Avoiding and Treating Heel Pain

Avoiding and Treating Tendon Dysfunction

Dr.Bruce Buckman PT, DPT, ART

 Background

 It has been reported that approximately 1 in 10 individuals will develop chronic heel pain with nearly 2 million Americans affected annually. Furthermore, tendinopathies of the Achilles tendon affect 2% of the general adult population. The typical report of pain presentation of plantar heel pain includes excruciating pain with the first few steps after waking up in the morning, prolonged sitting and with prolonged weight bearing activity. These symptoms often reduce throughout the day as compared to first thing in the morning, but lead to significant functional limitations and even prolonged disability.

Identifying the Problem

A tendon is an anatomical structure that connects muscle to bone, examples include the Patella tendon and Achilles tendon. A tendon is an inherently strong tissue; however, just as with muscular injuries, tendons are subject to overuse. Overuse injuries to tendons often occur with constant and repetitive loading in biomechanically flawed positions. Characteristic changes occur in the tendon structure, resulting in a tendon that is less capable of sustaining repeated tensile load (Cook JL, Khan KM, Kiss ZS, et al). Tendon injuries can occur in the mid-tendon, which is often the case in Achilles tendonitis/osis; however, most tendon pathology arises from the insertion of the tendon to the bone such as with patellar tendonitis/osis.

Tendonitis, Tendonosis, and Tendinopathyathy

The suffix “itis” implies acute (of recent onset/new) injury with inflammation. Different from acute injury with inflammation, tendon”osis” implies chronic (long term) pathology or degeneration without inflammation. Finally Tendon”opathy” simply refers to a disease of a tendon.

Can Exercise Improve Tendon Function?

Research suggests that eccentric exercise affects both the tendon structure as well as pain by increasing collagen production in abnormal tendons with both short and long term. Furthermore, recent research has added that exercise with a combination of manual therapy (hands on approach to treatment) provides greater clinical benefits in terms of function than just exercising and using modalities such as heat, ice, ultrasound, electric stimulation etc.

Eccentric, Concentric and Isometric Contractions

When you consider a muscular contraction, you may think of a simple motion such as a heel raise. During the initial part of the heel raise your triceps surae (calf muscles) are concentrically contracting (or shortening); however, what about the second portion of the exercise? During the descending portion of the heel raise, the triceps surae must control the decent of the weight being held or else your heel would simply drop towards the ground. Here, these muscles are contracting eccentrically, meaning contracting while simultaneously lengthening. On an unrelated note, isometric contractions involve a static muscle activation without associated movement. Consider the same heel raise exercise; however, after raising heels from a neutral position, your heel maintains in the same position for approximately 45 seconds, here your triceps surae muscles are active as to maintain the heel off position, but are not causing physical movement of a structure.

Physical Therapy Protocols for Achilles Tendinopathyathy

The exercises listed below are helpful in preventing and improving tendon pathologies; however, they should not be performed without proper evaluation by a physical therapist in order to determine proper dosage and prescription. To find out more contact us now!

Plantar Fascia Rolling        

Why focus on the bottom of the foot for pain in the back of my ankle you ask? Understanding anatomy is key! The plantar fascia inserts to the dorsal aspect of the calcaneus, which happens to also be bone in which the Achilles tendon attaches to (more posteriorly and superiorly). If your plantar fascia is tight, it certainly will affect the kinetic chain by increasing passive tension on the Achilles tendon. Rolling this structure is not “fun”, plain and simple, it hurts for most, but has a drastic impact on foot and ankle health!

Intrinsic Muscle Activation

The intrinsic foot muscles help to stabilize the arch of your foot and improve the biomechanical forces dispersed through the foot with simple activities such as walking to more complex activities such as running, cutting and jumping. Strengthening and activating these muscles will help to improve pain by improving functional movement patterns, thus reducing risk for re-injury.

Self Plantar Fascia Massage

Taking rolling to the next level, massaging the bottom of the plantar fascia will be imperative for the improvements of kinetic chain mobility. While doing so, observe the distal (far) attachment of the plantar fascia to the digits, this means that flexing and extending your toes passively with your non massage hand will sensitize the massage in order to create the best response to treatment.

Triceps Surae Foam Rolling

As always, rolling is imperative prior to stretching, rolling relaxes tissue prior to stretching the tissue out. This is important because stretching a tonic or tight muscle can actually cause more pain in an irritated irritable musculotendonus structure.

Gastrocnemius and Soleus Muscle Eccentric Activation (Heel Raises)

Properly performing this exercise depends on the location of pain, for mid belly Achilles tendon pathology, perform on a step. Start by raising your heels up in the air to the top of motion and slowly lower yourself back down below parallel. This exercise will help to strengthen the posterior lower leg muscles and reduce recurrent pathology.

 

 

Gastrocnemius and Soleus Stretching

The gastrocnemius is the large posterior lower leg muscle that crosses both the knee and the ankle joints, as seen below. What this means is that in order to effectively stretch this muscle both the knee and the ankle need to be taken into consideration (extended). To stretch the soleus muscle, the knee is slightly flexed secondary to this muscle not crossing the knee joint. Flexing the knee will eliminate some of gastrocnemius’ tension allowing for a deeper and more effective stretch.

References

O’Brien M. e anatomy of the Achilles tendon. Foot Ankle Clin 2005; 10(2): 225–38.

Cook JL, Khan KM, Kiss ZS, et al. Asymptomatic hypoechoic regions on patellar tendon ultrasound: a 4-year clinical and ultrasound follow-up of 46 tendons. Scand J Med Sci Sports 2001; 11: 321–7.

O’Neill, S, Watson PJ, Simon, B. Why are eccentric exercises effective for Achilles tendinopathy. The International Journal of Sports Physical Therapy 2015; 10: 552-63.

Cleland JA, et al. Manual physical therapy and exercise versus electrophysical agents and exercise in the management of plantar heel pain: A multicenter randomized clinical trial. Journal of Orthopedic and Sports Physical Therapy 2009; 39: 473-86.

Cook, JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med 2009;43:409–416.

Prenatal Chiropractic: The Key to a pain Free Pregnancy

Prenatal Chiropractic: 

The Key to a Pain Free Pregnancy

BY DR. KIMBERLY DELMAGE, DC

According to the American Pregnancy Organization and the International Chiropractic Pediatric  Association, women who seek chiropractic care during pregnancy report 24% shorter labor and delivery times and have fewer complications and 75% of women who received chiropractic care during their pregnancies stated they found relief from pain. Due to the increased hormone called relaxin that is secreted during pregnancy, a woman’s ligaments are more flexible and often any areas of weakness in the alignment of the spine are made worse. This can result in lower back pain and sciatica, neck pain and headaches, pubic symphysis pain and sacroiliac discomfort. The sooner you begin care the more likely you are to avoid the common pains and discomforts many women experience during pregnancy.

One of the most important roles of a chiropractor in prenatal care is to establish pelvic balance and alignment, not only to reduce the mother’s discomfort but also to allow the baby to be in the best position for delivery. When the pelvis is misaligned it may reduce the amount of room for the developing baby to be comfortable and they may seek out a less than optimal positioning for birth. A specialized treatment called the Webster Technique can be performed by a certified chiropractor if the baby is in the breech position during the final weeks of pregnancy. This technique is performed to safely turn the baby into the ideal position for delivery and has an 85 percent success rate when performed before 39 weeks. Common pregnancy complaints such as heartburn, insomnia, carpal tunnel syndrome and even swelling in the hands and feet can be relieved with chiropractic care.

Neck Pain | Cervical Disc Herniation and Pinched Nerves!

What the Neck Pain?

If you have neck pain related to cervical disc herniation or stenosis as it relates to your c3-c4, c4-c5 and c5-c6, then you should read the following:

We see many patients who complain about neck pain, stiffness in muscles such as shoulders, arms and biceps who don’t even realize they may have herniated their cervical discs.

Below you will find common questions and answers about Cervical Disc Herniations. We also discuss basic treatment styles for such herniations and explain how they work.

 

What is a disc herniation of the cervical spine?
Literally, a disc herniation is when the nucleus pulposis of a disc migrates out through the annular fibrosis into the outer portion of a spinal disc.  What the heck does that mean?  Picture it this way.  A disc is like a jelly donut, it is made up of 2 parts.  The center is the jelly (nucleus pulposis) and it is supposed to stay in the center.  It is surrounded by the donut (annulus fibrosis).  Unlike a donut, there is no hole in the disc to inject the jelly into so there are really no weak points for the jelly to come out.

There are so many different ways an intervertebral spinal disc can herniate.  I see a lot of patients that get into car accidents (what doctors call MVA’s or motor vehicle accidents).  When you suffer a whiplash injury, when your head gets violently whipped back and forth, that is one way a disc can herniate.  Sports injuries, slips and falls, or even abnormal wear and tear.  If the body is out of alignment and one side rubs more than the other it can lead to an area getting weak and that can cause a disc to herniate.  In my practice, I see a lot of people with bad posture that have sustained herniated discs.  Repetitive stress injuries, overuse syndromes and a whole lot of other issues can also cause intervertebral discs to herniate, but I think you get my point.

Before, we list the symptoms, we should explain why you get symptoms.  First, when you herniate a disc that means there has been soft tissue damage.  That damage causes a response in the body that includes inflammation, muscle spasms and pain.  Now that combination of symptoms you can tag to any type of soft tissue damage including; sprained ankles, black and blues, shoulder injuries, even cuts and bruises.  I think everyone knows what happens when they stub their toes.  That is your body’s response to injury and damage.  It is your defense mechanism and you don’t have to think about doing it because it happens automatically.  With herniated discs, though, it doesn’t stop there.  The jelly (nucleus pulpous) creeps out of the disc and goes into the part of the spine that the spinal cord and spinal nerves go through.  That’s where the real problems begin.  Sometimes the herniation is large enough where the jelly pushes right onto the spinal cord or the spinal nerves that go through the area of the spine that the disc herniates from.  When you “pinch” a nerve like that you get a whole other list of symptoms due to the injury to the nerve.  These can include; pain, numbness and tingling, burning, weakness, loss of sensation, loss of muscle strength, loss of muscle mass (atrophy) and even paralysis.  We all know what happened to Christopher Reeves when he injured his spinal cord and that is no good.

At The Spine and Health Center of Montvale and The Spine and Health Center of Jersey City, we have had tremendous success helping patients with herniated discs.  We have a large population of our patient’s that have suffered herniated intervertebral discs in their cervical spines (necks) and lumbar spines (low backs).  At our office we have combined the latest advances in physical medicine to help treat, not only the symptoms associated with herniations, but the discs themselves.  We officer services ranging from Chiropractic, Physical Therapy,  Massage to more technological modalities like Laser, Decompression, Active Therapeutic Movements (ATM’s), etc.

I hope this will answer some of your questions about herniated discs. If there is anything more I can help you with, don’t hesitate to call The Spine and Health Center of Montvale.  Our phone number is 201-746-6577 or email us at info@thespineandhealthcenter.com.

Dr. Peter Wohl, DC, ART, BCIM


Our Locations – Montvale, NJ and Jersey City, NJ

The Spine and Health Center of Montvale – Chiropractic and Physical Therapy

The Spine and Health Center of Jersey City – Chiropractic and Physical Therapy

Congratulations Dr. Peter Wohl – NJ Top Doc 2016

Congratulations to Dr. Peter Wohl, DC, ART, BCIM for being named one of New Jersey’s Top Doctors of 2016 for his commitment to excellence in chiropractic care and spinal disorders. Dr. Wohl is also Board Certified in Integrative Medicine and certified in Active Release Techniques (ART) and Trigenics. Dr. Wohl has also been named as one of the top chiropractors in Bergen County in 2015 and 2016 by 201 Magazine. He is also a team chiropractic physician for the 2015 ACC Champion Clemson Track and Field teams. Congrats Dr. Pete!

best chiropractor bergen county

Congratulations Dr. Kelly Blundy – NJ Top Doc 2016

Congratulations to Dr. Kelly Blundy, DC, ART, BCIM for being named one of New Jersey’s Top Doctors of 2016 for her commitment to excellence in chiropractic care and spinal disorders. Dr. Blundy is also Board Certified in Integrative Medicine and certified in Active Release Techniques (ART) and Trigenics. Dr. Blundy has also been named as one of the top chiropractors in Bergen County in 2015 and 2016 by 201 Magazine.

best nj chiropractors

Exercise of the Week #34 – Band Resisted Rows

Are you performing your exercises correctly? At The Spine and Health Center of Montvale, we see many patients performing rows initially with poor form. The key points to remember are keeping the shoulders down, chest up, and pulling back by squeezing the shoulder blades together to get the elbows to end up at approximately a 90 degree angle. Check out the examples of the incorrect and correct ways to perform rows in this week’s video.

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Keri Moran, PT
Bruce Buckman PT, DPT, ART

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DISCLAIMER: NOTHING AVAILABLE THROUGH OR ON THIS WEBSITE SHOULD BE CONSTRUED AS MEDICAL ADVICE. OUR WEBSITE DOES NOT OFFER MEDICAL DIAGNOSES OR PATIENT-SPECIFIC TREATMENT ADVICE. IT IS IMPORTANT THAT YOU CONSULT WITH YOUR HEALTHCARE PROFESSIONAL ABOUT ANY CONDITION YOU MAY HAVE. YOU SHOULD ALWAYS CONSULT WITH YOUR DOCTOR BEFORE BEGINNING ANY EXERCISES OR EXERCISE ROUTINE. DO NOT DISREGARD PROFESSIONAL MEDICAL ADVICE, OR DELAY SEEKING IT BECAUSE OF SOMETHING YOU HAVE READ IN OR ON THIS SITE.

© The Spine and Health Center of Montvale 2016

2 South Kinderkamack Road, Suite 200, Montvale, NJ 07645


Exercise of the Week #31 – Push-Ups with Alternating Knee Taps

Check out this week’s Exercise of the Week – Push-Ups with Alternating Knee Taps, which is great for core strength and stability, as well as increased obliques activation.

Our Physical Therapists

Keri Moran, PT
Bruce Buckman, PT, DPT

Our Physical Therapy Services

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DISCLAIMER: NOTHING AVAILABLE THROUGH OR ON THIS WEBSITE SHOULD BE CONSTRUED AS MEDICAL ADVICE. OUR WEBSITE DOES NOT OFFER MEDICAL DIAGNOSES OR PATIENT-SPECIFIC TREATMENT ADVICE. IT IS IMPORTANT THAT YOU CONSULT WITH YOUR HEALTHCARE PROFESSIONAL ABOUT ANY CONDITION YOU MAY HAVE. YOU SHOULD ALWAYS CONSULT WITH YOUR DOCTOR BEFORE BEGINNING ANY EXERCISES OR EXERCISE ROUTINE. DO NOT DISREGARD PROFESSIONAL MEDICAL ADVICE, OR DELAY SEEKING IT BECAUSE OF SOMETHING YOU HAVE READ IN OR ON THIS SITE.

© The Spine and Health Center of Montvale 2016

2 South Kinderkamack Road, Suite 200, Montvale, NJ 07645



Good Luck Natoya!

Make sure to watch former Clemson Track and Field star and ACC champion Natoya Goule run the 800m in the Olympics today! Our very own Dr. Peter Wohl had the privilege of working with Clemson University and Natoya this past year. She will be running this morning at 10:44 AM in Heat #8. So from everyone at The Spine and Health Center, good luck Natoya!!!

natoya goule dr peter wohl


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© The Spine and Health Center of Montvale 2016

2 South Kinderkamack Road, Suite 200, Montvale, NJ 07645

Exercise of the Week #30 – Eccentric External Rotation Ball Drops

Check out this week’s Exercise of the Week – Eccentric External Rotation Ball Drops, a great exercise for shoulder strength and stability especially for throwing athletes.

Our Physical Therapists

Keri Moran, PT
Bruce Buckman, PT, DPT

Our Physical Therapy Services

Our Chiropractor Services


DISCLAIMER: NOTHING AVAILABLE THROUGH OR ON THIS WEBSITE SHOULD BE CONSTRUED AS MEDICAL ADVICE. OUR WEBSITE DOES NOT OFFER MEDICAL DIAGNOSES OR PATIENT-SPECIFIC TREATMENT ADVICE. IT IS IMPORTANT THAT YOU CONSULT WITH YOUR HEALTHCARE PROFESSIONAL ABOUT ANY CONDITION YOU MAY HAVE. YOU SHOULD ALWAYS CONSULT WITH YOUR DOCTOR BEFORE BEGINNING ANY EXERCISES OR EXERCISE ROUTINE. DO NOT DISREGARD PROFESSIONAL MEDICAL ADVICE, OR DELAY SEEKING IT BECAUSE OF SOMETHING YOU HAVE READ IN OR ON THIS SITE.

© The Spine and Health Center of Montvale 2016

2 South Kinderkamack Road, Suite 200, Montvale, NJ 07645



Exercise of the Week #28 – Push-Ups

Check out this week’s Exercise of the Week – Push-Ups. One of the most basic yet most effective exercises for upper body strength and core stability, push-ups are a great part of any exercise routine.

Our Physical Therapists

Keri Moran, PT
Bruce Buckman, PT, DPT

Our Physical Therapy Services

Our Chiropractor Services


DISCLAIMER: NOTHING AVAILABLE THROUGH OR ON THIS WEBSITE SHOULD BE CONSTRUED AS MEDICAL ADVICE. OUR WEBSITE DOES NOT OFFER MEDICAL DIAGNOSES OR PATIENT-SPECIFIC TREATMENT ADVICE. IT IS IMPORTANT THAT YOU CONSULT WITH YOUR HEALTHCARE PROFESSIONAL ABOUT ANY CONDITION YOU MAY HAVE. YOU SHOULD ALWAYS CONSULT WITH YOUR DOCTOR BEFORE BEGINNING ANY EXERCISES OR EXERCISE ROUTINE. DO NOT DISREGARD PROFESSIONAL MEDICAL ADVICE, OR DELAY SEEKING IT BECAUSE OF SOMETHING YOU HAVE READ IN OR ON THIS SITE.

© The Spine and Health Center of Montvale 2016

2 South Kinderkamack Road, Suite 200, Montvale, NJ 07645