Plantar fasciitis is a very common condition and there are many different ways to treat it effectively. For those unfamiliar with plantar fasciitis, it is a painful condition that causes pain in the bottom of the foot. Usually, it is present in the heel and spreads into the soft tissue through the arch and bottom of the foot. It usually starts for no apparent reason and can be stubborn if left untreated.

How Common is Plantar Fasciitis?

Plantar fasciitis is a very common complaint and we are asked questions about it quite frequently. It is said to affect 10% of adults and people of all athletic abilities, so there’s a good chance you’ve either experienced this condition yourself or you know someone who has. Rupture of the plantar fascia is a relatively rare condition (when compared to plantar fasciitis) but the two conditions do share an interesting relationship…

Tear of the Plantar Fascia

The plantar fascia is a soft tissue structure on the bottom of your foot, running from the heel toward your toes. The movement of bringing your toes toward your shins puts a stretch on this tissue. Although relatively rare, the plantar fascia can be ruptured. Rupture of the plantar fascia most commonly occurs with one event. At the time of injury, the person will usually hear a “popping” noise and immediate pain.

Diagnosis of Plantar Fascia Rupture

There is usually an inability to perform a one-leg calf raise and bruising on the bottom of the foot. X-rays can be helpful in determining if there is an associated fracture of the calcaneus. A 2004 study published in the American Journal of Sports Medicine found that 17 of 18 cases of plantar fascia rupture had prior symptoms of plantar fasciitis. Perhaps more interesting, is that numerous studies have found a relationship between rupture of the plantar fascia and prior treatment with corticosteroid injection.

Treatment of Plantar Fasciitis and its Relationship to Rupture

- Leach et al; 6 ruptures studied / 5 had prior injection in the plantar fascia.
- Sellman; 37 ruptures studied / all 37 patients had prior injection to the plantar fascia.
- Acevedo et al; 51 ruptures studied / 44 patients had prior injection to the plantar fascia.
- Saxena et al; 18 ruptures studied / 4 patients had prior injection to the plantar fascia.

Corticosteroid Injection for Plantar Fasciitis

The proposed explanation for increased rupture is that the corticosteroid injection in the plantar fascia actually weakens the tissue. When this is followed by a rapid stretching of the plantar fascia (usually during athletic activity) rupture can occur. Keep in mind that rupture of the plantar fascia is rare and treatment for plantar fasciitis with corticosteroid injection may be a viable option for many people.

Conservative Treatment for Plantar Fasciitis

At Burlington Sports Therapy, we recommend an approach that uses one or a combination of treatment approaches. Active Release Technique (ART), Graston Technique, Laser Therapy (Cold Laser Therapy or Low Intensity Laser Therapy) and custom foot orthotics have all shown themselves as being effective ways to treat plantar fasciitis.

Active Release Technique for Treating Plantar Fasciitis

Active Release Technique or “A.R.T.” is a very popular soft tissue treatment approach that has a reputation for resolving injuries rapidly. It is utilized by many professional athletes and is performed all over the world on a daily basis. It has a unique ability to distinguish between different muscles and tissues and breakdown areas of dysfunctional “scar tissue”. The process of treatment involves gently moving the patient through different movements specific to different muscles. At the same time, the practitioner holds the muscle and assists in the scar tissue removal.

Graston Technique for Treating Plantar Fasciitis

The Graston Technique involves the use of six different stainless steel tools that are shaped for different areas of the body. It is very effective at removing scar tissue from dysfunctional soft tissues, especially in areas like the plantar fascia on the bottom of the foot.

Laser Therapy for Plantar Fasciitis

Laser therapy has become very popular in recent years due to its ability to rapidly resolve many conditions. Plantar fasciitis is one of these conditions. Laser therapy (also commonly called cold laser therapy or low intensity laser) assists the body’s natural healing process of cell regeneration. The stimulation of dysfunctional tissue using the laser is a painless way to recover from injuries, especially a condition like plantar fasciitis.

Orthotics for Plantar Fasciitis

Custom foot orthotics are made from casts of your feet. They are made to accommodate any foot abnormalities or biomechanical dysfunctions that may have contributed to plantar fasciitis. They assist the foot by stabilizing the arch and allowing for proper mechanics during standing and walking. They are also known to improve foot, ankle, knee and hip mechanics as well as improving chronic cases of lower back pain.

For further information or to schedule an appointment – 905.220.7858 

email – info@burlingtonsportstherapy.com

References
Delitto S, Dewitt J, Ferland A, Fearon H, MacDermaid J, McClure P, Shekelle P, Smith AR, Torburn L. Plantar fasciitis – APTA clinical guidelines. Journal of Orthopaedic & Sports Physical Therapy 2008; 38(4): A1-A18.
League A. Current concepts review: plantar fasciitis. Foot & Ankle International 2008; 29(3): 358-366.
Saxena A, Fullem B. Plantar fascia ruptures in athletes. The American Journal of Sports Medicine 2004; 32(3): 662-665.
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An ankle sprain is one of the most common sports injuries that we encounter at our clinic. The majority of ankle sprains are called inversion sprains. These sprains are the classic “rolling the ankle” when you twist your ankle from the outside of the joint. Perhaps a lesser known type of ankle sprain is a high ankle sprain. This is technically called a syndesmosis sprain.

What is a High Ankle Sprain?

A syndesmosis sprain is a different type of ankle sprain which affects ligaments higher up in the ankle when compared to those ligaments affected with common inversion ankle sprains. For this reason, syndesmosis sprains are frequently referred to as “high ankle sprains”.

What Structures are Damaged with a High Ankle Sprain?

High ankle sprains are not as common as inversion ankle sprains and they often take longer to heal. The primary structures that are damaged with high ankle sprains are the anterior inferior tibiofibular ligament, the posterior inferior tibiofibular ligament and the interosseous ligament. In simple terms, these are some of the ligaments at the very bottom of your tibia and fibula (the bones in your leg) including the long thin membrane that separates these two bones.

How does a High Ankle Sprain Happen?

There are various mechanisms for a high ankle sprain but external rotation of the foot, dorsiflexion (bringing your toes toward your shin) or a combination of these movements are the most common. It is usually painful to walk after a high ankle sprain. In some instances the patient with a high ankle sprain will prefer to walk on the forefoot as dorsiflexion causes pain (since it mimics the mechanism of injury).

Diagnosing a High Ankle Sprain

X-ray imaging can be helpful for ruling our fracture or assessing the severity of the sprain. (For any chiropractors or medical practitioners reading this blog, we can check the tibia-fibula clear space which should be less than 6mm if undamaged and we can check the tibia-fibula overlap which should be greater than 1mm in the mortise view).

Treatment for High Ankle Sprain

Treatment of a high ankle sprain depends on the severity of the case. Immobilization and non-weight bearing is sometimes necessary in more severe cases, while others can continue walking during the course of recovery. Initially passive modalities (physiotherapy) can be helpful in reducing inflammation and promoting tissue healing. Examples of these treatments include ultrasound, microcurrent and interferential current (IFC). Our clinic prefers the use of low level laser therapy. Low level laser therapy improves the cellular composition in the area of the injury, allowing less swelling and decreased pain. Active Release Technique and Graston Technique can also be effective for treating high ankle sprains. The treatment that is right for you will depend on a variety of factors.

We hope that you choose our clinic for your injuries. For more information or to schedule an appointment, please do not hesitate to contact us. Telephone – 905.220.7858. Email – info@burlingtonsportstherapy.com

References
Lin C, Gross MT, Weinhold P. Ankle syndesmosis injuries: anatomy, biomechanics, mechanism of injury and clinical guidelines for diagnosis and intervention. Journal of Orthopaedic & Sports Physical Therapy 2006; 36(6): 372-384.
Pajaczkowski J. Rehabilitation of distal tibiofibular syndesmosis sprains: a case report. Journal of the Canadian Chiropractic Association 2007; 51(1).
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The temporomandibular joint (TMJ) is a joint located just in front of your ear. It is primarily responsible for movements of the mouth or jaw, most notably chewing and talking. Just like any other joint in our body, it is subject to pain, dysfunction and injury. It is believed that 25% of the population experiences some form of TMJ dysfunction.

Symptoms of TMJ Disorder

Symptoms of TMJ dysfunction include pain in the face and around the ear, grinding, clicking or popping with movement and tenderness with manual palpation. Many patients with TMJ dysfunction also experience headaches. Obviously, the best way to ascertain whether you truly have TMJ dysfunction is to consult with a knowledgeable practitioner. In the meantime, try these simple tests on your own…

- Place your fingers directly in front of the opening in your ear. Open your mouth widely…do you feel any clicking or popping?
- Watch your mouth in a mirror when you open your mouth really wide…does it move straight or deviate sideways when moving?

Treatment of TMJ Pain

There are many different treatment options for TMJ disorder. The usefulness of each different treatment modality will depend on the specific nuances of each individual case. Strengthening of weak areas is often important as well as soft tissue therapy directed at overused, dysfunctional muscles. We have found that treatment using active release technique (ART) is very useful for this component of care. Other treatment adjuncts can include laser, joint mobilization, treatment of the cervical spine and postural correction.

If you’re suffering from TMJ dysfunction, please don’t hesitate to seek treatment. We have many treatment options at our Burlington Chiropractic and Physiotherapy clinic.

Email – info@burlingtonsportstherapy.com

References
Vinjamury SP, Singh BB, Comberiati R et al. Chiropractic treatment of temporomandibular disorders. Alternative Therapies 2008; 14(4): 60-63.
Younger JW, Shen YF, Goddard G, Mackey SC. Chronic myofascial temporomandibular pain is associated with neural abnormalities in the trigeminal and limbic systems. Pain 2010; 149: 222-228.
Yuill E, Howitt S. Temporomandibular joint: conservative care of TMJ dysfunction in a competitive swimmer. Journal of the Canadian Chiropractic Association 2009; 165-172.
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Restless legs syndrome is an unpleasant condition that affects people of all ages. Approximately 57% of elderly people and 5 – 15% of the general population experience restless legs syndrome. Although the symptoms are difficult for patients to describe, it is characterized by an urge to move the legs usually due to an unpleasant sensation between the knee and ankle. Many patients report a decrease in symptoms with movement, stretching, rubbing or hot water.

Symptoms of Restless Legs

- An urge to move the legs, usually accompanied or caused by uncomfortable and unpleasant sensations in the legs (sometimes the urge to move is present without the uncomfortable sensations and sometimes the arms or other body parts are involved in addition to the legs).
- The urge to move or unpleasant sensations begin or worsen during periods of rest or inactivity such as lying or sitting.
- The urge to move or unpleasant sensations are partially or totally relieved by movement such as walking or stretching, at least as long as the activity continues.
- The urge to move or unpleasant sensations are worse in the evening or night than during the day or only occur in the evening or night (when symptoms are very severe, the worsening at night may not be noticeable but must have been previously present).

Types of Restless Legs

There are two types of Restless Legs Syndrome; Primary Restless Legs Syndrome and Secondary Restless Legs Syndrome. In 40 – 60% of Primary Restless Legs Syndrome cases, there is a familial history. Secondary Restless Legs Syndrome is a result of a different health condition. Some of these include iron deficiency, pregnancy, renal disease, neuropathy, diabetes, rheumatoid arthritis and Parkinson’s.

Diagnosing Restless Leg Syndrome

As with any condition, the first step in effective management for Restless Legs Syndrome is confirming the diagnosis. Several conditions mimic Restless Legs Syndrome, so it is important to consult with a practitioner who is qualified to diagnose this condition (like your chiropractor!). Medical referral is sometimes warranted to rule out other causes (Secondary Restless Legs Syndrome). For example, if an iron deficiency is detected through blood analysis iron supplementation may be helpful. In fact, iron supplementation has been shown in the literature to have a positive result on Restless Legs Syndrome in those people with an iron deficiency. Magnesium deficiency has also been shown to be linked to Restless Legs Syndrome. Again, supplementation may be helpful in these cases.

Treatment for Restless Legs

There are various pharmacological options for treating the symptoms of Restless Legs Syndrome. According to the literature, dopamine agonists have been shown to provide the best results. It is important to realize that this treatment approach does not aim to eliminate the condition. Pharmacological intervention is aimed at reducing symptoms. Since Restless Legs Syndrome is usually progressive, it would be wise to delay this treatment option until necessary (to avoid building a tolerance). Decreasing alcohol and caffeine intake, getting regular exercise and practicing good sleep hygiene are all recommended for Restless Legs Syndrome. Our clinic has found the combination of Graston Technique and daytime use of compression socks to be a great way to combat Restless Legs. If you think you may have Restless Legs Syndrome, give us a call. We can assist you in confirming the diagnosis and finding the best way to reduce your symptoms of Restless Legs.

For further information or assistance with your restless legs, please call 905.220.7858 or email us at info@burlingtonsportstherapy.com

References
Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters As et al. Restless legs syndrome: diagnostic criteria, special considerations and epidemiology: a report from the restless legs syndrome diagnosis and epidemiology workshop at the national institute of health. Sleep Med 2003; 4:101-119.
Yee B, Killick R. Restless legs syndrome. Australian Family Physician 2009; 30(5): 296-300
Ondo WG. Restless legs syndrome. Neurologic Clinics 2009; 27: 779-799.
Stupar M. Restless legs syndrome in a primary contact setting: a case report. Journal of the Canadian Chiropractic Association 2008; 52(2): 81-87.
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Its resolution time again. For most people, getting in shape is probably at the top of the list. Usually this means hard work in the gym and eating healthier. But what if you’re in pain? Sometimes it’s difficult to make gains because a painful condition is getting in the way. The following suggestions might give your resolution a fighting chance…

Injuries Need to be Diagnosed

Has your condition been diagnosed? – It always surprises me how many people come to the clinic with conditions that they’ve had for a long time yet haven’t been diagnosed. This is the starting point for any recovery process. Your medical doctor or your chiropractor can diagnose your condition for you. They have been trained to know when and if advanced tests or imaging is necessary. The same way you would want your mechanic to know what is wrong with your car before making any changes, your condition should be diagnosed before anyone tries to fix it.

Don’t Exercise Through Pain

Have you eliminated the activities that are exacerbating your condition? – Some chronic injuries persist because the causative factor hasn’t been removed. For example, a runner with plantar fasciitis may not be helping their condition by continuing to run on it. Taking some time off and cross training may give an injury the adequate rest it needs to heal. This doesn’t mean that you have to stop exercising, it just means you need to make some different choices for a while. You can’t always expect a painful area to recover if you continue doing the activity that caused it in the first place.

Treatment for Injuries

Have you tried different treatments? – There’s a reason that different treatment options and different health professions exist. If you have found that a certain treatment hasn’t fixed your injury, it doesn’t necessarily mean that the condition isn’t fixable. Trying a different approach may be helpful. In our practice we have “different tools in the tool-belt”. If a patient doesn’t respond to a particular treatment, we learn more about their condition in the process and make appropriate recommendations based on what we have learned. At Burlington Sports Therapy and Evolution, we have many different treatment options available. Chiropractic, Physiotherapy, Athletic Therapy, Acupuncture, Massage Therapy, Active Release Technique, Graston Technique and Laser Therapy are all great options!

Physiotherapy Exercises

Are you continuing with your homework? – Usually, a health practitioner will give you recommendations for exercises or strategies at home to help with your injury. Did you follow through with them? Do you still know those recommendations? Were you given stretches? Strengthening exercises? Were you told to regularly ice your condition?

Knee Braces, Ankle Braces, Wrist Braces etc.

Have you tried different devices? – There are many assistive devices available for different conditions. Some common options include a good lumbar support for your desk chair, a knee brace (depending on the diagnosis), night splints for carpal tunnel syndrome, a new pillow for your neck pain, orthotics, over the counter insoles or different shoes for your foot pain, a new keyboard or mouse for your workspace or gripping straps for certain exercises at the gym. Although there are many gimmicks out there, your practitioner may be able to assist you in trying something that has shown to be beneficial for your diagnosis.

Personal Training

Are you exercising properly? – As mentioned above, you may be doing exercises that are exacerbating your condition. Thankfully our practice is affiliated with some great personal trainers. If you need help, a personal trainer would be able to check your technique and show you exercises that suit you and your resolution goals.

Hope that helps! Good luck with your resolutions!  info@burlingtonsportstherapy.com

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