The plantar fascia is an extension of the Achilles tendon that arises from the heel bone and connects with the bases of the toes. It is composed of three segments, a strong thick central portion and two weaker and thinner outer portions. The role of the central portion is to support the arch of the foot when stationary, and provide shock absorption when moving, to take the load off the bones and joints of the foot Plantar fasciitis is caused when the plantar fascia is exposed to too much force and starts to break down, it becomes inflamed and irritated.
How Does It Happen?
There are a number of issues which can predispose someone to developing plantar fasciitis. Stiffness through the joints in the feet and through the ankles will increase the amount of shock absorption required by the plantar fascia, which may become too great. Likewise, excessive weakness through the ankle muscles means that the plantar fascia is again required to provide more support than it can handle.
Furthermore altered foot types, (high arches and flat feet) also alter the load on the plantar fascia. A high arch foot is a poor shock absorber and transfers more load onto the heel and plantar fascia. A flat foot has less bony support, so the plantar fascia is constantly stretched as it tries to support the arches during standing, walking and running.
Other factors contributing to plantar fasciitis can be high loads of heavy impact activities i.e. running or dancing, poor footwear, and obesity.
Signs and Symptoms of Plantar Fasciitis
Usually there will be a gradual progression of pain, which is most often felt at the tip of the heel. Initially it may be worse in the morning and gradually improve with activity. As the condition becomes worse, pain will begin to surface whenever one is weight-bearing and become worse with activity.
Diagnosis & Investigations
A thorough assessment by an experienced MD Health Physiotherapist or Exercise Physiologist should be sufficient to diagnose plantar fasciitis. Other investigations may be performed to confirm the diagnosis. Ultrasound is the most accurate means of investigation, which will identify swelling, damage and tearing in the plantar fascia.
Treatment for Plantar Fasciitis
The goal of treatment is to reduce the amount of stress being placed on the plantar fascia. An MD Health practitioner will identify any areas of deficiency in your biomechanics and draw an appropriate exercise program to remedy these issues. This may include strengthening the calf and ankle muscles, calf stretching as well as hamstring and gluteal stretches if necessary, and joint mobilisation at the foot and ankle to try and improve flexibility.
To help manage the condition early on, you may be required to rest from any activity with is directly irritating the condition.
Pelvic Joint Dysfunction is a common problem during pregnancy and is related to hormonal effects on the ligaments/joints, weight gain and postural changes during pregnancy.
This blog article will help you with the common problems associated with pelvic joint dysfunction during pregnancy. It should be used in combination with MD Health’s Physiotherapist’s/Exercise Physiologist’s advice.
The pain associated with this problem tends to occur when there has been asymmetrical distribution of forces (i.e. putting more weight through one leg compared with the other).
Activities that may aggravate the pain:
Walking up stairs
Getting in/out of bed or the car
Jogging, long walks
Rolling side to side in bed
Single leg stance
Activities that may help relieve/reduce the pain:
Try and keep distribution of forces equal between the legs
When rolling in bed, put a pillow between your knees and roll with knees together on either side of the pillow
When getting in or out of the car, try and keep order ativan online your knee together and swivel on your bottom
When walking, use smaller steps to decrease the time spent on one leg
When walking, maintain good posture and try not to waddle because this places increasing stress on the spine and hips
Ensure that you use correct sitting and standing postures
Abdominal and buttock muscle strengthening exercises- incorporate these into activities of daily living whenever possible:
Gently lift your pelvic floor muscles and pull your lower abdominal’s in toward your spine
Squeeze your bottom (particularly when lifting or getting up from sitting)
Keep your back upright
Keep breathing normally
When seated, use arms to take more of the load (i.e. pushing off a chair with arms rather than an increased force through the legs)
Rest in horizontal position
Wear flat heels-well cushioned insole
You may need an abdominal brace to help decrease the load on the pelvis
A ligament is a strong band of connective tissue that connects bone to bone. The Anterior Cruciate Ligament (ACL) is the first of the major internal ligament that stabilises the knee, together with the Posterior Cruciate Ligament (PCL). It stops the lower bone of the knee (tibia) sliding forward uncontrollably on the upper bone (femur). Without this ligament, whenever you twist or change direction the knee collapses, so you cannot play pivoting sports such as football, soccer, netball and hockey without this ligament.
How Does It Happen?
This injury most commonly occur undertaking activities involving a rapid change in direction, especially twisting, such as during netball, basketball, football and volleyball. It can be a small twist that just felt a bit awkward, but unfortunately can be enough to tear the ligament.
Signs and Symptoms of an Anterior Cruciate Ligament Tear
There can sometimes be a popping sound (not always), and the knee feels like it gives way. The knee usually swells up immediately and it is very hard to continue with the activity that you are doing. You may not be able to straighten the knee fully and if you continue your activity, you’ll find the knee gives way. If you suspect you have done this injury, you need to be seen by a physiotherapist/exercise physiologist or sport doctor WITHIN THE FIRST HOUR, as it is much easier to test this injury before it swells too much than afterwards.
The management of this injury does vary depending on the demands you place on your knee through your life, but your options should be discussed in detail with your physiotherapist/exercise physiologist or sports doctor.
There are two main options:
1. Knee Re-Construction – Most people will need a reconstruction. This is appropriate if a. You want to continue to play sport throughout your life b. The knee continues to give way c. The is also a cartilage (Meniscal) injury
The rehabilitation for this operation takes 9-12 months (yes that long) and if you are not prepared to do this, the operation will not be successful and you should not proceed, however, you will be restricted in the activities you can do for the rest of your life
2. Rehabilitation Only – A specific strengthening program can help manage this problem if you choose not to have a re-construction, however, you will be limited in your activities and will not be able to play sports that involve pivoting activities again.
Diagnosis & Investigations
Usually a thorough assessment by an experienced MD Health physiotherapist/exercise physiologist will be sufficient to have a suspicion of an ACL tear, that will need to be confirmed by a surgeon. They will order at least an x-ray and usually an MRI scan, that will confirm the diagnosis, guide the need for surgery and rule out other potential injuries e.g. knee fracture.
Physiotherapy & Treatment for an Anterior Cruciate Ligament Tear
It is important that you follow MD Health’s physiotherapist/exercise physiologist’s instructions and advice as the rehabilitation process will dictate the extent that this will affect your life in the long term.
1. If you are going to have surgery, an excellent pre-habilitation before the operation will dictate how long and how well you will recover after the operation. The stronger your muscles are before the operation, the better and faster the recovery afterwards. The rehabilitation will take 9-12 months as it take this long for the new ligament to become strong again, but you strength and control will feel better after 3-4 months, if your strengthening program is guided by our physiotherapists/exercise physiologists and must be consistent
2. If you are not going to have surgery, a rehabilitation program is essential as the muscle control of the knee is the only thing stopping the knee from collapsing. Again it will take 3-4 months, needs to be guided by our physiotherapists/ exercise physiologist and needs to be consistent. However, if it continues to give way, this will lead to a larger risk of arthritis, and you will need to re-consider having a re-construction.
Although taping is widely regarded as an avenue of injury prevention and treatment, it is important to understand when, how and more importantly why to use it.
In the last couple of years there has been a massive craze in multi-coloured and funky taping patterns seen across athletes, but what exactly do they do? The evidence is quite stretchy when talking about actual changes in electromyography (EMG) muscular activation or proprioception (the bodies ability to recognize where it is in space) or even range of motion of the joint. So why then do it? Apart from the “cool” factor there are some instances where taping a certain part of the body can greatly aid in the reduction of pain or irritation to the area, or even preventing further injury , e.g. ankle taping.
When to Tape:
Prior to taping any body part it is imperative to consult a medical professional on the correct methods of taping, which brand of tape to use as some people may be allergic to them, or of course if it is appropriate for them . A comprehensive exercise plan is recommended prior to considering tape as a method of treatment as studies have shown that taping areas such as the pelvis can actually REDUCE the deep core muscles activation due to the tape taking or mimicking the role of muscles, or in fact lose proprioception in the ankle for those who have been taping for long periods of time.
The Most Common Areas Where Taping May Help:
Ankles: Following acute sprain to help prevent further damage, or for high grade tears or chronic ankle sprains during high level activity
Knees: E.g. for acute Patellofemoral pain syndrome to decrease irritation and friction due to mal-tracking of the patella (knee cap), frequent dislocation or subluxations, or tendinopathies or tendinitis.
Shoulders: E.g. Effective in acute rehabilitation of Rotator cuff Injuries, Sub Acromial/Coracoid Impingement, or frequent dislocations or subluxations
How to Tape:
There are plenty of instructional videos online which can guide people on how to tape specific body parts however it is recommended that a medical professional’s advice is consulted in order to make it specific as possible.
Taping a body part is not something that should be relied on. It is merely another treatment option available out there IF appropriate. A specific assessment and tailored rehabilitation program, which taping may or may not be a part of, is the best way to address any issues.
Written By Nicholas Charalambous Physiotherapist at MD Health