by Dr. Loni Rodriguez | Feb 13, 2020 | Exercise advice, Foot Pain, Injury, Running
Plantar fasciitis (PF) is a term used to describe inflammation or pain on the bottom of the foot. The plantar fascia is a taught band of tissue that holds the arch of the foot. There are also TONS of layers of muscles on the bottom of the foot that can give pain as well meaning the pain generator is not just the plantar fascia, it can be from muscles as well.
The pain can come in a few different forms – sometimes it’s pain on the heel, sometimes it’s pain on the arch. There are a few other things that “foot pain” could be, but there are a few classic signs of PF:
- Pain that is worse with the first few steps out of bed in the morning
- Pain after a longer time standing, walking, or running
- Pain that seems pin pointed on the bottom of the foot and is sensitive to the touch.
None of the above can rule in or rule out the diagnosis, but many people who come see us for PF pain present with some of the above. The main issue with PF is that it gets stressed every day because we are upright beings and we constantly have to put pressure on the spot that hurts. PF tends also to hang around way too long and when treated improperly, can lead to a very long bout of unnecessary foot pain.
Most people get a flare up from doing a bit more of something that they aren’t use to. How can you get it?
- Running longer
- More hills/inclines
- A change in shoes
- A significant change in terrain (I got it when I went hiking for the first time last season and wore running shoes)
- Doing more of the same activity that you aren’t used to
- Doing more walking in different shoes (walking around the city for the day in flats or flip flips if you aren’t used to it
The most common ways that people manage this type of foot pain is with ice, stretching, rolling the bottom of their foot on a ball, anti-inflammatory medications, and orthotics. While all of those play a role in the recovery process, there are some other things that should be focused on to really make the most out of your rehab.
The initial stage (0-72 hours)…
Gentle stretching, ice, and normal walking around, etc is appropriate especially if it is super irritable. But this really should only last as the sole type of treatment for the first few days of a flare-up. Yes… only for the first few DAYS! This means that more can be done that is much more beneficial if this has been going on for longer than a few days.
Anything but the initial stage (past 48-72 hours)…
You can continue to stretch, ice, ball massage, etc but there is a key component to PF pain that most people don’t address. This is the concept of adding stress to the foot. This would seem counterintuitive, right? Why would we want to stress an already overworked and stressed area of the body? That is actually how rehab works… in many cases our body responds best to adding an appropriate amount of strain to actually get it back to normal. Sometimes, that initial addition of strain gets the area a bit cranky, but as it is repeated that crankiness actually subsides.
This explanation was very brief for the purposes of this article so I want you to keep in mind that every pain experience is different and involve many other factors that affect the treatment outcome. This information can at least set the stage on the idea that there is more to PF pain than ice massage with a frozen water bottle and time off from the treadmill.
Here are some of our go-to PF pain exercises!
- Toes elevated heel raise – This exercise targets the plantar fascia directly to give a combined load stress and stretch.
- Single leg heel raise (modified) – This exercise is imperative for ALL RUNNERS to be performing on the regular. Single leg heel raise strength is incredibly important for runners – you are NEVER on two feet and your calves do a ton of work. They need isolated training and it needs to be hard enough to make gainz. This is a modified version for someone with irritable PF pain, a progression would be to loose the bench and perform with hand-held assist on a chair or wall. This exercise not only strengthens the calves but it also works on the foot muscles as well which can help build and repair the irritated foot!
- Double leg weighted heel raises – This is another staple in anyone’s foot pain program. Double leg her raises work to build up the calf muscles which, as stated above can help build and support the foot as well. The double leg feature allows both calves to work, adding load can help make it challenging enough to make changes.
Lastly… Are you more of a visual / auditory learner? I put a little video together explaining the exercise in the first video! How to help your foot pain
Were you intrigued by this an have more questions? Please reach out!
by Pippa Teague, Strength Coach | Oct 14, 2019 | Back Pain, Exercise advice, Injury, Injury Prevention, Personal training, Recovery, strength training, Uncategorized
By Loni Rodriguez, DPT
Having an animal in pain is really scary.
They can’t talk, they can’t tell you what makes it hurt, how severe it is, how it makes them feel, or what makes them feel better.
You can’t ask questions like, “Does eating make the pain worse?”
Or… “Has this been going on for a long time, you just haven’t done anything about it?”
You must rely on watching their body language and for signs of distress. But man, to base your plan of attack on a dogs sign of pain is really challenging.
It is hard because when you see these said signs (shivering, whimpering, panting), you want to try not to freak out and run to the emergency room. Sometimes, things like this just go away on their own. Also, everyone knows how expensive the vet can be and you are 110% at their mercy which means you have to have a trusted source for care.
Gracie (our 5 year-old Long-haired Dachshund) had suddenly began to show signs of distress one day. The signs would fluctuate, but she just was not herself and we made the decision to take her to the vet. After some blood testing and ruling out the real serious things, she was diagnosed with lower back pain. Now, Dachshunds are known for back issues because of their bodies, but she’s 5 years-old! She does love to play, jump and run but has had no prior history of this…
The vet’s treatment plan was high-dose anti-inflammatory medications and ‘crate’-rest for 2 weeks. I asked about physical therapy, I knew that “doggy” chiropractors existed but they didn’t have any resources for us. Nevertheless, we took the docs recommended plan and headed home. Mommy went into PT-mode.
I texted and messaged Instagram friends all over the country to see who knew what I could do for my dog with low back pain. Soon enough, responses poured in and I was in contact with one of the best animal chiropractors! (Social media is WILD). We spoke briefly on the phone and not to my surprise, the vet’s recommendations were pretty poor and she explained that it was a very ancient school of thought. I needed to find myself a local chiropractor for my pup…
A few days went by, Gracie was looking a bit better but still was well below 100%. She was not really eating, not wanting to leave her crate very much (even though that is what was recommended, I left the crate door open). She really was just feeling like crap. During this time, we also have Mr. Tucker (our other pup) right by her side cleaning her ears, eyes and mouth like a caring little bro – the CUTEST thing ever.
A few more days went by, still not looking up for our furry baby. One morning I woke up to get ready to go to OrangeTheory and took Gracie out to pee. She seemed like she had a little pep in her step without showing signs of distress so I was happy. That was until I took her outside and she stumbled and fell over on her hind legs while going to the bathroom. Her back legs were not working normally! That was it, to the vet ER I went at 5:30 am. Even though I could tell she was not in as much pain, I needed to get her looked at.
After waiting patiently and going through with the evaluation with the ER doc, they cleared her for severe loss of function via some testing and diagnosed her with MILD disc herniation and recommended HIGHER-dose pain medication for 6 weeks and complete crate rest (for 6 more weeks).
WHAT?!
But she wasn’t in pain? She was actually happy and seeing some improvements? If you clear the big scary diagnoses and say the leg weakness is a sign of a mild disc herniation then why the 6 weeks of bed rest and super high does pain meds that will knock her out?!
Could ANY of this be similar to a human? (I asked, and they said sort of but not really…) They said that if I did not follow these recommendations, I could be looking at severe negative effects and possibly needing surgery…
This seemed WAYYYY too close to some recommendations made to patients in the past who have made amazing strides without heavy meds, rest, or surgery.
Again, I reached out to the trusted chiro and she said PLEASE find a local doc. So… that is what I did. The SAME day that I brought her to the ER, she was seemingly better so I think she was gradually improving in regards to discomfort and pain, but her leg weakness and lack of coordination continued to be present. I absolutely wanted another opinion. I found a doctor of doggy chiropractic medicine that the other chiropractor approved of. We were seen for an appointment and all of my worries and thoughts of having to rest and medicate her were gone. He agreed with some mild disc-related pain, but explained that dogs are self-limiting. They will do as much activity as their bodies can handle. Yes, I needed to keep her from jumping, playing hard with her brother and limit how MUCH play… but to let her play and be normal. He did some gentle work on her and off we went.
Movement was medicine and she is now close to 100% after about a week.
Now… what did I learn from this experience?
It is really hard to trust ANYONE when your loved one is going through pain. You want what is best, but are not sure who’s recommendations to follow.
I need to continue to be very mindful of how I approach education and treatment recommendations for my clients. I found myself reflecting on how I have approached recommendations to patients. I am confident in what I tell people to do, but they HAVE to be confident themselves before they will follow what I have recommended. Even though I really did trust the original “virtual” chiropractor, I was faced with significantly different conflicting recommendations by an ER doctor… I am SO glad that I did not follow the original recommendations.
Find a medical professional that you trust. Find that medical provider that you really feel has your best interest in mind, has the resources to allow you to make your OWN informed decision on how you would like to proceed, AND has enough humility to admit when they may not know exactly what to recommend, but know someone who can help.
If this story resonated with you, please let us know leave a comment below or shoot us an email. If you are a current client and see Gracie in the office on the regular, give her a hug! She is a happy pup who loves attention.
Looking for the doggy chiropractor? Get in touch and I’m happy to share 🙂
by Pippa Teague, Strength Coach | Sep 9, 2019 | Breathing, Conditioning, Injury, Injury Prevention, Recovery, Running, strength training, Stressrelief, Stretching, Uncategorized, working with injury
The definition of adversity via Webster’s Dictionary:
“Difficulties, misfortune, ill luck, back luck, trouble, difficulty, hardship, distress, disaster, misadvantage, suffering, affliction, sorrow, misery, heartbreak, heartache, wretchedness, tribulation, woe, pain, trauma, torment, torture.” The list goes on.
Adversity can be defined as any of the above. Everyone goes through some sort of adversity. It’s not about what type you deal with, but about how you respond to it.
Do you ever feel alone when you’re dealing with something like this? I am sure of it, we all do. But guess what, you aren’t alone. The feeling of being alone EASILY gets more believable in a world where social media is constantly in our faces. Old friends, co-workers, gym buddies, cousins, acquaintances, celebrities… they all look SO happy on the screen of your phone. But guess what, they probably have shit going on. Don’t forget that.
So… How do you overcome adversity? You can’t just make it go away, you can’t just run and hide and let someone else deal with it, you can’t just forget about it because it absolutely will resurface at some point.
Adversity can be overcome by the way you react to it.
This can be applied to matters BIG and SMALL.
Small example…
Someone is going 40 MPH in the passing lane and you are LATE for work?
Option A: Tailgate them like a MASShole, honk and give them the finger?
OR
Option B: Remain calm and let them realize they are being slow where they will eventually speed up or switch lanes.
Big example…
Someone does something extremely unjust, unreasonable and unfair?
Option A: scream and yell, accuse and verbally abuse?
OR
Option B: Remain calm with them. Do you best to not let your emotions drive your words. Take your feelings to a conversation with a friend where you can say what you want and get some advice.
Take home… We all deal with shit on any given day. The sun still rises in the morning no matter what was dealt the day before. Get up, shake the dust off and keep moving. Use adversity to learn, grow and become stronger. Get your reps in, practice makes perfect so keep working on overcoming those small hardships because when the big ones roll around, you will be ready.
![5 Misconceptions Surrounding Low Back Pain]()
by Pippa Teague, Strength Coach | Jun 10, 2019 | Back Pain, Exercise advice, Injury, Injury Prevention, lifts, squats, strength training, Uncategorized, working with injury
By Loni Rodriguez DPT
Low back pain is an extremely common condition that many people are faced with on a daily basis and the incidence is climbing. From 1996 to 2006, the number of people who experienced low back pain increased from 3.9% to 10.2%. Recent research has also shown that up to 33% of individuals who have experienced low back pain experience it again within one year.
How can this be?
There have been significant advancements in medical technology including improved surgical procedures, imaging techniques, and medications. With these advancements, however, the incidence of low back pain continues to increase.
What are we doing wrong?!
One main underlying issue is the misconceptions surrounding the topic of low back pain. These misconceptions can lead to poor treatment outcomes, fear of movement, incorrect diagnoses, and worsening symptoms. The discussion today will help debunk some of these misconceptions and will better educate YOU on this low back pain epidemic.
Misconception #1: My back hurts, I should rest.
I don’t recommend anyone take complete rest from their activity. In every case of low back pain, there are specific activity modification recommendations that can be made. I will never tell someone to completely rest!
These modifications are specific to each person – it is recommended that you seek medical advice to find out what the right path is when you are dealing with pain.
Not convinced? Let’s hear Roy’s Story
Misconception #2: I should not lift weights because it is bad for my back.
One of the most effective ways to treat low back pain is strength training. Strength training creates full body resiliency. The most beneficial weight training exercises involved in low back pain rehabilitation programming include squatting, deadlifting, carrying, pressing, and pulling. All of these exercises help strengthen the muscles throughout the entire body including the lower back, which help to decrease pain and improve activity tolerance. Just like the previous recommendation, if you have low back pain do not think that jumping into these exercises without supervision is a good idea. Seek advice from a trusted professional!
Misconception #3: My back pain is from the chair I sit in at work.
Most of the time, back pain and the type of chair you sit in do not correlate. In some cases, the amount of time sitting and the lack of time spent up and moving are bigger contributors to symptoms. As stated before, movement is medicine, especially in the case of low back pain – when in doubt, just get up and move as frequently as you can.
Misconception #4: My back is stiff, I probably should be stretching more.
A stiff back does not always mean that it has to be stretched. A lot to times, stiffness is a perception of being tight and it is your body’s way of telling you that it needs some attention. Low back stiffness can be helped with frequent, active movement, versus stationary, passive stretching. This type of stretching does serve a purpose, but is not the most effective way of helping your stiff back. Here is a quick video to a great routine that you can perform on your own to “loosen” your lower back!
Misconception #5: I know where my pain is coming from, I have a disc herniation.
Disc herniations are not proven to be the cause of back pain. In most cases, disc herniations are not causing the symptoms. Especially when the pain has been going on for a while. This condition can be considered part of the normal aging process! The percentage of people with disc herniations increases with age and most of the people with herniations do not have pain! Please quit blaming your pain on a condition that can be considered the gray hair of the spine.
If you would like more information on back pain, or any pain for that matter, please visit www.infinitepotentialptw.com. On this website there is a plethora of free information and content, as well as a forum to ask questions.
References
Delitto et al. “Clinical Practice Guidelines linked to the international classification of functioning, disability, and health from the orthopedic section of the American Physical Therapy Association”. J Orthop Phys Ther. 2012;42(4):A1-A57
by Pippa Teague, Strength Coach | May 14, 2019 | Back Pain, Injury, Injury Prevention, knee pain, Ladies, lifts, Neck Pain, Running, running help, strength training, Uncategorized, working with injury
By Loni Rodriguez,
Physical Therapist
Do you know what fires me up more than anything? It’s hearing a story from a client that begins with… “I felt like the doctor did not understand where I was coming from.”
You may not know this story, but I dealt with hip and low back pain for just over 2 years when I was going through graduate school. It came on gradually while running one day on the treadmill. It was sharp, came on strong and would not let go. It gradually persisted and ultimately led me to have to stop running all together. It derailed me and created a borderline depression around the fact that I was unable to exercise like I had wanted to. I went from running almost every day to dealing with persistent hip pain that I would feel first thing in the morning and be with me until the minute I went to bed. I would wake up wondering if it would just go away…
How I was going to be able to go out with friends? Sit at a baseball game? Go shopping? Play football with friends on the beach? It consumed me.
I went to a plethora of doctors and physical therapists, had injections, saw specialists and was convinced that my hip required surgery because one MRI found a cartilage tear. I was constantly searching for answers to the cause of my symptoms and coming up short time and time again. Fast forward 7 years, symptoms have improved dramatically and I no longer deal with persistent pain. I feel stronger and more resilient than ever… so what can I contribute it to? That is a question I do not have the answer to… yet, but is not the point of my story. I am not going to tell you I have the magic answer to solve all persistent pain like this… But I am damn sure I know what would have helped me along the way.
Looking back on this, I realized one common piece that I was missing. I didn’t have a healthcare provider that told me that I was going to get through this and they were going to guide me… that is all I wanted, someone to tell me they would lead me on a path to feeling better and more confident in my hip.
At 21 I had one person – a doctor, surgeon and low back pain specialist tell me that I was going to be dealing with pain for the rest of my life. I remember crying in my car after the session, not because I thought he was right, but because I knew he was wrong. I was more upset because I knew he was going to be giving that same screwed up advice to all the other poor souls in the waiting room. I knew that I had a better understanding of pain and did not want to take that answer as my fate.
I wanted someone to listen to my entire story and not seem like the details were obsolete. I remember creating a pain log to show one of my providers and they didn’t even look at it. Finally, overtime I gradually improved and found my way of returning to exercise – running, lifting weights, competing in CrossFit and running races without even thinking about my hip or low back. This took time and hard work, but I made it.
This is not how an experience with a medical professional should be. You should 110% be involved in your own plan and be guided in that direction.
Have you ever had an experience with this? Have you ever been a fly on the wall in this situation with a family member? How many times have you or someone you know had to accompany a family member at a doctors appointment because you do not remember what they said.
I would love to hear YOUR story…
It does not have to be like this! Seek other advice from someone who listens.
Thank you for taking the time to read and have an awesome rest of the week!
by Dr. Loni Rodriguez | Nov 19, 2018 | Back Pain, Exercise advice, Injury, Injury Prevention, knee pain, lifts, squats, working with injury
What to do when you are having pain during a workout?
Have you ever just left the gym or class when pain starts to occur? How annoying is that?! First off, you didn’t get a workout in, second, you might have hurt yourself… I hope not, and third, what do you do now? Should you go back to the gym tomorrow? Take a week off?
I really would like this post to come across the right way. I am by no means, telling you it is okay to push through any significant pain while exercising. What I would like to do is to provide a guideline of what to do when pain comes on during a workout.
Before I get into the guideline, there is one major exception:
*If you actually feel like you had an injury, as in, there was an EVENT that caused your pain, please stop exercising and seek medical attention*
Eg.
- if you fall off the treadmill, and feel a pop or snap in a joint followed by severe pain
- if you hit your head
- if something occurs and you notice immediate swelling and pain
…you get the point
What this guideline is NOT…
- A way to treat your pain
- A way to continue to exercise multiple sessions in a row without seeing guidance from a medical provider
- A way to avoid formally dealing with your injury
Point being… please seek medical advice to really help your issue!
In the meantime, I want you to be able to have some understanding of how to allow training to continue despite some pain vs taking time off.
First… reduce the weight
- Try using a lighter weight, but continue the movement as prescribed.
- If the reps continue to be painful…
Next… slow it down
- Keep the weight and try using performing the movement slowly.
- If the reps continue to be painful…
Next… change the range of motion
- Keep the weight, return to a normal speed and limit how far you go into the movement being performed.
Finally… vary the movement
- There are various ways to perform different exercises.
- You can continue to get the same training effect while performing the movement in a slightly different way.
Here are a few examples of how you can vary the workout if you are experiencing pain during specific movements:
Knee pain with squatting?
- Reduce the load
- Alter the tempo – 3 seconds down, 3 seconds up
- Reduce the range of motion – Squat to a box or a bench
- Change the movement – go from front squats or goblet squats to a back squat
Back pain with deadlifting?
- Reduce the load
- Alter the tempo – try a quick lift from the floor and a slow lower
- Reduce the range of motion – Lift from an elevated surface (blocks or plates)
- Change the movement – go from a barbell to a hex bar or kettlebell
Use this to help keep yourself training, but PLEASE… also seek medical advice. There are many other things to be done in order to get you back to being pain-free during workouts… most of the time, it’s more exercise! Not rest.
