Getting your bike setup correctly

Over the last three weeks, the Tour De France has been running. The Tour consists of 21-day stages over a 23-day period, and the riders will cover around 3,500 kilometres (2,200 mi). While not all of us are elite athletes, there has certainly been an increase in cyclist on the road with the nice weather.

Cycling can be a great form of exercise. We get a great cardiovascular workout and it helps improve the strength of the leg muscles. There are, however, many common injuries that can occur when we start to ride or with high volume riding without the correct recovery methods.

Some of the most common sites of pain in cyclists are the neck, shoulder, knee, lower back and sacroiliac joints (SIJs). There are many reasons in which a person might be experiencing pain. It could be related to a new hobby, a predisposing injury, muscle tightness, or it could even be the set-up of your bike. Just like a work desk, our bike set up can be incredibly important to ergonomics, decrease injury, aid in decreasing pain and keep you riding for a longer period of time.

Getting the correct set up on your bike will depend on what kind of bike you have, how tall you are, shoulder reach, as well as what feels comfortable.

Here are a couple of quick tests you can do:

To check your seat height get onto your bike with one leg straight and place the heel of your foot on the pedal at the lowest point, which should make your leg straight. If this does occur then your saddle should be at the correct height for you.

To find the best saddle position, you should sit on the bike with the pedal at 3 o’clock. Place your foot with the joint of the toes on the pedal spindle. In the perfect scenario an imagery perpendicular line should run from your knee-cap through the spindle of the pedal. If the line runs behind the spindle, then the saddle needs to be pushed forward. If the line runs in front of the spindle then the saddle needs to be pushed backwards.

There are a lot of measurements and angles to take into consideration when setting up your bike with an ergonomics assessment. My best advice is that if you are experiencing any pain before, during or after riding your bike, it might be worth a visit to your local bike shop or your local specialized practitioner and ask for an ergonomic bike set up. This will allow to can for longer with the correct posture and decrease your chances of dealing with some of the getting some of the common cyclist pain.

If you would like more information on ergonomic set ups on bikes. Please ask us for a bike set up hand out.

 

Written by Brendan Ashman

 

Did you know that Brendan recently did a certification course for bike fitting and setup. For more information please ask Brendan at brendan@beachclinic.ca or call (416) 546 4887

 

 

 

 

 

 

 

 

 

 

 

Carpel Tunnel Syndrome

The carpal tunnel is a narrow passageway in the wrist, which opens into the hand. It is enclosed by the bones of the wrist (underneath) and the transverse carpal ligament (across the top).

Many structures pass through the carpal tunnel, including:

The carpal tunnel and its contents

The median nerve, which gives feeling to the thumb, forefinger, middle finger and half of the ring finger. The muscles of the thumb are also innervated by the median nerve. A person with advanced carpal tunnel syndrome may find weakness in thumb movements and difficulty grasping objects.

Many tendons also pass through the carpal tunnel – the long flexor tendons from the forearm run through the carpal tunnel into the hand. These tendons are covered by a smooth membrane called the tenosynovium and allow hand movement.

Signs and symptoms

The symptoms of carpal tunnel syndrome include:

  • Numbness
  • Pins and needles
  • Pain, particularly at night
  • Darting pains from the wrist
  • Radiated or referred pain into the arm and shoulder
  • Weakness of the hand
  • The little finger and half of the ring finger are unaffected.

Causes/Risk factors

Any risk factor that causes a reduction in the amount of space inside the carpal tunnel can cause carpal tunnel syndrome. If left unchecked, the median nerve is squashed against the transverse carpal ligament until the nerve cannot function properly. Numbness and pain are the result. It can affect one or both hands. Many factors can increase your risk of developing carpal tunnel syndrome.  These include:

 

  • Anatomic factors: A wrist fracture or dislocation that alters the space within the carpal tunnel can create pressure on the median nerve.  Carpal tunnel syndrome is generally more common in women. This may be because the carpal tunnel area is relatively smaller than in men and there’s less room for error. Women who have carpal tunnel syndrome may also have smaller carpal tunnels than women who don’t have the condition.
  • Nerve-damaging conditions: Some chronic illnesses, such as diabetes and alcoholism, increase your risk of nerve damage, including damage to your median nerve.
  • Inflammatory conditions: Illnesses that are characterized by inflammation, such as rheumatoid arthritis or an infection, can affect the tendons in your wrist, exerting pressure on your median nerve.
  • Alterations in the balance of body fluids: Certain conditions — such as pregnancy, menopause, obesity, thyroid disorders and kidney failure, among others — can affect the level of fluids in your body. Fluid retention may increase the pressure within your carpal tunnel, irritating the median nerve. Carpal tunnel syndrome associated with pregnancy generally resolves on its own after the pregnancy is over.
  • Workplace factors: It’s possible that working with vibrating tools or on an assembly line that requires prolonged or repetitive flexing of the wrist may create harmful pressure on the median nerve, or worsen existing nerve damage. There is little evidence to support extensive computer use as a risk factor for carpal tunnel syndrome, although it may cause a different form of hand pain.

 

Diagnosis

Early diagnosis and treatment are important to avoid permanent damage to the median nerve. An Osteopath will perform a physical examination of the hands, arms, shoulders, and neck which can help determine if your complaints are related to daily activities or to an underlying disorder, and can rule out other painful conditions that mimic carpal tunnel syndrome. The wrist is examined for tenderness, swelling, warmth, and discoloration. Each finger is tested for sensation, and the muscles at the base of the hand are examined for strength and signs of muscle wasting.

Occasionally it is necessary to confirm the diagnosis by use of electrodiagnostic tests:

  • Nerve conduction study: electrodes are placed on the hand and wrist to measure the speed with which nerves transmit impulses.
  • Electromyography: electrical activity can be viewed on a screen to determine the severity of damage to the median nerve.
  • Ultrasound imaging: may show impaired movement of the median nerve.

 

Conservative Treatment

Initial treatment of carpal tunnel syndrome generally involved resting the affected hand and wrist for at least two weeks – avoiding all activities that might aggravate the symptoms.  If there is inflammation, applying a cool pack can help to reduce swelling.

Osteopathic management consists of ensuring optimal hand, wrist, elbow, shoulder and neck biomechanics with techniques such as joint articulations, manipulations, and soft tissue therapies.  Identifying and removing the aggravating or underlying causative factor is important for a long term resolution.

Stretching and strengthening exercises are often helpful once the severity of the initial symptoms have reduced. Yoga has also been shown to reduce pain and improve grip strength among some patients with carpal tunnel syndrome.

 

Medication: Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other on-prescription pain relievers, may ease symptoms that have been present for a short time or have been caused by strenuous activity. Orally administered diuretics may help to decrease swelling. Corticosteroids* can be injected directly into the wrist or taken by mouth to relieve pressure on the median nerve and provide immediate, temporary relief to persons with mild or intermittent symptoms. Additionally, some studies show that vitamin B6 (pyridoxine) supplements may ease the symptoms of carpal tunnel syndrome.

*Corticosterioids should not be taken without a doctor’s prescription.

 

Surgical Treatment

Occasionally carpal tunnel symptoms do not resolve with conservative treatment alone. Carpal tunnel release is one of the most common surgical procedures and is generally considered if symptoms last for 6 months. Surgery involves severing the band of tissue across the wrist (transverse carpal ligament) to reduce pressure on the median nerve.

Although symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take months. Some patients may have infection, nerve damage, stiffness, and pain at the scar. Occasionally the wrist loses strength because the carpal ligament is cut. After surgery, an Osteopath will assist to restore wrist strength and mobility.

Recurrence of carpal tunnel syndrome following treatment is rare. The majority of patients recover completely.

 

If you are suffering from any type of hand or wrist pain, contact us for an appointment.

Proper posture at your office

Most postural issues are caused from everyday habits from everyday activities such as sitting in office chairs, staring at a computer, prolonged use on your mobile phone, especially smart phones and iphones, carrying a purse or bag over your shoulder, driving and repetitive physical activities.

If your job involves prolonged sitting, like so many individuals that work in an office space or corporate environment, you may experience the pain and discomfort caused by poor posture.

Prolonged sitting for desk work can lead to muscular and skeletal imbalances. Your skeletal system gets used to the hours of sitting in an unnatural position, wreaking havoc on your body, posture, and causing more serious long-term issues. Continuous daily sitting affects posture and can also cause physical pain, strain, and discomfort.

Here are some basic tips to improve posture and ergonomics, especially for people who sit for most of most of the day.

  • Sit up straight
  • Align the ears, shoulders, and hips in one vertical line.
  • Sitting in the one position for a prolonged period of time, even a good one, can be tiring. Shifting forward to the edge of the seat with a straight back and alternating with the support of the chair can help add some variety.
  • Take regular breaks and get up and move around. Get up every half hour for two minutes to stand, walk or stretch.

Improve your set up at your desk:

  • Head is level and inline with the torso. Beware not to draw the head forward towards the computer screen as this can put a lot of stress on the neck.
  • Shoulders are relaxed, not shrugged, and upper arms hang normally at the side of the body.
  • Hands, wrists, and forearms are straight, inline and roughly parallel to the floor.
  • Keep your elbows close to the body, ideally at your sides, this will take stress off the back of your shoulders and your mid back.
  • Keep your back upright and not slouched.
  • Keep the knees and hips at the same height
  • Keep your feet on the ground and if you cannot touch the ground use an elevated footrest.

If you are still finding that you are having a very hard to sitting for long periods of time, talk to your HR to request a sit stand desk. A simple and affordable sit stand desk, such as veridesk, can be a good solution.

Try to keep an active lifestyle. This can help reduce the impact of poor posture on your skeletal system and improve overall health. Try to incorporate more physical activities into your routine, such as going for a walk with your pet or taking advantage of a gym membership. Being active doesn’t necessarily have to mean an intense gym workout or marathon, although those are great too. It can be as simple as taking some time to stretch and do low impact yoga or taking a walk in your neighbourhood or local park.

Try these simple tips and you will notice a difference. If you are still experiencing pain, such as neck or back pain, feel free to call us on (416) 546-4887 to speak to one of our osteopathic manual practitioners or book online at beachclinic.janeapp.com and we can help you become pain free.

Most Common Basketball Injuries

The Toronto Raptors are in the NBA playoff finals for the first time in History and what an exciting time it is to be in the city of Toronto. With a current 2-1 lead, a championship certainly favours the Raptors. With certain key players like Thompson and Durant out with Injury, it has certainly made the Raptors job easier. Pivotal moments like this, where injury is a huge factor, it brings on a great topic of discussion – INJURY.

What makes basketball players susceptible to injury?

In basketball, there are a lot of quick pivoting moments such as jumping, running, cutting. You have people going in different directions at all speeds, playing offense and defense. Athletes today are stronger and more powerful with more explosive force than ever before, thanks to sports nutrition, sports performance and conditioning.

What can players do to prevent injury?

Maintain a good balanced workout, stretch daily and strengthen your core muscles. Flexibility is extremely important, but it’s not as much of a focus for young athletes. As you get older, flexibility becomes important to help limit injuries on the basketball court.

What are the most common injuries in Basketball?

  1. Foot and ankle injuries

Lateral ankle sprains are the most common injury in Basketball. With the quick movements, lots of jumping and especially big feet in some players, some injuries are bound to happen. You may see a player jump and land on another players foot, causing their foot and ankle land awkwardly, resulting in a sprain.

High ankle sprains, an injury to the ligaments between the two lower leg bones (tibia and fibula), can be more of a serious injury and sometimes require surgery to reestablish the relationships between the bones.

With a sprain, follow RICE: Rest – Ice – Compression – Elevation. A lot of these injuries don’t need surgery, but if you can’t put weight on it, get an X-ray to rule out a fracture.

  1. Hip and thigh injuries

An injury to the hips, such as a strained hip flexor, can result from quick pivoting movements. Getting a knee from another playing into the thigh can cause bruising and possible contusions. This may seem like no big deal, but it can be painful and keep you out of the game. For this, ice it for the first 24-48 hours, then switch to heat and stretching so the thigh doesn’t get too tight.

  1. Knee injuries

Basketball requires extensive stop and go and cutting maneuvers which can put the ligaments and menisci of the knee at risk. Injury to the medial collateral ligament is most common following a blow to the outside of the knee and can be often be treated with ice, bracing and a gradual return to activity.

An injury to the anterior cruciate ligament is a more serious injury and can occur with an abrupt change in direction and landing for the jump. Although this ligament tear is most commonly a season ending injury that requires corrective surgery, current techniques used to repair the ACL ligament generally allow the player to return to play the following season.

  1. Wrist and hand injuries

From jammed fingers to sprained, dislocated or fractured fingers, these injuries are very common among basketball players. The ball can hit it your hand or fingers at a fast speed and can cause a significant sprain or break. Sprained wrists can occur if a player falls and puts his hand down to protect himself.

  1. Head and face injuries

Concussions, bloody lips, and other head injuries are usually the result of getting elbowed accidentally or coming down from a layup and getting hit in the head. It’s common when a player is rebounding or fighting for position.

For concussion, players should always get out of the game and have an evaluation by a medical health professional that regularly manages concussions.

 

For an assessment, treatment and management of your Basketball Injuries our osteopaths, massage therapist and chiropodist at Beach Integrated Health Clinic can help you get back on the court. Feel free to contact us directly with any further questions on (416) 546 4887 or  book an online appointment.

10 Tips to Get Ready For Summer Activity

As Osteopaths we can see many different types of injuries around this time of year, some which can be avoided with some good advice whether you are a gym junkie, athlete, weekend warrior or just like to be out in the sunshine, so here are my top 10 tips to stay injury free this summer.

  1. Don’t Go Too Hard Too Fast

So, you have decided to use this warmer weather to your advantage and start getting back into your workout routine. That’s awesome! Your fitness journey is underway. But remember don’t go too hard to fast, in my opinion this is one of the worst things you can do. Going to hard too fast increases your risk for injury, whether it is running flat out, running a distance you haven’t done for a long time, or lifting the same amount of weight you did before after having time off. Make sure that you ease yourself into your training session and let your body adapt to the training routine.

  1. Don’t Over Train

If you are training for the first time or getting back to training, make sure you are giving your body enough time to recover. Overtraining can increase your risk of injuries such as tendinopathies or muscle tears. I would recommend at least one days break in between your training sessions if you are new to a particular type of activity to allow adequate time for your body to recover. If you are someone that has been training throughout the winter and feel that your body is already use to the routine. Then I would suggest doing a smaller run/ walk the day after a large run/walk that way you are still training, but not pushing the body to the limit.

  1. Poor Technique

As osteopath we are trained in identifying muscle weakness and will be able to tweak your technique to help you stay pain free and increase your performance. If your technique is off, your body will compensate whether it be your knees, back or shoulders. This does not just apply to weight lifting technique at the gym. It could be applied to poor gait or running form, improper golf or tennis technique, and even poor curling technique.

  1. Don’t Be Afraid to Ask for Help

If you are unsure on how to use a bit of equipment in the gym or unsure whether you should walk up hills, but the best thing you can do is ask for help or ask questions. If at the gym and you are unsure about how to perform a specific movement or how to use a machine, ask a gym staff member. This will help you decrease your risk of injury and help improve your training.
As Osteopaths we are here to help you, educate and ultimately get you pain free. If you are having trouble walking up hills or something specific is causing you pain, let us know. Your goals are our goals to help you achieve!

  1. Jumping straight into it!

With the increasing trend in functional fitness classes and high intensity training gyms like F45. Plyometric exercises have become increasingly common for people to do. While I am a fan of F45, promoting a community feel with short bursts of continual intense exercise, it can lead to some problems. If you have never done plyometric exercises such as box jumps, this can cause a few problems. Plyometric training requires a combination of strength, power and control. It is important to gradually build up all of these factors. So take your time with your training and build yourself up to the jumps, this way you’ll avoid injury.

  1. Training Through an Injury

No pain, No gain. This is not always true. If you are getting intense sharp pain when you train, then this is your bodies way of telling you that something is wrong and that something is not 100%. You could potentially already have an injury or your body is about to get an injury. One of our Osteopaths would be happy to help out with your injury with a combination of motion testing, treatment, education on the injury and active rehabilitation.

  1. Forgetting to Warm Up

Warms up should be active and specific for the kind of training you are going to do. What does that mean? Well, warm up should be movement based in which primes your muscles for the activity you are going to be doing. Roughly about 10minutes should be spent on activating the area in which you are about to work on. One of the ways in which you might like to try is using a resistance band on the targeted area that you intend to use. Our Osteopaths can make specific warm up for you, and the type of training you are doing, so don’t be afraid to ask!

  1. Avoiding a Cool Down

After training the last thing we want to do, is hang around the gym or the running track to cool down. However, cooling down is important and part of our recovery phase. Sometimes our body can be stiff and sore after training so try using a foam roller or performing some stretches for the muscles that you have just used in your training session.

  1. Nutrition

While restricting calories is common with people that are trying to lose weight, it is important to fuel your body with nutritious foods and the right amount of food for your daily activities. If you are unsure about how much food or the type of foods you should be eating, I would suggest consulting with a Dietician or Naturopath.

  1. Lack of Sleep

Sleep helps our body heal from the activities we have done and also the injuries that we have. If you are not sleeping well or long enough then there is a chance that your muscles may not be recovering to their full capacity.

 

Written by Brendan Ashman

Pregnancy And Osteopathy

New life and the whole process of pregnancy is always such a magically and amazing feat by the human body. Sometimes there can be pain and discomfort associated with pregnancy. Many processes occur during pregnancy, hormones increase and decrease, weight is gained, and then sometimes pain can present itself. There are many areas of the body in which pain or discomfort can occur, however there are some complaints that are a little more common, which include the sacroiliac joint (SIJ) pain, thoracic pain, neck pain and even complaints of reflux or GORD.

Some of these complaints can be explained by an increase in weight from the growing baby in the womb. Posture is another factor, whereby the mother’s centre of gravity changes as a result of the growing baby, causing some of these complaints. One of the main culprits for pain and discomfort that you may experience can be related to the hormones that are stimulated. Relaxin is a hormone that occurs during pregnancy and is incredibly active during the third trimester. Relaxin is responsible for the relaxation of ligaments around the pelvis so that the child may pass through the birth canal. If our ligaments are being told to relax more, it will place more stress on our muscles and joints particular the SIJ and even the pubic symphysis causing pain.

How can Osteopathy help?

The philosophy of Osteopathy is that structure and function are interrelated and interdependent. Our treatments aim to normalise the structure so that it functions as efficiently as possible. Treatments during pregnancy are no different. We aim to assist the natural process of pregnancy and birth by aiding the body to adapt and align as the pregnancy progresses. Osteopathic treatment achieves this by using safe and efficient techniques, while making sure the mother is comfortable at all times. During birth, a range of factors influences the descent of the baby through the pelvis. The mother’s pelvis may be twisted or rigid which can interfere with the baby’s passage through the birth canal. Osteopathic treatment can help to align your body so that your pelvis and lower back mechanics are in the best possible position they can be and with as little tension or restriction as possible. Osteopathic treatment will maximise your body’s ability to change and support you and your baby with minimum pain and discomfort.

We would also prescribe some exercises to help the patient manage their pain at home based on our findings. Some of these exercises may include banded hip abduction to help strength the pelvic stabilizers, the use of a foam rolling/ tennis ball to help reduced some tension in tight muscles or other mobility exercises.

Is It Safe To Have Osteopathic Treatment During Pregnancy?

Osteopathy is safe and gentle for both the mother and the baby. The techniques used during pregnancy are carefully selected to minimise any risk. These techniques are gentle and the comfort of the mother is always taken into consideration and may be adapted to suit each patient. Some therapists use specifically designed pregnancy cushions if they need you to lie on your front for certain techniques. Pregnant patients can tell the therapist how comfortable they are in certain positions. An osteopath can accommodate any woman, regardless of size.

Can Osteopathy Help Postnatally?

Depending on the type of labour experienced, women can have a wide range of issues postnatally. Osteopathic care can help to restore and maintain normal pelvic alignment and mobility and therefore, taking away any pain and discomfort they may be feeling. If you have unresolved childbirth stresses from labour, these can contribute not only to ongoing back problems, but also to difficulties with menstruation, stress incontinence, and bowel problems such as constipation. Osteopathic treatment can also help with aches and pains associated with poor breast-feeding posture, lifting car capsules and prams, carrying your baby and bending over the cot.

It is especially important after pregnancy to work on strength and stability to help restore the body back to it’s pre pregnancy status. This is something that we can help and guide you with and help you get back to be the best parent that you can be.

 

If you have any questions about your pregnancy and related musculoskeletal complaints, feel free to email one of our osteopathic manual practitioners:

Brendan (brendan@beachclinic.ca) or

Daniel (daniel@beachclinic.ca)

Or call us at (416) 546-4887

Osteoarthritis

As an Osteopath, one of the common conditions that we see is Osteoarthritis or OA. OA is the most common type of arthritis which affects nearly five million Canadians or 1 in 6 people. So what is Osteoarthritis? OA is described as a progressive disease of the whole joint that leads to breakdown of joint cartilage and the underlying bone. And used to be described  as degeneration or “wear-and-tear”, but recent studies have described it as a result of the body’s failed attempt to repair damaged joint tissues, as the body lays down more bone to protect itself.

So who gets OA? Osteoarthritis does not discriminate against race or sex, however according to the World Health Organization, Women are more likely to get osteoarthritis than men at a 2:1 ratio. This is most likely due to hormonal and bio-mechanical differences.

There are a number of risk factors than may influence and increase the risk of a person’s chance of developing osteoarthritis beginning with; Age, sex, family history, excess weight, previous joint injuries, some occupations, Joint misalignment/deformities, muscle weakness and a sedentary lifestyle.

 

What are the signs and symptoms of OA?

The most common presenting complaint is pain, which generally gets progressively worse over months to years. The joint pain or joint stiffness may may last up to 30 minutes or until the joints warm up and is typically worse in the morning or after long periods of inactivity. The most common places of pain are typically weight bearing joint such as the knees, hips and spine, although OA can occur at any joint in the body. OA symptoms may also disrupt your sleeping patterns, which can make your symptoms feel worse, and alter your mood.

 

How is Osteoarthritis Diagnosed?

There is no specific test for the diagnosis OA. A diagnosis is made based off a patients extensive medical history and physical examination findings. However, there are imaging techniques such as x-rays that can be useful in determining the progression of a patient’s OA.

However, it is important to remember, that a patient’s symptoms do not always match what is found on x-rays. For example, in a patient with early OA, your x-ray may show no evidence that reflects the patients symptoms they are experiencing. On the other hand a patient can have severe OA on a x-ray, but present with minor pain. Which is why it is important to take an individual approach to every patient.

 

Is there a Cure?

There is currently no cure for OA. However, it is very important to remember that there are ways to manage a patients symptoms and improve their function. A treatment approach is generally centred around a combination of stretches/ massage, physical exercises, weight management and medications, which can be a useful way to help patients control there pain levels. In extreme cases a referral to a healthcare professional specializing in orthopaedic care may be needed.

Remember if you have any other questions please don’t hesitate to ask one of your friendly osteopaths

 

Written by: Brendan Ashman

 

Tennis Elbow

The most common elbow condition is tennis elbow,  also known as lateral epicondylitis,  is caused by overuse and excessive strain on the extensor muscles of the forearm resulting from wrist extension, such as in back hand tennis players, or occupations that involve repetitive wrist movement, such as carpenters or bricklayers. It may be provoked by any exercise that involves repeated and forcible extension movements of the wrist, like using a screwdriver or hammer.

Symptoms of Tennis Elbow

Tennis elbow usually has a gradual onset but it can also be sudden. There may be a constant muscular ache in the forearm and/or near the outer elbow. It is aggravated by movements that involve extension of the wrist, such as picking up bags or turning on taps and sometimes it may feel like there is less strength when grasping objects. The outer elbow can be tender to touch, is painful with resisted extension of the wrist and is painful when stretching the wrist.

Tennis Elbow Treatment

In the acute phase of the tennis elbow rest is vital. Apply ice 2-3 times daily to reduce inflammation and pain. Anti-inflammatory medication or gels can also work very well. Osteopathic treatment can help loosen and stretch the muscles involved and also reduce the amount of inflammation in the elbow. Your Osteopath will also check any other areas that may be affected, such as the shoulder or upper back and neck, and show you stretches you can do to reduce tension in the forearm muscles and also show you exercises you can do to strengthen these muscles.

Achilles Tendinitis

Achilles tendinopathy or generally known as achilles tendinitis is a common condition characterised by localised pain and swelling at the achilles tendon. The achilles is a large tendon connecting the major calf muscles, the gastrocnemius and the soleus, to the heel bone. During a calf contraction tension is put through the achilles tendon and if this tension is excessive due to too much repetition or high force, damage to the tendon occurs, leading to subsequent degeneration and inflammation.

Signs & Symptoms of Achilles Tendinitis

Pain at the achilles tendon is most commonly felt either at the mid-point of the tendon or at the portion where it joins with the heel bone. The pain can either be sharp or a dull ache. There may also be limited ankle flexibility, redness or heat over the painful area, a nodule (a lumpy buildup of scar tissue) that can be felt on the tendon, or a cracking sound (scar tissue rubbing against the tendon) when the ankle moves.

Causes of Achilles Tendinitis

Achilles tendinitis commonly occurs in both recreational and professional sports athletes, usually involving running and jumping type activities. Occasionally, it may occur suddenly due to a high force going through the Achilles tendon beyond what it can withstand. This may be due to a sudden acceleration or forceful jump. It can also be caused by adverse lower limb biomechanics, tight or fatigued calf muscles, previous calf strain/ tear and ankle sprain, weak muscles, overtraining, increasing training load too quickly, excessive hill running or speed work, overpronation and inappropriate footwear.

Treatment, Management & Prevention of Achilles Tendinitis

If you start experiencing achilles pain, then stop doing the activity that started the pain and rest. Ice the area for 10-15 minutes multiple times a day, until the swelling subsides. Take some anti-inflammatory medication is the pain persists for more than 2 days.

Manual therapy such as osteopathy can help with the pain, muscle tightness, joint mobility, body alignment, inflammation and swelling. This may include techniques and modalities such as  soft tissue massage, manipulation, dry needling, electrotherapy and taping.

Shock wave therapy has also shown to be effective, especially more for insertional achilles tendinopathies.

A strengthening program should be implemented once the swelling has gone down. This exercise program should consist of eccentric exercises, but also exercises such as concentric strengthening and other exercise to address possible functional deficits (ie. weak gluteals). One of the most useful strengthening technique for the achilles is the heel drop. This is where you lower yourself from being up on your toes and allow your heel to slowly drop down and off the level of a step. This exercise should be done slowly and it can be normal it feel some pain, but as long as it doesn’t stick around longer than the exercise (irritable). From this exercise once it becomes easier and less painful, load can be added (ie. a backpack), increased repetitions, increase in range, and increase in speed (much later). Although this is one exercise it is best if you consult your osteopath or physiotherapist to rehab your achilles tendon correctly.

If you are a runner, you can start running once there is no pain on calf raises, heel drops or hopping. Make sure that there is no speed or hill work in these run sessions and there is at least one rest day between each run. Once there is no pain during or between runs you can gradually increase your volume.

Plantar Fasciitis

Plantar Fasciitis and Running:

The Plantar Fascia is a broad, dense fibrous connective tissue that runs across the bottom of your foot and connects your heel bone to your toes. The plantar fascia is designed to support the foot and form the arch. Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. If tension on that bowstring becomes too great, it can create small tears in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed.

Plantar fasciitis is one of the most common causes of heel pain and it commonly causes stabbing pain that usually occurs with your very first steps in the morning. Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing or after getting up from a seated position.

Plantar fasciitis is particularly common in runners. In addition, people who are overweight, women who are pregnant and those who wear shoes with inadequate support are at risk of plantar fasciitis. It is also common in occupations that require you to be on your feet and especially if the surface you are standing on is hard, such as factory workers. Other factors that can have an influence are improper shoes and faulty foot mechanics.

Ignoring plantar fasciitis may result in chronic heel pain that hinders your regular activities. You may also develop foot, knee, hip or back problems because of the way plantar fasciitis changes your walking. Common problems including shin splints, patella tendonitis and ITB syndrome. Continuous pulling of the fascia at the heel bone eventually may also lead to the development of bony growth on the heel. This is called a heel spur.

Running Injury Management Tips:

  • Put your feet up. Stay off your feet for several days when the pain is severe.
  • Apply ice. Hold a cloth-covered ice pack over the area of pain for 15 minutes three or four times a day or after activity. Or try ice massage. Freeze a water-filled paper or foam cup and roll it over the site of discomfort for about five to seven minutes. Regular ice massage can help reduce pain and inflammation.
  • Decrease your distances. You probably won’t have to permanently retire your running or walking shoes, but it’s a good idea to cover shorter distances until pain subsides.
  • Take up a no- or low-impact exercise. Swap swimming or bicycling in for walking or jogging. You’ll likely be able to return to your regular activities as heel pain gradually improves. However, some people find that the only way to avoid a recurring problem is to give up high-impact activities, such as running and some forms of dance.
  • Add arch supports to your shoes. Inexpensive over-the-counter arch supports take the tension off the plantar fascia and help absorb shock, or if you want to invest more in a good pair of custom orthotics go see your local podiatrist. Also make sure that your runners are not too worn out as they will generally cause you more problems; general rule of thumb is 600km until a new pair is required.
  • Stretch.Simple exercises using household objects can stretch your plantar fascia. Also try using a rubber bouncy ball or a golf ball to help release certain tension points in the muscle. Simply do this by having the ball on the ground and apply pressure directly onto it where it is sore. Also stretch your calfs and hamstrings as these muscles will have an impact on the plantar fascia.
  • Treatment. Go see your local osteopath for pain relief and for a speedy recovery.

Prevention of Plantar Fasciitis:

You can take some simple steps now to prevent painful steps later:

  • Maintain a healthy weight. This minimises the stress on your plantar fascia.
  • Choose supportive shoes. Avoid high heels. Buy shoes with a low to moderate heel, good arch support and shock absorbency. Don’t go barefoot, especially on hard surfaces.
  • Don’t wear worn-out athletic shoes. Replace your old athletic shoes before they stop supporting and cushioning your feet. If you’re a runner, buy new shoes after about 600 kilometres of use, as uneven wear can develop.