Monday, April 24, 2017

Plantar Fasciitis: A Common Source Of Heel Pain

By Dr. John A. Papa, DC, FCCPOR(C)


Plantar fasciitis is caused by injury to the plantar fascia, which is the tendon-like soft-tissue along the bottom of the foot that connects your heel bone to your toes.  This condition is a common source of heel pain that can be quite disabling.
 
Plantar fasciitis usually develops gradually, but it can also come on suddenly.  Sharp, knife-like pain on the inside-bottom part of the heel is often characteristic.  Pain and discomfort can also extend into the arch of the foot.  Heel pain tends to be worse with the first few walking steps in the morning, and after extended periods of sitting or inactivity.  If plantar fasciitis becomes severe or chronic, heel and/or arch pain will be present with all weight-bearing activities, and may result in secondary areas of discomfort in the foot, knee, hip or back due to compensatory movements.
 
Under normal circumstances, your plantar fascia acts like a shock-absorbing rubber band, supporting the arch of your foot.  Excessive tension and repetitive stretching can create small tears in this soft-tissue fascia, causing it to become irritated or inflamed.  This may occur with activities that require running, jumping or prolonged walking and standing.  Improper footwear can make the plantar fascia more susceptible to stretch and strain during these activities.
 
Faulty foot mechanics may also contribute to the development of plantar fasciitis.  Individuals with flat feet or those who excessively pronate (role feet inward) will experience added strain on their plantar fascia.  Old lower extremity injuries such as ankle sprains and fractures can increase susceptibility due to altered lower limb movements.  Being overweight is also a risk factor.  Carrying extra pounds can break down the protective fatty tissue under the heel bone, causing heel pain and putting additional mechanical load on the plantar fascia.
 
Self-care strategies for reducing the pain of plantar fasciitis include: ice application; rolling a tennis ball or soup can from your heel and along the arch of your foot; and gentle stretching of the achilles tendon, calf muscles, and plantar fascia.  Gel or “donut pads” placed under the affected heel(s) in shoes may also provide relief.
 
Plantar fasciitis that does not respond to self-care strategies may require professional treatment.  This can include electrotherapeutic or laser modalities to assist in healing, manual and soft tissue therapy to supporting structures, therapeutic taping of the heel, and specific rehabilitative  exercises for the muscles and joints of the lower leg and foot.  A custom made orthotic may also be helpful by minimizing pronation, cushioning the heel, and supporting the arch.
 
It is important to establish an accurate diagnosis of plantar fasciitis.   Other causes of heel pain may include stress fractures, heel fat pad syndrome, achilles tendonitis/bursitis, arthritis, gout, or nerve irritation.  If you are having difficulty with heel pain, a qualified health professional can determine the cause of your pain and prescribe appropriate therapy and rehabilitation strategies specifically for your circumstance.  For more information, visit www.nhwc.ca.
 
This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Tuesday, April 18, 2017

Non-Invasive Recommendations For Managing Low Back Pain

By Dr. R. Greg Lusk, DC

In January of this year a new clinical practice guideline was published in the European Journal of Pain with respect to the non-invasive management of low back pain (LBP).  A clinical practice guideline aims to summarize research evidence, with the goal of optimizing patient care and improving health outcomes, and to prevent clinicians from considering interventions that are ineffective, expensive or harmful.  LBP affects 80% of people throughout their lives, is a common cause of disability, and is the most common musculoskeletal complaint for which people visit a healthcare provider.  In more ways than one it is a very expensive condition that warrants guidance from best evidence.  For this particular guideline, over 2500 research titles and abstracts were reviewed with only 10 previously published guidelines being included due to quality.  The recommendations are as follows.
 
For Acute LBP (i.e. LBP that started suddenly or has only been present for a few days or weeks), or Chronic LBP (i.e. LBP that persists beyond 3 months), all 10 guidelines recommended:
 
1.    Advice, reassurance or education with evidence-based information regarding the expected course of recovery and effective self-care options (e.g. ice or heat for pain, short-term rest, medication).  With respect to course of recovery, most cases of LBP improve much or completely within six weeks of onset, with a slower rate of improvement noted beyond six weeks if it persists.  Recovery is also affected by risk factors such as job demands, sedentary lifestyle, body weight, age, and smoking.
 
2.    Acetaminophen (e.g. Tylenol) or NSAIDs (e.g. Advil) if indicated, with advice and consideration of risks and warning signs and symptoms.
 
For Acute LBP only, all guidelines encouraged an early return to activity, staying active, and the avoidance of prolonged bed rest.  A short course of muscle relaxants alone or in addition to NSAIDs if acetaminophen or NSAIDs did not reduce pain was also an option.  Spinal manipulation (i.e. spinal joint "adjustment") was also advised for those not improving with self-care methods.  Also, in rare cases when the pain is severe and unmanageable, short-term use of opioids was mostly recommended as long term use is associated with significant risk, something we have all become increasingly aware of due to the amount of media coverage on the topic.
 
For the management of Chronic LBP, other interventions recommended by all guidelines were exercise or yoga (for up to 12 weeks), manual therapy (i.e. spinal manipulation or mobilization) for up to 12 weeks, and extensive rehabilitation with both physical and psychological components over 8 weeks.  If acetaminophen or NSAIDs have not provided adequate pain relief, short-term use of opiods was also recommended taking into consideration side-effects, risks, and evidence of ongoing pain relief on re-assessment.  Massage, acupuncture, and antidepressant medication was also recommended by most guidelines.
 
Some interventions for Chronic LBP were also NOT recommended by most guidelines.  This does not mean these treatments don't provide relief, just that the supporting evidence isn't strong enough to warrant a recommendation.  This included the use of muscle relaxants, gabapentin (a medication for nerve-based pain), and passive electrotherapeutic modalities including TENS, laser, IFC, or ultrasound.
 
A key thing to remember with all of these interventions is that there are options and patient preference is an important consideration.  Some people want to avoid medications at all costs and others have no interest in having their low back manipulated.  For chronic LBP, results are often better with the inclusion of a more active component of treatment (e.g. exercise) but many patients admit that they will not comply with a regular program.  Thankfully the passive approaches still have value.
 
This article is for general information purposes only and is not to be taken as professional medical advice.
 
 

Wednesday, April 12, 2017

Nutrients That Support Musculoskeletal Health

By Dr. John A. Papa, DC, FCCPOR(C)

The musculoskeletal (MSK) system includes the muscles, tendons, joints, and bones of the body.  Many nutrients contribute to the healthy functioning and integrity of the MSK system.  Included below is a summary of 5 common nutrients that significantly contribute to MSK health.
 
1.    WATER brings vital nutrients to muscle tissue to support movement and decrease the risk of cramps and strains.  Water also eliminates waste products and toxins from the body and helps to protect our joints by providing lubrication and cushioning.  The consequences of inadequate water intake/dehydration include:  muscle and joint pain, cramping, and fatigue.  A general rule of thumb to follow is to consume 0.5-1 litre of water daily for every 50 pounds of body weight.
 
2.    CALCIUM is best known for building strong bones.  It is also needed for muscular growth and contraction.  A deficiency in calcium status can lead to aching joints, muscle cramps, and osteoporosis.  Foods such as milk, yogurt, and cheese are good sources of calcium but may not be suitable for individuals sensitive to dairy products.  Other healthy foods high in calcium include pinto, navy, red and white kidney beans, sesame seeds, almonds, and dark leafy vegetables.
 
3.    VITAMIN D is essential for helping bones absorb calcium, keeping them strong, and preventing osteoporosis.  Signs of Vitamin D deficiency may include painful muscle spasms, leg cramps, numbness in the extremities, bony malformations, and arthritic pain.  Vitamin D is naturally found in food sources such as cod liver oil, salmon, mackerel, tuna fish, sardines, and egg yolks.  Sensible and safe sun exposure is also an important natural source of Vitamin D.

4.    VITAMIN C plays a vital role in collagen production and tissue repair.  Collagen is the building foundation for many body tissues and is found in all MSK structures.  There is an abundance of Vitamin C in strawberries, citrus fruits, and vegetables including, red peppers, broccoli, spinach, brussel sprouts and cauliflower.
 
5.    GLUCOSAMINE SULPHATE is a normal element of cartilage matrix and joint fluid and provides the body with the building blocks necessary to repair joint damage.  As we age, our bodies slow down the production of glucosamine sulphate.  Published research suggests that glucosamine sulphate is beneficial for arthritic patients, particularly for those individuals with mild to moderate osteoarthritis of the knees.  Some glucosamine sulphate supplements also contain anti-inflammatory herbs that can be combined with other nutrients such as Omega-3 fatty acids to help with arthritic pain.
 
Sensible eating should include nutritional balance with the correct proportion of quality carbohydrates, proteins, healthy fats, and adequate water intake.  Although nutritional supplements can help support MSK health, many nutrients appear to be most effective when consumed in their natural state within whole foods.  For additional information on diet, nutrition, and how you can improve your MSK health, visit www.nhwc.ca.
 
This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Tuesday, April 4, 2017

Knee Pain And Prevention

By Dr. John A. Papa, DC, FCCPOR(C)
 
Knee pain is often caused by either a one-time acute injury or repetitive motions that stress the knee, particularly as we age.  Included below are some of the conditions that commonly cause knee pain:
 
·        Osteoarthritis results from the protective layers of cartilage in the knee becoming worn over a period of time, leading to change in the composition of the bone underneath the cartilage.  This may result in a number of symptoms including:  joint pain and stiffness, decreased ranges of motion, weakness, swelling, inflammation, and instability.
 
·        Patellofemoral pain syndrome refers to knee conditions that involve the kneecap and/or the structures around it.  Pain can be generated by breakdown of the cartilage under the kneecap, tight or weak tissues around the kneecap, or misalignment of the kneecap.
 
·        Meniscal injuries directly involve tearing/damage to the cartilage cushioning in the knee.  This type of injury can result from a sporting event or fall where the knee undergoes a sudden twisting motion or impact.  It can also occur in older individuals who develop a chronic tear in a worn meniscus.
 
·        Ligaments are tough bands of fibrous tissue that connect one bone to another.  They help stabilize joints, preventing excessive movement.  Ligament injuries can occur when these structures become over-stretched or torn, often during activities where there is a direct blow to the knee or there is an awkward fall or twisting motion involving the knee.
 
·        Tendons are strong tissues that anchor muscles to bones, and these structures can become torn or inflamed around the knee joint leading to tendonitis and muscular strains.
 
·        Bursitis can involve several fluid-filled structures in your knee that help provide more cushioning in the joint.  Certain activities, such as kneeling on the floor, can cause a bursa to become irritated.
 
Below are some useful tips that can help individuals avoid or minimize the chance of knee pain and injury:
 
1.    Maintain a healthy bodyweight to decrease the overall stress on your knees.
 
2.   Wear appropriate footwear that supports your activities and helps maintain proper leg alignment and balance.
 
3.    Prepare your knees for physical activity by stimulating the joints and muscles, and increasing circulation.  This can be accomplished with a quick cardiovascular warm-up and gentle stretching of the muscles in the thighs and lower legs.
 
4.    Choose activities that are knee friendly for you.  This may include low impact activities such as walking or cycling.  Remember to start slowly and build up the intensity gradually.
 
5.    Strength, balance and flexibility exercises can train your leg muscles to better support your knees and avoid injuries.
 
In the event that you suffer a knee injury that does not subside, you should contact a licensed health professional who deals in the diagnosis and treatment of knee pain.  For additional information on knee pain and treatment of muscle and joint injuries, visit www.nhwc.ca.
 
This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.