Top 10 Reasons to go to Pursuit Physical Therapy: BONUS: Better Outcomes, Faster Results, Period!

BONUS:  Better Outcomes, Faster Results, Period!

Perhaps the most essential and significant reason for any patient to not hesitate in seeking out therapy at Pursuit Physical Therapy is quite straight forward and unpretentious—Patients see better outcomes, exponentially quicker results, and most important to the patient, Pursuit Physical Therapy adapts and customizes to each individual to ensure they get back to their activities and passions faster, pain free!  We get results!

For example, here is a case:  A patient complains of left Achilles pain after Cross Fit training.  Patient was pain free after one treatment session and home exercise program by the end of the 1st week.  After the second treatment session, the patient was pain free with exercise, and returned to Cross Fit workouts and running pain free at the end of the 2nd week.  Pain free and back to training in 2 weeks!  Visit www.PursuitTherapy.com for more information and call us at 407-494-8835 to schedule today!

  

What are the Risk Factors that can cause Plantar Fasciitis?

The cause of plantar fasciitis is multi-factoral and actually poorly understood, but here are some risk factors that have been proven to contribute to the cause plantar fasciits:

1.  Decreased ankle range of motion.  A decrease in ankle dorsiflexion has been shown to be a high risk factor for plantar fasciits.  This can be caused by dysfunction at the ankle joint or due to calf muscle tightness.  Many people are lacking the amount of range of motion(ROM)  needed.  The picture below shows an example of normal ROM

2.  Obesity and being overweight.  Increased body weight is a well established risk factor for plantar fasciitis because the increase weight causes and increase in stress to the plantar fascia.

3.  Work related prolonged standing.  Individuals who spend prolonged period of standing, walking, and work related weight bearing on their feet have an increased risk for plantar fasciitis.

4.  Training errors.  Overtraining, plyometrics, too rapid increase in distance, increase in intensity all can lead to the onset of plantar fasciitis.










There are many risk factors that many people believe to be the cause of plantar fasciitis but the presence of these factors to not always lead to the development of heel pain and plantar fasciitis.  Some of these factors are:

1.  Having flat feet or a high arch.  The research on this is not always consistent.  The risk of developing plantar fasciitis may increase with having a high arch or flat feet.  This is not always the cause though and this means that just because you may have flat feet does mean you will get plantar fasciitis.  Below is a picture of flat (hyperpronated) foot.  You can see how the arch is collapsed against the floor.

2.  Having a bone spur.  The presence of a heel spur is common is people without heel pain, and again, just because you have a bone spur on an x-ray does not mean that you will get heel pain or plantar fasciitis.  Bone spurs have found to be more common in older individuals, people with osteoarthritis, and those who are overweight.

Summary:

By understanding these risk factors you may be able to prevent plantar fasciitis from occurring or at least understand what factors have led you to experience your heel pain.  Remember just because you may have one of these factors doesn't mean you will get plantar fasciits.  Stay tuned to our next posts about diagnosis, prognosis, and what treatments are the best for plantar fasciitis.  If you are experiencing heel pain or plantar fasciitis symptoms contact Pursuit Physical Therapy now and get out of pain!

Here is an example of what one of our patients said who was experiencing plantar fasciitis:

Great physical therapist, I've tried EVERYTHING for my plantar fasciitis and gotten numerous injections, but Ron was the first doctor to actually look at my foot and asses the actual cause and show me how to fix it rather than just tell me to stop running and have it come back again!  I would definitely recommend him to anyone with any kind of sports injury!  He's great, PLEASE go see him!!!! He will be worth your time.  Best doctor I've seen hands down!  My foot is so much better! I'm running virtually pain free for the first time in 6 months.

What is Plantar Fasciitis?

Have you ever experienced a sharp pain in the bottom of your heel when you step out of bed first thing in the morning?  Do you get heel pain when you run or from a long day standing at work?  Well, it is most likely a condition called plantar fasciitis and it is estimated over 2 million people experience plantar fasciitis each year.  The plantar fascia is a tight band of connective tissue that supports the arch of the foot.  Plantar fasciitis is thought to be caused by biomechanical overuse to the plantar fascia, thus creating microtears at its insertion of the heal.  Some experts have deemed this condition not an true tendinitis, implying that its etiology is a more chronic degenerative process versus acute inflammation.  Usually people will complain of a sharp pain on the bottom of their foot or pain closer towards their heel.

People state that walking, first stepping out of bed in the morning, walking after prolonged sitting, and running will cause their pain.   Usually people will report a decrease in pain after a warm-up or some stretching.   If you have a questions or concerns about plantar fasciitis feel free to visit www.PursuitTherapy.com or call 407-494-8835.  Stay tuned to see what are risk factors, diagnosis, and what is the best treatment!

Top 10 Reasons People Should go to Pursuit Physical Therapy: 4. Unmatched Credentials

4.  Unmatched Credentials

Due to the credentials of our specialists, Pursuit Physical Therapy proposes a higher quality of treatment, to each and every patient. Treatment is always received by Doctors of Physical Therapy, and a board certified specialist. Within the practice we accommodate numerous athletic and rehabilitative needs, for instance, our very own Ron Miller, DPT, OCS has advantageously completed a post-doctoral residency in orthopedic physical therapy; moreover, he is Titleist Performance Institute Certified to treat golf-related injuries as well as to provide a full golf-swing analysis. Emphasizing on swing mechanics, posture, proper alignments of the body, as well as follow-through; all ultimately tailored to the individual player to optimize performance and minimize injury.  Call today to get seen by our Board Certified Specialists 407-494-8835 or visit www.PursuitTherapy.com for more information.

Can Tart Cherry Juice Really Help Me With My Pain?

I must admit that I am fairly new to this tart cherry juice thing.  I usually don't believe the general press or the internet on certain claims or statements, but the affects of tart cherry juice is beginning to have more research to help support its claim of decreasing pain, decreasing the effects of exercise and DOMS (delayed onset muscle soreness), and decreasing inflammation.  Recently Life Extension just released an article, with attached references, regarding the Anti-Inflammatory Properties of Tart Cherry and reviewed it effects of decreasing exercise muscle soreness, decreasing inflammation, prevention of CV disease, and its anti-cancer properties. Imagine if a simple supplement could help decrease medication usage (and its known side effects) in patients with chronic pain and inflammation such as gout, osteoarthritis, RA, and atherosclerosis?  What is it could prevent or change the state of disease in pathologies such as atherosclerosis, cancer, or Alzhiemer's disease?

Chris Johnson, PT recently blogged about the performance effects of tart cherry juice with endurance training and states he is an avid user of tart cherry juice with his training.  One study in 2010, showed tart cherry juice supplementation aided in recovery after strenuous exercise when running.  Another study, showed a decrease in pain and muscle strength loss after exercise induced muscle damage.   Further research, showed an increase in antioxidant defense towards decreasing oxidative damage.  These three research articles are starting a body of literature that supports the use of supplementing tart cherry juice to help decrease pain, decrease inflammation, and decrease side effects of exercise.  As Chris Johnson said, are you on the juice?  Great stuff!

Can You Tell Me Where Your Low Back Pain is Coming From?

Where is your low back pain (LBP) coming from?  This is an MRI of a 56 year old male with LBP.   Many patients come to me with spine pain and the first this that they tell me is ..... "well I have degenerative disc disease", " I have a herniated disc", "I have a bulging disc", etc.  Usually I come back and say " Well, I have a bulging disc at L5-S1 too and I don't have low back pain."  Their facial expression is usually disturbed and surprised!  This is what my lumbar spine looks like and what a normal spine should look like (as compared to the first picture).

For those that do not know what we are looking at this is an MRI image of a lumbar spine.  The last disc before the sacrum starts is L5-S1 and this is the most common area of LBP.  To the left is the front of the body and the right is the back.  You can see that my L5-S1 does not look the same as the other discs above it and it is not as bright.  So some degeneration is going on there, but it doesn't mean that you have to experience pain.  This may be normal degenertion that occurs from stress to the spine, weightllifting, and from playing sports.  I usually tell my patients that you can take 10 people with LBP, put them in an MRI machine, and their MRI will have positive findings, such as a herniated disc, degenerative disc disease, modic signs, osteoarthritis, etc.  You can then take 10 people WITHOUT LBP, put them in an MRI machine, and their MRI will have the same positive findings!  Research has shown ( from a highly respectable journal and from a high quality study) that these abnormalities seen in MRIs do not strongly correlate the underlying pathology and cause of your LBP.  This means that there are false positives with MRI and with most LBP, you may not need an MRI right away.  This is when you can get started with physical therapy and treatment right away!  Why do you need to see a physician with complaints of LBP and get diagnosed with LBP, and then get referred to a specialist?  Research has shown the cost effectiveness, improved outcomes, and more efficient treatment with the early treatment of LBP with physical therapy services.

In Florida, you have direct access to physical therapy so you can begin you treatment early and there is no need to wait for weeks to begin treatment.  If you do not respond to physical therapy or if you present with red flags, then you can be referred to a spine specialist for more diagnostic testing and possibly warranting an MRI.  Contact Pursuit Physical Therapy today for your LBP and start treatment now!  407-494-8835 or www.pursuittherapy.com.  We also have a Patient Perspective page for information for patients regarding LBP and physical therapy.  Feel free to consult with us regarding your LBP and what is the best treatment for you!  Remember just because you have a herniated disc or a positive MRI finding doesn't mean you have to have LBP.  Even this person was asymptomatic and did not have LBP!  Look how far the spine has slipped forward in the picture below!

Physical Therapy for Acute Low Back Pain? Can This Work?

Lets review this example of low back pain (LBP), that I happened to go through over the past 4 days.  So, for some reason, I decided to go to the gym on Tuesday and perform deadlifts as a part of my workout, which I haven't done since last year.

So later that day, after working at a skilled nursing facility and driving to my other job, I noticed an increase in LBP with strong muscle spasms.  Pain is a good thing (yes, it is very important!) and it tells you that something is wrong.  I always tell patients to "listen to your body", and if you are doing a certain task or position and you have increased pain try to avoid this, stop that activity, or attempt to complete it in a different position.  It is accepted in the research that acute LBP will spontaneously resolve in 4-6 weeks, but who wants to wait that long?   I know what caused my pain and that starting treatment with physical therapy with acute LBP as soon as possible will show better outcomes, decrease unnecessary testing, decrease the cost of healthcare, and I can start my treatment now!    So I was flexion sensitive, meaning I probably injured my low back during the deadlift during a flexion activity, driving also increased my pain (a flexion position again), and I know that prolonged sitting, bending forward, and any lifting would all increased my pain.

 I attempted to avoid these position as best I can, but as I was seeing patients, my work required me to be in some of these positions.  So I began treatment by myself throughout the day ... by doing prone press ups!

Since I was flexion sensitive, I would treat my LBP with repeated extension.  Many people with acute LBP fall into a directional preference and you can treat this with repeated motion with good research to support this.  I would perform at least 1 x 10 of prone press ups every hour to help me get through my day.  When I got home I usually sit in my chair, send some emails, and watch TV with my wife, but I knew that sitting would increase my pain, so I decided to do this.

I watched TV and checked my emails in this position, and by the time I was done I had no LBP!  This remained throughout the night and the next morning, and I was able to do a run/walk the next morning with only some muscle tightness.  I continued throughout my workday to perform at least 1 x 10 prone press ups every hour and was able to get through my day without exacerbating any symptoms.  On the 3rd day, I was able to return to the gym and perform basic strengthening during a light workout.  I could say that on the 3rd day I was pain free with no muscle spasm with no increased pain with flexion activities or prolonged sitting.  I know that this case will not work for every case of LBP, but this is a perfect example with acute LBP how early access and treatment with physical therapy can greatly help your pain and show a great outcome faster than the standard.  Physiopedia is a great online resource regarding physical therapy and LBP.  Pursuit Physical Therapy also has posted free information regarding LBP on their patient perspective page that reviews how LBP with effect their treatment and care.  Don't wait 4-6 months until your acute LBP to resolve, call Pursuit Physical Therapy at 407-494-8835 or visit us at www.pursuittherapy.com and start your treatment today!

Achilles Tendinitis: Can Physical Therapy Treat This?

Achilles tendinitis is a common injury that many athletes and non-athletes experience.  It may be caused by too much stress to quick to the Achilles tendon (like running for the first time) or too much stress over time that is associated with a lack of calf flexibility or a work related activity.  Many believe that this is an inflammatory condition but research shows that this is more of a degeneration of the tendon and not an inflammatory condition.  This is why sometimes, NSAIDs and other anti-inflammatories don't help with treatment.  Physical therapy has been shown to have great outcomes with Achilles pain and have been recommended as the first line of treatment.  When treated with manual therapy, stretching, and strengthening, your pain and symptoms should begin to decrease within the first couple of visits.  Some patients have even been pain free in 2-4 visits!  For more chronic Achilles pain, treatment may takes longer, even up to 4-6 months, but a good outcome is expected. Physiopedia has a great resource and tool kit regarding information, diagnosis, and best treatment for any achilles tendinitis or tendinopathy.   Visit www.pursuittherapy.com or call Pursuit Physical Therapy for more information regarding the treatment of Achilles pain and what is the best treatment for you!

Common Cross Fit Injuries?

What are some of the most common Cross Fit Injuries?  We really want to get involved in some of the local Cross Fit gyms around Central Florida. Injury prevention, training with proper biomechanics with the squat, deadlift, clean, and jerk lifts, and assisting with evidenced based treatments may help prevent an injury from occurring and, if injured, we can help you to get you back to Cross Fit pain free faster than the standard.  Feel free to comment on this blog, on the Pursuit Physical Therapy facebook page, or via email at pursuittherapy@gmail.com.   Visit our website at pursuittherapy.com for more information!

NSAIDS + runners = NO BUENO!

The New York Times wrote a great article and quoted good research regarding the use of NSAIDS (ibuprofen) in runners and cyclists.

Plantar Fasciitis: How Many Injections Does it Take?

Over the past 2 months I have seen an increase in referrals from a foot and ankle surgeon, and my number of cases of plantar fasciitis have increased.  I am all about what is best for my patients and what is the best treatment for them.  So as a physical therapist, I feel I can show great results with patients with plantar fasciitis (of course! ha ha) and I wonder why so many physicians implement corticosteroid injections for plantar fasciitis, and even sometimes give multiple injections over weeks to months, use steroid dose packs, and oral anti-inflammation when post acute plantar fasciitis has no S/S of inflammation and research has shown it is more of a degenerative tendinopathy?  I try to step back and look at the big picture and maybe the only patients that get referred to physical therapy are the complex ones that don't respond to injections and other anti-inflammatory methods.  Maybe a high percent of their patients respond well with a injection with a good outcome and never need physical therapy (PT).  Why even use anti-inflammatories?  Do physicians have evidence to support multiple injections and their clinical decision making? What about recurrence rates?  Why focus on short term outcomes and not only long term outcomes?  Why is it months to years before the patient gets referred to PT?  What is best practice for plantar fasciitis?

In 2008 JOSPT published clinical guidelines for the treatment of plantar fasciitis with orthotics only showing strong evidence to support, and stretching, modalities, and night splints showing moderate evidence to support.  Manual therapy has poor/theoretical evidence! but why does it work in the clinic for me?  Maybe the research as not caught up to clinical practice with high quality RCT, especially when good outcomes are already established?  A physician article shows a 90% success rate with conservative interventions, but this consisted of physical therapy, stretching, and injections.  These physical therapy guidelines were published in 2008 and may need to be updated: they do not have baxter's nerve entrapment in differential diagnosis and new high quality research may have been performed.  So then I performed a current Pub Med search for physical therapy and plantar fasciitis, and it showed no new current high quality research.  most of the research looks at more specific interventions such as corticosteroid injections, shockwave therapy for chronic plantar fasciitis, and orthotics.  This would be a great research topic to look at the outcomes of physical therapy care vs physician care in patients with plantar fasciitis in a RCT!  Looking at long term outcomes, cost effectiveness, and efficacy. Also, i would love to see treatment outcomes in plantar fasciitis with dry needling!  I could go on forever about physical therapy, so i will stop now.

The American College of Physicians and the Annals of Internal Medicine published physician guidelines for the treatment and management of plantar fasciitis for physicians in the clinic.  A Pub Med search using corticosteroid injections and plantar fasciitis was also performed.   I was shocked to see all of the evidence (the number of publications and quality of research) that has been performed to support physician interventions and the lack of evidence physical therapy has?  Maybe this is why they do not send patients to PT first.   Most of the research supports the use of corticosteroid injections for the short term treatment of plantar fasciitis, but their guidelines recommend to use injections as a second line of treatment.  I don't think this ever happens.  Poor long term outcomes were noted in patients with chronic plantar fasciitis and corticosteroid injection.  The physician guidelines state:

" due to the degenerative nature of plantar fasciitis, corticosteroids may have only limited effectiveness, and they have many potential side effects, including infection, tendon rupture, fat pad atrophy, and skin atrophy."  

One study showed a small increase in plantar fascia ruptures after an average of 2.67 injections when reviewed 120 cases.  I see patients after 4-6 injections sometimes?  I even had patients return and say that the physician told them it takes 5-7 injections sometime?  Where is the research to support this?  I have searched for the past week and still cannot find anything to support multiple injections.  Isn't the definition of insanity is doing something over again, (and again), and expecting a different outcome.  The physician guidelines further state:

"a meta-analysis of 5 studies showed that although a cortisone injection may have some benefits, they were short-term in nature and that there was no difference in long-term outcome."

Overall, it looks like a conservative approach and a corticosteroid  injection can assist with good short term outcomes.  Other interventions are recommended with chronic plantar fasciitis, such as surgery and shock wave therapy.   More research needs to be performed to support the use of physical therapy interventions.  I have not found any research to support the use of multiple corticosteroid injections in the treatment of plantar fasciitis.   I still would like to see how my clinical outcomes would change if i saw patients with plantar fasciitis prior to physician corticosteroids injections.

RECOMMENDATION TO PATIENTS: Roughly 90% of plantar fasciitis patients get better.   Research supports a conservative approach (physical therapy and stretching) and you may benefit from an early corticosteroid injection to decrease pain for plantar fasciitis.  Patient education is the key!  If you can treat it early, you may be able to prevent it from progressing to a chronic problem and getting a better outcome with faster results.  If you do not respond to an injection or anti-inflammatories, the plantar fasciitis may have progressed to more of a degenerative chronic stage, but conservative treatment can still help so consult your physical therapist!  No need for multiple injections that have already not helped you.   Many states have direct access to physical therapy services so you can consult your physical therapist and get treated now instead of waiting for symptoms to worsen.

Regards,

Ron Miller, DPT, OCS