Plantar Fasciitis

Plantar fasciitis is one of the most common foot injuries, affecting approximately 10% of runners. It is an inflammatory condition, in which the connective tissue on the underside of the foot becomes inflamed. Intrinsic factors contributing to this condition include biomechanical factors related to the foot and ankles, as well as muscle imbalances in strength and flexibility of the lower leg and foot muscles. Extrinsic factors include incorrect footwear, poor training and excessive running on hard or uneven surfaces.

Signs and Symptoms

Pain is experienced on the underside of the foot, near the heel, and is usually worse after rest and will be particularly severe first thing in the morning when weight is placed on the foot. This pain tends to improve within a few minutes of walking. In more severe cases, where there is neural involvement as well, pain is more severe and widespread. Pain often improves with activity, but will recur after rest.

Management

Ice and non-steroidal anti-inflammatory drugs are used to manage the acute pain and inflammation. Massage is used to reduce inflammation in the fascia. Strapping and heel lifts may be used to take the pressure off the arch of the foot. Achilles tendon stretches should be performed, as well as various other exercises to improve range of motion in the ankle and foot, within pain-free ranges. Gentle strengthening exercises can be done to improve muscle strength around the foot and ankle, again within pain-free ranges. A biokineticist can then assess factors contributing to the condition and provide appropriate stretching and strengthening exercises to improve muscle imbalances, thereby preventing the condition form recurring.

References

Foundations of Athletic Training: Prevention, Assessment and Management

Newsflash!!

I would like to welcome Monique Turner to my practice.

Monique is a registered biokineticist and she will be practicing at:

95 Boeing Road East

Bedfordview

(entrance on Marais Street)

Tel: 011 454 0232

Hamstring Strains

The hamstrings are the most commonly strained muscles in the body. This injury occurs when the hamstrings are stretched beyond their acceptable range of movement, either in a sudden movement, such as a violent stretch, or from repetitive motions. Hamstring strains range from mild (Grade I) to severe (Grade III), depending on the number of muscle fibres affected and the severity of the strain.

Risk factors for hamstring strains

The following factors increase the risk of developing a hamstring strain:

·         Poor flexibility

·         Poor posture

·         Muscle strength imbalance

·         Improper warm-up

·         Muscle fatigue

·         Poor neuromuscular control

·         Previous injury

·         Overuse

·         Incorrect technique

Signs and symptoms

Grade I (mild) hamstring strain:

·         Mild pain and tightness in the back of the thigh

Grade II (moderate) hamstring strain:

·         Tearing or popping sensation

·         Moderate pain and weakness

·         Difficulty bending the knee

Grade III (severe) hamstring strain:

·         Tearing or popping sensation

·         Severe pain and weakness

·         Individual will limp

·         Inability to straighten the knee completely or strike the ground with the heel first when walking

·         Difficulty bending the knee

·         Swelling and bruising occurs 1-2 days after the injury

Management

Initial treatment should include rest, ice, compression and elevation. Non-steroidal anti-inflammatory drugs are often prescribed as well. Crutches are used in more severe cases, if deemed to be necessary. Physiotherapy is required to reduce pain and swelling and regain range of movement.

Individuals with this injury often complain that the injury is chronic and recurring. This is usually because the strengthening and final-phase rehabilitation is neglected. It is crucial that the hamstrings are strengthened following a strain, to prevent the injury from reoccurring and to prevent injury to other parts of the body, such as the knee, as a result of muscle imbalances. A biokineticist can assist in prescribing appropriate exercises to strengthen the hamstrings and return an individual to full function, whether it be the normal daily activities, or specific sporting movements.

References

Foundations of Athletic Training: Prevention, Assessment and Management

Ankle Joint Fusion

Fusion of the ankle joint may be required as a result of chronic degeneration of the joint from conditions such as osteoarthritis. A surgical procedure is performed, where the bones are fused together, reducing movement and, therefore, pain at the joint. This loss of mobility of the ankle joint can have numerous side-effects on balance, walking pattern and functional ability. Recovery from an ankle fusion is long and includes the ankle being immobilized and the patient being off the affected leg for several weeks, sometimes as long as 10-12 weeks. The patient is then put into a moon boot and partial weight-bearing will be allowed for several more weeks. Once your surgeon is satisfied that the bones have completely fused, you will be able to return to more normal activities. This prolonged recovery has significant implications on the surrounding leg muscles, joints, balance and walking pattern.

If you have had an ankle fusion, it is important to consider the implications of the fusion on the rest of your body. The lack of mobility at the joint itself will affect how you walk and your ability to carry out your daily activities, such as climbing stairs. Your posture may also be affected. These changes may cause aches and pains in other areas of your body, because you are now walking and standing differently to what you are used to. Adaptations to one’s walking pattern and functional movements will most likely need to be made to compensate for the restricted movement at the ankle joint.

The muscles of the calves and thigh will have become atrophied, or wasted, due to lack of use while the affected leg was not being used so that it could heal. It is important to rebuild the strength of these muscles following an ankle fusion, so that walking and functional ability can return to as close to normal, as soon as the fused joint will allow. Strengthening of the leg and core muscles will assist in the adaptation process of getting used to the new joint.

A biokineticist will assess and provide appropriate exercises to assist in rebuilding the leg muscles, regaining balance, and re-establishing a natural and correct posture and walking pattern. If the appropriate rehabilitation programme is followed, one will be able to return to most previous activities, with only slight adaptations needing to be made.

References

http://www.aofas.org/footcaremd/treatments/Pages/Ankle-Arthrodesis.aspx

Lower-Limb Amputation

Lower-limb amputation refers to the surgical removal of the lower limb (leg) or part of the lower limb. Of course, amputations of the upper limb, or arm, also exist, but due to the non-weight-bearing nature of the arm, this is much less complicated and so will not be discussed in this blog article.

Lower-limb amputations are caused by the following:

·         Circulatory and vascular diseases associated with type 2 diabetes and peripheral vascular disease – 70%

·         Trauma to the limb itself – 23%

·         Removal of tumours – 4%

·         Congenital deformities – 3%

Lower-limb amputations caused by vascular diseases are more common in individuals over the age of 55 years; whereas, those caused by trauma, tumours or congenital deformities are more common in individuals under the age of 50 years.

It is important to know the cause of an amputation from an exercise perspective because the purpose of the exercise therapy will differ slightly. If an amputation was caused by a vascular disease, then it is important that the exercise programme focuses on reducing the progression of the associated vascular condition. On the other hand, the purpose of the exercise programme for those with amputations caused by trauma, tumours or congenital deformities is the same as that for able-bodies individuals, the aim being, to reduce the risk of diseases associated with a sedentary lifestyle, such as high cholesterol, high blood pressure, diabetes and obesity. Individuals who have had an amputation are at greater risk of developing these diseases, as they are more likely to be sedentary, purely because of their physical limitation. However, this should not be an excuse not to exercise, as there is a wide variety of exercises that can still be performed.

Depending on the level of amputation – at the foot, below the knee, above the knee or at the hip – various factors must be considered when planning an exercise programme. Appropriate exercise modalities need to be chosen according to the individual’s physical capabilities and current level of fitness. Swimming and arm ergometry are generally both safe and appropriate forms of exercise for most lower-limb amputees. Strengthening exercises are important and can usually be done with minor adaptations. It is generally more safe to use machines, rather than free weights, because an amputee’s balance is more likely to be compromised.

Walking is important to enable individuals to become as independent as possible; however, one cannot overdo it. Individuals with a prosthetic leg are susceptible to sores and infections, as a result of the prosthesis rubbing on the skin. This can cause further disability if the sores do not heal. These individuals also expend more energy when walking than able-bodied individuals and so cannot walk as far or for as long. Phantom pain, a common complaint of amputees, is pain experienced in the amputated limb. This pain ranges from mild to severe and can also hinder one’s exercise ability.

Although amputation is considered a disability, there is still a wide range of movement and functional exercises that amputees can achieve, ranging from the normal daily activities to competitive sport. It is crucial that one does not give up following an amputation, but rather seeks professional advice, such as that of a biokineticist, to assist in implementing an appropriate exercise programme that focuses on the needs and goals of the individual.

References

ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities