If you experience strong headaches in the morning or after work you could be experiencing Cervicogenic Headaches
Are you experiencing headaches in the morning or after a long day of work? Do you notice pain localized to the back of the head where the junction with the neck begins, the front of the head, or behind one or both eyes? This and many other symptoms can be a sign you are experiencing what is called Cervicogenic Headaches. These headaches consistently get misdiagnosed as migraines. Part of the reason is many of the symptoms are similar including nausea, dizziness, and sensitivity to light and sound. These headaches are often stemming from an issue with the joints, muscles or nerves of your neck (cervical spine).
Common symptoms may include:
Reduced neck range of motion
Upper neck pain in conjunction with a headache
One-sided headache pain that presents in a “rams horn” pattern
How to Treat Cervicogenic Headaches
These headaches can quickly be diagnosed by a trip to your Orthopedic Physical Therapist. Through a biomechanical analysis and mechanical special testing designed to pinpoint the structures at fault, your physical therapist will be able to identify the true cause of your pain.
Treatment options include spinal manipulation, mobilizations of the spine, myofascial release, correction of faulty posture mechanics, contract/relax stretch, strengthening of the deep neck muscles, and education on self-treatments. We focus on correcting the mechanical generator of your pain, not simply offering quick fixes or temporary relief.
Schedule Your Consultation Today
If you have been experiencing any of the above symptoms do not hesitate to give us a call. There is no reason to suffer through another day of work with a nauseating headache. The board certified therapists at Fox Physical Therapy specialize in identifying disorders of the head and neck. We take pride in using only the latest in evidence-based treatments to fix the root cause of your problems.
Learn how these 4 simple at-home exercises can help you remedy the pain caused by Plantar Fasciitis.
By: Stephanie Beckel, DPT and Eric Alexander, DPT, OCS, Cert. MDT
If pain occurs with your first steps in the morning, chances are you may have plantar fasciitis. In fact, plantar fasciitis is the single most common foot condition treated by healthcare practitioners, affecting about 2 million Americans each year. This type of injury is especially prevalent in runners, as studies have found that over 30% of runners struggle with this condition. The good news is that greater than 95% of cases will heal non-surgically with the correct application of skilled physical therapy by a state licensed doctor (DPT).
So what exactly is the plantar fascia?
The plantar fascia consists of three bands of dense connective tissue that run along the bottom of the foot. All three bands originate from the calcaneus (heel bone) and then spread out as they run forward to connect to the base of each phalynx (toes). This fascia is responsible for tightening during the push-off phase of walking to elevate and support the medial arch, so that the foot may become a rigid lever propelling the body forward.
Plantar Fasciitis describes a condition that is often associated with overuse, resulting in a chronic degenerative process. The condition begins with repetitive strain, which leads to microtears ultimately inducing an inflammatory response. Over time, this leads to degeneration of the plantar fascia, primarily at its attachment site to the heel. When looked at under a microscope, there is evident thickening and fibrosis as well as damaged collagen and calcification of the fascia.
Plantar Fasciitis Symptoms:
Symptoms include pain in the medial heel, usually most noticeable with first steps out of bed in the morning, standing after a period of inactivity, and also after prolonged weight-bearing. Pain is also present with deep palpation of the heel at the insertion of the plantar fascia.
While 80% of heel pain stems from the plantar fascia, several other conditions can mimic this pain and may need to be ruled out. In one retrospective study of 250 individuals with plantar heel pain, the majority were diagnosed with plantar fasciitis. The next most common diagnosis was fat pad atrophy (approximately 15%). Those with fat pad atrophy were more likely to have pain primarily after long periods of standing, pain at night, and lacked the characteristic first-step pain in the morning. Les common conditions include Ankylosing spondylitis, Reiter’s syndrome, and osteoarthritis. If symptoms are in both heels, rheumatoid arthritis becomes a likely culprit in women, while ankylosing spondylitis or Reiter’s is more common in men. For patients with a history of diabetes, an abscess in soft tissue must be ruled out. Rarely the condition may be caused by entrapment of nerves (usually the first branch of the lateral plantar nerve or the medial calcaneal nerve), proximal plantar fibroma, lumbar herniation causing S1 radiculopathy, or a hidden fracture. These conditions can be ruled out during the evaluation process with your physical therapist.
There are several categories of risk factors, some of which can be mediated and others which are more difficult to change. Anatomic risk factors are those that are inherent characteristics that you may be born with. These include flat feet, high arches, or a shortened Achilles tendon. Limitations in hamstring flexibility and the difference in leg length have also been associated with this condition. Biomechanical risk factors are those that describe faulty movement patterns. These include an inward roll of the foot (overpronation), poor alignment of the lower extremity, limitations in ankle dorsiflexion, and weak plantar flexor and intrinsic muscles of the foot. The condition also frequently occurs after a recent increase in activity, such as a recent increase in walking mileage or training for a run, so make sure to increase activity slowly. Lastly, there are environmental risk factors, which are often the easiest to eliminate. These include poor footwear, walking barefoot, hard surfaces, unusually long weight-bearing, lack of stretching, and being deconditioned/ overweight.
How can physical therapy help?
A full biomechanical evaluation is warranted in all cases of plantar fasciitis. Often times it is not the tissue at the bottom of the foot that is faulty, but something up the chain that is driving increased or aberrant forces through the fascia on the bottom of the foot. What is often seen clinically is dysfunction in the calf musculature, weak stabilizers in the lateral hip preventing proper control of the femur, and stiffness through the thoracic and lumbar spine driving aberrant forces through the chain from a top-down fashion. These are just a few examples of biomechanical faults that may be present. Failure in addressing the cause of the biomechanical dysfunction and only treating the irritated tissue will lead to failed treatment. Addressing deficits of the entire lower extremity often result in improved biomechanics and correction of the underlying cause of dysfunction. Some of these interventions include correction of gait mechanics, joint mobilizations to improve the mobility of the first metatarsalphalangeal joint (big toe), talocalcaneal/talocrural (ankle), knee, and hip, as well as stretching to restore optimal muscle length to the calf, thigh, and hip. Important areas to strengthen in order to limit pronation and reduce impact when the foot hits the ground include the tibialis posterior and fibularis longus (directly limit midtarsal pronation via eccentric contraction), tibialis anterior (eccentrically controls ankle plantarflexion), quadriceps femoris (eccentrically limits knee flexion), gluteus medius (eccentric control of hip adduction and internal rotation). At Fox Physical Therapy all of our board certified Doctors of Physical Therapy will help to identify the true cause of your pain and teach you how to prevent it from ever coming back.
Here are a few home treatments you can start right now. Many of these techniques will treat the painful site at the heel directly. Remember that to truly rid yourself of this issue work up and down the chain is needed as well. This is where a visit to a skilled Doctor of Physical Therapy can get the help you need.
Tips for at Home Treatment
Tip #1: Calf and arch stretch with a towel. Perform 3 sets pulling back on the foot for 30 seconds before going to sleep and before first steps in the morning.
Tip #2: Stretch of the plantar fascia stretch with cross-friction massage. Stretch the big toe up and massage bottom of the foot for 1 minute, 3 times before taking first steps. This can also be done throughout the day by placing the heel on the ground and the ball of the foot on the wall and leaning forward.
Tip #3: Roll plantar fascia over a can or ball. Perform for 1 minute (3 times with 30 rest in between) before going to sleep and before first steps in the morning. You can also roll over a frozen water bottle as needed for control of pain and inflammation.
Tip 4: Use the toes of the painful foot to pick up a dry paper towel, drop and repeat for 2 minutes. Also, scrunch a towel using only your toes.
Contact us today and let us get you back on your feet!
If you or someone you know is suffering from foot pain, the board-certified Doctors of Physical Therapy at Fox Physical Therapy can provide a complete evaluation, including biomechanical screening to identify deficits and underlying causes. No two people are the same and therefore it is essential to have a plan of care that is specific to your needs. Individualized treatment programs can help to relieve plantar fasciitis and prevent it from coming back.
So, what about medication to help with spine pain?
Because low back pain can be excruciating, many doctors prescribe opioids for pain relief. These are narcotics and include common brand names such as OxyContin and Vicodin. In the U.S., narcotics are currently the most commonly prescribed drug, and more than half of these prescriptions are for the treatment of low back pain.
Before deciding to use these prescription drugs, it is important to understand that they alter the chemistry within the brain and have the potential to become highly addictive. Opioid addiction is responsible for more than 14,000 death per year. In as little as two weeks, the body may develop tolerance requiring increased doses and leading to withdrawal symptoms once the medication is removed. Research does show that using opioids for a short time can provide modest pain relief (up to 30%).
However, opioids provide minimal to no improvement in function. In other words, these drugs have not been shown to expedite return to work or improve functional outcomes. Moreover, long-term use has been associated with worsening disability and increased sensitivity to pain (hyperalgesia). This is because long-term use causes a reduction in the ability to tolerate pain naturally, which may mean the pain is experienced long after the original cause has healed. Other side effects include constipation, nausea, sedation, increased fall risk, fractures, depression, and sexual dysfunction. Therefore, if you decide to use these medications, current recommendations include using the lowest possible dose for the shortest amount of time.
One viable alternative to opioids includes anti-inflammatory drugs (NSAIDS), as several high-quality studies have shown they are just as effective if not superior to opioids in reducing pain and improving function with much less risk or potential harm.
Here’s why you should explore all options and consider physical therapy before making your decision:
Surgery is almost always a last resort. The preoccupation and misconceptions associated with disc herniation found on imaging have led to many unnecessary surgeries, sometimes resulting in even worse outcomes, particularly when the herniation is not the true source of pain. Surgery carries inherent risks of complications, including infection, bleeding, and the possibility of permanent nerve damage. Significant complications occur in approximately 20% of patients. Depending on the type of procedure, the surgeon may have to cut through bone, muscle, fascia, or ligaments. Even with successful procedures, these structures take time to heal and can potentially cause scar tissue leading to pain and restricting motion. Muscles may shut down temporarily and motion may be limited for a period, which may lead to additional pain and stiffness since healthy discs require the motion for proper nutrition. The stiffness and muscle guarding may also cause other compensations in motor patterns in an effort to protect the spine. This can cause undue stress to other tissues, ultimately leading to further pain and dysfunction. Likely, physical therapy will be prescribed post-surgery and it will generally take some time to regain full function.
What can conservative care offer me?
For all these reasons, surgery is generally recommended as a last option after all other conservative treatments have failed. Research has shown that long-term outcomes after an appropriate bout of physical therapy are generally equivalent to, if not superior to outcomes after surgery. In most cases, low back pain can be addressed and relieved via physical therapy, as research shows that that therapy leads to greater pain relief and decreased drug consumption. In fact, many insurance companies require a course of physical therapy and other more conservative measures before authorizing funds for surgery. This is because the evidence shows that addressing the issue with physical therapy is successful most the time, saving both patients and their insurance companies money and eliminating potentially expensive and debilitating complications. In addition, trying therapy first is never a waste because in cases where surgery is ultimately required patients who have completed “prehab” (therapy prior to surgery) ultimately have better outcomes and faster recoveries.
We hope this small series of imaging, medication, and surgery has cleared up some preconceived myths about low back pain.
At Fox Physical Therapy, our board-certified Doctors of Physical Therapy specialize in mechanical diagnosis and treatment of spine symptoms. Contact us today to find out how we can help you feel better.
Patellofemoral Pain Syndrome is Causing Major Issues for Athletes Living in Miami
Read our physical therapy tips for overcoming knee pain caused from Patellofemoral Pain Syndrome
By: Eric Alexander DPT,OCS,MDT,CSCS
If you are an active individual there is a good chance at some point in your life you have experienced knee pain. In one report, over the past 30 days, at least 1 in 5 adults in the United States have cited some form of knee pain¹. One of the more common types of knee pain is called patellofemoral pain syndrome (PFPS). This is basically an umbrella term for knee pain that occurs at and around the patella, also known as the knee cap.
The knee cap is a bone contained within a tendon that facilitates movement at the knee. The knee cap slides within a groove in the femur during flexion and extension at the knee. It is thought that pain originates when the patella begins to ‘mal-track’ through this patellar groove in the femur and causes uneven forces through the bony surfaces. The mal-tracking is commonly attributed to muscular imbalances in the hips, thigh, and lower leg. Common populations presenting with PFPS include runners, bicyclists, and young athletes. Pain can typically intensify by sports, walking, running, stair climbing, or sitting for a long time, often called the “Movie-Goers Sign.”
One research article, in particular, has demonstrated the importance of lateral hip strength in relation to knee alignment with activity². College athletes were followed over the course of an athletic season. The athletes who experienced knee and ankle injuries throughout the season all shared two things in common: a weakness of the hip abductors and external rotators of the hip. Any weakness of these muscles during activity can allow your knee to drop-in towards the midline during motion, known as genu valgum, facilitating mal-tracking of the patella and PAIN.
The muscles in question are the gluteus medius, piriformis, and smaller external rotators of the hip. There are a few key exercises that you can add to your normal exercise routine that will help strengthen these muscles in question. These exercises include:
Side-lying Leg Raises
Hip External Rotation Clamshells
Three sets of fifteen reps (3×15) of the side-lying leg raises and clamshells coupled with two sets of thirty to sixty-second holds (2×30-60”) in the side plank position will target these muscles and assist in strengthening. Perform these exercises three to four times a week for six to eight weeks to allow for appropriate strength gains.
If you are experiencing knee pain or know someone who does, Fox Physical Therapy board-certified therapists deliver full biomechanical screens during the evaluation process to specifically identify which structures are at fault. Schedule you consultation today at 305-735-890 or click here.
1. Centers for Disease Control and Prevention. QuickStats: Percentage of Adults Reporting Joint Pain or Stiffness, — National Health Interview Survey, United States, 2006. MMWR 2008:57(17);467.
2. Leetun, DT, et al. Core Stability Measures as Risk Factors for Lower Extremity Injury in Athletes. Medicine & Science in Sports & Exercise. Vol. 36, No. 6, pp. 926–934, 2004.
Learn How Kinesiotape Helps Athletes to Recover Faster
By: Tim Alemi
Kinesiotape is a type of elastic taping technique that has increasingly become more popular since the widespread use by Olympic athletes during the 2008 Summer Olympics. Now, it is common to see professional athletes, cross-fit enthusiasts, weekend warriors, and general population patients wearing brightly colored kinesiotape for both function and fashion. The application of kinesiotape technique is designed to help enhance the body’s healing process, improve stability, and decrease stress load on tissues. It is similar to a brace in that it may provide support to the surrounding structures to decrease the load of impact activities, also, the tape does not restrict the range of motion like a brace typically would. According to RockTape which is a different brand of tape, pathologies commonly treated with tape include achilles tendonitis, plantar fasciitis, jumpers knee (PFS), ACL/MCL issues, rotator cuff injuries, groin and hamstring pulls, lower back issues, shin splints, tennis and golf elbow, pain associated with pregnancy, postural corrections, and skin abrasion protection.
Taping can be used for various reasons, and depending on the application it may have several different proposed benefits. According to RockTape, it is able to decrease the sensation of pain by raising the threshold required for nerve fibers to send an impulse to the brain4. Also, it can decompress an area of swelling, bruising, or inflammation by lifting the skin away from underlying tissues resulting in vasodilation. It is widely proposed that tape can normalize tone by activating or inhibiting appropriate corresponding musculature; as well as support tissues by absorbing and properly distributing stress forces. Patients often prefer this method of treatment because of ease of application, comfort, convenience, and longer wear times (2-7 days) with decreased pain and no loss of range of motion2.
Further research needs to be assessed to make an appropriate determination on the effectiveness of kinesiotape versus alternative taping techniques. However, experts suggest that the application of kinesiotape may provide the immediate short-term reduction in pain2. There is limited moderate level evidence that suggests kinesiotape is no more effective than sham tape or other modalities, but it is difficult to make any definitive conclusions due to a limited number of RCTs included in reviews2, 3. This does not mean that kinesiotape is ineffective, but it does suggest that it may not be more effective than other alternatives. However, kinesiotape is beneficial compared to other modalities because it may provide a safe and immediate reduction in pain for short periods of time2.
Testimonial: “ I had shoulder instability that would not allow me to workout. The taping helped support my arm while I did my stability exercises until I was able to gain enough strength from the physical therapy”
— Sandra S.
For More Info
Contact us today and schedule a complimentary consultation for Kinesiotape taping at 305-735-8901 or click here.
Heal Faster With Instrument-Assisted Soft Tissue Mobilization Therapy
By: Tim Alemi – Fox Physical Therapy
Patients experiencing soft-tissue dysfunction such as the formation of scar tissue, trigger points, or sprains/strains are often treated with manual therapy techniques such as Instrument-Assisted Soft Tissue Mobilization (IASTM), manual soft-tissue mobilization, or many other types of massage techniques. These techniques are used to help stimulate the healing response, promote correct realignment of collagen fibers, and decrease pain. Instrument-Assisted Soft Tissue Mobilization is a manual therapy technique that utilizes specifically designed concave/convex tools to identify and breakdown myofascial restrictions, soft tissue fibrosis, scar tissue adhesions, and chronic inflammation, which should result in improved outcomes for both the patient and the physical therapist when compared to other manual therapy techniques. The shape of the tools allow for ease of use, swift and comfortable adjustment to contours of the body, minimal stress on the PT’s hands, and maximal penetration into soft tissue.
Patients that are typically treated with IASTM include those diagnosed with soft-tissue dysfunctions such as tendinopathies, ligament sprains, muscular strains, and scar tissue adhesions. Further examples of common injuries treated with this technique include Achilles tendinitis, plantar fasciitis, IT band syndrome, medial and lateral epicondylitis, cervical/lumbar sprains/strains, patellofemoral disorders, rotator cuff tendinosis, shin splints, and carpal tunnel syndrome. Further research needs to be completed to appropriately determine which pathologies are most effectively treated with IASTM.
The proposed mechanism of IASTM utilizes controlled microtrauma resulting in increased fibroblast production to the treatment area, stimulating an inflammatory response triggering the healing process of affected tissues. Also, this technique is believed to increase blood flow to the area, as well as facilitate the breakdown of cross-link adhesions found in collagen fibers of myofascial soft tissues and scar tissue. However, perhaps the greatest proposed advantages of IASTM is that the tool helps to protect the PT’s hands from injury, and provide the clinician with greater palpation skill to specifically identify an area that needs to be treated.
Although further research needs to be completed to determine if IASTM is truly any more beneficial than other manual therapy techniques, much of the evidence supports IASTM as an effective treatment to determine. Burke et al proposed that the primary benefit of IASTM over other manual therapy techniques may only be the decreased stress on the hands of the physical therapist2. However, according to Loghmani et al, injured ligaments treated with instrument-assisted soft tissue mobilization were “43% stronger, 40% stiffer, and 57% more able to absorb energy” than the untreated contralateral injured side3.
The jury is still out if this is a more effective treatment than traditional manual therapy, IASTM continues to make a strong case to be greatly beneficial for both the patient and the clinician. In our clinic, we have seen great results with patients that have soft tissue restrictions. Within one treatment session patients are able to move better after use of IASTM. Some common areas we see great results with are low back, knee, neck, and ankle.
For more information on IASTM Therapy and to schedule your free consultation contact us at 305-735-8901 or click here.