5 Tips To Fast Track Your Heel Pain Recovery

Heel pain can be highly debilitating, not to mention extremely frustrating.

One of the main issues is that heel pain has many contributing factors.

Sometimes people only address one or two at a time and start to feel better, but the problem never really goes away completely.

To get your heel pain better you need to follow as many of the recovery guidelines (shown below) as possible for at least a month.

This may mean some changes to your lifestyle and you may need to make some room in your life to allow proper healing to take place.

5 Tips To Fast Track Your Heel Pain Recovery:

1. Update your footwear, including your running/exercise shoes and your work shoes immediately. Find the most comfortable and supportive shoe that suits your feet.

100% AVOID thongs, high heels and bare feet for a minimum of 3 months.

2. Stretch your calf muscles daily. Hold a gentle stretch for 1 min x 3 per day (dropping your heel over a step is a good option).

3. Reduce inflammation by using ice on your heel for 15 mins x 2 per day.

Either an ice pack with a velcro compression sleeve or you could also roll a frozen water bottle under your foot.

4. Tape your foot.

Use a simple rigid tape to pull from the outside of your foot, under the arch and up to the inside of the foot. Try a few pieces so at least half your foot is supported.

5. Gradually increase the walking you are doing each day.

Start with 10 mins and gradually build up to 30 mins everyday.

Monitor your time, distance and pain levels (during and the day after) by keeping a journal.

Maintaining a healthy weight is a key to getting better.

Bonus Tip:

Keep in mind the only evidenced based treatment to get both plantar fascia and achilles tendonitis issues better is a graded strengthening program. Start with these two:

- Strengthen the foot by doing daily foot 'scrunches'. Imagine you are picking up a towel with your foot - hold the position for 30 secs and repeat x 5. Aim to do this x 3 per day. A small amount of pain < 3/10 is OK.

- Strengthen your calves. After your daily walk, do 3 x 15 heel raises, lifting your body up onto your toes.

If you would like some more personalised advice on how to overcome your heel pain, we'd love to help you. It is a condition we see in the clinic everyday...and you don't have to put up with it!

After a thorough assessment, if you are a viable candidate for our program, we will map out a personalised plan to get you feeling (and staying!) better as soon as possible.

If you have any other questions…please contact us.

Benefits of Restorative Yoga

Benefits of Restorative Yoga: From a personal perspective, what inspired me to teach it.

Written by Evelyn Krull

Restorative Yoga is a deeply relaxing and healing yoga practice that equally calms body and mind. It is the corrective practice for our modern lifestyle that tends to be go-go-go and stopping is more like collapsing in front of the tele, rather than consciously rejuvenating.

However, these insights didn’t come to me easily.

In fact, my life before yoga and in the first years of Yoga was oriented towards strong, adrenaline-producing activities like mountain-biking, trail-running and rock-climbing. In the beginning, yoga was just a means for me to stretch my tight muscles.

And then I broke my hip in a cycling accident (one of many injuries): But this is when I first discovered that while I couldn’t do much else, I could still practice yoga – albeit highly modified.

But it was exactly those modifications (support through bolsters, blankets and blocks and relaxed, longer stays in the posture) that allowed me to progress the healing from the inside out.

There are so many studies now that document the healing power of the mind and while meditation is certainly one of the best practices to initiate healing on a deep level.

However, for those who are in chronic pain, have difficulty stilling their mind and are in need of physical recovery to calm the fast tracked mind, Restorative Yoga is a great way to let the cells of the body heal through slower breathing and a reduced heart-rate.

Experiencing first-hand how beneficial Restorative Yoga was for my recovery, I felt compelled to share the practice in my studio.

Now we run dedicated events that allow for deeper immersion into the Restorative Yoga practice as more and more people discover the effect of Restorative Yoga on body and mind

Evelyn Krull (PhD)

Evelyn is the Principal Teacher and co-Founder of Yogita Yoga with a focus on bringing the benefits of yoga to the wider community. She has practiced yoga since 2007 and teaching since 2011 after completing her initial teacher training in India with Noah McKenna (Sukhashanti Yoga).

Living a physically active life through her passions for rock-climbing, running and cycling her first interaction with yoga was centred on practicing asana. Her practice quickly evolved beyond asana to focus on learning, practicing and teaching the 8 Limbs of Yoga for its therapeutic benefits.

Through the inspiration of her teachers, her style of teaching is tailored to the individual and her classes allow students to progress further as well as helping those starting on their yoga journey to develop the correct foundations.

Evelyn continues to pursue her yoga studies from a number of master teachers, to enhance her ability to individually assist each yoga aspirant.

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Knee Osteoarthritis (OA) Part 2 - What Is The Best Type Of Exercise?

Exercise therapy: the treatment of choice

This months blog has a focus on exercise for knee osteo-arthritis (OA), an issue that I’ve had a passion for treating for many years.

It’s predicted that arthritis will soon impact over 3 million Australians.

Thankfully, there has been some very positive research showing the benefits of combining a tailored Physiotherapy program with an exercise program to build your bodies capacity, with significant benefits in the short term (six weeks) and long-term (one year).

I hope you will find some useful information and if you know anyone suffering with knee pain from OA, it would be great if you could please share it with them.

Current guidelines recommend exercise for everyone with knee osteoarthritis, irrespective of radiographic disease severity.

Evidence shows a personalised exercise program, gives the best long term outcomes. 

These exercise programs consist of:

• specific neuro-muscular exercises to help align the knee joint

• cardiovascular aerobic fitness

• strength training

Ideally this exercise program is set up by a Physiotherapist after a comprehensive assessment. 

Is exercise and movement safe for people with knee OA?

It is a common misconception that exercise causes arthritis.

Research shows that the main risk factors for knee OA are:

• excess body weight

• reduced muscle strength

• knee mis-alignment

• history of a prior traumatic knee injury

An important point to make here is that (except for traumatic injury) all of these factors are modifiable, meaning we have control over them.

This can be quite an empowering feeling, when you contrast this with someone who is told by a specialist, after viewing their scans, that nothing can be done, apart from surgery.

The risk of pain and injury are greatest when your physical capacity is low, as it sets you up for constant overload and damage.

It's important to note that regular moderate exercise strengthens joints and can decrease the risk of osteoarthritis.

Moderate activity levels provide the ‘sweet spot’ for physical health and acts like a vaccine against injury.

Getting past the fear of movement in OA

APA physiotherapist Dr Christian Barton, an OA researcher at LaTrobe University, says:

“One of the biggest problems we have to address is that many people are told to rest when they have pain, rather than stay active. As a result they often become quite sedentary, which can lead to depression, weight gain and an increased risk of other chronic diseases.

Proper exercises, regular physical activity and good health education are essential for OA management, all of which can be delivered by exercise specialists like physios. The missing link is the funding to provide patients the opportunity to do this.”

You Have Two Options:

1. OA Diagnosis —> Fear of doing more damage —> rest/avoid activity —> deconditioning —> depression —> weight gain —> increase load on knee —> downward spiral —> general health declines

2. OA Diagnosis —> Consult with Physiotherapist (with a special interest in knee OA) —> personal assessment —> address fear of movement —> set up with graduated exercise program —> Physiotherapy manual techniques to decrease pain, improve joint alignment —> re-build capacity —> maintain happy and healthy life

What is the point in doing exercise and rehab if I’m eventually going to need surgery?

The first thing to keep in mind is that not everyone with OA will progress to a point where they need a joint replacement.

In fact only about 30% in those are diagnosed with OA subsequently go onto require a total knee replacement.

We know that ‘prehab’ gives significantly better outcomes if you do eventually need to go for surgery, so by getting your knee stronger and more robust will have direct benefits. You

A Few Notes On Pain

As you start to move more, you most likely feel some knee pain.

It's critical though you understand one key fact: "Pain does not equal tissue damage".

The truth is pain is related to the threat of tissue damage, not actual tissue damage.

There is a whole field of pain neuroscience research now showing that the pain you feel is not correlated with how much tissue damage there is.

This is relevant to know for people with knee OA, as many people have severe joint degeneration on x-rays, yet have absolutely no pain.

Rather pain is a 'request for change' and in chronic knee pain may be more related to ongoing weakness and stiffness in the knee.

A sure sign that movement is needed to get the muscles stronger and protect the knee joint.

It’s OK for exercise to be painful (especially as you warm-up at the beginning), but try and keep it to an acceptable level (e.g. < 5/10). Also, monitor the response in the following 24 hours after you exercise.

Patience is key.

As you build your capacity over time, you will get less intense and frequent pain flare-ups.

Credit: Christian Barton Presentation

Three Components To An Effective Exercise Program:

1. Neuro-muscular control

One important risk factor that can lead to progression of knee OA is the mis-alignment of your knee (in particular the kneecap).

Many people with knee pain who get motivated to exercise may end of causing a flare-up if there knee is out of alignment.

Some signs you may have a knee alignment issue:

• general ache/pain in the front of the knee

• pain aggravated activity involving a bent knee and body weight on the leg (e.g. walking up and down stairs, squatting, kneeling, jumping or hopping)

• pain aggravated by sitting for prolonged periods e.g. driving or sitting in a movie theatre (eg, jumping, hopping, running, going up or down stairs, or squatting).

• some people also hear and feel a grinding / clicking around the knee with mild swelling

A number of factors can alter the mechanics of the patellofemoral joint and increase joint stress, leading to OA.

This is where an detailed Movement Assessment with an experienced Physiotherapist can really pay dividends.

We can quickly see which parts of your body are moving efficiently and which are not and then take the time to out together a customised plan of attack for you and this can have the capacity to not only reduce symptoms but have the potential to slow disease progression.

Manual therapy, dry needling, exercise and taping can all greatly assist with re-aligning your knee joint.

Pilates can also very beneficial it helping to build the neural pathways for efficient movement.

2. Aerobic fitness

Aerobic exercise has many benefits for people with arthritis that include:

• stimulating natural endorphins that can help decrease pain as much as taking medications (without the side effects)

• builds your physical capacity and increases muscle strength to help protect the joint

• helps in managing your weight (there is a large body of evidence that identifies obesity as a risk factor for developing OA of the knee, particularly in women)

• improves mental health and lowers the risk of depression and anxiety

• getting you out of the house and away from sedentary behaviours

• strengthens social connections

What exactly is aerobic exercise?

Aerobic exercise can be defined by light to moderate intensity, and is characterised by our ability to maintain it for a prolonged duration (many minutes to several hours). You should be able to maintain a conversation as you move.

Capacity vs Demand

We know that your symptoms are likely to flare-up when you get fatigued. It is important to build your cardio-vascular capacity so you can comfortably perform your everyday activities with ease and comfort.

When you’re had a flare-up and are in pain, your activity levels tend to drop off. This has in impact on your bodies capacity, and your ability to deal with demand and loads will be temporarily reduced, until you can build it back up again.

Pacing yourself with a graded exercise program is the best way to re-build capacity. Monitoring your time, distance and pace can be extremely beneficial with a GPS watch or app in your phone.

How much aerobic exercise should I aim for?

Current guidelines recommend aerobic exercise be performed ideally on most, and preferably all, days of the week, for a minimum of 30-60 minutes a day.

This 30-minute total can be performed in one go, or be made up of 3 x 10-minute sessions, if that’s more convenient for your lifestyle.

How do you choose what sort of cardiovascular exercise to do?

“The best exercise is the one you’ll commit to doing”

Factors to consider:

• What do you enjoy doing and what you will commit to?

• How much time do you have to fit into the day?

• Do you have any social support that would increase adherence?

Before you begin

As you begin an exercise program, you may need to allow a period of 'body tuning' i.e. using manual therapy, massage, dry needling and specific exercises to improve tissue quality and joint alignment.

Similar to playing an instrument, tuning up before hand makes things perform much better and reduces the wear and tear.

Walking

Gradually increasing the amount you walk would be an excellent way to start building your aerobic fitness.

Don’t forget to invest in some good quality shoes that are replaced every 3-6 months, depending on how active you are.

Cycling

While cycling can be good for the health of the knee joint, unfortunately it can contribute to muscle imbalances.

Specifically cycling inhibits the glutes and makes the hip flexors and hamstrings tighten up. This can have consequences when walking and standing for long periods, as the knee joint is likely to experience increased load and strain.

If you really enjoy cycling, that’s cool, but you may need to spend some extra time working on correcting your muscle imbalances.

Running
For many years it was thought running ‘caused bad knees’ and it was best to avoid if you have knee pain.

However, much research has come out recently with some surprising findings - runners are at a reduced risk of developing knee arthritis.

The exact mechanisms for this are still unclear, but may be related to runners maintaining a healthier weight level, with stronger muscles and more resilient joints.

BENEFITS OF RECREATIONAL RUNNING - Recreational running is not only good for your overall health, but also benefits your knees and hips—just 3.5% of these runners develop hip or knee arthritis. A sedentary lifestyle—not running—or competing as an elite runner increases the risk of hip or knee arthritis by 10.2% and 13.3%, respectively.

Source: Journal of Orthopeadic Sports Physical Therapy

Bottom line: there are certain strategies for helping offload the knee when running (such as increasing your cadence 5-10%) to keep you from aggravating your knee pain. Please contact us to find out more.

Swimming

Getting in the water regularly would be one of the best things you could do for knee OA. The buoyancy of the water helps decompress the joints and allows you to move freely with minimal pain. Swimming, water aerobics or even just walking in the water can be very healing for the knee joints.

Just ensure you are still getting enough weight bearing exercise to stimulate your muscle and bone growth.

3. Strengthening

National guidelines recommend x 2 strengthening sessions per week.

This doesn’t mean you you need to necessarily go to the gym, (but it may be helpful if you have a small weights at home) to gradually progress your strength capacity.

Your Physio will be able to guide and progress your strength program.

Major muscle groups that should be targeted include the quads, glutes, hamstrings and calves.

Dealing with flare-ups

• flare-ups are a natural part of the OA presentation and should be expected

• the main thing is to listen to your body and temporarily reduce any load and strain for a few days

• focus on non-weight bearing exercise such as pool and pilates exercises to help keep strength in glutes and core

• take panadol as needed

• use ice or heat packs

• keeping an activity log to monitor how your body responds to your exercise can help identify triggers

• If your symptoms persist for more than a few days, make an appointment to see your Physio.

How can a Physiotherapist assist someone with knee OA?

1.  Assessment and Diagnosis

A modest investment in a Physio Assessment early on  in your journey pays big dividends in terms of identifying relevant contributing factors and helping you get on the fast track to healing. 

We spend a lot of time in the beginning educating you so you know what to expect in terms of recovery and what you need to do, to manage your recovery successfully.

"Give me six hours to chop down a tree and I will spend the first four sharpening the axe." - Abraham Lincoln

2.  Dry Needling / Massage and Taping

Often 4-6 sessions of manual therapy will help minimize pain, re-set your tissues and get you into a position where you can confidently self-manage. 

Muscles that are commonly tight and affecting your knee include the

• ITB

• TFL

• hamstrings,

• quads and calves

Foam rolling and spiky ball massage are effective at maintaining flexibility, but dry needling has the ability to get to the deeper part of the muscle and get a more effective release. 

Find out more about dry needling here.

We can also show you how to tape your knee to provide relief in the short-term.

3.  Guidance on load management

We will give you advice on how to gradually re-load your tissues to safely protect your knee from future flare-ups.  We work with your coach or trainer to manage your return to doing what you love. 

4.  Building a personalised home exercise program

You are the most important part of the healing process and what you do is the most important part getting you better. 

We use the convenient Physitrack App to build your personalised home program with videos delivered to your smart phone.

5.  Movement Re-Training

Once your pain is under control we then watch how you move and optimise your movement patterning to decrease the chances of the knee pain returning.

Pilates can be a very effective way to maintain efficient movement patterns.

Is Knee Pain or Injury keeping you from being as active and healthy as you want?

Summary

I hope this post has given you some valuable guidance in planning your exercise to help your knee. It is very general information, so please consult your Physiotherapist for advice specific for you.

There is a lot of positive research now that shows taking a proactive approach to your health can have a very successful outcome for your knee pain.

If you have knee issues and like some more personalised guidance, it would be a pleasure to help you (we can help in person or via our online tele-health portal).

Please take a moment to fill out the form below and we’ll get back to you as soon as possible.

Knee OA - Part 2 - Exercise

1. Do you think exercise is a beneficial intervention for knee OA patients. If so why?

Yes exercise is very beneficial for knee OA.

2. How often do you prescribe exercises for knee OA patients?

Doing some form o

3. What are the most effective exercises for your pt groups.

For knee pa

4. Do you often see changes in patient function and pain after an exercises prescription? If so what sort of changes do you often observe?

5. How many days a week should OA patients exercise?

6. How many repetitions and sets do you often prescribe patients with mild, mod and severe knee OA

7. How many times a week do you often prescribe such exercises?

8. What sorts of lower limb exercises do you prescribe patients with knee OA and why?

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5 quick tips for sudden onset lower back pain

1. Stay calm and confident

Twinges in the lower back are extremely common and can be thought of as like the 'common cold' of the spine.

A bad cold can certainly knock you around and make you feel pretty crappy.  With a cold, you know you're going to get better so you just accept it is part of life and don't stress too much over it.

On the other hand, a lower back flare up can sometimes leave you feeling rather vulnerable and fearful of damaging your spine.

Some typical thought patterns may be along the lines of:

• 'Am I ever going to get better?'

• 'Did I bulge a disc?'

• 'Do they even heal?'

• 'I may do more damage if I keep moving'

Negative thought patterns can trigger off a cascade events that can put your body into a 'fight or flight' state where some muscles get tight (superficial power muscles) and others (deep stabilisers) tend to become inhibited.

We know from pain research that the intensity of pain you experience correlates with the THREAT of tissue damage, not ACTUAL tissue damage.

Any way you can reduce the perception of threat can go a long way towards getting you on the right track with greatly reduced pain.

Spending a few minutes on these re-activation exercises will help no doubt help engage the core muscles.

But really it's more about pushing through the mental barriers and regaining confidence in your body's ability to heal.

"Your Body is an Incredible Self-Healing Machine" (Kelly Starrett).

It is amazingly robust and resilient.

We just need to set up the right environment for quality healing to take place.

2. Keep moving and stay at work if possible

If your back pain is more severe, you may need 1-2 days of rest and time off work, but then you gotta get moving. 

Staying active (and even trying to get your heart rate up a little) will increase blood flow through the body and promote the healing response. 

Being at work can be a good distraction from the pain and means you're not sitting around at home feeling sorry for yourself.

Take frequent short walks when you're at work. 

3. Change your position frequently

Don't be  sitting or standing in any one position too long.

If you have to sit at work, once again vary the position as much as possible.

Slumping is fine occasionally.

Don't get into the trap of holding yourself bolt upright in the 'perfect' posture.

Learn to chill a bit.

"Variability of posture trumps a perfect posture".

4. Book in to see your Physio

Try and find a Physio who spends time observing your movement patterning and who can perform some targeted manual therapy and dry needling to get things moving again.

Getting some personalised advice and treatment early on often pays big dividends in preventing ongoing issues and can save you a lot of hassles down the track.

5. If you're flare-ups are becoming more frequent or intense, this is a pretty good warning sign that something needs to change

"Pain is a request for change" - Perry Nickelston

If you're able to, find some space and time in your life to re-build your movement immunity and resilience through things like:

• gym

• pilates

• running

• yoga

• home stretching / strengthening program

Sensibly and gradually re-building the capacity of your body will be the most reliable long term strategy of overcoming chronic back pain. 

A Physiotherapist can help get you on the fast track and we'd love to assist you your journey.

Bookings:

If you think we are the right fit for you and you wish to get relief right away, use our simple online booking system to make an appointment.  If you would prefer to speak to us directly,  call us 1300 657 813

Please tag a friend that may benefit from this and please leave any comments or questions below...

Neck pain? Try these 4 simple exercsies

Neck pain is really common. 

Thankfully, most neck pain is not related to anything structurally wrong, but more a warning sign from your body telling you, "it's time to move".

Your muscles don't like stagnant conditions, as the blood flow is restricted and creates acidic conditions in the tissues which contributes to the pain experience. 

If you can, pay close attention and become aware of the early stages of stiffness building up in your neck and shoulders. 

If you can get moving as soon as possible, there's a good chance you can avoid the downward spiral that often involves more intense neck pain, restricted movement and headaches.

These set of four exercises targets the upper back (thoracic spine), which is often very stiff in people who experience frequent bouts of neck pain. 

Cat-Cow

Start on your hands and knees with your back in a neutral position.
Arch your back, lifting your head up and pushing your tail bone out, making a dish with your spine.
Hold this position for one breath.

Next, arch your upper back by tucking your head and tail bone in and pulling your belly button in towards your spine, making a curve through your back.  Exhale completely as you activate your deep core stabilisers.
Repeat x 10 times

Thread The Needle

Bring yourself up onto your hands and knees.
Your hands should be under your shoulders and your hips over your knees.
Take one hand off the floor and reach in and through between your other hand and leg on that side.
Allow your shoulder and head to follow, moving down towards the floor as your hand reaches through.
Allow your upper back to twist and rest your head gently on the mat. 
You should feel a stretch in your upper back and shoulder blade.
Hold for 30 seconds and then repeat on the other side. 

Push-Up To Side Plank

Push yourself up into a plank position with your hands under your shoulders and
Perform a half push up.

As you're coming up, rotate your body, turning one arm up towards the ceiling.
Allow your head and body to follow the movement.
Your may rotate a little on the balls of your feet.
Return your hand to the floor and repeat on the other side. Repeat x 3 each side.

Thoracic Mobilisation On The Foam Roller

Lie with a foam roller in your mid-back, and hug your arms across your chest to open up the upper back.
Lift your hips off the mat, and roll back and forth for about 30 seconds, pushing with your legs.  You may feel a few cracks and pops which is a great sign your are releasing the joint stiffness.

Try spending 5 mins every morning and night and see how it helps your neck pain.

If you have any questions please contact us dan@kinfolkwellness.com.au

If you'd like to get a more personal assessment and treatment of your neck pain, please use our easy online booking system below to make an appointment: