Why Is The Bottom Of My Foot Hurting?

You may have heard the term plantar fasciitis when asking around about pain in the bottom of the foot or researching your symptoms, but what is it and why is it inflamed? The plantar fascia is a thick fibrous band of tissue that runs along the bottom of the foot, starting along the heel and connecting to the base of the toes. It’s main purpose is to provide support to the arch along the inside of your foot. Just like any other tissue of the body, it can become stressed, strained, irritated, and/or inflamed, leading to pain anywhere from the heel to the arch of the foot. The plantar fascia is most commonly stressed due to decreased flexibility, higher body weight, increased pronation (or flat feet), activities involving prolonged weight bearing, or a rapid increase in activity levels, such as the beginning of a new running program. All these factors can place increased stress along the arch of your foot and the plantar fascia, leading to inflammation and possible pain.

So what can you do to reduce the pain and improve mobility? Physical therapy is a proven method for treating plantar fasciitis, helping patients to develop a personalized program to reduce pain and improve mobility. Typically, physical therapists will address flexibility and strength impairments, while also utilizing specific taping methods and going over proper shoe selection. Here are a few exercises typically used to treat plantar fasciitis:

Calf Stretch

Seated Plantar Fascia Stretch

Plantar Fascia Myofascial Release

If your symptoms seem to be lingering or you have more questions, contact us in order to schedule an appointment with one of our qualified physical therapists for evaluation and treatment. Get started now!

-Brian Collins, DPT

Anatomy 101: The Rotator Cuff

You’ve probably heard of the term “rotator cuff” before, but do you know what the rotator cuff is? More often than not, a thorough explanation is required when introducing the rotator cuff to individuals in physical therapy for shoulder pain. So what is it? The rotator cuff is simply a group of four muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) that work collectively to stabilize the ball-and-socket structure that makes up the shoulder joint. By itself, the bones of the shoulder joint are not very stable, as the ball-and-socket structure is similar in composition to a golf ball sitting on a golf tee, with the golf ball being the humeral head and the golf tee being the glenoid. Inherently, a golf ball resting on a golf tee is not very stable, i.e. it is easy to knock the ball off of the tee. Physiologically, this would be rather problematic if this were the entire design of the human shoulder joint complex. Enter the rotator cuff, which helps hold the golf ball securely in the center of the golf tee. As you raise your arm overhead, the rotator cuff activates, pulling the humeral head down while it rolls upward in the glenoid. Without a healthy and efficient rotator cuff to provide the necessary counterforce, the golf ball would get dangerously close to rolling off the tee. This would not be an issue on a golf course, but could result in injury in the human body. In fact, many common aches and pains in the shoulder are the result of an injured or inefficient rotator cuff, which can result in an unstable shoulder joint, particularly with overhead activities such as swimming, rock climbing, and tennis. Shoulder impingement syndrome is a common diagnosis that involves a pinching of the supraspinatus tendon. Rotator cuff tears can involve any of the four rotator cuff muscles, but most often impact the suparspinatus. The good news is physical therapy can help strengthen the rotator cuff, in hopes of improving the stability and subsequent function of the shoulder joint. Here are a few therapeutic exercises used to strengthen the rotator cuff:

Band-Resisted Wall Crawl

Band-Resisted Shoulder External Rotation At Sides

Resisted Scaption

Quadruped Scaption

So, if you are experiencing nagging shoulder pain, you may benefit from having a physical therapist or other sports medicine specialist evaluate the health of your rotator cuff. Treatment can be rather effective and typically only takes between 6-8 weeks, the average time required to strengthen weak or dysfunctional muscles. Get started now!

-Grant Hennington, DPT

How To Reduce Back Pain At Your Desk Job

It is well known that Seattle is a growing hub within the tech industry, being home to companies such as Amazon and Microsoft. With this brings hoards of individuals working extensive desk jobs, sitting at a computer for the majority of each day. In fact, according to the U.S. Bureau of Labor Statistics, software developers spent an average of 90% of their workday sitting in 2016. All of this sitting can lead to aches and pains, the result of a stiff spine or tight muscles related to hours of inactivity. More often than not, desk jobs can result in stiffness in the thoracic spine, along with tightness in the hamstrings and hip flexors, all of which can contribute to back pain. So what can be done to combat this? Here are some helpful exercises that can be performed in the workplace:

• Workplace Exercise Series

A helpful recommendation is to set a timer on your cell phone prompting you to take a break and stand every 30 minutes, performing one or two of the individual exercises each bout. All exercises should be pain-free and performed in a safe, open space. With a sedentary workday, the importance of getting regular physical activity outside of the workplace grows, so setting a goal of 150 minutes of moderate intensity physical activity per week is crucial. It is reported that up to half of adults in the United States do not meet this physical activity recommendation, contributing to many chronic health issues. While 150 minutes of moderate physical activity per week may seem intimidating, this does not mean you have to start running if you are not a runner or going to CrossFit workouts. Rather, common exercises that fall into the “moderate-intensity” category are walking, yoga, or hiking. Running or CrossFit would fall in to the “high-intensity” category, which only requires 75 minutes per week to meet the physical activity recommendations.

Several more involved therapeutic exercises can be performed after work, in the comfort of your own home, most of which target the thoracic spine and hip joints. Here are a few for your to try:

• Lower Extremity Stretching Routine

• Foam Rolling Of The Thoracic Spine

• Open Book Stretch

• Foam Roll Chest Opener

While many jobs require periods of sitting, there is always the opportunity to sneak small bouts of movement/exercise into your work day. Start small and reward yourself for hitting your daily movement goals. Even little bits can add up over time.

It’s time to get moving!

-Grant Hennington, DPT

How To Select A Pair Of Running Shoes

Asics. Brooks. Saucony. Nike. Hoka One One. Altra. The number of running shoe manufacturers we have access to is extensive. And with each running shoe produced, a hopeful declaration is made to the customer: run faster, hurt less, go farther. So how do we sift through the myriad of options and settle on the best running shoe for us? Here are a few helpful tips:

• Comfort is key

  • Millions of dollars have been spent researching and developing systems to help individuals select the perfect running shoe for them, within a particular line. Have you ever stood on a fancy pressure sensor at a shoe store geared at helping you pick out a shoe? This is in that vein. While this is not necessarily a bad thing, it may not be adding any value. Researchers have concluded that the best predictor of a running shoe being appropriate for the individual does not require fancy foot scans or pressure maps. Rather, the best predictor of a running shoe being appropriate for an individual is comfort. So simple. By in large, if you are attempting to decide between two different running shoes, evidence suggests the one that is more comfortable is the better option for you.

• Know the lingo

  • Do you know the difference between a stability shoe, a neutral shoe, and a minimalist shoe? Do you know what heel-toe drop refers to? Knowing the vocabulary and relevant measures within the running shoe industry can help you make more informed choices for yourself. For instance, a stability shoe aims to limit excessive foot motion during the running cycle, while a neutral shoe alternatively aims to maximize cushion. A minimalist shoe attempts to reduce the weight of the shoe in hopes of improving running efficiency and, subsequently, speed. Heel-toe drop refers to how much higher off of the ground your heel is as opposed to your toes when donning a running shoe. All of these are important factors to consider when selecting a running shoe, given that comfort still needs to come first.

• Be a bit of a skeptic

  • While some running shoes are more popular than others, there is no one running shoe that has shown to be superior to others at reducing injury risk or vastly improving performance, despite advertising campaigns claiming otherwise. By in large, the overall rate of running-related injury is relatively the same regardless of footwear. However, some running shoe designs have higher rates of certain types of injury, with lower rates of others. For example, the barefoot running craze resulted in an increase in production of minimalist running shoes, with claims of reducing your injury risk. While some minimalist running shoes have been shown to reduce the risk of knee pain, this comes at the expense of an increased risk of Achilles tendinopathy and forefoot stress fractures. The reason? Running in a shoe with less cushioning tends to move our strike pattern to more of a mid or forefoot strike, reducing the impact force on our knee while increasing the load to our forefoot and Achilles. While the injury profile may be changed, the overall injury risk is the same. So, be a bit leery of any particular shoe manufacturer’s claim that a specific shoe in their line will dramatically reduce your injury risk.

• Try on numerous pairs

  • Given that comfort is the most important factor in selecting an appropriate running shoe, it is integral that you try on a number of pairs of shoes from different manufacturers in order to find the best fit. Ordering running shoes online does not provide this opportunity. Even if you are purchasing the same line of shoes from a manufacturer, it is important to note that small changes can be made to the design and fit from year-to-year. And, your foot can change a bit over time. So, again, you must try on several pairs to find the best fit for you.

• Focus on the fundamentals

  • While selecting an appropriate running shoe is an important component within a training program, the most significant factor related to injury and performance is your training program itself. No shoe will protect you if you are running too much or increasing your mileage or speed too rapidly. You must stick to the tried-and-true principles of training in order to set yourself up for success. In other words, regardless of your footwear, there are no shortcuts to the finish line.

Happy shopping!

-Grant Hennington, DPT

How To Set Fitness Goals

Getting fit can be a very good thing, often helping us feel better both physically and mentally. For those of you who want to get fit, do you have a goal in mind? Setting a goal is an important first step in improving your overall fitness. However, setting fitness goals can often feel daunting, as well as a bit trivial. Frequently, clients will tell me they have a goal of getting in better shape. My response: How are you measuring that? Getting in better shape can come in a variety of forms: losing weight, building strength, improving flexibility, running faster, and so on and so forth. All are great things to strive for, but in order for a goal to be effective, it must follow some guidelines. Thankfully, there is an acronym for that (surprise, surprise). It is recommended to set SMART goals when attempting to improve fitness. Here is what that means:

S: Specific

• Any fitness goal you set should be specific. “I want to get in better shape” is not very specific. Rather, “I want to finish a marathon” is more specific. Specific goals help us come up with a more robust plan to achieve said goal.

M: Measureable

• Having a measurable goal will help ensure you know when you have actually achieved the goal. “I want to run a fast marathon” is not all that measurable. How are you defining fast? What is the cut point for fast versus slow? “I want to run a marathon in under 4 hours” is both a specific and measurable goal, allowing me clear metrics to analyze whether or not I achieved this goal.

A: Achievable

• While it is alright to dream big and set lofty goals for yourself, it is important that you set a goal you can actually accomplish. Setting a goal of running a marathon in 20 minutes is not an achievable goal, as the fastest any runner has ever covered 26.2 miles is 1:59:40. However, many individuals have run marathons under 4 hours and there are numerous training programs out there geared at breaking the 4 hour barrier. If you are brand new to running, this might be a lofty goal, but not necessarily unachievable. The achievability of a goal depends a lot on your level of experience surrounding the activity associated with your goal.

R: Relevant

• Selecting a goal that is meaningful and consistent with your current state of being is critical before moving forward. What would finishing a marathon mean to you? Would achieving a different goal mean more to you? This is very much a values-based criteria geared at helping you figure out the “why” behind the goal you have set your sights on.

T: Timely

• Any goal we set for ourselves should carry with it a deadline in order to help keep us on track. The example of running a marathon tends to be fairly simple, as our deadline is the date of the race. If I have set a weight loss fitness goal, it would be beneficial to set a timetable that is consistent with a healthy rate of weight loss, which tends to be 1-2 pounds per week. Therefore, a safe and timely goal could be “I want to lose 10 pounds in 2 months”.

With any fitness goal you set, make sure to reward yourself along the way, as well as once you achieve your overall target. Setting short-term goals can make loftier long-term goals seem more attainable. It is also recommended to have a contingency plan if you get off track or if a major life event postpones your efforts. In this event, don’t beat yourself up, rather use any disappointment as motivation to set and achieve a new goal that will lead to you achieving your original goal. Fitness goals can be set and achieved at any point in the life cycle so it is never too late to work towards getting fit. Just make sure to keep them SMART.

-Grant Hennington, DPT