Additional Services


Endurance Athlete Consulting covers a broad range of topics regarding human performance in sport, sport related injuries, and rehabilitation. If there is something specific you would like to inquire about, please feel free to email me at: bradsenska@yahoo.com.

I am available for speaking engagements and in services regarding aspects about injury, injury prevention, training for specific competitive events, injury treatment protocols, and workplace ergonomic assessments for a healthier work environment.

Saturday, November 26, 2011

Beware Newbie Barefoot Runners!

In spite of what your friends and what self appointed "fitness gurus" might tell you, running does not injure your knees, running does not injure your back, nor your hips, or your ankles, or any other joint in your body.  Let's put it this way, you can run poorly, or you can run properly.  When running properly, you should never experience back pain or pain in your legs other than that of a good workout.  You see, barefoot running has been blamed for a sudden increase in heel pain, plantar fasciitis, and other pains in the legs and feet.  Well, it's not the actual act of running in a barefoot or minimalist manner that is causing these injuries.  It's the person that is partaking in the barefoot running that is causing injuries to themselves because of improper barefoot running mechanics.

The whole concept of barefoot running is that of getting back to the root of when the populous of this world didn't wear shoes or shoes that were of "minimum" support.  Barefoot running is getting back to the use of all of our leg and foot muscles in a very proficient and efficient manner. We as a people have become extremely lazy regarding the way we move and give very little attention to proper movement.  Our shoes are so cushioned now that we just stomp and plop our feet down with out even having to think about how we walk.  In fact, trying to correct foot supination and foot pronation is rather comical.  Being either supinated or "over pronated" is an accumulation of daily lifestyle habits.  We can choose to pay attention to how we walk and utilize muscles in our feet and legs, just as we pay attention to how we sit our desks, whether we slump or sit straight.  Well, when getting back to walking and running in minimalist footwear or barefoot, our running and walking are performed very differently than if we had supportive shoes on.

I'm going to be a bit harsh here, but if you're heel is hurting after even just several minutes of running barefoot or in minimalist shoes, then you probably deserve it!  You can't expect to step out of a supportive shoe and then run in the same manner that you did when in the shoe.

Foot mechanics as well as mechanics in your legs are very very different when running minimalist style.  Here's why:
1.  First of all, your heel shouldn't be forcefully striking the ground when running barefoot!  You should be reaching for the ground with your mid foot when running barefoot.   
2. There should be relatively no up and down motion during your running stride and therefore eliminating a downward impact on your heel.  All of the energy put into running should be forward and not upward.  To really get the concept of this, look at an elite 100 meter sprinter or a middle distance runner.  Look at the way their foot strikes the ground, watch how they hold their trunk, and notice how little their body will translate in an up and down direction during their running stride.  Everything they do is pure efficiency, a smooth transition in to forward propulsion.  There is no energy lost in upward movement.  There is no time lost moving from a heel strike to mid-foot, to toe off.  It's a mid-foot strike to toe off and even then, the toe off isn't going from the small toe over the large toe, it's just straight forward.  And take a close look at their shoes.  The don't have a supportive or padded heel at all!  As said before, this is because they don't even come close to striking their heel.

So, getting back to the heel and foot pain when initiating barefoot running, you need to approach this technique like a gymnast being newly introduced to the pommel horse.  It takes practice, it takes time to develop proper technique, and it takes time to get to know your body again when starting something this new and challenging!  The payoff though is super incredible!  You'll develop a great awareness of your body, you'll develop more muscle in your feet, legs, hips, and lower back, you'll burn more calories in the same amount of time, and your fitness level will sharply increase!

The best thing of all is that if you do start barefoot running with an injured leg or foot, this injury will probably go away after a short while as long as your introduction to this type of running isn't too quick or aggressive.  This is because you'll most likely be normalizing a muscle imbalance, one that was most likely caused by foot wear that is "too" supportive and therefore reduces the amount of muscle activation that is required when wearing something more natural.  If you want speed and efficiency, then go barefoot but use the right technique!  If you are new to running or running barefoot, find a coach and have a couple of sessions with this running coach.  It will be worth the investment!

I wish you the best of luck with barefoot running and minimalist shoe running.  Be smart about it though!  The payoff is more than you would have expected.  If you have any questions or concerns, just drop me a note and I'll do my best to help out!

Happy Bipeding!

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

Wednesday, October 19, 2011

Rocker Soled Shoes...You Know, the So-Called Butt Shapers?!

In my previous blog, I talked a little bit about the butt shaper shoes.  The most popular of these are the Skecher Shape Ups.  For those of you already wearing these shoes and are looking for more information on the benefits, or for those of you that are thinking of getting a pair, PLEASE DON'T WASTE YOUR MONEY!!  More importantly, don't waste the health of your feet, legs, and back.  These shoes have absolutely no truth to what advertisers say they will do.  There are absolutely no clinical or peered reviewed studies that show these shoes shape your hamstrings or butt!  Millions and millions of dollars have been spent on advertising claiming that all you have to do is wear these shoes and you'll get the benefit of the equivalent of a good leg and hip workout.  In truth, these shoes turn off muscles in your legs and feet.  There is less muscle activation in the legs and feet.  Instead of having to propel yourself off the ground, you end up just rolling over the sole of your foot making you do less work.  They provide an unstable base of support that would normally be present for good posture and mechanics of the lower extremities and back!

So, what are these shoes good for?  Here's a list of what "rocker soled" shoes are good for:

  • Cerebral Palsy and muscle spasticity
  • People who have suffered strokes and have lost motor control in the legs and feet
  • People suffering from varied levels of Muscular Sclerosis
  • Traumatic Brain Injury
  • ALS or Lou Gehrig's disease
  • Any illness that causes loss of motor function that affects a person's ability in which it limits normal walking or gait mechanics and requires the aide of a prosthesis or orthotic to help with clearing their toes off the floor when advancing their foot.

In other words, for a normal healthy person who is just too lazy to lift their own foot up so they don't scrape their toes on the ground, well then, a rocker soled shoe is just for this person!  Sorry to be so harsh but this is the plain truth about these shoes.  Rocker soled shoes are designed to use less energy and skip the use of specific muscles in the lower extremity below the knee.  Because the sole is rounded, it allows a person to "roll" over their foot.  Muscles responsible for performing this action are no longer needed or are used.  If you're interested in these muscles, then here's a list:

  • TIBIALIS POSTERIOR MUSCLE
  • SOLEUS MUSCLE
  • GASTROCNEMIUS OR CALF MUSCLE
  • ANTERIOR TIBIALIS MUSCLE
  • FLEXOR HALLUCIS & FLEXOR DIGITORUM: muscles that flex the toes
  • PERONEAL MUSCLES: muscles that flex and turn the foot outward

In other words, all the muscles involved with plantar fasciitis and tibialis posterior tendonitis.  The incidence of people coming into the clinic from Skecher Shape type shoes is becoming higher and higher for treatment of tibialis posterior tendonitis and plantar fasciitis.

I really don't like getting into the political or legal aspects of things, but just 2 weeks prior to posting this topic, a class action law suit was finally filed against companies that manufacture rocker soled shoes.  The lawsuit is for the false claims being made regarding the "positive" effect that these shoes have on increasing "muscle tone" in the butt and legs.  In reality, these "positive" benefits or claims are actually the opposite!

I’m not sure that these are the best final words to leave you with, so, without going on and on about why it’s not a good idea to invest in these shoes, here’s the truth about rocker soled shoes:

  • ·      Rocker soled shoes are used for motor deficient individuals
  • ·      Muscles in the legs become inactive
  • ·      Rocker soled shoes do not increase or tone muscles in the legs and hips
  • ·      You may find yourself more comfortable for periods of time on your feet because you’re no longer doing the same amount of work to walk!

Happy Bipeding!

Brad Senska, PT, DPT,BS, ASTYM.

Monday, September 5, 2011

Plantar Fasciitis or Tibialis Posterior Tendonitis?!?

Ok, here's my dilemma.   I've been seeing more people who have what is called "Tibialis Posterior Tendonitis".  This can often present as plantar fasciitis but it does have clear cut tell tail signs and symptoms that distinguish it from plantar fasciitis.  The mechanism of injury or the cause of tibialis posterior tendonitis differ only somewhat from those of plantar fasciitis.  

Before I go on, I've got to get on my soap box and tell you what's bothering me.  In my past and recent experience, doctors are apparently having a hard time properly diagnosing the difference between tibialis posterior tendonitis and plantar fasciitis.  That being said, I'd really like to empower you to be your own diagnostician!  So, here we go!

In my experience, if people have a problem with their feet, they go to a podiatrist.  You could also go to an orthopedic doctor who specializes in the foot and ankle.  Here's the difference.
An orthopedic doctor can treat dysfunction coming from the foot, ankle, knee or anywhere above the foot.  An orthopedic doctor, if thorough, will check the joints and muscles above the ankle and will take into consideration that the problem in the foot or ankle could be coming from somewhere upstream (often times the hip is the source). 
A podiatrist looks at the foot from the ankle down.  Most often and especially in an athlete, a foot problem stems from a biomechanical or physiological dysfunction upstream; you know, like the knee or hip or even your back.  Podiatrists are often able to address the symptoms in your ankle and foot but very often they are unable to resolve the cause of the foot or ankle injury because the source of the foot and ankle dysfunction is coming from above the ankle or knee.    
The point I'm trying to make is that if you have pain in the arch of your foot and/or pain in your heel, especially for the first few steps in the morning when getting out of bed, this is not an automatic diagnosis of plantar fasciitis!  If you feel that something just isn't adding up with what you are feeling and what the doctor has diagnosed you with, I encourage you to heed that little voice that's speaking to you from your body!  Some simple problem solving can go a long way with finding the origin of your foot and ankle pain and curing your pain in the foot!  Unless the podiatrist or orthopedic doctor isn't able to discern the signs and symptoms between tibialis posterior tendonitis and plantar fasciitis along with it's origins or mechanism of injury, you may be a long time in getting rid of your pain in the foot.  This could quite possibly be at a high cost physically and monetarily!

Image 1
Notice that the Tib Posterior Tendon and the origin of the Plantar Fascia overlap


Image 2
Pain can be present along the path of the Tib Posterior muscle up to the
back of the knee.  Palpation is one way to distinguish between plantar fasciitis
& tibialis posterior tendonitis.

Before I give you a tell tale sign of tibialis posterior tendonitis, I need to review some anatomy with you.  Image 1 shows the area that is occupied by the tibialis posterior tendon on the plantar surface of the foot.  Its job is to point the foot or plantar flex the foot and invert the foot or turn it in.

Then, notice the origin of the muscle in Image 2.  It's high up in the leg and originates just below the knee.  Now, here's the important part.  Looking at Image 1, the area inside the circle is occupied by the origin of the plantar fascia on the calcaneus and the insertion of the tibialis posterior tendon that crosses over the origin of the plantar fascia and terminates deeper in the foot but running nearly parallel with the plantar fascia for a short distance.  This distance extends somewhat into the area that is the "arch of the foot".  This is the same area that the plantar fascia spans.

So, if you're trying to diagnose whether the pain in the heel and arch of your foot is plantar fasciitis or tibialis posterior tendonitis, then your going to have a hard time doing this by just palpating the arch of the foot. 

So here's how you tell what's what:  
On the inside of the ankle feel or palpate the underside and back side of the medial malleolus or ankle bone.  If your tibialis posterior tendonitis is severe or acute, then a sore or bruised sensation upon palpation will be felt.  If symptoms are not too bad at this spot, then go higher up in the leg.  Now, palpate the medial side of your calf muscle where the tendon starts to go into the muscle belly as indicated in Image 2.  If in fact you do have tibialis posterior tendonitis then this area will be quite sore.  If you keep palpating upwards toward the back of your knee on the inside of your leg/calf, the soreness may become even worse.  These symptoms are most likely those of tibialis posterior tendonitis.  Plantar fasciitis usually doesn't present with pain up into the calf muscle.  Plantar fasciitis will present with pain on the back of the heel vs. the inside of the heel and up the medial calf muscle.  
When palpating the arch of the foot near the insertion of the tibialis posterior tendon, usually only the insertion site is sore vs. the entire arch of the foot or the metatarsal heads as would be typical with plantar fasciitis.

So, now you know!  You are now empowered to be your own diagnostician!  

I'll go into much more detail about the mechanics of the foot and causes of both pathologies in a separate post.  The Plantar Fasciitis Cure goes into detail regarding the causes of plantar fasciitis and tibialis posterior tendonitis.  The treatment for tibialis posterior is similar to the treatment of plantar fasciitis.  

Something that will help resolve tibialis posterior tendonitis is to...now wait for it...wear minimalist shoes but part time to start with.  If your new to this blog and the minimalist shoe, these would be the Vibram Five Finger Shoe, New Balance Minimus, Nike, Merrill, and many other brands now have nice minimalist shoe.  

If these are too aggressive initially, then try the latest version of the Nike Free or the Zoot racing flats.  These shoes are great for restoring the use of the tibialis posterior muscle and strength to this muscle.  But to really and permanently get rid of tibialis posterior tendonitis and plantar fasciitis, my simply written, The Plantar Fasciitis Cure will give you the resources, insight, and advice for you to take control over your feet without having to fear the recurrence of this nagging and style cramping injury.

Well, until next time...Happy Bipeding!!

Brad Senska, PT, DPT, BS, ASTYM.




Tuesday, July 12, 2011

Cycling & Plantar Fasciitis Part...?

I want to expand a bit on plantar fasciitis and cycling.  I previously talked about this several blogs ago.  I’ve had a lot of interest in this post and requests for more information on this. 

Bear with me; I have to be serious here in the next couple of paragraphs!


The reason why cycling does not affect plantar fasciitis:



The sudden loading and impact of the heel up through the toes are absent.  The required work of the plantar fascia is absent when in cycling shoes.  The muscles in the foot and toes are working, but it is a different kind of work being performed.  When cycling, the movement or the joints and muscles in the foot are minimized.  



There are 26 bones in the foot.  One reason for the many bones is that the foot has to adapt to a multitude of surfaces and absorb large amounts of force with ballistic types of movement such as running and jumping.  If the foot were rigid, the amount of force would not be dissipated and our knees and hips.  This in turn could cause injury in our knees, hips, and back.  A second reason why there are so many bones in our feet is so our feet can wrap and adapt to surfaces to give us stability in an upright and weight bearing position on multiple surfaces. 


So, how does all this relate to cycling?  If forces going through the foot are such that the leg and foot muscles are too weak to handle, then the joints of the foot, the muscles within the foot, and the plantar fascia will absorb this excess force.  The plantar fascia will to a point be able to handle this extra load.  If the muscles of the foot and leg do not become stronger in a relatively quick time frame, the plantar fascia will then become affected, especially at the origin on the heel.  When your foot is in a cycling shoe, the sole of the shoe is very rigid.  The force going through the foot is much less than would be with dynamic and sudden loading or weight bearing force such as would be present with jumping, walking over river rocks, etc.  The foot, when in a cycling shoe, is held securely.  The 26 different bones with the multitude of articulating surfaces are held more securely and are only moving a fraction of what they would be doing if in a sandal or running shoe.  Of significant importance - the plantar fascia when in a cycling shoe and pushing on a pedal is not under nearly the load as a foot would be when performing an easy jog or run.  There is no sudden loading and unloading of the plantar fascia.  Additionally, when cycling and your pedal stroke is performed in a correct manner, the calf muscle, and flexor muscles of the ankle and foot are being strengthened.  Even the anterior tibialis muscle is being strengthened from the up stroke on the pedal when clipped into the pedal and using a proper pedal stroke.     

So, this is a small explanation of why cycling can really help when recovering from plantar fasciitis.  You are able to maintain cardiovascular fitness, maintain lower extremity strength, and even improve strength in the calf and foot muscles.  

Brief Summary of a Proper Pedal Stroke


If you get a chance, pay attention to cyclists and the way they push down and pull up on pedals.  Most likely you’ll see quite a difference between peoples’ pedaling.  Sometimes the heels are held high when pressing down on the pedal.  Sometimes, the heels are in an exaggerated down position. 


So, what is the correct or most efficient way?  

What you want to do is make sure you attempt to lead with the heel on the down stroke just after you cross over the top dead center position of the crank.  This ensures that the leg muscles (you know, the muscles in your lower extremity from the knee down, not the hip down, are fully engaged).  You’ll get the best leverage this way and be able to increase power output through the improved positioning and leverage.  Once the foot approaches and then passes bottom dead center, the hamstring muscles along with the muscles that pull your foot up (dorsiflexion) perform more work.  By distributing power evenly through the pedal stroke, you develop a proper muscle balance throughout the lower extremity.  


Here's a little trivia:  In the mid to late 80's when triathlon and biathlon were booming with the Bud Light and Coors Light race series, it was very common to see cyclists in a training ride with their heels held high through the entire pedal stroke.  What seemed to be a common denominator amongst these cyclists were each one of them was that they each had a very strong background in running.  They weren't adjusting their body mechanics to the activity of cycling. 


Happy Bipeding!

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



Sunday, May 29, 2011

Plantar Fasciitis & Its' Healing Pains

When suffering from chronic foot pain such as plantar fasciitis, tibialis posterior tendonitis, a bunion, or general osteoarthritis in the foot, a different type of gait or walking pattern is adopted to avoid the pain  being caused.  Remember the word "chronic".  This typically means that a person has been suffering from plantar fasciitis for several weeks to several months or even years.  When a long or even a short period of time passes, the tendons and muscles in the leg become weak quickly if they're not used appropriately.  So, after you find help with resolving your foot pain, you need to prepare yourself for experiencing some moderate to marked soreness in your calf, achilles, and foot.  Pain deters us from normal movement.  If this abnormal movement and disuse of specific muscles continues over a long period of time, then muscle atrophy and weakness are imminent.  The articular cartilage in the affected joint will also become soft and subsequently be prone to temporary effusion and joint soreness.  Unused muscle atrophies quickly!  Introducing weight bearing activities through muscles and joints are are strongly subjected to marked soreness following the introduction of very mild resistance training.

And so, this is the case with plantar fasciitis and tibialis posterior tendonitis.  For those of you who are or have experienced pain from either diagnoses, I believe you would agree that the manner in which you walk or participate in sport and recreation is quite altered from your normal manner of weight bearing.  Let me ease your worries some with the following statement:

You Do Not need to panic about this!  This is a very common occurrence!  Remember, plantar fasciitis is about how you've not been using your feet over a long period of time.  When retraining your leg and foot muscles, tissue that has been dormant for a very long time will now begin to work. This is the reason for what seems to be very "unreasonable" soreness!

Here is a summary of a specific case:
A patient comes in to the clinic complaining of a long history of heel pain.  Over a course of several months, this patient prior to seeking professional help, used over the counter orthotics, heel pads, heel lifts, and even has tried multiple shoes to help alleviate their pain.  None of the self help methods alleviated the heel pain and this put quite a damper on what was a very active lifestyle.  So, this patient sought help from a physical therapist.  After a thorough evaluation was performed, it was deemed that this patient was suffering from chronic plantar fasciitis and was having acute pain symptoms.  The physical therapist exhausted all the usual conervative treatment methods such as ultrasound, iontophoresis, cross friction massage, ice, passive stretching, and revised orthotics.  The patients plantar fasciitis was not resolved.  The treatments were spread out over a course of several weeks.  During these weeks, the leg muscles had not attenuated any substantial forces.  In other words, the muscles were becoming weaker and quickly atrophying.  It was the therapists instructions to the patient to not aggravate the symptoms with physical activity.  In this situation, conservative treatment was a failure.
After the patient made a change in therapist, a thorough evaluation was performed regarding her symptoms, her history of treatment, history of physical activities, and even her postural habits.  The  patients prior daily lifestyle down to the smallest details were discussed.  Shoe type was discussed as well.  So, after all was taken into consideration, treatment was performed of which consisted of several mintues of deep soft tissue work on her achilles tendon, the tibialis posterior tendon and muscle belly, and any other adjacent tissues that presented with symptoms.  Through the soft tissue mobilization, the specific soft tissue structures of which were responsible the current symptoms were identified.  Through further evaluation, two of the muscles and tendons involved were not gliding independently of each other.  The prolonged inflammation and disuse created an environment in which fibrotic tissue or scar tissue had set in.  There was severe discomfort present with the soft tissue work.  This however was unavoidable.  Over time, the tissue became so de-conditioned that to the patient it felt like pressure was being applied on a very painful bruise when just light palpation pressure was being used.  During this same treatment session,  the patient was introduced to partial and full weight bearing exercises using air discs, a bosu ball, and other specific exercise modalities.  In all, the patient performed just 20 repetitions of assisted calf and foot exercises.  The patient was to come in the following day for a follow up but instead called and cancelled their appointment.  The patient reported being extremely sore in the calf muscles and achilles tendon area.  The patient was encouraged to continue performing the same exercises, contrast baths, and to passively stretch the calf muscles.  

Four days had passed before the patient returned to the clinic.  It was obvious that this patient was quite upset about having to go through this pain.  The patient thought for sure that there was severe damage done to their calf muscles, achilles tendon, and foot.  The patient was very upset about this.  After a discussion of the process and reassuring the patient that the process taking place and what she's experiencing is very often a normal response with regards the chronicity of her symptoms.  The patient after feeling reassured and confident again agreed to further treatment.  
After the second treatment of soft tissue work on the achilles, tibialis posterior muscle/tendon structure, and foot intrinsics, the bruised sensation resolved.  The patient walked out of the clinic pain free!  The patient was not entirely out of the woods yet though.  Strengthening and stretching would need to be continued though to make sure that her current symptoms and disuse atrophy would be permanently resolved.

For any of you going through chronic or acute plantar fasciitis or tibialis posterior tendonitis, this is not an uncommon event!  These muscles have not been used properly over a long period time.  In this case, introduction to very light and mild resistance training caused severe delayed muscle soreness (also known as "DOMS").  During the recovery and healing process it is not uncommon for soft tissue work and manual procedures on the plantar surface of the foot, in the heel cord, and in the calf muscle to  be moderately or more than moderately painful at times.  Again, this is a normal healing process!  The body is so good at protecting itself that we don't even know it's happening!  So, those of you that have plateaued with conservative treatment, it may be that someone with good manual skills and soft tissue work is prudent.  Delayed muscle soreness just might order for the healing process to begin again and then finally be completed.

Our bodies are extremely tuff and durable.  In many instances our body needs an external stimulus specific to the diagnoses for it to respond in a manner in which healing will be activated.  Chronic "itis'" are stuck in the middle of a healing process.  Unless affected directly, this healing process or chronicity will not resolve.  Chances are, the inflammatory process will worsen.  The trick is to continue the appropriate amount of stimulus and treatment until the inflammatory process has stopped and healing is completed.

Happy Bipeding!!

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

Saturday, May 7, 2011

Five Finger Toe Shoes by Vibram: Part II

So, one of the reasons why I like the Vibram Five Finger Shoes so much is that they help solve a very frustrating problem with many people who are avid bipedalists (you know, people who spend a lot of time on their feet or using their feet while performing various acts of locomotion over various terrain all over the world).  However, many of these people don't quite know it yet.  Over the past two months, the theory and principles that I've applied in treating plantar fasciitis, involve the use of a minimalist shoe.  Vibram realized the need for a good minimalist shoe, and I was able to stop telling people to go out and find a pair of sandals that they can tolerate.  Sandals were the closest thing to minimal that was available and affordable. 

This shoe, and I've stated it before, lets all of the muscles in the leg and foot work the way they are intended to work.  The dilemma that running shoes with all of their cushion and support cause, is that we as avid bipedalists, take for granted how hard we can be on our bodies.  Running shoes allow us to land hard on our heels.  This allows a tremendous amount of force through our feet and legs.  The trade off is that running shoes allow us to not use muscles in our legs and feet the way they are intended for a faster run time.  Yes, when competing against yourself or others, we do need all the edge we can get.  However, over time, if we don't condition our feet and leg muscles the way they need to be while performing specific sports, the repetition of these activities allow nuances like plantar fasciitis to creep in.  When plantar fasciitis sets in, the first thing we do is run out and get a more supportive and more cushioned pair of shoes just so we can pound our heels harder into the ground.  When the new more supportive and cushioned shoes stop working, well, we go and buy a cushioned in-step for our cushioned shoes.  The trend here is that instead of properly conditioning the foot, leg, heel cord, etc, we continue to soften it and shorten it.  Without knowing, the usual prescription for treating plantar fasciitis is just making plantar fasciitis worse.

The Vibram minimalist shoe, when used in a proper manner over a course of time, does condition our feet the way they need to be.  They also allow the muscles attached to the achilles tendon or heel cord to elongate in a more functional and natural manner.  You know those big night splints that many people use at night to passively stretch out the plantar fascia and achilles tendon, well, why not quit propping your heel up in those fancy supported cushioned shoes during the day.  Spend a couple of hours out of the day wearing a minimalist shoe like the Vibram.  Several things will happen.  The leg muscles will begin to work again like they should.  You'll find yourself stepping or walking with purpose.  Your heel strike won't be nearly as forceful or severe.  And you'll find that you're toe off during walking or running will become more purposeful and powerful. 

One last thought here.  Let's say that after about 4 or 6 weeks of trading off wearing the minimalist shoe with your regular day shoes or running shoes, you notice that your plantar fascia, or arch of your foot, or your heel cord is no longer bothering you!  I believe that the carry over or transference of what you;ve accomplished in the minimalist shoe to your running shoe is going to improve your gait mechanics.  It will make you more efficient with running, and you'll most likely notice an improvement in your running times.

Using a minimalist shoe like the Vibram Five Finger Shoe is one of the main principles when I am treating and resolving plantar fasciitis.

Happy Bipeding!

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

Sunday, March 27, 2011

To Orthotic or Not to Orthotic

Ok, so it's been awhile since my last post.  Sorry about that!  It's been an interesting past 2 months or so.  So, at this point in time, and with what I've been dealing with in the recent past, has really intensified my dislike of "custom" orthotics, or orthotics in general for plantar fasciitis.  From recent people that I've been working with in the clinic, I truly, truly, truly dislike the concept that people have about how an orhotic will change an acitve person's life!  The concept that I'm talking about is that if a person begins to have foot pain then an orthotic is the answer.  Wrong, wrong, wrong!  I'm not saying that an orthotic wouldn't be prudent in specific cases.  What I'm saying is that an orthotic is not the answer the majority of the time.

Let me say something about persons pushing orthotics.  First of all, it's a big money maker for them.  Second, the orthotics are typically made from the foot of a person who is currently experiencing foot pain.  The orthotic is made from an imprint of the persons foot.  The imprint is usually done by the person pressing their foot into a foam that retains the imprint.  Then it's sent out to a lab that creates the orthotic.

Now let's just think about this for a moment and reflect on this technique.  OK, are you done reflecting?  What did you conclude?  This is my conclusion and it comes from years of experience as an applied physical therapist, physiologist, elite competitor, and from many, many, many case studies as a Doctor of Physical Therapy.  The problem with this technique is that the imprint taken is an imprint of an injured foot.  It's a mirror image of the problem!  There was no consideration taken into account to possibly "customizing" the orthotic to correct the mechanics of the problematic foot.  The only thing that the orthotic accomplished is to keep your foot in the same position in which it orginally was when the foot pain initially began.

So, I'm not going to only point out why this technique of making an orthotic can be problematic.  I am going to tell you the correct way to make an orthotic.  First, if possible, make an imprint of the problematic foot while during the single leg stance phase of the running or gait pattern.  Then adjust the orthotic so that when the foot is in full contact with the orthotic, it promotes the correct mechanical operation of the foot during the single leg stance phase during walking or running.  However, this then creates another problem.  How would a person get an imprint when running?  I have some ideas but their not really workable.  The best way is to have an experienced physical therapist observe you running, oh let's say on a treadmill!  It would be great if the person was video taped while running.  Then the therapist could go frame by frame and analyze your mechanics from torso down and identify any abnormalities or areas in which need changing.  Then, from the therapists extensive experience, devise an orthotic appropriate for you that works on the "contact cue" principal!

Let me explain the contact cue principal.  In my opinion, orthotics really work via what is called "contact cueing".  This means that the contact of the orthotic promotes a different way of stepping, walking, or running.  This in turn causes different or the desired muscle groups in the foot or leg to begin working in the appropriate manner.  Remember, plantar fasciitis is usually a product of weakness somewhere in the leg or foot.  If the weakness is not addressed, then the muscles that are working in the place of the weak ones will eventually become overworked and stop supporting you they way they previously have or should have.  Then, the force of the gait cylce is  transferred onto the plantar fascia.  Once the plantar fascia becomes overworked, the inflammation of the fascia begins.

So, who do you go to in order to get the correct orthotic?  My advice is to wean yourself out of the orthotic.  Get advice from a phyical therapist that has extensive experience in gait mechanics!  And whatever you do, don't waste your money on the Dr. Scholls consoles!  In my opinion, this is purely a money maker for them using your ignorance about orthotics.  Don't let their propoganda reel you in!  Our feet are the way they are because they are made to your bodys' order.  The easiest fix is to get up off the couch and get your legs and feet moving the way they were intended to!



Happy Bipeding!

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