5 Tips for Pain Free Running: Avoid Heel Strike

1.  Avoid Heel Strike

Many beginner runners ask me how they should be running.   Running training should be focused on 1 of 2 things:  1)  injury prevention or 2)  performance.  So the main purpose of this post is to focus on injury prevention and treatment.  So I promote runners to avoid a heel strike and to try more of a mid foot strike when running with pain or recovering from an injury.    Landing with a midfoot strike has been associated with decreases in peak impact loads and a decrease in knee pain (patellar-femoral symptoms).  Below is a diagram from a breakthrough article in Nature   that shows landing forces with different striking patterns.

Notice the lack of the sharp increase spike with a mid foot strike.  One of the main points to take away from the article is the decrease in force and lack of transient impact with strike with a mid foot strike.  This difference and benefit of barefoot vs shod running is for another post, but these two articles show great evidence to help support a mid foot strike to help prevent injury and decrease impact forces to the legs.   I personally tried this and loved the way it feels when running vs with a heel strike. Tune in next week for Tip #2!!!  For more information about running injuries, our Running Injury Program, and about Pursuit Physical Therapy, call us at 407-494-8835 or visit us at PursuitTherapy.com.  Exercise is medicine!

Regards,

Ron Miller, DPT OCS

Pursuit Physical Therapy on the Radio! Tune into am 740 The Game

Tune into am 740 The Game from 9am-12 throughout the week, starting labor day weekend, to hear the new Pursuit Physical Therapy radio commercials!  Also, on Fridays, we will have a call in live-talk and ask a question to our very own Dr. Ron Miller about sport injuries, rehab, and prognosis of injuries.  Visit www.thebeatofsports.com or 740 The Game for more information.  For more information about Pursuit Physical Therapy, our specialty programs, and what we can treat, visit us at PursuitTherapy.com

Do you have a tennis injury? What is the best way to treat it? Call Pursuit Physical Therapy!

Not many people know that Andy Murray played through sciatica with his recent win at Wimbledon, but many tennis players play through injuries and pain.  Pain such as low back pain, sciatica, tennis elbow, knee pain and shoulder pain are some of the more common injuries tennis players experience.  Many of these injuries are due to over-training, structural problems, or poor technique and can easily be solved.  There is no need to play through pain and Pursuit Physical Therapy can help get you back to the tennis court pain free!  We will design a specific biomechanical analysis to identify the impairment, treat the problem, and teach you exactly what to do at home.  Contact us now at 407-494-8835 to schedule your appointment know or visit our website at www.PursuitTherapy.com for more information.

A Runner's Clinic at Fleet Feet Orlando with Ron Miller of Pursuit Physical Therapy

Come join Ron Miller of Pursuit Physical Therapy on August 8th at Fleet Feet Orlando for a Runner's Clinic about the BIG 3 running injuries!  RSVP at the Fleet Feet website.  Get back to pain free running now!

Why Don't We Compare Healthcare Providers Like We Do Everything Else? Is This the Best Treatment For Me?

My wife and I have recently experienced the complexity of buying out first home and what bank we should go through to help finance our house.  As we compared what each bank had to offer and interest rates, it got me thinking: why do we not do this in healthcare and with health care services?  When you are buying a house, you go to multiple banks and see who would give you the best offer.  When you buy a computer, you can go to multiple locations and see who can give you the best deal.  When you purchase auto insurance, you can get multiple quotes from different companies and then choose the best deal.  Even restaurants are graded now to a high standard with a letter grade outside their front door to pass an inspection.  Why don't we do this with health care providers and see who can offer the best service and the best outcomes?

For some reason we just blindly fall into the healthcare process expecting a high standard and the best outcome is given.  We don't ask questions or even question is this the best and most cost effective treatment for me.   Can someone else offer a better services and get me pain free faster?  With healthcare, we just expect an accurate and correct diagnosis, proper treatment, and then a quick and positive outcomes, right.  This is not always the case.  With some cases, a specific diagnosis is hard to confirm, there are multiple ways to treat the same diagnosis, lacking of evidenced based treatments, causing different outcomes some good and some bad.  This variability among treatments causes a problem.  Sometimes, especially physical therapy, you can have the same diagnosis and go to 3 different clinics and receive 3 different treatments!

 As healthcare begins to change and patients are going to be more financially responsible for their care (increased deductibles, increased co-pays, etc), there will be a benefit to the patient to be aware of patient outcomes.  The faster you get better, the less expensive your treatment will be!  For example, instead of having physical therapy for the standard 3x a week for 4 weeks for 12 sessions, what if you can be seen and treated 2x a week for 2-3 weeks!  This is why Pursuit Physical Therapy was started.  Focusing on better outcomes in fewer visits, and better yet, you will only see the board certified specialist with only one-on-one patient care.  This way of treatment can allow you to get out of pain quicker with less visits, thus saving you time and money.

So what should you look for when seeking a health care provider.  I put some questions that you can ask to make sure you are receiving the best care.  What are the right questions to ask?

1.  How much will each visit cost? This way, you will know exactly how much each visit will cost you before you sign up for treatment.

2.  Will I see the specialist?  If not who will be treating me?  With the changes that are coming with healthcare, more and more patients will be seen by assistants and less qualified clinicians.  If you have pain and are seeking treatment, (and better yet, paying out of pocket more money for the service!) don't you want to be seen by the specialist?

3.  Will I be double booked with another patient?  Many clinicians will be forced to see more and more patients per day causing some patients to be double booked with another patient.  No one wants this and this just leads to a decreased quality of care, increased number of visits, and a poor outcome.

4.  Look at the clinicians credentials.  You may not need to know what the credentials mean, but if a clinician has pursued special certifications and is board certified, they have probably specialized in a certain field, received extra training, and has kept up to date with the latest evidenced based treatments.  This may lead to a better outcomes.

If you have any questions or concerns regarding your pain and the quality of care you are receiving, contact Pursuit Physical Therapy today at 407-494-8835 and see if physical therapy is appropriate for you.  You can also find more information at our website at www.PursuitTherapy.com.

New Pursuit Physical Therapy Website Layout!

Visit www.PursuitTherapy.com and see our new website layout.  New design, new picutres and updated information.  Don't for get to see the Top 10 Reasons to go to Pursuit Physical Therapy!  Let us know what you think?

How do you Diagnose Plantar Fasciitis?

The diagnosis of plantar fasciitis can be made with a reasonable level of certainty in the clinic by an experienced clinician after a history and examination.  Diagnostic testing (x-rays and MRI) usually do not need to be ordered to diagnose plantar fasciitis and normally should not be ordered unless the diagnosis is uncertain or the patient is not responding to treatment.

Signs and Symptoms of plantar fasciitis are:
1.   insidious onset of pain under the plantar surface of the heel upon weight bearing after a period of non-weight bearing
2.  This pain in the plantar heel region is most noticeable in the morning with the first steps after waking or after a period of inactivity
3.  In some cases, the pain is so severe that it results in an antalgic gait.
4.  Heel pain will lessen with increasing levels of activity (ie, walking, running), but will tend to worsen toward the end of the day
5.  The history usually indicates that there has been a recent change in activity level, such as increased distance with walking or running, or an employment change that requires more time standing or walking
6.   In most cases the patient will initially complain of sharp, localized pain under the medial heel as in the picture above

There are some other differential diagnoses that can be ruled out during the examination that include:  stress fractures, bone bruise, heel fat pad atrophy, nerve entrapments, and referred pain from the lumbar spine.

The good news is that >80% of plantar fasciitis symptoms resolve within a 12 month period.  But who wants to wait 12 months to be pain free!  Schedule your visit at Pursuit Physical Therapy 407-494-8835 and resolve your heel pain now!  No injections, no medication, no surgery, no problem!  We can get you back to the activities you love pain free!

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 to go to Pursuit Physical Therapy: 8. We Save You Time and Money

8.  We Will Save You Money and Time

Here at Pursuit Physical Therapy, we are dedicated to saving our patients their valuable time and money.   If you compare our private pay model vs an insurance based model, you still save money and time with our treatment approach.  Remember, there are no co-pays, unmet deductibles, and no miscellaneous bills with us.  Just one flat rate and you get better results in fewer visits.  If there is a possible way to use insurance benefits—such as flexible spending accounts—or for possible reimbursements, we will assist you to the absolute fullest ability. We can provide you with detailed paperwork for submitting claims to insurance companies. Also, there are applications available to apply your physical therapy sessions to your insurance deductible.  Call 407-494-8835 or visit www.PursuitTherapy.com to schedule today!

What does the evidence say is the best treatment (other than a total knee replacement) for knee osteoarthritis?

Dr. Harriet Hall just did an excellent review of The American Academy of Orthopaedic Surgeons (AAOS) new report evaluating the evidence on what is the best treatment for knee osteoarthritis (OA)!  You may be surprised at what has good and bad evidence to support its usage for the treatment of knee OA!  HINT:  you can do one of these at physical therapy!

Barefoot Running Shoes? Good or Bad for a Running Injury?

Do you run in barefoot running shoes?  For some it may be OK, but for others especially those with an injury, this may be a problem that will not allow you to fully recover and return to pain free running.  Bruce Wilk, PT, OCS just wrote an excellent blog about barefoot running and post injury running.  What is the best shoes to wear when recovering from an injury?  Consult with Pursuit Physical Therapy if you have any questions regarding running shoes and post injury running at www.PursuitTherapy.com

The Park Press Release!

Don't forget to grab a The Park Press June 2013 issue and look at our local Winter Park, Baldwin Park, Maitland, and College Park Press Release!  You can also view it online here.  Visit our Testimonial Page to find out what our patients are saying about their experience at Pursuit Physical Therapy.  Feel free to call us at 407-494-8835 or visit www.pursuittherapy.com for more information.

How Long Should I Hold my Stretch For?

First, it actually took me longer to find a good picture of a calf stretch than I though it would.  Surprising!  But, second, a common question that many patients ask me is " How long do I need to hold my stretch for?"  Many people (and I will admit to doing this also) is recommending the usual 3 sets for a 30 second hold.  This may have been based on a old research article that showed no greater benefit after a 30 second on stretching the hamstring muscle. There are many reasons for stretching, ie: injury prevention, performance, and to increase flexibility.  For this blog, today, we will focus on flexibility.  But what does the research say about the optimal time to stretch a muscle?  This study showed the best long term results are from a passive static stretch when comparing four different stretching techniques.  Short term results were seen with active stretching, though.   Research shows that the greatest increase in flexibility to a muscle was experienced with 5 sets with a 90 second hold stretch.  Chris Johnson has a great video that reviews the proper technique to perform a calf and hamstring stretch.  So we promote a static passive stretch with a 90 second hold for our stretches.  For more information and more home exercise videos, visit the Pursuit Physical Therapy You Tube channel or visit www.pursuittherapy.com.  Pursuit Physical Therapy trying to set a new standard of care in the Central Florida and Orlando Area and we focus on what is best for the patient.  Don't be in pain any longer!  Call us to schedule a consultation today.

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!

Should I run with a Heel Strike or Midfoot Strike?

Many beginner and novice runners ask me how they should be running.   Running training should be focused on injury prevention or for performance.  So we will focus on injury prevention and treatment with this post.  Landing with a midfoot strike has been associated with decreases in peak impact loads and a decrease in knee pain (patellofemoral symptoms).  Below is a diagram from a breakthrough article in Nature from Lieberman et al.,  that shows landing forces with different striking patterns.

Notice the lack of the sharp increase spike with a mid foot strike.  One of the main points to take away from the article is the decrease in force and lack of transient impact with strike with a mid foot strike.  This difference and benefit of barefoot vs shod running is for another post, but these two articles show great evidence to help support a mid foot strike to help prevent injury and decrease impact forces to the legs.  I promote most long distance runners to land with a mid foot strike, with a shorten stride length, and increased step rate to help prevent injuries and to return to pain free running.  Feel free to contact Pursuit Physical Therapy at 407-494-8835 regarding any questions or visit www.pursuittherapy.com for more information.

Running with Knee Pain? Try this. Physical Therapy!

Do you get knee pain when running?  Tired of knee and foot pain?  The picture above shoes a great example of the difference in forces (yellow line) when running with a long stride with heel strike vs a shorter stride with mid foot strike.  Here is something very simple and easy to do to help you get out of pain and decrease the stress to your knees!  Current research shows an increase in step rate (with a decrease in stride length) can  reduce the loading to the hip and knee joints during running!  This may also prove beneficial in the prevention and treatment of common running-related injuries.  I tried it and I feel I can run much more efficiently now with less stress to my knees.  There is no need to run with pain so consult with Pursuit Physical Therapy for a biomechanical analysis or visit www.pursuittherapy.com for more information.  Visit the Pursuit Physical Therapy You Tube Channel for more running exercises and information with great videos by Chris Johnson, PT  regarding tips for runners.

How Does the Foam Roll Work? Everyone is using It!

This is a great review by Better Movement about how the foam roll works and the theories behind it.  Enjoyed reading this.

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!