Heel Pain Got You Down?

Heel pain
.  We have all had it at one point in time, and it can be a pain (no pun intended) to get rid of it.  Many people do not understand how or why their heel hurts.  There are many conditions out there that result in heel pain.  Today we will discuss one of those conditions and provide treatment suggestions.


Plantar Fasciitis

On the bottom of your foot there is a strong and dense structure of connective tissue known as your plantar fascia.  It extends from the base of the heel to the beginning of your toes.  The plantar fascia serves two purposes: it provides static support for your arch and it acts as a shock absorber for your foot.  During high-impact activities, the plantar fascia can suffer micro trauma from repetitive heel strikes.  When this happens, patients will feel pain at the base of heel.  Those who have flat feet or pronated feet, tight calf muscles, or abnormally high, rigid arches may be predisposed to plantar fasciitis.  It is commonly seen in sports/activities that have repetitive impact such as running, long distance walkers, dancers, tennis players, or even those who are on their feet for extended amounts of time daily.  The pain can vary, but most active individuals will find the pain to be very debilitating.

The good news is that plantar fasciitis can be resolved by conservative treatments.  The bad news is that it can sometimes take months before the symptoms are fully resolved.  Should you have plantar fasciitis, here are some treatments that you will find to be beneficial:


Stretch your plantar fascia and Achilles tendon daily.


Plantar fascia stretch – Sit with your knees bent and your heel flat on the floor or table.  Use your hand to bend your toes up toward the ceiling.  Progress into dorsiflexing your ankle and then bending your toes upwards.  Hold this position for about 10 seconds.  Repeat 10 times. (This is a good one to do before you get out of bed in the morning)

Seated plantar fascia stretch – While seated, place your toes into hyperextension.  Hold for 30 seconds.  Repeat 10 times.

Plantar fascia stretch on wall – Place your heel on the floor and your toes on a wall.  Lean forward.  Hold for 30 seconds.  Repeat 10 times.

Calf stretch – Using a step, stand with your toes just on the end of the step with your heels hanging off.  Lower your heels while keeping your knees straight.  Hold 30 seconds.  Repeat 10 times.  Repeat stretch with your knees bent.

Change work out shoes regularly.  Shoes will break down over time.  If you have poor biomechanics, your shoes will begin to show the abnormalities.  Shoes are generally made with proper support, but usage wears down the support.  By changing your shoes regularly, you can get the support you need.


Use cushioned heel inserts or orthotics.  Heel inserts and orthotics have been shown to provide proper mechanics of the foot.  I would recommend trying heel cushions first.  They are available at any drug store and most grocery stores.  They are relatively inexpensive, and they will help with the
Plantar Fasciitis pain
.  If the heel cushions do not work, I would try orthotics.  They can be custom made or off the shelf.  Each individual is different, so find the pair that works for you.  Just remember to buy multiple pairs, or switch them from one pair of shoes to others.


Ice massage.  This works wonders, and it is very simple to do.  One of the most beneficial ways to do this is to fill a plastic bottle with water and freeze it.  Take the frozen bottle and roll the bottom of your foot over it for approximately 5-7 minutes.  It may hurt at first, but as your foot gets cold it will feel great.  Please be careful not to hurt yourself from prolonged periods of cold!!


Use a night splint.  A night splint is a device that keeps your ankle dorsiflexed and your toes extended while you sleep.  During the night, your foot can spend hours in a position that causes pain.  This is why you may have a lot of pain when you first walk in the morning.  Wearing a night splint will keep your foot in a comfortable position that will decrease your pain in the morning.  They can be purchased from pharmacies that have orthopedic supplies, or you can find them online as well.  They range from about $30-$60, but it may be worth it.

And finally….


Take some time to rest.  It is something that can be very hard for some to do, but it is very important.  Time will heal almost everything.  Allow your body the proper amount of time to heal.  In the meantime, there are plenty of others ways that you can be active without being on your feet.


I hope this helps!  Next time I will discuss another common reason for
heel pain
.  Until next time.


Corey H

Helpful Hints for Coaches

The USA is a sports overloaded country. There are millions of kids every year who participate in some form of organized sport and a large number of them get injured. Coaches can play a huge role in not only the prevention of injuries, but also the return to play. Some coaches or organizations are blessed to have Certified Athletic Trainers working with them (Ok, so I’m a little biased.) Many other coaches, on the other hand, have to go it alone. It was this aspect that got me thinking…Do coaches really know what they are doing in terms of injury prevention or care? I would say most likely, no, but it totally depends on the coach. Back in the day, you had the old school coach who said “water breaks show weakness”. Well that’s just crazy. Any sane person knows that dehydration can lead to a whole host of problems and anyone who is exercising (particularly in hot or humid conditions) is going to sweat and they need some way to replenish that fluid. Studies have shown that athletes (or the active population) need to drink approximately 8 oz (some studies will say different amounts) for every pound of weight lost during exercise to replenish your system. Sports drinks are a good alternative to water if you prefer but good old fashioned water works too. You also have the old school coaches who say “rub some dirt on it”. I’d like to think that this was more of a joke and was basically telling the kid to suck it up but you never know. Putting dirt in an open wound…NEVER a good idea (just wanted to throw that out there in case anyone was unsure.)

My personal pet peeve is when teams jog, stretch, shoot (or something), so the players are all nice and warmed up and then the coach comes in and sits them down to talk about plays or the practice plan for the next 20 minutes. That whole process of jogging and stretching and what-not was just eliminated because the coach wanted to talk. Coaches…I beg you…talk before they warm up or after practice or talk for a shorter amount of time. Once an athlete is warmed up, those effects only last about 15 minutes or so if the athlete just sits around. If you absolutely MUST talk for 20 minutes, please give them time to warm up again. Making you’re your athletes are warmed up prior to exercise (not just at some point that day) will help decrease the chances of an injury, specifically muscle pulls.

Other good suggestions for coaches who want to move into the 21st Century:

1. Pick up any loose equipment around the playing surface. Balls, bats, jump ropes, etc lying around can lead to ankle sprains if an athlete were to land on it.
2. Give adequate water breaks…especially if it’s hot or humid outside (even for indoor sports)
3. Don’t move a joint if it looks deformed (like a dislocation). If you aren’t trained to reduce dislocations…DON’T. Just because you’ve done it once to yourself or a friend, doesn’t mean that you should attempt it on a player.
4. If you suspect an injury, seek professional medical help. Not all ankle sprains are the same or should be treated the same.
5. You are responsible for injuries that happen whether they were preventable or not, so don’t just ignore them.

~ Missync MS, ATC, LAT ~

Low Level Laser Therapy a Vital Treatment? Or an Unnecessary Expense?

What is Low Level Laser Therapy
Low Level Laser Therapy (LLLT), also known as cold laser therapy, photobiomodulation, and laser bio-stimulation is a therapeutic modality which is slowly making its debut in athletic training rooms, sports medicine clinics, and physical therapy clinics around the U.S. These units use red and near infrared light which is converted to chemical energy and applied to the body to relieve pain and stimulate healing of common wounds and injuries.

How Does It Work?
The applicator applies between 1-500 milliwatts of energy in the form of non-thermal photons of light to tissues. Supposedly, this light penetrates the skin up to one inch and results in physiologic effects such as: increased cell metabolism, increased circulation, vasodilation, decreased inflammatory effects, stimulation of nerve function, and analgesic effects. Treatment times are under a minute and a half and are applied directly to the skin.

What Types of Injuries Can Laser Therapy be Used for?
This type of treatment is indicated for conditions such as tendonitis, arthritis, fibromyalgia, post surgical pain, swelling, ulcers, TMJ, and acute and chronic pain to name a few.

Are There Side Effects?
This type of treatment is thought to produce similar effects of NSAIDs (non-steroidal anti-inflammatory drugs) except without the possible negative side effects to the gastro-intestinal system. The only known possible negative side effect is exposure to light to the eyes. This is prevented by usage of the safety-filter spectacles by the therapist and the patient. These Units were approved by the FDA in 2002 for carpal tunnel syndrome, iliotibial band syndrome and other musculoskeletal disorders.

Who should NOT Receive This Treatment?
Low Level Laser Therapy is not safe for use by those with a pacemaker, those who are pregnant; those who suffer from epilepsy, children, those who are receiving radiation, those suffering from cancer, also the area over the thyroid gland should not be treated.

How Much Does It Cost?
Low Level Laser Therapy units range in price from $80 dollars to $4, 000 dollars depending on quality of the machine, the diameter of the applicator, and whether the unit also contains electrical stimulation and ultrasound. Treatment costs to patients can be between $35 and $115 and some insurance companies will not cover them.

Is It Worth The Cost?
Given the fact that there is not sufficient evidence in regards to the effectiveness of low level laser therapy, is it really worth the high cost of the unit to the practitioner, or of the treatment to the patient? For me personally, I’ll stick with the dependable and economical treatment of an ice bag and ibuprofen which I know together work to decrease cell metabolism, pain, and inflammation.

Resolution Running Wild

Not long after the champagne had its last fizzle, and we finished our best American Idol impression of Auld Lang Syne, it is customary to come up with a New Year’s Resolution. Resolutions range from losing a few pounds to being happier. I welcomed in the New Year sitting on my couch watching a documentary about Tom Petty entitled “Runnin’ Down A Dream.” As I was thinking of topics for my first blog, that title stuck in my mind. A lot of us will begin running down a dream this year. For some it is a metaphor of finally doing something that they have always wanted to. For many others, we will literally be running down that dream of getting into shape or losing a few pounds. If you are one of those people who are looking at getting into shape or losing a few pounds, here are a few suggestions that you may find helpful before starting:

1. Consult a physician before beginning any work out program. It sounds a little cliché, but it is extremely important to know that your body is in good health to even begin a workout program.

2. Properly warm up before exercise. It is very easy to jump right into a workout and not warm up properly. I am probably the most guilty of this. But a proper warm up is very important because it prepares the body physiologically for exercise. This preparation will result in increased blood flow and temperature in your muscles which can help prevent musculoskeletal injuries. A good article about warming up may be found at: http://coaching.usolympicteam.com/coaching/kpub.nsf/v/Sep02-5

3. Stretch after your workout. Studies now suggest that stretching before exercise can actually lead to more injuries. The idea behind this theory is that after muscle fibers are stretched out, they tighten to protect the muscle fibers. This tightness is what can lead to injuries. Before you exercise, a dynamic warm up consisting of brisk walking, lunges, knee-to-chest, or any other activity that is specific to your workout would be beneficial. Save the usual static stretching for after the workout.

4. Start off slow and work your way into shape. This is especially true for those who have been inactive for sometime. It can take up to two weeks for your body to become accustomed to the new stresses being placed on it. If you start off with too much intensity, you will become very sore. This soreness may then become an excuse not to work out. Begin slowly and gradually increase your intensity.

5. Take care of your body. There will always be little nagging aches and pains. Take care of them when they are little aches and pains and do not let them become major aches and pains.

Hopefully these few suggestions will help you get your workout started on the right track. With some hard work and dedication you will hopefully reach your goals, whatever they may be. Then when you ring in 2009 you can resolve to do something else other than get into shape. Until next time!

Corey H

Suffering From an Injury? Want to Stay in Shape? Aquatic Therapy Could be the Answer!

Suffering from a serious or athletically related injury? Long since past are the days when this meant taking weeks or even months off from working out. Thanks to current technology in aquatic therapy patients and athletes alike can still stay active even during injury. Hundreds of companies manufacture various models of underwater cardio equipment such as elliptical trainers, stair steppers, and stationary bikes. Probably the most popular is the underwater treadmill. These pieces of equipment allow you to walk, run, swim, and even perform drills and plyometrics. Some of these machines actually elevate and depress into the water to allow variation in depth, others allow you to raise and lower the water of the pool in which it is immersed, still others offer incline features on the actual treadmill.

Aquatic therapy allows you to workout in an environment that provides buoyancy thereby making it low-impact. The hydrostatic pressure increases blood flow to the tissues and decreases inflammation. Depending on the type and severity of your injury this may mean earlier opportunity for rehabilitation and quicker recovery. Rehabilitation on one of these treadmills can help maintain cardiovascular efficiency, increase strength and range of motion, and decrease stress on joints.

Some of these pieces of treadmills are equipped monitors which allow for gait analysis and biomechanical corrections; they also serve as a safety feature. Some also come with attachable hoses which are secured over the jets and can be utilized for massage purposes to flush lactic acid from fatigued muscles, assist with myofascial release and scar tissue manipulation, or simply for pain management.

This type of therapy can be useful for those who suffer from arthritis, disc injury, recovery from stress fractures/reactions, bursitis, tendonitis etc. It can also be useful in injury prevention for those elite athletes who log a significant numbers of miles per week. Some physicians recommend it for prenatal patients due to its low-impact characteristic. Lastly for those who train animals, some companies have even designed underwater treadmills for dogs and horses!

So what if you do not have access to a clinic or institution with the funding for one of these large and expensive pieces of equipment? You can still benefit from aquatic therapy in your local lap pool. If your physician, athletic trainer, or therapist has recommended you to participate in non weight bearing exercise you can aqua jog in the deep end of the pool by wearing aqua jogger belt around your waist and treading water. Swimming is also a great non-impact cardiovascular exercise. Upper body injury? Use a kick board and rest your arms! Lower extremity injury? Squeeze a buoy between your legs and pull your legs with your arms. Other items can be purchased to increase resistance such as aqua dumbbells, ankle cuffs etc.

Remember this type of therapy might not be suitable for all types of injuries and you should always consult your physician first. But for many it can help to keep you in shape and to prevent the depression and disappointment that often accompanies injury.

Posted by Heather Cobb LAT, ATC