Plantar Fasciitis

What is Plantar Fasciitis?
The plantar fascia is a thick, fibrous band of tissue located on the bottom of your foot. It extends from the heel to the base of the toes. This tissue plays a crucial role in stabilising and supporting your foot as you move through daily activities. However, when the plantar fascia becomes overloaded and strained, it can become inflamed and injured, leading to pain and discomfort. This condition is known as plantar fasciitis.

The primary cause of plantar fasciitis is a change in how you load your foot. Several factors can increase your risk of developing this condition, including:

Overuse and over-training

  • Inadequate or worn-out footwear
  • Poor strength, mobility, and flexibility in the lower limbs
  • Muscle imbalances and dysfunction
  • Weight gain and a sedentary lifestyle
  • Rigid feet with poor mobility and flexibility, which are inadequate to absorb shock
  • Leg length differences
  • Abnormal walking and running patterns that place extra stress on the heel bone and ligaments
  • Careers and hobbies that involve prolonged periods of standing
  • Age; as you get older, your tissues become less elastic

When high loads are repeatedly placed on the heel bone and surrounding soft tissues, they can become fatigued and lose their ability to absorb shock effectively, leading to plantar fasciitis.

Plantar fasciitis typically begins with mild pain at the heel bone, often described as a stone bruise. This pain is usually felt after (not during) exercise. It is most pronounced right after getting up in the morning or after a period of sitting. Without treatment, plantar fasciitis can become a chronic condition, potentially leading to reduced activity levels and further issues with the foot, knee, hip, and back, as the condition can alter your walking pattern.

Managing plantar fasciitis involves a combination of exercises, physiotherapy, and massage to alleviate pain and promote healing. Here are some effective treatment methods:

  1. Stretching Exercises: Regular stretching of the calf muscles and the plantar fascia can help reduce tension and promote flexibility. Try stretching exercises such as calf stretches, towel stretches, and toe stretches.
  2. Strengthening Exercises: Strengthening the muscles of the foot and lower leg can improve stability and reduce strain on the plantar fascia. Exercises like toe curls, picking up marbles with your toes, and resistance band exercises are beneficial.
  3. Physiotherapy: A physiotherapist can design a personalised exercise program, taping, and manual therapy to reduce pain and inflammation.
  4. Massage: Regular massage can help increase blood flow to the affected area, reduce muscle tension, and alleviate pain. Techniques such as deep tissue massage and trigger point therapy are particularly effective.
  5. Footwear: Wearing supportive shoes with good arch support and cushioning can help alleviate symptoms. In some cases, orthotic inserts may also provide additional support and reduce strain on the plantar fascia.
  6. Rest and Ice: Resting the affected foot and applying ice can help reduce inflammation and pain. It’s important to avoid activities that exacerbate the condition.

By understanding the causes, recognising the symptoms, and following a comprehensive treatment plan, you can effectively manage plantar fasciitis and maintain your active lifestyle.

Strength x Tension

Tight Muscles Might Actually Be Weak Muscles
There is a common belief that when a muscle is tight, that it needs to be stretched and strengthening that muscle may aggravate the issue. Let’s explore why this isn’t the case and what should be done instead.

What Really Causes Muscle Tightness?
People often think tight muscles mean the muscle is too strong and just needs stretching to loosen up. But sometimes, tightness means the muscle is weak and is trying hard to protect itself and nearby parts—like joints and ligaments—from getting hurt. This protective tightening can happen when there’s a risk of injury, or when an injury has already happened, and the muscle is trying to guard against further harm.

The False Belief: More Stretching, Less Strengthening
There is currently an existing belief that “tight muscle = needs to stretch”, which often leads to neglect in strengthening. While stretching does play a role in maintaining flexibility, it does not address the underlying weakness. Strengthening, on the other hand, teaches the muscle to function correctly through its full range of motion and to tolerate load effectively, which can reduce unnecessary tightness.

Why Strengthening Should Not Be Overlooked
Strengthening weak muscles can:
•⁠  ⁠Improve Muscle Balance: It takes the burden off overly tight muscles, helping them relax naturally.
•⁠  ⁠Enhance Flexibility and Range of Motion: Strong muscles can handle greater stretches and activity, improving overall functionality.
•⁠  ⁠Prevent Injury: Strong muscles support joints and protect the body, reducing the risk of strains, sprains, and other injuries.

Exercises to Consider
Here are a few exercises designed to strengthen muscles through their full range of motion. Remember, the goal is controlled movement, focusing on both strength and flexibility:

•⁠  ⁠Romanian Deadlifts: Excellent for strengthening the entire posterior chain, including hamstrings and lower back.
•⁠  ⁠Squats: Full-depth squats promote strength and mobility in the hips, knees, and ankles.
•⁠  ⁠Lunges: These target multiple muscle groups in the legs and improve hip flexibility.
•⁠  ⁠Dumbbell Shoulder Press: Enhances shoulder stability and range by strengthening through the full movement.
•⁠  ⁠Push Ups: Great for building upper body strength and core stability while engaging multiple muscle groups.

Always Consult a Physiotherapist or Exercise Physiologist:
Before starting any exercise program, especially if you have pain, past injuries, or specific health conditions, it’s important to speak with a physiotherapist or exercise physiologist. They’ll assess your needs and ensure your exercise plan is safe and tailored to your individual requirements, including disease management if needed. This step helps prevent injuries and maximizes the benefits of exercise for your overall health.

Tight muscles often need more than just stretching; they need to be strengthened as well so that the muscle will get stronger through a larger range of motion. Understanding and addressing muscle weakness can lead to better flexibility, fewer injuries, and improved overall health. Take the first step towards improving your muscle health today by consulting with one of our physiotherapists or exercise physiologist to develop an exercise plan design for your needs.

Kiara Lanphier (Physiotherapist)

Football (“soccer”) injuries

Soccer is a contact sport with loads of sprinting and cutting, jumping and explosive movements such as kicking a ball. Each of these can lead to a different type of injury, from an ankle or knee sprain to a muscle injury or a ligament injury. Aside the goal keepers injuries (hand and wrist), the lower limb is the most affected body part. Hamstring and calf strains are the most common type of muscle injury. Groin pains are usually due to an imbalance between inner thigh muscles strength (adductor) and hip mobility and strength, but it can also be a referred pain from a hip injury (i.e. labral tears or cam injuries). The knee is the most common site of pain, coming from the patellar femoral joint (PFP, i.e chondromalacia), patellar tendon, collateral ligaments, or from internal structures in the knee, such as the meniscus or the ligaments ACL/PCL. Ankle injuries are usually from sprains. Treatment will vary on the site location and severity. When acute injuries such as a cork (contusion in the muscle) or a sprain, physiotherapy would focus primarily in reducing pain and inflammation and restoring movement; when pain is not due to an acute injury, like muscle cramps, or knee pain or patellar or achilles tendinopathy, treatment should focus not only on manual therapy techniques but mainly on exercises to build capacity and reduce recurrences. Regardless of the type of injury, we can help. Understanding the biomechanics of the sport and the most common injuries, a preventive exercise program can be implemented to help reduce the risk of injuries, along with understanding your body’s current capacity and how to build it up.

Running injuries

What to do? Should you stop running? Will everyone benefit from a running assessment?

Despite the odd ankle sprain, the majority of running injuries are due to overload. This is doing more than your current capacity to bear it. Running injuries occur mainly in the leg but low back pain can occur from running. Injuries can vary from a muscle strain to joint pain, to tendinopathy, to a bone stress fracture.

Such injuries occur due to spikes in training loads. Sudden increase in the running routine, are the usual culprit in causing running injuries.

What is load? And what load means in the running context?
This concept is key to manage your running program and run pain free.

Increase in load can be considered, a sudden increase in your pace or doing more speed training, adding hills training, starting to run with a running partner (who runs faster than you, which you make you push your training harder), new shoes, returning from a break with no running such as holidays or if recovering from an injury or illness. To adapt and get stronger, without getting injured, all changes in your running program need to be slow, not sudden.

Previous injuries can increase your risk of getting a new injury, or suffering from the old one again. Do you know that niggle here or there, that you just pretend it does not exist?

This niggle might be a sign that something is off, maybe a muscle compensating from a weakness somewhere else. Our body is really good at adapting when progression is slow, sudden changes might push the body too farther to allow adaptation and injury occurs. An imbalance between training load and recovery will shift the scales towards an injury rather than towards adaptation. Knowing when to add the more intense sessions or when to add rest sessions or light/recovery sessions can be the gold nugget to keep you running pain free.

You decided to go to the physio, what now?

A sports physio will assess your injury, gather the history and perform clinical test to identify what is happening. Strength tests, endurance, mobility, your history of injuries, your training routine, are all key factors to consider. Most running injuries will allow you to keep running even during physio. Some of those can even improve with only a slight change in the running routine, to give your body time to recover and adapt to the intense training load. Load management is key to recovery and to overcome a running injury, which can be long-lasting and recalcitrant.

On the other hand, some injuries can be harder to improve and may require physiotherapy treatment. Treatment will depend on the structure injured and the severity of injury. Bone injuries such as a stress fracture may require some time off running and specific exercises to progressively expose the injured bone back to loading and consequently safely back to running.
Other injuries such as patellar-femoral pain syndrome (PFP), ITB syndrome, gluteal, patellar or Achilles tendinopathy should require no rest, rather resistance exercises to work on weak muscles and biomechanics, and other types of exercises such as jumps and hops. Jumps and hops are important part of return to sport, as they target the springs in your body (tendons) aiming to improve tendon load capacity, required for running.

For most running injuries, treatment will be exercise based. Manual therapy has a role, but only an adjunctive role. Exercises allow the injured structure to get progressive exposure to load and allow adaptation, and therefore, allowing the tendon, muscle, joint and bone to get stronger and more resilient.

For some people, especially novice runners, of for those with a long-lasting injury, a running assessment may be warranted. There are some key things to assess in a running assessment, and potentially change in your running style, to improve efficiency and reduce the risk of injuries.

The road to recovery is not without bumps but we are here to help along the way, to provide you with the best support and guidance through your recovery and return to running pain free.

Our goal is to keep you active while you recover, and to support you in being the best runner you can be.

Portuguese – version (adapted)

Lesões de corrida, e agora, o que fazer? Devo parar de correr pra me recuperar? Uma analise de video da corrida adiciona benefício a todos os corredores?

A maioria das lesões de corrida estão associadas a um “overload”, ou seja “sobrecarga”. Isso signifca, fazer mais do que o corpo consegue aguentar. As lesões de corrida acometem principalmente a região da perna, apesar de algumas vezes podermos termos uma dor lombar associada a corrida; com lesões que variam entre um estiramento muscular, uma dor/inflamação articular (artrite ou sinovite), uma tendinopatia (“tendinite”) a uma lesão óssea pós estress (fratura/reação de estresse).

Estas lesões acontecem na maior parte das vezes, devido a um pico (aumento) na carga de treino (intensidade, frequencia, etc). Um aumento subito na rotina de treinos, geralmente é o principal responsável por lesões de corrida.

Mas afinal, o que é carga? ou sobrecarga? E em que contexto isso se encaixa na corrida?

Entender esse conceito é crucial na organizacao de um programa de treino de corrida, para que você consiga progredir e correr sem dores.

Um aumento da carga de treino é considerado por exemplo, quando feito de forma subita, sem planejamento, exemplo: um aumento do pace, ou começar a fazer treinos mais frequentes de corrida, ou adicionar ladeira. Outro exemplo é começar a correr com um parceiro de treino que corre com um pace maior que o seu, e tentar acompanhar. Mudança de tênis podem tambem ser um fator importante, por exemplo, saindo de um tênis com mais suporte, pra um mais minimalista (ou vice-versa). Sobrecarga pode ser considerada também, o retorno aos treinos, ao mesmo nível que estava acostumado, após um tempo sem correr, por conta de férias, ou se está retomando aos treinos por conta de doença ou lesão.

O seu histórico de lesão, é um fator de risco para novas lesões or para uma reincidiva. Isso pode estar associado a uma lesão que não foi bem tratada, ou a um desequilíbrio muscular associado a essa lesão antiga, que ainda não foi corrigido.

Na mesma tecla, sabe aquele incômodo que você sente durante ou depos da corrida, que você está empurrando com a barriga há algum tempo?

Isso pode ser um sinal de que alguma estrutura (tendão, músculo, a articulção) está sendo sobrecarregada e por estar fraca (de uma lesão antiga) ou que o corpo está tentando se adaptar mas, está criando uma compensação de outra região. Isso mostra a presença de um “ponto fraco” que precisa ser avaliado e corrigido pra evitar virar uma lesão mais seria. Um equilíbrio entre a intensidade de treino e descanso é extremamente importante para que o corpo se adapte ao treino, e fique mais forte. Um desequilíbrio, gera uma lesão. Entendendo quando fazer uma sessão de treino mais intensa, ou quando acrescenta sessões de recuperação/ou mais leves, são o fundamentais para progredir no treino de corrida, sem dor/lesões.

Isso não funcionou, e você se lesionou. Você precisa de fisio. O que esperar da sessão?

Um fisio esportivo vai te avaliar e tentar enteder sua lesão atual. Pra isso, parte da sessão inclui tomar nota do seu histórico de lesões e programa de treino. Na sessão, o fisio vai utilizar de testes clínicos para indentificar o que está acontecendo, quais estruturas estão lesionadas e a severidade da lesão. Testes de força, resistência a fadiga; entender a sua progressão e rotina de treno são todos fatores importantes a serem considerados. A maioria das lesões de corrida, permite que voce continue ativo(a), correndo ou se exercitando de alguma forma. Como um fisio esportivo, a ultima coisa que eu quero dos meus clientes é que eles parem de se exercitar; isso so traz problemas na recuperação e atrasa o retorno ao esporte. Alguma lesões inclusive, melhoram somente com um reajuste no programa de corrida e alguns exercícios específicos pra corrida, focando em mobilidade por exemplo.

Por outro lado, algumas lesões vao precisar de uma redução mais drastica na rotina de treinos, como por exemplo reações/fraturas por estresse. Essas por exemplo podem requerer, parar de correr por um tempo, mas ainda permitem que voce continue fazendo musculação, nadando, pedalando, para manter seu fitness em alto nível e a musculatura forte, o que ajudar a recuperção óssea. Ainda falando sobre as fraturas, o tratamento mais importante e eficiente é exercicio, e repouso relativo. A contração muscular ajuda o osso a se reconstruir e ficar forte, a falta de exercício torna o osso mais frágil e poroso; no entanto, os exercícios são inicialmente leves e precisam respeitar uma progressão controlada para permitir uma recuperação total e o retorno a corrida.
Outras lesões como, dores anterior no joelho (dor patelo-femoral), síndrome da banda ílio-tibial, tendinopatia (tendinite) patellar, de glúteo ou de Achilles, não precisam de repouso; ao contrário, o tratamento é baseado em exercícios. Esses exercícios são focados em corrigir as falhas biomecânicas e desequilíbrios musculares, e introduzir outros tipos de exercícios, como saltos. Exercícios de salto são muito importantes em atletas de corrida, já que eles focam em restaurar a capacidade/performance das molas do nosso corpo (os tendões).

O tratamento da maioria das lesões de corrida, é baseado em exercício. Outras terapias como massagem, taping, etc, tem seu lugar, mas como coadjuvante, não como a principal linha de tratamento. Exercícios permitem explorar as deficiências musculares, articulares, dos tendões e ossos, restaurar a resiliência desses tecidos, os tornando mais fortes e mais adaptados para suportar os treinos e as cargas impostas com a corrida.

Para alguns corredores, especialmente novatos na corrida, uma análise de vido da corrida, pode ser interessante. Com esse tipo de análise, podemos indentificar falhas no movimento que, corrigido, conseguimos melhorar a performance e a mecânica do movimento, e prevenir algumas lesões.

Ninguém falou que o processo de reabilitação seria fácil. Essa fase pode ser demorada e frustante.
Infelizemente muitas decisões erradas, ou o retorno antecipado a corrida, podem atrapalhar e atrasar o retorno ao esporte.

O nosso objetivo é acompanhar o seu processo, e auxiliar seu retorno ao esporte da maneira mais segura e eficiente.