Age and Plantar Fascitis or "itis" In General!

Time and time again, I here people talking about an injury that they feel shouldn't have occured because they've been participating in a specific sport all their lives.  It's the same comment, "my body is used to this.  This shouldn't have happened!"  In fact, it was recent that my brother-n-law voiced an injury he just acquired when playing soccer.  He's 49 years old, has been playing soccer nearly all his life, and doesn't understand why all of a sudden he strained his quadriceps muscle.  He explained that it was a simple kick.  He was standing still when he attempted to kick the ball over several players that were coming at him.  I asked him if he does strength training for his soccer and he said no.  He then vigorously stated why he shouldn't have to strength train since it's something he'd been doing for so long.  Time and time again it's the same cliche, "I've been doing this all my life, why now?".  I tried to explain to him in terms that he could wrap his head around but it didn't sound like he was buying it. 

It is a fact that with age, even though a person has been doing a particular activity for a long time, your muscles and connective tissue will atrophy and experience injuries that otherwise in a younger person would be benign. This is due to two specific events.  One, as we age we begin to lose collagen and elastin in our muslces and connective tissue.  This means that our muslce and connective tissue becomes more brittle.  It doesn't spring back to shape as it would if we were younger and the muscle were more elastic or pliable.  This results in injured tendons and strained muscles.  Second, with age, and with prolonged repetitive activity, we set ourselves up for overuse injuries.  It makes sense doesn't it?  If we've already lost elasticity in our soft tissue, and we continue to repeat the same forceful movements, then something eventually is going to have to give.  Strength training will significantly reduce the loss of muscle elasticity/pliability and nearly put a stop to muscle atrophy! "Jerry, look at me, I'm huge!" (you know, Seinfeld)

The solution to the majority of these aging pathologies/injuries is to improve the strength of the muscles or soft tissue involved with a repetitive activity.  You must apply the "overload principle".  You need to condition a muscle beyond what it is going to be used for in your usual activities and sports!  It's a proven peer reviewed fact that strength training can easily and significantly reduce the amount of muscle and tendon injury by performing specific strength training exercises.  I'll put it even more plainly in the equation below:

Aging = muscle atrophy = muscle weakness = tendon weakness = injury!

There are other details involved with this equation, but the major intent of it, I believe, has been made.

As I've said before, the plantar fascia is a very large tendon.  This tendon originates with several muscle groups in the leg such as the calf muscle or gastrocnemius, the soleus, the flexors of the toes, the posterior tibialis muscle etc.  These muscle groups need to be used beyond that which is required by your sport to keep them healthy and injury free.  Running, running, running, and more track work just won't do it!

Plug some strength training in on your light workout days or recovery days.  I promise that this won't mess up your personal race or event goals!  It will only improve them!  The strength training should incorporate movement in all planes and not just forward and backward (what is called the sagittal plane).  Perform lateral and roational movements especially in the hips and torso! 

If your sport involves a lot of running, and you've had a history of foot pain or plantar fasciitis, then denying the fact that you are not affected by age is going to set yourself up for a potential injury that may keep you side lined for quite some time.  I say quite some time because with age, you also heal more slowly than someone in their teens or 20's.

Happy New Years!!

Happy Bipeding!

Brad Senska, PT, DPT, BS, ASTYM.
bradsenska@yahoo.com

Plantar Fasciitis & Cycling

Rarely if ever does cycling cause plantar fasciitis. In fact, if you are recovering from plantar fasciitis, cycling is an excellent way of maintaining cardiovascular fitness while healing. I'm sure you're able to put some of the reasons why cycling would not cause plantar fasciitis just by using some common sense. If you noticed how rigid cycling shoes are, then you could also deduce that without the movement in the foot and the stress through the arch of the foot as well as the achilles, there would not really be any mechanism of injury to the foot. The sole of a cycling shoe is designed to put as much power as possible through the drive train of a bicycle. If your foot were to move too much in a cycling shoe, this movement would be translated into lost power that would be used to propel you and the bike. Compared to running, a running shoe is made to absorb forces and power. The many bones of the foot along with the joints that are designed to glide in unison when running are dispersing potential damaging forces during that part of the gait cycle when your foot first hits the ground through toe off.

So, let me throw this out there as well. If you are a cyclist and want to get into running or duathlons, triathlons, etc., then a period of acclimation from cycling to running, in my opinion, is necessary to avoid potential foot and leg injuries. A cyclist, being very fit cardiovascularly, may feel that running would come easy to them. In truth, running may come easier but specific conditioning is still necessary.

This necessary transition or cross conditioning just doesn't pertain to physical injuries but also to maximum oxygen uptake (V02 Max). Runners will typically display larger V02 Max values due to the larger amount of work being done. If I may just state a true fact, the measured V02 Max in cycling measures very differently than the V02 Max in running. This statement comes from my own research done at the National Institute of Health. Even though my initials are BS, this statement about V02 Max is not!

Enjoy your holidays and until next time,

Happy Bipeding!

Brad Senska, PT, DPT, BS, ASTYM.
bradsenska@yahoo.com

Racing Flats

I was recently reviewing the latest racing flats coming out on the market. My favorite racing flat back in the day was the Asics Gel DS. It's now considered a tempo training shoe. At the time I was wearing them they were still lace up vs. the elastic laces and they certainly didn't have the snug sock liner in them. I've recently been trying out the Zoot Tri racing flats. I really like them. But here's the catch. You just can't land lazily on your heel! To be efficient in them, they require control of your heel/foot strike.  I say "foot strike" because with a minimalist shoe like the Zoots or any of the new racing flats, it's important to land almost mid-foot and on the lateral aspect of your foot.  Don't misunderstand me though.  Your heel will still make contact with the ground.  The difference is that your heel won't take the full brunt of the foot strike when running minimalist or barefoot style.  By using this method, it gives you the advantage of smoothly going through the gears of your foot which gives you a quicker toe off and leg turnover.

When running in racing flats its like running in track spikes. With track spikes you don't want to perform a heel strike.  If you're landing on your heel, you'll end up way in last position unless you're some kind of superhero.  Sure, the racing flats have cushioning but they're not meant to take on a repeated full on heel strike like a posted heel with a dual density sole. This has the strong potential of causing injuries in your feet and legs if you do not condition yourself by gradually getting accustomed to running in them.  I strongly recommend that a person of large stature to not run in a pure racing flat.  A larger person does need some protective cushioning to avoid acquiring injuries from a emphasized and forceful heel strike.  I would recommend going to something like the current Asics Gel training shoe. This will still let you have that feeling of running with your foot unrestricted and with good mechanics.

I remember the first time I ran in racing flats. I would have run in flats sooner but at the time I was a starving student at Arizona State University.  I ran in the New Times 10K in Phoenix, AZ.  I shaved two minutes time off of my best 10k time outside of a triathlon.  I ended up running a 34:34.  I also strongly remember how sore my calves were as were the muscles in my feet.  Fortunately I got away with just having to recover from just sore muscles vs. an injury.  It was these many moons ago that turned me on to the biomechanics of running delving into further improving my running.  Previously, I thought that running was just running, that it was all cardiovascular for the most part and brute strength.  I was consumed in the cycling aspect of triathlons and biathlons.  The technology that was coming out at that time with cycling was just so cool!  Cycling required attention to the weight of the bike, aerodynamics, frame stiffness, having the right fit, etc.

Silly me!

Happy Bipeding!

Brad Senska, PT, DPT, BS, ASTYM.
bradsenska@yahoo.com

Are You Truly Flat Footed or Do You Have Adult Acquired Flat Foot?

I would like to make one thing clear.  Having pes planus, also known by a more common term as being “flat footed”, does not increase the risk of acquiring plantar fasciitis.  It is however a common misconception.  Many times when in the clinic working, I will hear seasoned physical therapists, trainers, coaches, and runners saying they need an orthotic for their flat feet so that they don’t become afflicted with plantar fasciitis. 

It is a fact that people who are truly flat footed were born this way.  Pes planus is a genetic trait.  Either you are flat footed or you are not.  Pes planus should not be confused with acquired pes planus oradult acquired pes planus.  It is a fact that if one is born with pes planus, they should count themselves as lucky especially if they plan to participate in high impact endurance sports.  Since the plantar fascia associated with pes planus is already elongated genetically and lets the arch of the foot fall to the ground, then there is going to be much less stored energy in the plantar fascia during heel lift and toe off phases of the gait cycle.  The incidence of plantar fasciitis among those people that have a true pes planus is very low! 

This then begs the question of whether or not the person with pes planus would not be as efficient a runner as someone with a higher more rigid arch?  Again, the answer is yes, the person with pes planus can be just as efficient running.  The body does what we are told to do.  We respond to conditioning and training.  While attending a running seminar in Las Vegas, NV, we were studying the gait cycle during walking and then during running.  While taking notes of the subjects in standing, it was noticed that true pes planus was present on two of the male subjects.  When observed during a fast gait and running, the pes planus was not observable.  The subjects had been trained to adjust their walking and running mechanics so that a more efficient stride was used. 

So, in summary, being flat footed rarely is the single contributing factor to acquiring plantar fasciitis.  Also, being flat-footed does not make you a less efficient runner.  However, if you do not adjust your foot mechanics from heel strike through toe off, the potential for being a less efficient or slower runner is present.

Acquired Flat Foot

Acquired flat foot can be a combination of break down in the arch of the foot or a break down and subsequent changes in the ankle joint.  But be careful, acquired flat foot is not just limited solely to soft tissue, musculoskeletal imbalances, and joint breakdown.  There are other factors that can cause acquired flat foot.  These factors include prior injuries, predisposition to osteoporosis, nutritional deficiencies, as well as systemic disease, and genetics.

A very common place for acquired flat foot is in a joint in the ankle called the “subtler joint”.  This joint is just below the area that the tibia (our shin bone) meets the calcaneus (our heel bone).  If the muscles connected to the tendons that cross over the subtalar joint become too weak, then the inside of our ankle will drop causing an appearance of being flat footed.  When the inside ankle drops, this also causes the arch of the foot to drop closer to the ground.  Again, this is the flat foot that the majority of laypersons literature is referring to.  It’s very important to know that acquired flat foot can be corrected.  You were not born with this!  There is a catch though.  If this is left unattended, then the joint could suffer irreversible damage.

Prior to writing this, I performed a rather extensive literature review and found that plantar fasciitis is much more common in the population with acquired flat foot.  In fact, these studies confirmed my findings over the past three years in the clinic when working with people that suffered from plantar fasciitis.  The most common age group with acquired flat foot is between the ages of 40 to 55 years of age.  As far as gender, plantar fasciitis prefers men and women equally.  Children and adolescents rarely present with plantar fasciitis!  These findings coincide with my clinic findings.

So Why Not Use an Orthotic to Maintain Arch Height?

I only prescribe orthotics when working with the most chronic and stubborn cases of plantar fasciitis.  I will only use them for specified lengths of time as well as intermittently.  Initially, the orthotic can facilitate improved mechanics of the foot.  Orthotics doesn’t ever support a foot during running or walking.  Instead, orthotics put pressure on specific areas of the foot causing the wearer to adjust their gait so that the discomfort from the pressure lessens.  Orthotics acts as a contact cue to the foot so the movement of the leg/foot performs a desired movement.  Basically, the orthotic is retraining you.  The reason I don’t like long-term orthotics are that if worn too long, the compensation in gait can cause weakness in specific leg/foot muscles (especially in the foot).  An imbalance in muscle strength can occur.  That being said, if you want to go back to not wearing orthotics or orthotics go bad for some reason, then you would have to do so slowly.  Otherwise, you run the risk of re-acquiring plantar fasciitis because the intrinsic muscle of the foot is significantly weakened.  This is especially true if you wear a full-length or three quarter length rigid foot orthotic.  Beware!  Orthotics is not necessarily your friend in this situation!  It’s extremely important to improve the strength of the foot intrinsic muscles!

So, What to do Next?

The most conventional method so far to treat plantar fasciitis is to rest.  Rest so that you don’t inflame the tissue any more than it is already.  If rest doesn’t do it, then get an injection.  If the injection doesn’t do it then see a physical therapist.  If physical therapy doesn’t resolve it, then try an orthotic and continue with conservative treatment from a physical therapist. 

Whew! What a tedious process!  All of the above are the traditional methods for resolving plantar fasciitis.  Stretching, strengthening, icing, self administered massage, and reducing your activities to just about nothing has and for the most part remains the standard for treatment for plantar fasciitis.  Much of this leaves a person questioning whether or not if this plantar fasciitis is going to go away. 

YES! IT WILL GO AWAY WITH THE RIGHT TREATMENT! 

Happy Bipeding!

Brad Senska, PT, DPT, BS, ASTYM.

bradsenska@yahoo.com

Five Finger Toe Shoes by Vibram: Are They Worth the Hype?!

In my opinion, absolutely! I’ve read and reviewed their research.  I’ve also plugged their research in to my outcome studies and theories of the mechanics of the feet.  Lets say a person goes in to, oh maybe Roadrunner Sports, and you’re looking for a new pair of shoes. The first thing the sales people does is put you on the treadmill, run you for several minutes so that you assume your normal running mechanics. You then stand on some machine, it looks at hotspots on your feet as well as the imprint your foot leaves, then the machine decides what shoe you should be running in.  To me, this is just a hard sell!  If we go by this model, this means that every one alive walking has a deformed or malfunctioning foot or feet.  This is so far from the truth! There is absolutely nothing wrong with any of our feet. The only time our feet malfunction is when we don’t take care of them! Like all things, our society feels that there is room for improvement.

The reason for the increased interest in minimalist or barefoot running is because peer reviewed studies are seeing that our mechanics with running change significantly when barefoot.  The "technological" advances in shoes do not limit or reduce running injuries.

The mechanics of running becomes much more efficient and easier on our bodies when minimalist running.  The force of impact through the body becomes less; our stride shortens and makes us more efficient in regards to energy expenditure. Because of the higher leg turnover with a shortened stride, time over distance decreases.  This is because we are spending more time in contact with the ground propelling ourselves forward vs. having more vertical movement in our running stride.  This vertical movement is a result of us relying on our shoes to cushion our landing.  Energy spent going vertical takes away from energy propelling us forward.  In other words, our running times improve, injury decreases, and our feet work like they are supposed to.

The structural integrity of our feet stays in tact vs. weakening our feet and legs by putting them in massive stability shoes. I’m not saying that a racing flat isn’t beneficial, because it is! I’m just saying that going back to basics vs. relying on technology that doesn't even come close to what our bodies are already capable of doing will benefit all of us!

No shoe can replace the way our natural foot works. No cushioning in any shoe can mimic the cushioning properties of our own natural heel pads. I could go on and on with technical jargon and research. So, if you don’t agree with what I’m saying here then good. Don’t take my word on it.  Go straight to the sources of the research and look into it yourself.

Happy Bipeding!

Brad Senska, PT, DPT, BS, ASTYM.
bradsenska@yahoo.com

My First Blog

This is my first blog ever!  I most certainly hope that what I write here will be of stupendous use to those that read it.  As a professional, I will only give you objective information in terms that all will be able to understand. 


For those of you that are not familiar with me and have happened to stumble upon this page, I am an avid competitor in cycling, running, and of course normal everyday driving! I am a physical therapist and exercise physiologist who prides himself with a keen eye for the interpretation of the biomechanics of running and cycling.  I have most recently started a website that gives advice about plantar fasciitis as well as provide a treatment method for resolving plantar fasciitis...um, that would be here at www.enduranceathleteconsulting.com.  


So, tell all of your friends that you've found this great blog that gives all kinds of PT and endurance sport training advice...for free!


You'll be hearing more from me soon!

Brad Senska, PT, DPT, BS, ASTYM.
bradsenska@yahoo.com