Monday, July 30, 2018

Heel Fat Pad Syndrome

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

Heel Fat Pad Syndrome (HFPS) refers to damage or disruption of the fatty pad that sits under our heel bone (calcaneous).  This structure is approximately one inch thick and is made up of fatty tissue enclosed by ligamentous chambers.  The purpose of this structure is to absorb shock and cushion the heel bone.  If the fat pad is displaced or thins, then its ability to protect the heel bone from impact is decreased, which can result in heel pain.

HFPS is commonly misdiagnosed as plantar fasciitis.  Plantar fasciitis symptoms tend to be located towards the inner front portion of the heel and can extend into the arch of the foot, whereas symptoms of HFPS are characteristically located in the centre of the heel and described as a deep, dull ache that feels like a bruise.  Other symptoms characteristic of HFPS include central heel pain that is aggravated by prolonged periods of standing and barefoot walking on hard surfaces.  It is also possible to have both plantar fasciitis and HFPS present at the same time.

There are several factors that can contribute to the development of HFPS.  Trauma to the heel from high impact sports or a forceful blow to the heel from a fall can cause injury to the fat pad.  Repetitious chronic overload from activities such as running, jumping or prolonged walking and standing can also cause injury which can be exacerbated by the use of improper footwear.  It is known that the fatty heel pad breaks down as we get older which can make an individual susceptible to this condition.  Carrying extra pounds can also break down the protective fatty tissue under the heel bone.

Self-care strategies for reducing the pain of HFPS include: relative rest from any painful activities; ice application; and gentle stretching of the achilles tendon, and calf muscles.  Gel or “donut pads” placed under the affected heel(s) in shoes may also provide relief.  Long-term strategies may include activity modification and weight loss where applicable.

HFPS that does not respond to self-care strategies may require professional treatment.  This can include electrotherapeutic 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.  Supporting the foot with proper footwear and correcting faulty foot mechanics can decrease excessive strain on the fat pad.  A custom made orthotic with a deep heel cup design to cradle and cushion the fat pad may also be helpful for decreasing symptoms.

It is important to establish an accurate diagnosis of HFPS.  Other causes of heel pain may include stress fractures, 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

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.

Wednesday, July 25, 2018

Tips for Bending With Low Back Pain

By Dr. R. Greg Lusk, DC

Sitting and standing were discussed thoroughly in my last article as they are common activities that trigger low back pain (LBP). Modifying how they are done form part of our daily upkeep of our backs, referred to as spine hygiene, which when coupled with appropriate exercises can help make you more resilient to symptoms. Bending is another frequent trigger for  low back pain and how it can be performed in a more spine sparing or friendly way will form the focus of this article.

If you have or had LBP, it is highly likely that bending is or was an aggravator to your symptoms. Imagine yourself flexing forward to put on socks, stooping to brush your teeth, or trying to pick up that pen you dropped on the floor. Many of you will dread the thought of having to do that when you have LBP. However, you can employ strategies to do this that spare the spine, allowing it to stay in neutral, thereby minimizing pain. Squatting, by moving predominantly at the hips and knees, will allow you to lower yourself without rounding your back. To get even lower you could use a lunging pattern. To perform this move, you stagger your feet one in front of the other and offset side to side, so you don't feel like you're standing on a balance beam. Once again, you move about the hip and knee joints while lowering the rear leg toward the floor, keeping the back straight throughout. From the bottom of this position you can generally reach near the floor with your hand with minimal spine motion needed. Good technique is paramount to minimize stress on the hip and knee joints so symptoms are not produced there, which may be particularly challenging for some of you with a history of injury and or arthritis there. An alternative that may be helpful is referred to as the golfer's lift or pick-up. Similar to the action you'll see a golfer perform to retrieve the ball from the hole, you balance on one leg while you hinge about the hip joint, lowering a hand toward the ground while the free leg extends backward as a counter-balance. Particularly for relatively light items, this is an effective way to get your hand low while keeping your spine neutral and your core tight. Balance may be an issue for some so using your free hand to lean on a wall or hold onto another firmly rooted object will provide another contact point for improved stability in this position.

The stooped (i.e. slightly bent) posture you can observe when someone is brushing their teeth over the sink, gathering laundry out of the washer or dryer, or kneeling to do gardening can also be modified to become more kind to your spine. With these activities we use our arms but really only need the free motion of one hand to be efficient. The other hand, which is typically non-dominant, can instead form a contact point of support on either the vanity counter, the appliance, or ground, while you also hinge at the hips and keep your spine neutral. The support hand now bears much of the load that leaning forward imposes on the spine, which is surprisingly substantial when you consider how much the upper half of our bodies weigh coupled with the multiplying power of leverage.

Good luck employing some of these ideas to bend with increased ease. With low back pain the more we can reduce all of the contributing sources of aggravation the more likely you'll experience decreased symptoms and prolonged relief. This article is for general information purposes only and is not to be taken as professional medical advice.

Tuesday, July 17, 2018

New Hamburg Shockwave Therapy

Extracorporeal Shockwave Therapy (ESWT) is a treatment modality that has been extensively researched, and clinically shown to accelerate the body’s natural healing process. Shockwave Therapy generates strong energy waves for short periods of time. The energy wave is conducted from the applicator to the desired tissue through the use of an acoustic wave generator (coupling gel). These energy pulses create bubbles (micro-cavitation) that expand and burst.

The force generated by these cavitations penetrates tissue and has been shown to stimulate cells responsible for new blood vessel formation, bone, and connective tissue healing. This stimulus increases circulation and cellular metabolism in the region of injury to enhance the healing capability of the body. This process helps individuals decrease or eliminate pain and improve mobility and quality of life.

Shockwave Therapy is the most effective in recalcitrant (unresponsive to treatment) pathological alterations of tendons, ligaments, capsules, muscles and bones. This includes conditions and injuries such as:

  • Bursitis                         
  • Hip Pain
  • Knee Pain
  • Tennis Elbow
  • Stress Fractures
  • Hamstring Strains
  • Patellar Tendinopathy
  • Achilles Tendinopathy
  • Scar Tissue Treatment
  • Repetitive Strain Injuries
  • Plantar Fasciitis & Heel Pain
  • Calcific Rotator Cuff Tendinitis
Patients typically experience the benefits of Shockwave Therapy after only 1 or 2 treatments. Literature has shown that Shockwave Therapy when combined with exercise has an 85% success rate for plantar fasciitis, 76% success rate for achilles tendinopathy and a 75% success rate for the treatment of patellar tendinopathy (jumper’s knee).


Wednesday, July 11, 2018

Muscle And Joint Injury First Aid

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

Physical injury to your muscles and joints can occur with workplace, household, sporting, and recreational activities.  This can cause pain, stiffness, and swelling in a joint or muscle, leading to injuries known as sprains, strains, and contusions.  Initial conservative management and first aid of such injuries should follow the P.R.I.C.E. principle (Protection, Rest, Ice, Compression, Elevation) outlined below.

PROTECTION:  Immobilize the injured area to protect from further injury.  This can be accomplished with the use of an elastic wrap, brace, splint or sling.  Walking aids such as crutches or a cane can be useful to help you get around.

REST:  To ensure proper healing, rest the injured area and avoid activities that cause pain.  Do not restrict all activities completely.  Other regions of your body can still be used.  This will help prevent physical de-conditioning.  An attempt should be made to return to regular or modified activities as soon as possible provided it does not put you at risk for further injury.

ICE:  Ice cubes, frozen vegetable bags, or commercial ice/gel packs are examples of cold sources that can be molded or applied to an injury site immediately.  Icing will help to reduce pain, swelling, and inflammation in the injured tissues.  Ice application should not exceed 10 to 20 minutes at a time.  Allow for skin temperature to return to normal before ice is reapplied.  This cycle can be repeated as often as necessary within the first 24 to 72 hours.  Ice should never be applied directly over the skin for a prolonged period of time as this can damage the skin.  A wet towel can safely be used as a barrier between the ice and skin and acts as an excellent conductor of cold.  Do not apply ice to blisters, open cuts, or sores.  Individuals hypersensitive to cold and those who have circulation problems should avoid ice.

COMPRESSION:  Compress the injured area with an elastic tensor bandage.  This will help decrease swelling.  Do not wrap the bandage too tightly as to cut off circulation.  You should not feel an increase in pain with compression.

ELEVATION:  Elevate the injured area (whenever possible) above the level of the heart, especially at night.  Gravity helps reduce swelling by draining excess fluid.

You should seek immediate medical care under the following circumstances:  a popping sound heard during the injury accompanied by a feeling of joint instability or inability to weight bear; obvious evidence or suspicion of a broken bone, fracture or joint dislocation; or injuries at risk for infection.

By using the P.R.I.C.E. principle after an injury, you can significantly reduce swelling, tissue damage, inflammation, muscle spasms, pain, and recovery time.  In the event that you suffer from ongoing muscle and joint pain following an injury, you should contact a licensed health professional who can diagnose your condition and prescribe appropriate therapy, exercises, and rehabilitation strategies specifically for your circumstance.  For more information, visit

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, July 3, 2018

Summer Season Safety Tips For Your Body

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

The summer season is upon us, which for many individuals means spending time outdoors and becoming more physically active.  Whether you’re an aspiring athlete, a serious nature lover, or someone who enjoys fun in the sun, there are special precautions that need to be taken to protect your body during the summer season.

1.    Prepare your body for activity and exercise:  There are many activities made more enjoyable during the summer season such as gardening, walking, running, swimming, canoeing, bicycling, and golfing to name a few.  Prepare your body for physical activity by stimulating the joints and muscles, and increasing blood circulation with a proper warm-up.  If you have been inactive for a period of time, gradually ease into activity and take it slow.

2.   Drink plenty of water:  The body’s water supply is responsible for many important functions such as digestion, controlling body temperature, and protecting our joints by providing lubrication and cushioning.  In warmer temperatures, we lose more water from the body through increased perspiration.  The consequences of inadequate water intake/dehydration may include: headaches, fatigue, digestive problems, joint pain, muscle pain and cramping.  Therefore, special care should be taken to replenish fluids lost during the summer season.  Limit diuretics such as caffeinated and alcoholic beverages which actually drain the body of water.

3.    Get just enough sun:  Appropriate sun exposure can provide many health benefits associated with the natural production of Vitamin D.  Avoid sunburn which is a result of overexposure to the sun’s UV radiation and can contribute to certain skin cancers, along with premature aging and wrinkling of the skin.  To protect yourself, apply sunscreen regularly, wear a wide-brim hat and light-colored clothing that covers your exposed skin.  Your eyes should also be protected with UV blocking sunglasses.  Outdoor activities and sports should be limited to the early morning or late afternoon when UV rays are not as strong.  Be cautious on cloudy days, as your skin is still susceptible to burn under these conditions.

4.    Think safety first:  Water sports and other outdoor activities should always be performed with safety in mind.  This means wearing a life jacket in deeper water or if you are not a strong swimmer.  Parents should always keep a watchful eye on young children around water.  Diving into shallow or unknown waters should never be performed to eliminate the chance of serious spinal injury.  Running on pool decks may result in serious slip and fall injuries.  When bicycling, in-line skating, or skateboarding/longboarding, be sure to wear bright reflective clothing and protective headgear.  In addition, wearing appropriate footwear for the activities you are performing will give you balance, support, and protection.

Following the above rules and safety tips can go a long way in protecting your body during the summer season.  For additional information on health, wellness, muscle and joint health, visit our website at

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.