 When people complain of heel and foot pain, one of the most common terms tossed around is “Plantar Fasciitis”. Exactly what is Plantar Fasciitis? It is inflammation of the plantar fascia, or in layman’s terms, inflammation of the thick band of tissue that connects the heel bone to the toes. It is responsible for supporting the arch of your foot.  It presents itself as a sharp pain in the bottom of the foot. It is usually around the heel or just in front of the heel bone. The pain is usually worse when you first get out of bed or get up after sitting for a long time. In addition, being on your feet for long periods of time usually exacerbates the pain. Discoloration and significant visible swelling do not usually occur. It is, however, tender to the touch.  What is the best treatment for Plantar Fasciitis? Common sense says if it hurts, don’t use it. This is impossible, since we all need to walk! I recommend three basic steps to begin the healing process. First, always wear shoes, even around the house. It is important to wear shoes with good arch support. A quality tennis shoe works well. This will take some of the pressure off the plantar fascia. Going barefoot usually increases pain due to the lack of support.  Second, stretch your calves. One of my favorite stretches is to create an incline that you can comfortably stand on for 1-2 minutes at a time. By making the calves more flexible, some of the pressure is taken off the plantar fascia.  Third, ice the painful areas of your feet. This helps take some of the inflammation and, in turn, pain out of the foot (since inflammation is contributing much of the pain). My favorite way to ice is to freeze a water bottle and roll it on the bottom of the foot over the painful area. This not only ices the area but massages it as well. Plantar Fasciitis treatment is usually pretty straight forward but requires time and patience. Two things are important to remember: First, “no pain no gain” is not a good approach. You want to keep your treatment pain to a minimum while still making strides to stretch the area when pain is minimal. Second, try to catch it early! If you can catch it before it gets bad, it is much easier to treat. Give it a month or so of supportive shoes, resting, and stretching, and it should improve. If not, it is time to see your local physical therapist to try some more exercises and treatment options.  By: Brian Colvin, PT
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Low back pain has become one of the largest causes of pain and disability in the United States. Billions of dollars are spent on trying to care for and remedy this issue. People are advised by friends, coworkers, and physicians to seek out certain types of treatment such as physical therapy, chiropractic care, medicines, diets, or other newfound treatment approaches.  So what to do? If your back is hurting which track do you pursue? While pain can be a very complex problem there have been ways that consistently show how someone can at least better manage their pain if not altogether get rid of it. The Journal of Pain Research has proposed factors to consider when deciding how to address your pain.  Obviously, physical problems within your muscle or nervous system can be a direct cause of your pain. Structures in your body can become quite sensitive to pain causing a compounding problem that never seems to resolve. Even having a sedentary lifestyle or being deconditioned can cause structural deficits which can cause pain with movements or mobility. Another area can be more of an environmental factor such as work satisfaction, perceptions or demands at your job or even the attitudes of your employer. These can cause a higher risk or predictability of pain.  Some people also say, “I have a ‘high’ or ‘low’ tolerance for pain.” These pain-related beliefs and attitudes can have a real effect on someone’s ability to recover from a painful condition. Often time someone’s expectations, beliefs, or perception of their condition can have a direct effect on their ability to overcome the condition. Our attitude as physical therapists is to educate each individual on their specific condition, so they understand what will positively and negatively influence their symptoms. Also, we promote that the person have an ACTIVE involvement in trying to manage their care. Many studies have shown that individuals who actively participate in managing their condition do better than those who passively receive care.  You may be faced with many recommended options to help take care of your back pain. We would recommend that you first understand that there can be many causes of your back pain and especially many things influencing the level of your perception of pain. We feel a conservative approach such as physical therapy often helps people to manage or alleviate their symptoms. If physical therapy doesn’t work for you, there are other options that you can pursue as well. Give us a call to sign up for a free consultation if you'd like one of our physical therapists to sit down and talk with you about your low back pain, and discuss what PT can do for you.  By: Steve Bartz, PT You commonly hear terms like sprain, strain, broken bone, fracture, tendonitis, and bursitis, but do you know what they mean? We’re going to break down some common diagnoses so if your doctor tells you that you strained your hamstring, sprained your ankle, or your child broke their arm, you know a little more about what exactly that means. Strain vs. Sprain  STRAINS are the overstretching or tearing of muscles or tendons (tendons are the dense tissue that connects bones to muscle). For example, if you're carrying something very heavy with poor form and injure your back, it may be a muscle strain in muscles of your back. SPRAINS are the overstretching or tearing of ligaments (the bands of tissue that connect bones together in a joint). A common sprain you've probably heard of is an ACL tear or sprain (ligament in the knee joint), or an ankle sprain (most commonly in ankle sprains the anterior talofibular ligament on the outside of the ankle is overstretched when the foot rotates inward).
Both strains and strains can be debilitating depending on the severity of the tear/stretch. Both can lead to swelling, pain, and limited flexibility. Fracture vs. Break Fractures and broken bones are the same thing. There are many different types of fractures, but all involve trauma to a bone due to the stress on the bone being greater the the strength of the bone.  This stress on the bone that causes is to "break" (fracture) can be caused by different circumstances:
 Tendonitis vs Bursitis  Tendinitis is the inflammation of the tendon (like we talked about earlier, the tendon connects the muscle to bone and is tissue making up a chord-like structure). You've probably heard of rotator cuff tendinitis (inflammation of the tendons that make up the rotator cuff). Bursitis is inflammation of the bursae, which is a fluid-filled sacs that cushions bones and tendons/muscles to reduce friction. Bursas and tendons are located near each other, and tendinitis and bursitis share some common symptoms. Often tendinitis and bursitis often occur concurrently at a given joint. These similarities cause the two terms to be assigned incorrectly when there's pain and swelling at a joint. If you are suffering from a sprain, strain, fracture, or other musculoskeletal injury and live in the Hudsonville, Jenison, Grandville, or West Michigan area and need physical therapy, give us a call! These types of injuries are our specialty and it's our goal to get you better efficiently so you can get back to your favorite activities this Spring!  By: Lisa Pfotenhauer, Cert. Exercise Physiologist We all know someone (or maybe experienced yourself) who has had a concussion. Concussions range in severity, and unfortunately are common in sports, particularly contact sports like soccer, football, hockey and wrestling.  What causes concussions? Trauma to the head, often caused by motor vehicle accident, falls, and sports injuries, causes concussions. Your brain is made of soft tissue, cushioned by spinal fluid and protected by your skull. A blow or bump to the head can jolt your brain, causing it to literally move around in your head. This can cause bruising, blood vessel damage, and nerve injury, which leads to the concussion symptoms we see below.  How do I know if it’s a concussion? Symptoms of a concussion include headaches (this is the most common), nausea, balance problems, sensitivity to light and/or noise, drowsiness, amnesia, trouble comprehending and concentrating, and feelings of being in a fog. When someone experiences a concussion, they may have just one or many of these symptoms, depending on the severity and how they respond.
What should I do if my child or someone I know appears to have a concussion? When do I call the doctor? If your child experienced a blow to the head, it may take anywhere from 2 minutes to a few hours for concussion symptoms to appear. If symptoms of a concussion are apparent, you should consider taking your child to the doctor. If they did not lose consciousness during their concussion, they should wait until symptoms subside to return to normal activity (could be minutes, hours, or days depending on their concussion). They should get lots of rest and take precautions to avoid another concussion, and may be advised to avoid strenuous physical or mental tasks, and take time off from from sports, school, or work. Symptoms normally go away within 6-10 days. If he or she loses consciousness or experiences a neck injury, you should take him or her to the doctor or the emergency room for observation and treatment.  Prevention Concussions can be dangerous, especially because once you sustain one, you are at a three to five times greater risk for experiencing another one. To decrease the likelihood of concussions for yourself or you child, always wear seat belts in the car, wear a helmet when biking, riding a motorcycle, skiing, etc. Have handrails on your staircase and safety gates on your stairs if you have young children. If you child does experience a concussion as the result of a contact sport, make sure they rest from that sport for the amount of time their doctor recommends, because repeat concussions (while their brain tissue and nerves are still healing) are much more dangerous to the brain than the first concussion.  Sources: Clevelandclinic.org: Concussions, January 2015; WebMD: Concussion (Traumatic Brain Injury), 2018; Center for Disease Control and Prevention: Traumatic Brain Injury & Concussion, February 2019  By: Lisa Bartz, C-EP Vertigo is defined as a sensation of whirling and loss of balance, associated particularly with looking down from a great height, or caused by disease affecting the inner ear or the vestibular nerve; dizziness, loss of balance, loss of equilibrium, or spinning.  There are two types of Vertigo: peripheral vertigo and central vertigo. Central vertigo is less common and is caused by the central nervous system (primarily the brain). Peripheral vertigo is by far the most common. There are five types of peripheral vertigo: 1) Benign Paroxysmal Positional Vertigo (BPPV) 2) Meniere’s Disease 3) Vestibular Neuritis 4) Acoustic Neuroma 5) Labyrinthitis Of the five, Benign Paroxysmal Positional Vertigo (BPPV) is, by far, the most common. Common symptoms of BPPV are dizziness, loss of balance, spinning and even nausea. The cause of BPPV is the disturbance of the inner ear crystals.  Physical therapy is often used to treat BPPV. Physical therapists screen each patient to see is their vertigo is BPPV, and if it is, there are several maneuvers used by PT’s to realign the crystals of the inner ear. Often the symptoms can be resolved or significantly improved in just 1 – 2 visits.  The first step, if you suffer from vertigo, is to see your medical doctor or physical therapist. If he or she diagnoses you with BPPV, try physical therapy. It might be a safe, quick and drug free approach to feeling better.  Brian Colvin, PT While we may laugh at this old quote from a commercial, the reality of balance problems is becoming significant in our ever-aging population.  Balance problems can occur from a variety of issues including: - Joint stiffness - Inner ear problems - Certain medications - Lack of activity or sedentary lifestyle - Simply aging Balance problems can also be caused by medical conditions such as stroke, Parkinson’s disease, multiple sclerosis, brain injuries, arthritis, spinal cord injuries, cognitive diseases, or diabetes. Balance issues can also occur when one or more systems in the body are not working properly including: vision, inner ear, muscular system, awareness of your own body position (proprioception).  A person may feel dizziness, instability, vertigo, or a sense that there falling. They may be fine while standing still, but as soon as they move or change position they may suddenly lose their balance. This often causes fear in performing simple daily tasks and causes the person to becomes more and more sedentary. It becomes a vicious cycle of loss of conditioning and decreased activity level. It is important to identify how your balance issues occur. How often do you have them? What are you doing when you experience them? What medications do you take? Have you had your vision or ear checkup recently? Do you have any other medical conditions or problems?  Physical therapy can offer numerous options for treating balance problems based on each person’s needs. Therapist look at multiple systems of the body including muscles, joints, inner ear, eye tracking ability, skin sensation and positional awareness of the joints. They are experts at prescribing active movement techniques and physical exercise to improve the systems, including strengthening, stretching, proprioception exercises, visual tracking and inner ear retraining. This can help you reduce fall risks, reduce the fear of falling, improve mobility, improve balance and strength, improve your movements, and increase your activity levels. Reference: moveforwardpt.com  By: Steve Bartz, PT Most of us have heard of shin splints, but I’ll bet than many don’t really understand what shin splints are. Typically if a patient describes pain in the front of the lower leg, it will be diagnosed as shin splints. Let’s talk about the causes and treatment of this condition.  This condition is common in people who do a lot of running, as well as with people who have jobs that involve excessive standing or walking. The pain is typically felt in the front of the lower leg bone, the tibia. It is often described as a throbbing pain, or a deep ache, but also can produce sharp pain as well. The interesting thing is that although the pain feels as if it is coming from the bone, it is typically produced by the soft tissues that attach to the bone. This includes the tibialis posterior muscle, which is attached on the posterior (back) side of the tibia bone. This muscle is active whenever we are bearing weight on our leg. It helps to keep the arch of our foot from collapsing during weight bearing. People who have flat feet/arches would be more prone to developing this condition, as the tibialis posterior muscle will work hard to try to support the collapsing arch.  In terms of treatment, there are a couple of things to consider. First, a precautionary X-Ray or bone scan is often a good idea, as repetitive stress on the shin (especially in long distance runners) can lead to a stress fracture. If this is ruled out, then we treat the soft tissue problem. As always, we want to identify the cause of the problem, not just treat the symptoms. Patients can take anti-inflammatory meds, or ice the painful area, but these will only provide temporary relief and will not address the cause of the pain. We first need to look at the lower leg and foot alignment to see if an orthotic is indicated. If a patient has poor foot structure (especially flat arches, but sometimes excessively high arches), a shoe insert to support the arch can relieve stress from the lower leg muscles (tibialis posterior) that have to work excessively to support the arch. We also want to make sure that the patient has full range of motion and flexibility in the lower leg/ankle/foot region, as well as good muscle strength in the lower leg/ankle/foot region. A gait evaluation and possibly a running assessment are also indicated to identify abnormalities which may be contributing to the condition.
If you have been dealing with shin pain, please give us a call so that we can help you! This can be a difficult condition to treat, but it is treatable, especially with the help of an excellent physical therapist.  By: Mason Riegel, PT 1. What is osteoporosis? Osteoporosis is a term many people are familiar with – it’s when one’s bones become weak and brittle from losing too much bone (becoming too “porous” – hence the term osteoporosis), or from making too little bone. It is dangerous because weak bones are more susceptible to breaking from falls, bumps, and accidents. Also, it can affect vertebrae and lead to hunched posture, often resulting in pain. Osteoporosis is especially prevalent in women and older populations.  There are MANY causes of osteoporosis, and it can occur in conjunction with dozens of different medical conditions and medications. This is an important conversation to have with your primary care physician to see if you are putting your bone health at risk. 2. How is it treated, and how is it prevented? Half of women over 50 who have osteoporosis will break a bone. If you know you do have osteoporosis, is your condition hopeless or is there something you can do to take care of your bones? Osteoporosis cannot be “cured”, but there are measures one can take to treat it. Doctors sometimes prescribe medications (bisphosphonates, prolia, forteo, estrogen-like drugs, fortical, and more) that work either by preventing the breaking down of bone or by increasing the building of bone, but all come with side effects. Depending on the severity of your osteoporosis, a medication treatment may be worth discussing with your doctor. Each person is unique, and a different treatment may work better for one person than another  Nutrition is another key component of treating (and preventing) osteoporosis! Calcium is the “building block of bone”, and your body needs vitamin D to help absorb the calcium. Daily multi-vitamins are one way to ensure you’re getting enough calcium and vitamin D, but here are some foods that are calcium-rich and vitamin D-rich (and don’t forget good old sunshine!) Most adults should aim for 1000-1200 mg of calcium, and 400-1000 IU of vitamin D daily.
Lastly, exercise is key for keeping your bones strong. Proper and consistent exercise not only strengthen your bone density but also will strengthen the muscles and tendons that connect to and support your bones, relieving pressure from your joints. Exercise for treatment and prevention of osteoporosis should include two types of exercise: weight-bearing exercise, and muscle-strengthening exercise. Weight-bearing exercise puts stress on your bones - "good stress". This stress increases production of bone - increasing your bone density and mass or reducing the loss of bone mass. (If you want to learn more about how bone production and loss work check out this video on bone remodeling!) To exercise and use this "good stress" on your bones, do activities like running, walking, tennis, dancing, or anything repetitive on your feet. The impact on your bones actually makes them stronger. HOWEVER, if you suffer severe osteoporosis, you should consult your doctor about what exercises are safe for you to participate in. Running may not be the best exercise for someone with severe osteoporosis who is at a high risk of breaking a bone.  Muscle-strengthening exercise (“resistance” exercise), should be done for the whole body. If you’re just going to do a little bit, focus on complex movements and large muscle groups. Strengthening the legs, hips, and glutes are going to give you the support you need and this lower body strength may help prevent falls! Core and upper body strengthening are also important. If you already have osteoporosis, consider adding some fall-prevention exercises to your day, like balancing on one foot.  If you do not have osteoporosis now, remember that the best solution is prevention!  By: Lisa Bartz, C-EP Sources:
National Osteoporosis Foundation: What is Osteoporosis and What Causes It? 2018; The American Society for Bone and Mineral Research: Response to New England Journal of Medicine Study: “Biphosphonates: Where Do We Go From Here?” 2012; Endocrine Web: The Role of Calcium and Vitamin D in Bone Health: Nutrients for Osteoporosis Prevention, P. Camacho, MD, D. Toft MD, PhD WebMD: Osteoporosis: Diagnosis and Treatment, 2017 Unfortunately, knee pain is common. The good news is, many cases of knee pain can be prevented, treated, and reduced or eliminated with proper treatment and exercise! Here are a few tips for dealing with you knee pain. Remember, knee pain has many causes, and if you’re dealing with acute pain, severe pain, or knee pain from trauma, you should see your doctor or physical therapist to find the cause of your knee pain.
Air squats Backward lunges
Glute bridges Single leg balance
Calf raises Donkey kicks  Clams
Calf stretch 1 Calf stretch 2
Quad stretch Hamstring stretch
When should you see a doctor? If your pain is new, very painful, or persistent, it is a good idea to see a doctor or physical therapist right away and get advice on what treatment you may require or what your next steps should be.  By: Lisa Bartz, Certified Exercise Physiologist (C-EP) One of the common conditions that we treat here at Hudsonville Physical Therapy is muscle tension headaches. Headaches can be a very complex condition, with many different contributing factors. However, when it is determined that the headaches are “muscular” in nature, physical therapy is a very effective solution.  One of the most common causes of muscle tension headaches is poor posture. When we sit or stand with correct posture, our head is centered over our torso, and is in a balanced position. However, many people do not sit or stand with proper posture. Our typical posture is what we refer to as a “forward head” posture, where our head is out in front of our torso. Heads are quite heavy (14-16 pounds on average), and when the head is in front of the torso, gravity is pushing it downward. So in order to keep our head up, the muscles in the back of our neck and shoulders have to continually hold our heavy head up. Over time, this causes the muscles to fatigue and get tense, leading to muscle tightness and pain.  Another cause of muscle tension headaches is stress. People tend to carry their stress through their neck and shoulders, leading to abnormal amounts of tension and lack of rest for the muscles. Over time this takes its toll and leads to chronic muscle tension and headaches. Most people will begin taking some type of medication (pain relievers or anti-inflammatories) to treat their headache. This can provide short term benefit, but unfortunately is not a long term solution because medication does not treat the cause of the pain, only the symptoms. However, physical therapy gets to the root cause of the problem and provides a long term solution! So what is this solution to muscle tension headaches? Typically it involves several of the following interventions: 1. Postural Education. It is essential to teach our patients proper posture so that they can eliminate the strain on their muscles caused by faulty posture. If we do not do this, the headaches will likely return. This includes identifying potential posture problem areas including use of laptop computers or cell phones.  2. Identifying stress and the body’s response to it. People often know why they are stressed, but have difficulty eliminating the effect of the stress on the body. One effective technique is by teaching correct breathing. When stressed, people often breathe with their “accessory muscles” through the neck and shoulders. This leads to shallow, quicker breathing and increased tension through the neck and shoulders. The diaphragm is supposed to be our main breathing muscle, and the diaphragm is located in the abdomen. When we breathe correctly, we use our diaphragm (abdomen) to breathe, which results in deeper, more efficient breathing. This breathing provides more oxygen to our body, which it needs. Diaphragmatic breathing also eliminates tension in the neck and shoulder muscles and helps our body to relax. 3. Soft tissue massage. When muscles have been tense for a long period of time, it’s almost as if they don’t know how to relax anymore. A skilled physical therapist is able to work on these tight muscles and release this chronic muscle tension, which can be extremely helpful in eliminating symptoms.  4. Stretching and mobility exercise. Tight muscles lose flexibility, resulting in reduced range of motion in the neck. PT can help to stretch these tight muscles and restore full range of motion in the neck, which enables the body to move without compensation. 5. Exercise. We need to identify the proper muscles to strengthen, so that the muscle tension problems do not return due to having weak muscles. This includes strengthening the deep cervical flexor muscles (front of the neck) as well as the scapular and shoulder girdle muscles. Maintaining a good exercise routine often makes the difference between having chronic headaches and being headache free. Those are just some of the treatment interventions used by physical therapists. In all cases, it is important to have a thorough physical therapy evaluation to determine your specific needs. If you have been struggling with tension headaches, give us a try. You’ll likely wonder why you didn’t do it sooner!  By: Mason Riegel, PT |
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