they note may be explained by the evolution towards rubberised turf designs over time. 

One very large study found  https://journals.sagepub.com/doi/abs/10.1177/0363546519833925 that there is a significantly increased risk of knee injuries on AstroTurf. Interestingly it was more discerning than some other papers as it isolated the exact kind of knee injuries that AstroTurf pre-disposes.

There are many other strands to the research, and as is always the case with such complex issues (with so many variables) it is not 100 percent conclusive as to whether AstroTurf is as bad as so many athletes and coaches have claimed. Regardless of the details,  I feel there is enough noise here for us to confidently make a ‘no smoke without fire’ call on this topic.

Within all this furore over astroturf I may have my only semi-measurable piece of evidence for my theory on hard surfaces. There wasn’t anyone gathering data on the frequency of ankle sprains among the generally public in Victorian England during the transitions from cobble stones to paving after all. In my view the AstroTurf example may form a solid piece of circumstantial evidence at least. We are only talking about a very small number of people spending a very small amount of time on these surfaces to have caused a fair amount of uproar. 

In many ways it may be every bit as relevant that athletes report more aches and pains on AstroTurf as it is that they have a greater number of confirmed posterior cruciate tears on that surface. This is because in theory we are talking about ‘repetetive strain’ when we discuss the link between concrete and knee pain, hip pain, back pain, ankle pain and plantar fasciitis. Repetitive strain does not show up in our bodies as massive tears so often as it does aches and pains. The increase in pain reported by athletes on AstroTurf to my mind is a very clear suggestion of increased strain on their tissues regardless of what the incidence of cruciate ligament sprains is. 

A Pain Epidemic 

It is debatable of course whether my theory about hard surfaces being a major contributor to knee pain, ankle pain, plantar fasciitis, foot pain, hip pain etc. is correct. One thing that is for sure though is that we live in the middle of an epidemic of lower body pain. The statistics for lower back pain, foot pain, plantar fasciitis, knee pain, hip pain, ankle pain and hip pain in or culture boggle the mind. And all this in an age of extremely sophisticated health technology. 

we live in an age of knee pain, back pain and foot pain

knee pain.. common as concrete!

We also live in a time where osteoarthritis affects virtually everybody, it’s just a matter of at what age  and where (sorry if that’s a shock). It’s my belief that this epidemic of back pain, hip pain, knee pain, ankle pain and foot pain earlier in life is part of a species wide early warning system which heralds the undeniable epidemic of osteoarthritis we suffer later in life. If we look at where all this wear and tear occurs we can see it is all too often in the weight bearing joints of the body. If you know someone who has had a joint replacement or fusion it will most likely be their knee, hip or ankle. 

It is totally up for debate whether a meaningful amount of this pain and wear & tear is caused by our failure to adapt to life on hard surfaces. The elephant in the room is that we know people had osteoarthritis and pain before we invented paving stones, the question is where and how much. It would be crazy to make it out that this is a simple topic. Diet, genetics, occupation, injuries, activity levels and stress all afterall have a major part to play in the genesis of pain and injury… and presumably always have done.

The Nature Of Wear & Tear 

To highlight my personal take on how all this may fit together I want to talk you through a small thought experiment on the subject of hip pain, knee pain osteoarthritis and wear and tear.

osteoarthritis come to us all in the end

wear and tear..complex.. but a normal part of life

I have a friend.. let’s call him Gary.. because that is his name. Gary has always been an extremely active bloke, hunting as a hobby, forestry work for an income. During his thirties Gary has some brief but unpleasant episodes of hip pain and sciatica, his sciatica wasn’t disc related, it was caused by muscle spasm in the back of his hip. All his scans and x rays were clear. 

In his late 40’s Gary found that if he began to get consistent right sided hip pain and knee pain after longer walks. Hunting days that he used to take literally in his stride had begun to leave him with a deep ache in the back of his right hip that lasted several days on each occasion. It gradually go to the point where he would take painkillers at the end of a days walk in anticipation of the pain that was to come. He also began to get more frequent stiffness in his lower back on the right side. 

To cut a pretty long and miserable story short let’s fast forward to Gary’s 65th birthday. By this point he had reached a level of disability and frustration that men like Gary always struggle with psychologically as well as physically. He was still hunting occasionally, over short distances and never to any of his favourite spots which were all too long of a walk for him. Every time he did hunt he suffered terribly for days and sometime weeks afterwards. Gary has also developed a consistent limp which was the thing that’s affected him the most because along with the pain it made him permanently feel like he was 85. He felt self conscious about moving like he was old and crippled when he still felt like he was pretty young at heart. By Gary’s 65th birthday he had already had the osteoarthritis in his right hip and knee confirmed on x rays and was waiting for a joint replacement surgery on the hip. 

So here is the thing…. like the vast majority of people in Gary’s situation his left hip and left knee had no arthritic change whatsoever and had not caused him a single day of pain in his whole life. 

Now let’s be super clear headed about this pain free hip of Gary’s for a moment. For 65 years his pain free hip had exactly the same DNA, the same job, the same hobbies, the same mileage, the same diet, the same environment and the same mattress. And yet his left hip showed no signs of osteoarthritis, while his right hip by age 65 has been hurting for 35 years and was completely worn out. How can we explain this? 

The only possible factor I know of that could determine the wearing out of right hip like Gary’s is mechanical strain…. either through injury or through persistent repetitive strain. Given that Gary has never injured that painful right hip we are left with the repetetive strain explanation. 

Gary’s right hip had worn out very very slowly and uncomfortable over 4 decades while his left hip remained fine. It seemed like a mystery until he was exposed to computerised gait analysis which revealed a severely fallen arch on the right side. For all those years his right arch had been collapsing with every step and without him knowing, and over millions of steps it had caused not only pain but catastrophic damage to the knee and hip joint. 

Now if we go back to the environmental factors that are the main order of business in this article.  It is abundantly clear that despite spending most of its life on hard ground that Gary’s left hip had not worn out. And this is to remind us that these things are never simple. 

You can eat a huge amount of sugar over a long period of time and find many of your teeth will still  be spared from decay. Similarly, you can stomp around on concrete and paving for a lifetime and many of your joints will be spared. Bodies and their interactions with environmental stress are complex. The fact remains (my view) in both instances that the sugar and concrete were both hugely significant factors in what occurred. In Gary’s case it was the long standing weakness and misalignment in his right leg that lead the joints to wear out, while the left was in a good state of alignment and was spared. If Gary had known what custom orthotics and rehabilitation exercise could have done for his weak side it would not have happened. This was the equivalent of him having poor dental hygiene against a background of sugar consumption.  

Closing Thoughts  

So the theory is that hard flat surfaces are as stressful to our joints and soft tissues and sugar is to teeth. And, if it is combined with weakness or misalignment in the body it can easily lead to back pain, hip pain, knee pain, knee injuries ankle pain, ankle injuries, plantar fasciitis, foot pain and even osteoarthritis. 

Perhaps surprisingly, the Gary case (and the untold millions like it) act as good news stories for those of us who are willing to work on acting preventatively on strength and alignment to avoid back pain, hip pain; knee pain, ankle pain, foot pain, plantar fasciitis and possible even osteoarthritis. This is because there are things we can do to sustain and nurture alignment and strength .. as there are things we can do to successfully mitigate the damage of sugar in our diets. Afterall we eat more sugar now than we ever have and yet we have less tooth decay than ever. 

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What Causes Plantar Fasciitis & What Does Treatment Look Like?

What Causes Plantar Fasciitis & What Does Treatment Look Like?

Achilles Tendonopathy

Approximately 2 million people in the United States alone suffer from plantar fasciitis pain at any given time, many of whom will need plantar fasciitis treatment. Plantar fasciitis is one of the most prolific types of foot pain. About 83 percent of active adults, ages 25 to 65, will experience plantar pain at some point during their lifetime. The more active we are on hard surfaces, and the more vigorous those movements are the more likely we are to develop plantar fasciitis that needs treatment. 

 With this many people suffering, and many badly enough that they seek plantar fasciitis treatment it is worth asking ‘why do so many of us end up needing help?’. The answers to this question may  reveal the underlying reasons behind all this plantar fasciitis.  And the answers are to a large degree are environmental. SO what is it about our environment that causes all this plantar fasciitis leading to a need for plantar fasciitis treatment ? 

For a seriously long time your ancestors walked mostly on soft, uneven ground. Winding the clock back a few million generations, all of your direct ancestors (going right back to little furry 4 legged individuals who rarely sought plantar fasciitis treatment) essentially walked on soft uneven ground. 

 Soft uneven surfaces act very differently on the bodies tissues when compared with the hard flat surfaces we walk on today. 

Walking On The Beach & Your Plantar Fascia 

 Imagine a normal walk on the beach in bare feet. 

During a step, as your heel strikes the ground there is a significant amount of shock absorption, the sole of the foot is not compressed particularly hard and the outer (lateral) portion of your heel digs deeper into the sand than the inner (medial) portion. Very different to the heel hitting concrete in almost every way. 

As your full body weight transfers to the middle section of your foot sand pushes up under your arch providing arch support. This doesn’t happen on concrete or paving when you walk on them. 

As your weight bears down there is further dissipation of energy that is much greater than if you were walking on concrete. This is because you continueto  squish into sand. Imagine the difference between your skull hitting an airbag vs hitting a dashboard… but in the foot. 

Finally as you propel yourself forward with your forefoot, the outer portion once again digs a little deeper into the sand and the compression is quite mild due to the pliable surface. 

The hard, jarring stress, the compression and absence of contoured support that lead to you needing plantar fasciitis treatment are simply not present when you are walking on the beach. There is a fraction of the strain in the plantar fascia on the one hand, and stimulation of foot muscles on the other hand. 

Walking In Forest & Your Plantar Fascia 

 Imagine a walk through a forested area in bare feet as your ancestors often did.

Firstly, you probably place your feet a lot more carefully than you do if you are briskly walking down and paved urban street, thinking about making it to a meeting on time. 

When your foot does come down many of the aspects are identical to walking on sand. There will be a mixture of soil and variably decaying vegetable matter that your foot sinks into, providing significant structural support to your arch. If you walked here all day it would be very hard to develop plantar fasciitis.

plantar fasciitis free

This is about as far from walking on a street as you could be, not only is there a great deal of shock absorption, the muscles of the foot have to work quite hard. Having strong foot muscles is one of the ways in which you prevent the occurrence of plantar fasciitis that gets bad enough to need treatment.  

In the forest there is constantly changing terrain which includes different inclines and the occasional fallen limb. Safely navigating all this, requires huge amounts of muscle activity, not only your foot but also your knees and hips. You will also have a great deal of stretch going on in the foot which keeps it flexible. 

 The overall influence of walking through a forest like this on your plantar fascia is like a really great workout for the foot; with lots of firm but fair stretching and strengthening, and minimal opportunity for overloading. A perfect recipe for the prevention of having to spend all ones pocket money on treatment for plantar fasciitis.

Walking On A Street And Your Plantar Fascia 

Now imagine briskly walking along in a paved urban area in corporate footwear or fashion trainers. Perhaps your are rushing to make an appointment and possibly even texting ahead to inform someone you may be a few minutes late. 

As your heel comes down there is no give in the ground so your plantar fascia is sandwiched hard between your calcaneus (heel bone) and the firm sole of your shoe. 

The lack of squish in the ground means that your heel cannot dig deeper on its outer ‘lateral’ side which tilts the foot inwards begging the arch to collapse. To prevent this collapse your gluteal muscles have contract much harder than they would in this moment on softer ground.

cause of need for plantar fasciitis treatment

ouch!

As your mid foot arrives at ground level there is no flexibility in the surface, so no significant arch support forms like it did on the beach or in the forest further begging the arch to collapse. Even high arches drop under these conditions. 

As you propel yourself forward with your forefoot there is still no ‘give’ in the ground so your plantar fascia is compressed severely once again as your body weight shifts forward. 

You are probably moving way quicker than you did when you were on the beach or in the forest because it’s so easy without changing terrain, this means the ground forces in the plantar fascia  are further magnified. This kind of stress is many many times the natural amount and forms a perfect trigger for plantar fasciitis in itself.

The hardness and flatness of the ground means there is also not much need to balance or much stimulation of the leg and foot muscles, and they don’t get much of a workout which makes the system lazy. 

Now repeat this cycle 12 thousand times per day.  Is it any wonder that treatment for plantar fasciitis becomes a topic for so many of us at one time or another ??? 

Plantar Fasciitis In The Modern World

Even if some of the details of what I have described above were hard to picture for you; I hope you at least got a general sense of what hard modern surfaces inflict on your plantar fascia, and on the likelihood of you needing treatment for plantar fasciitis. 

 There is a huge increase in stress in your poor feet if you live in an urban environment, on top of that they tend to become weak in these environments which renders them somewhat defenceless against the likes of concrete. 

 In a sense we could say that overwhelmingly it is sugar that leads to us needing treatment for dental pain. In the same spirit we can say that it is hard flat industrially manufactured surfaces that lead us to needing treatment for plantar fasciitis. Hopefully though, we make these statements with keen awareness that regardless of our diet and our environment there is MUCH that we can do to care for ourselves. We eat more sugar than ever now, and yet we have a fraction of the tooth decay we did 300 years ago after all !!! 

 

 The Steps To Effective Plantar Fasciitis Treatment? 

 

Plantar Fasciitis Pain Treatment – Step 1. 

 Purchase some large machinery, systematically remove all concrete, tarmac, paving, tiles, hardwood floors and stone flooring from the planets cities that you intend to spend time in during your life (jokes). 

 

Plantar Fasciitis Pain Treatment – Real Step 1. 

Hire a professional to remove all scar tissue and from plantar fascia and promote blood flow using hands on treatment methods. 

Some combination of acupuncture/acupressure/scraping/percussion/ stretching is likely to work for you. The key is having a practitioner who is willing to throw the kitchen sink at your problem, this is because scar tissue can be stubborn stuff.

 

Plantar Fasciitis Pain Treatment – Real Step 2 

 Gain deeper insight into your foot biomechanics to better understand what movement patterns triggered the scar tissue to form where it did in the first place, and further guide plantar fasciitis treatment options. 

 Further investigation into foot biomechanics can be done in person using computerised Gait Analysis or remotely using photographs and impressions taken in a foam box and posted to a practitioner. 

 

Plantar Fasciitis Pain Treatment – Real Step 3 

 Correct and ease  your foot mechanics with a combination of exercises to specifically strengthen weak muscle groups,  and custom orthotics to provide natural arch support that mimics natural surfaces. 

 By way of example, one of the classic patterns I often see in my clinic, that leads to the need for plantar fasciitis treatment pain, is the combination of high arches and glutes that aren’t firing effectively. This combination is bad for the plantar fascia. 

In this instance we prescribe ultra-specific glute strengthening exercises and custom orthotics to fit the arch. In this way we are able to effect long term change in the exact cocktail of biomechanics issues that left the foot open to repetitive strain in the first place. There are many other such examples of plantar fasciitis treatment that are customizable to the individual. 

Closing Thoughts 

The world we have created for ourselves is pretty great. We don’t have to worry about getting wet too often, let alone grizzly bears attacking us and honey badgers eating all our rhubarb. And yet the modern world is as imperfect as anything else in life. It has made us frail and soft compared to what nature intended for us, and it has also beaten the hell out of our feet, knees, hips and spines with its hard ground. Plantar fasciitis is just one of the issues that arises from this issue. 

successful plantar fasciitis treatment

no plantar fasciitis and no grizzlies.. cause for a high 5

Regardless of what life is going to throw at your plantar fascia there is plenty of scope for healing. We don’t all get plantar fasciitis after all. Resolving the pain and scar tissue that has built up in your foot, and then addressing the underlying biomechanical causes you can take control of your pain and find lasting relief. This is a comprehensive strategy for plantar fasciitis treatment

 So now you know why so many of us need plantar fasciitis pain treatment and you also know what comprehensive and effective plantar fasciitis treatment looks like. 

 Neat & Tidy ! 

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Knee Pain

How Do You Cure Knee Pain?

The good thing about looking for a cure for your knee pain is that it means you have developed the right mindset around resolving your pain. The bad thing about looking for a cure is that the whole concept of a ‘cure for knee pain’ runs the risk of severely oversimplifying the issue.

People often ask me if there is a way to cure knee pain. In response I usually ask them .. ‘is there a cure for dental problems?’. There is a reason I am a bit evasive like that. The whole concept of a cure for conditions like knee pain and dental pain is a bit wonky. But don’t worry, because it doesn’t mean that you can’t find the kind of relief you are looking for.

A Cure For Dental Pain ?

When it comes to episodes of dental pain, we can resolve them very effectively using the usual drills etc, not much fun but it definitely works!  If we start to talk about a ‘cure’ for dental pain things get a bit more complex though right?

If from today you eliminate sugar from your diet, see a dental hygienist regularly and perform excellent daily dental self care; you may on your death bed be able to look back and say you cured yourself… or you even after all that, you might still have some cavities as you go along. In any case you know that to be at least semi-confident of a life without dental pain,  you are required to act consistently on self care for a lifetime,  and possibly require a reasonable dose of luck.

A Cure For Knee Pain ?

The same eternal truth may apply to the topic of ‘curing’ your knee pain as it does to the dental pain. With the eternal presence of concrete (which is as bad for your knees as sugar is to your teeth),  a history of knee problems, and a busy active life, you are permanently at risk of knee pain.

On the other hand if you work hard at the types of rehabilitation that people like myself prescribe, you have a shot at being able to look back and say you never had any more pain.

So we may not be able to count on a cure, because life is unpredictable at the best of times, but there  are effective tools for managing knee pain. So we needn’t lose any sleep over a cure.  

If you have had toothache during your lifetime,  but you don’t lie awake at night worrying about a permanent cure for dental pain then you don’t need to do the same with your knees. It’s more just a case of doing the work.

How To Manage Your Knee Pain

So we have moved past worrying about a cure but that doesn’t mean we aren’t going to aim for one. That’s where good management of knee pain comes in. The following is a good outline of how to manage cases of knee pain that doesn’t involve significant damage and injury, in other words ‘most’ knee pain cases:

Step 1
Get a proper diagnosis for exactly what tissue within your knee is sending the pain signal, eg tendon, ligament, muscle, bursa. Is there some scar tissue in the quadriceps attachments? Is there an enflamed bursa? Is there tendinosis in the patella tendon?

Step 2
Get a proper biomechanical diagnosis for your knee pain. What this means is finding a practitioner who can identify what movement issue or old unresolved injury has caused the irritation and pain signal in the tissues of your knee. Flat feet can cause knee pain. Weak glutes can cause knee pain. Certain types of habitual walking and standing can cause knee pain.

Diagnosis for knee pain with gait analysis

Gait Analysis For Knee Pain Diagnosis

Step 3
Receive appropriate pain relief / tissue healing treatments in an attempt to resolve the immediate knee pain. This can involve acupuncture, acupressure, cupping, stretching, breaking up scar tissue, ultrasound etc etc. The basic principles are usually along the lines of increasing blood flow, relieving muscle spasm, deactivating trigger points and breaking up scar tissue.

Step 4
Work towards greater strength of the muscles around the knee. Most knee pain sufferers have a severe need to build the muscle up around the knee. To highlight the value of this maybe it’s interesting to know that there are a growing number of professional athletes finding good results not have surgery for their ACL and meniscus tears, but instead work on muscles strength.

Step 5
Work on the functional strength of your knee muscles and your hip muscles. Weight bearing exercises that target the main supportive/stabilising muscles of the leg help to rewire the knees support muscles for pain and injury prevention. What this would feel like to your is improvements in your ability to balance.

Step 6
Recieve an appropriate orthotics prescription it it is necessary for your particular biomechanical issues. Supporting that arch of the foot and protecting the knee for surfaces like concrete and paving slabs is a crucial component in resolving knee pain for many people.

Step 7+
Keep doing that exercises 5-10 mins per day forever the same way you are going to brush your teeth forever. Keep wearing your orthotics forever. Get your knee checked out any time you get any pain whatsoever. Don’t run marathons on tarmac. Cross your fingers.

In Summary

The idea of a cure for knee pain is an admirable but slightly naïve one. Preventing knee pain for a lifetime is something that many of us (myself included) have to work on. Despite this there are many effective tools and strategies for working not only knee pain but it’s underlying causes.

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What Is The Best Treatment For Plantar Fasciitis?

What Is The Best Treatment For Plantar Fasciitis?

Plantar Fasciitis treatment

What Is The Best treatment For Plantar  fasciitis? 

Plantar fasciitis is widely considered as being notoriously hard to treat, I see this fact reflected in the faces of those who come to my clinic for treatment on a daily basis. Most have been in search of the best treatment for plantar fasciitis for some time. 

 I find that the average new patient with plantar fasciitis has suffered for more than a year and has usually been to at least 2 other practitioners in their search for the best treatment for plantar fasciitis before they attend my clinic. It’s not unusual for people to cry when they talk to me about their pain on their first visit, which to me really shows how much pain and frustration can be caused by this condition. 

 There are strong re-occurring themes in terms of the types of advice people have received while doing their best to search for treatment of their plantar fasciitis. Exercises, insoles, heel inserts and painkillers are the most common, all of which most definitely have an important part to play in the best treatment plans for plantar fasciitis. 

 That most fundamental question which is always of course on most people’s lips is ‘What is the best treatment for plantar fasciitis’ This is a reflection of how little success they have had in treating their plantar fasciitis. 

 So what are the missing links because as I said before exercises, inserts and pain killers are all valid components of what you might call best treatment for plantar fasciitis!? 

There are a handful of treatments that tend to work best when you are trying to treat plantar fasciitis, and the very best of those are generally the ones that work on scar tissue. 

Scar Tissue & Your Feet 

 Plantar fasciitis is a condition that involves a build-up of microscopic scar tissue and collagen trauma in the sole of the foot.

It’s understanding that scar tissue is often it’s primary pain mechanism that guides us towards finding the best treatment for plantar fasciitis. Breaking up the scar tissue and promoting blood flow is key to reducing the immediate pain of plantar fasciitis. . 

 How do you end up with this type of scar tissue in the sole of your foot? Thr answer is repetitive strain. Most people have heard of the term ‘repetitive strain injury’ but we usually reserve it for describing overuse in the forearm and hand that are caused by repetitive work activities like typing. There is probably no part of the human body that is subjected to more repetitive strain however than the sole of the human foot. 

 Modern human beings take an average of 15,000 steps per day during our lifetimes and with every step our entire body weight pushes through the heel when it comes down on the ground. This is a fantastic recipe for developing repetitive strain in the sole of the foot so perhaps it is little surprise how many of us suffer from plantar fasciitis, foot pain and heel pain at different times in our lives. 

 The sheer number of steps we take each day, month and year is in itself extreme and that’s before we have taken into account one other major factor in the development of all this scar tissue .. and that is the hard surfaces we live on.

 Your direct ancestors lived outdoors mostly on soft, squishy surfaces that hugged the soles of their feet. Modern humans spend almost our entire lives walking on the likes of concrete, tarmac, paving stones and hard wood floors. The pressure that goes through the sole of the foot with each step in the modern world is many times what it would have been before the industrial revolution, due to hard surfaces. Concrete is a fertile soil for growing scar tissue, and for developing plantar fasciitis and heel pain

The Best Treatment For Scar Tissue

 By removing the buildup of scar tissue and underpins the pain of plantar fasciitis and heel pain,  we not only relieve pain in the short term but we also make way for more preventative measures like insoles and exercises. 

The best way to treat the scar tissue that underpins plantar fasciitis is to break it up using a combination of specialised massage techniques. Some of these involves using blunt scraping tools on th sole of the foot, some use intense vibration using a powerful mechanical massage device, some cases require acu-pressure and others still require acupuncture. These are all methods that have the ability to break up and force remodeling of scar tissue 

By gradually breaking up the scar tissue in the sole of the foot we gradually allow the soft tissues of the foot to heal and return to a normal healthy state. This process is not unlike a training effect at the gym however,  and it takes a wee bit of time. Making these changes is nearly always the best treatment for plantar fasciitis, it’s just a matter of finding which tools work best for you.

 Once they are finally getting the best treatment they can for their plantar fasciitis most people do notice some improvement in their condition over the first couple of visits. Breaking up scar tissue sufficiently that they feel consistently better takes a little longer. I would estimate that the average plantar fasciitis and heel pain sufferers who attends my clinic take 8-10 weeks before they consistently feel better and their activity levels go back up to near normal levels. Some find relief comes shockingly fast and others are a little more stubborn but 8-10 weeks is about the average. 

Rehabilitation For Plantar Fasciitis 

 Once the pain of plantar fasciitis is all but relieved through the reduction of scar tissue the stage is set for exercises, insoles and orthotic prescription. All of which work preventatively by reducing the amount of stress on the foot and prevent reoccurrence.

If we can resolve the causes of strain in the foot we can reduce the build-up of scar tissue and inflammation in the foot, this is how we attempt to stop the pain coming back. 

 Irrespective of the details however what this all boils down to is freedom. Freedom to do all the things you need to do in order the survive, and freedom to do all the things you enjoy doing as part of a normal active life. 

 Stubborn pain is always life altering and not in a good way, but plantar fasciitis and heel pain hit us not only with pain but with limitation of movement which is something that can affect almost any aspect of our existence. This is why pursuing not only pain relief but full rehabilitation of the underlying issues makes a lot of sense to me. 

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Is Your Hip Pain Caused By Old Age?

Is Your Hip Pain Caused By Old Age?

Hip pain old age

Is Your Hip Pain Just Old Age?

Being free of hip pain really boils down to quality of life. The type of quality of life that comes with being able to not only sleep, sit, stand and walk in comfort, but also lead a fully active life.

The slightly scary truth is that we value these freedoms as much when we are elderly as we do when we are young. The scarier truth is that quality care for age related hip pain is the exception not the rule in hospitals and at our doctors offices.

I have managed hip pain in a primary healthcare setting for 2 decades. After this experience I can confirm that we have an almost comically extreme tendency to explain hip pain before 40 as hip pain, and hip pain after 40 as old age. At least it might be funny if it didn’t cause so much unnecessary suffering.

A recent study in the US measured how long ‘pain consults’ lasted when elderly people visit their doctors office. The study measured how long the pain part of the conversation lasted from the moment it was raised by the patient. The shocking average was 2 and a half minutes. To put that in context my average consult time with an elderly new patient in relation to their pain is 30 minutes for the history and 15 minutes for the examination.

Perhaps the most shocking illustration of what a primitive society we are when it come to hip pain, is a common interaction that plays out every day of the week at a doctors office near you. This is that doctors visit where an older patient presents with hip pain. X rays are ordered and they reveal osteoarthritis (wear & tear). Cutting a long story short and setting aside the limited treatment offered, the patient is left with the understanding that their hip pain is simply the onset of old age and that this is to be expected. Painkillers, possibly surgery one day and that’s it.

Regardless of what our doctor tells us, the scientific data tells us that osteoarthritis and it’s associated hip pain syndromes are genetic, dietary, environmental, lifestyle, age and wellness related (as opposed to just age related).

Let’s set aside science for a moment though and talk common sense. More than 90% of hip replacements are single replacements, due to the fact that the opposite hip is either completely free from osteoarthritis or only has mild issues. Both hips are the same age, both hips have the same hobbies, mileage, diet, genetics and lifestyle yet only one of the 2 hips needs replacing. Logically speaking how can old age be the explanation when both hips are the same age and have the same mileage???

The truth is that the specific reasons why one hip develops arthritis so much quicker than the other is unrehabilitated injuries, asymmetric weaknesses and movement imbalances. Do I need to remind you again that the genetics, diet, mileage, environment, hobbies and lifestyle are the same in the non-arthritic hip???

The good news that springs forth from these observations is that we may be able to prevent much of the pain, wear & tear of old age. If we are willing to work preventative on strength and movement in our bodies we may find that preservation of our quality of life is possible.

The possibility of preservation of our movement and comfort means that we need to be extremely proactive about the niggly little hip pains we get when we are younger. I am alluding to another truth here which is that 2019’s crippling need for a hip operation was usually 1999’s niggly little hip pain and 2009’s limiting hip pain.

If you have persistent back pain, hip pain, knee pain, ankle pain, foot pain or plantar fasciitis, or any other stubborn pain for that matter I would encourage you to be proactive with both treatment of the pain and rehabilitation of the muscles in that area. Your quality of life may depend upon it.

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Is Muscle Wasting the Reason for your Back Pain, Hip Pain, Knee Pain & Plantar Fasciitis?

Is Muscle Wasting the Reason for your Back Pain, Hip Pain, Knee Pain & Plantar Fasciitis?

Muscle Weakness

Movement is Everything

Movement is everything. Imagine waking up fully conscious but completely paralysed from the neck down. I can’t speak for you, but for me there is no prison on earth scarier than that. It feels to me like every single last expression of my life force starts with a thought but ends with movement. Everything from my shallowest breath between sips of coffee, to acts of service, winning races & sky dives is predicated on movement. Even my deepest sleep is a state of perpetual motion.

Weakness & Pain

To some degree all movement requires physical strength. When movement and strength suffer we suffer. The most obvious suffering is the knee pain, plantar fasciitis, bursitis, hip arthritis etc etc. More subtle forms of suffering caused by loss of movement we call disability, difficulty doing the things we enjoy, difficulty performing life’s most basic functions. Disability can be as horrifying and scary as pain itself if it is bad enough.. that’s what the paralysis example is about.

The truth is that we are virtually all on a spectrum of weakness. Even the most perfectly conditioned of professional athletes have some particular weakness, pain or imbalance that they find they need to work on.

There is a meaningful questions that those interested in prevention and rehabilitation should ask here… ‘’ Is it possible to accurately identify these weaknesses and work on them?’’ Happily the answer is yes of course we can!!!

Spotting Weakness

I have a very good friend called Oliver. Oliver is a very talented soccer coach, and it’s what he has done professionally for the past 15 years. To say that Oliver see’s things that I don’t when he watches a game of soccer, would be a diabolical understatement. He sees small defensive error’s; he picks up on subtle cues that there is a lack of communication and cohesiveness in the offence. He picks up on subtle shifts of the balance of power on the pitch.

When I ‘watch’ soccer it literally just looks like some athletic losers kicking a ball back and forth… occasionally someone manages to get a ball in the goal.. some passes are more accurate than others.. this is the full depth of my analysis.

My point is this, when we have a depth of experience on a topic, we see things that others do not. This is why it is not cocky of me to say that when I look at human beings moving around I see things that others don’t.

The truth is, if I see someone moving I can spot weakness, movement deficiency and muscle wasting from a distance that might shock you. Knowing whether someone has pain is sometimes not spot-able due to the complex nature of things, but the weakness is crazy obvious once you have attuned to all the many ‘tells’.

I was inspired to write this post yesterday afternoon. It was a lovely calm, sunny afternoon in Wellington and there were lots of people out walking. My attention was drawn by some sudden movement and I saw a robust looking toddler who had burst into a run.

The most obvious problem with this kid was that he was headed directly towards, and in close proximity to a busy road. The second problem, was that his poor overweight mum who looked to be in her mid 40’s can’t (even with the benefit of adrenaline and primal instinct) keep pace with a 3 year old,, even if his life is dependant upon it. It was one of those moments that happens in slow mo .. for all the wrong reasons.

Fortunately it turned out that the wee man just really wanted to press the button and activate the crossing, so his mums lack of athleticism wasn’t his undoing. I have to say I was relieved, it looked like a bad situation for a moment there. Having witnessed her movements though, I can foresee no such happy ending for his mums health in the near future.

When I reflect on the image in my mind of the boys mum trying to run and failing, what I see is severe weakness. Both her knees have ‘valgus stress deformities’ or what you might call knock kneed. This lets me know her glutes and VMO muscles not firing. She had a short shuffling gait which is mainly due to general stiffness in her lower back and pelvis. The angle of her legs when she bears weight tell me her arches collapse when she bears weight on both feet which is a combo of the glute weakness and the feet themselves. Her upper backs ‘support system’ isn’t firing either so she can’t use her shoulder and arms in the way that one needs to when running effectively. It all sounds pretty clever and insightful when you write it down.. but to be honest none of it is particularly subtle.

As I was reflecting on excessively all in depth analysis, I realised that most people would look at the same scene and just think that mum’s obvious struggle was just her weight, with maybe a general comment on ‘lack of Cardio’.

There is a reason why I believe being able to ‘read’ people’s weaknesses is a valuable enough topic to dedicate my life to it.

If we can identify weakness we can work on it. If we overlook it and just tell ourselves and each other to loose weight we are going to miss out on tools and solutions that could be profoundly life altering.

I was with a lady very recently who had a very similar pattern of weakness to that poor lady who can’t run. She also had all the classic pains that usually go along with it .

She was suffering badly with chronic knee pain, back pain and plantar fasciitis all of which she felt were preventing her from being active more than her weight. She had consulted her doctor a year before about the pain in her knee, back and plantar fasciitis pain, and her lack of mobility. All he had told her was she needed to loose weight. I believe that there is more to caring for people who are both over weight and in pain than this …

The Solution

The solution to all this weakness, all this stiffness and all this unnecessary suffering is movement, move or die my people! There is of course the question of how to move though.

Those of us who have a reasonably fit and strong ‘base’ can be quite general about our approach to movement and that mostly will give the body what it needs.

For those who are no longer as fit and strong, the requirements of healthy restorative movement will be more specific. If you have suffered from knee pain & injuries, plantar fasciitis, hip pain, ankle pain, chronic back pain or even if you have just slowed up a lot, you’re probably in need of a much more specific approach to movement. And then there are the things that often need to be avoided because they cause more pain. All this adds up to a much more specific but easily prescribed approach.

Those with the most persistent pain and stiffness often need time spent doing very specific exercises designed to strengthen  their weakest areas before they do much in the way of general fitness. These type of exercises can easily be done at home in 10 minute windows once you know how. There is now a mountain of research that supports the idea that weakness is a part of virtually every stubborn pain complaints there is. 

By deliberately stabilising the weakest areas when we are ‘unfit’ or weakened, we can gradually work ourselves into more normal activity, the same way people do after bad car crashes and the like. This is a stepping stone to restoring the freedom that comes with having a natural and normal level of strength in our bodies.

The Conclusion

Like I said.. movement is everything. Movement is having the freedom to stand and watch your children play sport without burning pain in your lower back. Freedom is being able to travel without fear of unexpected and unpredictable hip pain episodes. Freedom is being able to work in a state of comfort without feeling like you have sharp rocks in your foot due to plantar fasciitis.

Freedom can even boil down to being able to just sit and lie down without back pain. This part of life deserves care and it deserves attention, the greatest benefit of giving that care to our bodies is preservation, prevention of pains both felt now and those still to come. And for many, that care is best given by way of strengthening !

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Why Do I Have Pain In The Middle of My Foot ?

Why Do I Have Pain In The Middle of My Foot ?

Pain middle of foot

Why Do I Have Pain in the Middle of My Foot ?

If you have been asking the question ‘why do I have pain in the middle of my foot?’ the chances are you have developed some form of a repetitive strain injury in that foot. Repetitive strain in the middle of your foot can lead to inflammation, damage to collagen fibres and scar tissue. In other words, you probably have strained and microscopically damaged the soft tissues in that foot over time.

If you do have strain & pain in the middle of your foot it also most likely relates to some movement issue you have developed when you walk and run. These type of issues can come about as a result of old injuries, specific muscle weaknesses and movement habits that we develop over time. Repetitive strain and pain in the middle of your foot can also be the result of particularly high arches or flat feet.

It’s entirely likely that you take over 3 million steps per year, quite a few more if you lead a very active life. Every time your foot strikes the ground and you shift forward the entire weight of your upper body is sustained by the connective tissues of your foot. The arch in the middle of your foot is a major shock absorber in all this charging around that you do and it bears a huge amount of strain.

Consider for a moment how many people get RSI in their forearms from repetitive tasks like keyboard work. Now consider the potential for repetitive strain in similar connective tissues that sustain your entire body weight millions of times per year. Is it any wonder that ‘Why do I have pain in the middle of my foot’? is one of the most commonly asked questions I hear from people.

In addition to the ‘Why do I have pain in the middle of my foot?’ question, the other common question is ‘How do I get rid of the pain in the middle of my foot?’ The trick to getting rid of pain in the middle of the foot is firstly to treat the actual ‘Repetitive Strain Injury’ itself. Treatment of the injury can include stretching, deep tissue release, acupuncture and the like. The other trick to successfully managing the old ‘pain in the middle of my foot’ scenario is of course to figure out what movement issue caused it and address that too.

Depending on the reason for your ‘why do I have pain in the middle of my foot’ episode certain exercises may be necessary to address specific muscle weakness. Changes in the way you walk and run can be required and of course orthotics, shoes insert or insoles might be necessary in the longer term.

For those of us who find ourselves wondering why we have pain in the middle of our foot the important thing is to understand that pain in the heel, arch and middle of the foot is always happening for a reason. It’s also good to know that those reasons are nearly always identifiable and can be worked on.

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Stretching Exercises For Plantar Fasciitis

Stretching Exercises For Plantar Fasciitis

Plantar stretch

Stretching Exercises for Plantar Fasciitis ! 

Virtually everyone  who comes to my office for treatment for plantar fasciitis  have tried stretching exercises for plantar fasciitis relief at one time or another. The frustrating thing for many of them however is that these stretching exercises for plantar fasciitis have either offered only partial, temporary or even non-existent levels of relief despite their hard work. Yet personally I have found that stretching exercises for plantar fasciitis do play an essential role in managing the condition.

The truth is that stretching exercises for plantar fasciitis are an essential part of the key to successful recovery but they are often not much immediate help for the pain itself.

So what I am saying here is that stretching exercises for plantar fasciitis are an essential part of the foot pain puzzle but that they are not great for achieving pain relief. The reason for this is that plantar fasciitis is a complex issue and like many such complaints there are layers of dysfunction that must be dealt to using various approaches in the correct sequence.

Stretching exercises for plantar fasciitis in most cases work best for managing the condition when they are prescribed in the rehab/prevention phase of care, as opposed to the initial pain relief phase. In other words the best stretching exercises for plantar fasciitis are good at stopping the pain from coming back.

Imagine for a moment that you had a need for emergency dental care due to a terrible toothache. You go to the dentist and having taken a closer look he explains that you have a massive root infection. When you ask him what you should do he shows you how to floss your teeth twice a day and then thanks you for your visit. What wrong with this picture?

We all know that flossing is an integral part of the long term management of a painful tooth, yet we also know that once we have tooth pain there is a more pressing issue required in the form of root canal work. The point here is that we can’t floss our way out of a root infection and we often can’t use stretching exercises for plantar fasciitis as a way out of a severely inflamed plantar fascia.

We all understand the wisdom in not prescribing rehab exercises at the side of the road to someone who has just been hit by a car !!! This is because while we hopefully know that rehabilitation is absolutely crucial when the body is damaged there is usually some ‘doctoring’ that needs to be done first so that the body can heal itself. Treatment first , exercises later. If you are suffering from plantar fasciitis and you are looking for pain relief this is the key concept to bear in mind when considering stretching exercises for plantar fasciitis.

When we have chronic pain in the sole of our heel and arch there is nearly always a build up of scar tissue and damage to collagen  that must be resolved before we can rely on stretching exercises for plantar fasciitis to deal with the underlying tightness in our leg and foot.

Okay so we don’t use stretching exercises for ‘pain relief’ necessarily we use them for ‘rehabilitation’ but what kind of stretching exercises?

To answer this question effectively it’s best to first dig a bit deeper into what really causes plantar fasciitis and heel pain to happen in the first place.

Plantar fasciitis and heel pain in basic terms are essentially caused by millions of steps taken in a lifetime spent on hard unnatural surfaces like concrete, tarmac and paving. All this stomping around on hard ground causes repetitive strain and compression in the sole of the foot which leads to a painful build up of scar tissue and tissue damage.

While this connection between the strain of hard ground and scar tissue build up in the foot is an inescapable fact of life so is the fact that we don’t all get plantar fasciitis despite being exposed to the same environment and similar activity levels. And this is a key observation because the difference is plantar fasciitis and heel pain sufferers have significant weaknesses in their legs and feet.

The most common difference I see between plantar fasciitis and heel pain sufferers and non-sufferers is a strength difference rather than a flexibility difference, this should give you a clue as to what kind of exercises are involved.

The best exercises for plantar fasciitis are not stretching exercises – they are STRENGTHENING exercises.

Setting stretching exercises for plantar fasciitis aside for a moment. If you have strength from your hip and glutes through to your foot your arches won’t drop unnaturally when we walk and we don’t get strain in our plantar fascia. If on the other hand you have muscle wasting in your hips and knees your arches drop when you walk ( even high arches ) and you will tend to get scar tissue build up in the sole of the foot.

Effective activation of the glutes etc. during ‘functional’ weight bearing movements is they key to exercising for plantar fasciitis and heel pain!! Picture simple balance board type exercises executed correctly and simple squatting and lunging movements. These kind of exercises stabilise the entire leg and reduce strain in the sole of the foot. Most people find that this does so much more for them than stretching exercises for plantar fasciitis.

Gait lines in plantar fasciitis sufferers.

Faulty gait analysis line in a plantar fasciitis sufferer reveals underlying weaknesses that need to be addressed.

When I take this long term ‘stabilisation’ approach with people I find that they stay pain free much more reliably and consistently then when they focus solely on stretching exercises for plantar fasciitis. Interestingly it is also quite normal for people that as they get stronger any stubborn knee, hip and back pain they might have had also reduces. These effects would be considered quite normal effects of ‘stability exercises’ in today’s world.

Plantar fasciitis strength exercise

Balancing on wobble pads is an excellent exercise for plantar fasciitis sufferers

If you are exploring pain relief options I would definitely encourage you to try out stretching exercises for plantar fasciitis to help manage your pain because they can definitely help. There are downloadable PDF’s here. 

I believe that anything that is safe and that works for you in a lasting way is valid, if you drink frogs milk for breakfast and it improves your ability to exercise without pain keep drinking it. If you are using something that isn’t working for you throw it out.  I met a lady recently who has been working diligently on stretching exercises for plantar fasciitis for over a year without seeing any results whatsoever, I admired her persistence.

If you are on a mission to resolve your plantar fasciitis I advise you to be persistent,  but if you are and you still don’t at least see slow but definite results try something else. This is probably the best principle we can apply to all treatments and exercises for plantar fasciitis and heel pain.

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