Bryan Christie

Injury Tip Sheet: Plantar Fasciitis

Learn what you need to know to help treat and prevent this common foot injury

Kathy Weber, M.D., M.S.
Daphne R. Scott, PT, Dsc
Chicago, IL

Fast facts

• Affects over 2 million people each year
• Occurs mostly in individuals between 40-60 years old
• Is more likely to effect women than men
• 10% of cases are running-related

What you need to know

What is plantar fasciitis?

• Plantar fasciitis is an inflammation of the thick band of tissue, called the plantar fascia, that runs along the bottom of the foot
• The plantar fascia connects the heel bone to the toes and when it becomes inflamed or swollen can cause severe pain in the heel
• Can become chronic if the inflammation is left untreated

Signs & symptoms

• Sharp pain in the heel, typically complains of pain with first steps in the morning or after sitting during the day
• Pain localized to the bottom of the heel with or after exercise
• Pain subsides with rest and often improves after muscles in the foot have been stretched
• Pain develops gradually and often effects only one foot

When should I see a doctor or other professional?

• You should see a doctor if the pain continues despite rest, stretching, and icing.  Occurs when there is no weight placed on the foot, pain wakes you from sleep, or if the heel pain is in conjunction with fever, redness, or numbness in the foot
• Doctors may provide additional stretching exercises, cortisone shots to relieve the pain, or splints to wear at night.  Surgery is rarely offered as a treatment

Causes

• Overpronation and/or flat feet can contribute to plantar fasciitis, especially in conjunction with poor footwear
• Tightness in the calf muscles can lead to inflexibility in the foot
• Excessive exercise, especially running on hard surfaces, over overtraining

Risk factors

• People who are overweight or over the age of forty
• Imbalanced foot mechanics, such as a difference in leg length or inadequate footwear
• Exercises that place added stress on the tissues in the foot such as long-distance running, ballet, or dance

What you can do

Prevention

• Make sure that shoes have adequate arch support and heel cushioning
• Avoid overtraining and increase workout increments gradually
• Stretch the arch of the foot and the calf muscles  prior to and after  exercising
• Ice after stretching and after your workouts

Recommendations for treatment and rehab

• Icing the foot for 15-20 minutes a few times daily while taking an anti-inflammatory (if appropriate) can add in reducing inflammation and pain.
• Stretching the arches, calves, and Achilles tendon multiple times during the day to help increase flexibility
• Wearing a night splint for plantar fasciitis keeps the foot in a position to reduce tightening of the calf muscles and plantar fascia during sleep
• Minimize irritation to the heel first thing in the morning by putting shoes on before taking the first step when getting out of bed
• Upon waking, stretch the feet and toes up toward the head to stretch out the calf and foot before stepping

What can I do to stay active?

• Non-impact activities such as swimming, cycling, circuit strength training are better choices to minimize pain at the heel during recovery
• Decreasing running mileage and substituting with cross training

For more information on plantar fasciitis and learn the Six S’s of plantar fasciitis, read our Ask the Expert on plantar fasciitis pain.

Bryan Christie

Injury Tip Sheet:  Back Sprains and Strains

Learn what you need to know to help treat and prevent this source of back pain.

Kathy Weber, M.D., M.S.
Daphne R. Scott, PT, Dsc
Chicago, IL

Fast facts

• Strains and sprains are the most common causes of low back pain
• Sprains and strains are the most common workplace injury in the United States
• Symptoms and treatment for both strains and sprains are often the same

What you need to know

What are sprains and strains?

• Both involve overstretching or tearing of tissue
• A sprain is defined as an overstretching  or tearing of a ligament while a strain is an overstretching or tearing of a muscle or tendon.
• Ligaments are tough, fibrous bands of tissue that connect the bones in joints to each other; tendons connect the muscles to the bones.

Signs & symptoms

• Pain and/or muscle spasms in the lower back
• Often there is pain and limited range of motion in the lower back
• Pain often increases with movement
• In severe cases, there may be mild swelling in the involved muscle of the lower back

When should I see a doctor or other professional?

• You should see a doctor if you have persistent pain despite icing, over-the-counter anti-inflammatory medications (if appropriate), or associated weakness, numbness in the lower back or legs.
• If there is a change in normal bowel or bladder function.
• If you have a history of previous lower back injuries

Causes

• Strains or sprains can also be the result of sudden twisting, lifting, or pulling
• Sprains and strains can result from overusing muscles or ligaments

Risk factors

• Any sport that requires sudden jerks of movement, such as weightlifting or football, can increase the risk of a back injury
• People who are overweight and/or deconditioned are more susceptible to sprains and strains
• Individuals with excessive arching of their lower back or poor posture place additional strain on those muscles making strains and/or sprains more likely

What you can do

Prevention

• Use proper lifting techniques
• When initiating a weight lifting program start out slow with light weights, focus on proper technique, and increase the weight and intensity of your program gradually to allow the body adequate time to adapt
• Maintain a healthy weight by eating a balanced diet and a regular exercise program.
• Improve strength conditioning in the muscles surrounding the spine to help strengthen the core and reduce stress placed on the discs and surrounding tissues.

Recommendations for treatment and rehab

• Self-treatment for sprains and strains includes ice and heat therapy, compression, and the use of over the counter anti-inflammatories (if appropriate) to reduce swelling and control pain
• Immobility is not recommended after the first 24-48 hours.  It can reduce overall mobility and lengthens recovery time.
• If symptoms continue for more then two weeks physical therapy may be ordered by your doctor.

What can I do to stay active?

• Remain active with movements that do not increase pain or make symptoms worse
• Avoid all activities that increase pain
• Begin with gentle pain-free back stretching
• Once the pain has improved stationary sitting upright cycling of walking may be activities that may be tolerated since they load the spine less
• Avoid activities such as running or other cardiovascular equipment impact activities that require more stabilization since they typically aggravate back sprains/strains

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Bryan Christie

Injury Tip Sheet: Stress Fractures

Learn what you need to know to help treat and prevent this common injury

Kathy Weber, M.D., M.S.
Daphne R. Scott, PT, Dsc
Chicago, IL

Fast facts

• Occur most often in the leg and foot    
• Occur more often in women than in men
• Majority heal without surgery or complications

What you need to know

What is a stress fracture?

• Stress fractures are tiny (micro) breaks that occur in bones
• Bones, like muscles, need time to recover.  If you demand too much of the bone it weakens and can develop small breaks or fractures
• Stress fractures are generally the result of overuse; when muscles become weakened or fatigued by overuse they cannot properly absorb repeated shock or impact and the impact gets transferred to the surrounding bone

Signs & symptoms

• Pain at the site of the fracture; symptoms for stress fractures in the lower leg can be similar to symptoms for shin splints
• Localized pain at the site of the stress fracture
• There may be mild swelling 
• Initially the individual may experiences localized pain at the site during exercise and typically decreases after exercise or with rest
• Pain initially will resolve with rest but overtime if the stress fracture is not treated pain will be noted during rest

When should I see a doctor or other professional?

• You should see a doctor if the pain does not decrease with rest or the pain persists
• You develop a rash or redness and bruising at the injury site
• If pain does not subside with time, see your doctor
• Your physician will perform a physical exam and typically radiographs of the area will be obtained.  If the radiographs are inconclusive, your physician will determine if further imaging is necessary to determine the exact location and severity of the fracture
• Many times the clinical history and the exam is sufficient to diagnose a stress fracture

Causes

• Repetitive pressure or use of force on a bone, such as with running or jumping
• Increasing the intensity of training without proper conditioning
• Sudden trauma to the bone such as landing improperly after a long jump or a direct blow to a bone can result in a stress fracture 

Risk factors

• Individuals who have weakened bones from conditions such as osteoporosis
• Athletes who play on hardened surfaces or who use worn out shoes or orthotics
• People who have flat feet or high arches
• Increasing activity to much, to soon, without adequate recover

What you can do

Prevention

• Never increase the intensity of your workouts by more than 10% each week
• Ensure that you properly stretch prior to and after all workouts
• Make sure you rest between workouts to allow your body time to recover
• Cross training and maintaining a healthy diet to improve bone strength can help improve bone health

Recommendations for treatment and rehab

• Treatment is specific to the type and location of the stress fracture.  Some stress fractures require strict immobilization and non-weight bearing status while others may be treated with relative rest and others with surgery.  Your physician will tailor the treatment to the specific stress fracture.
• Elevate the limb, if possible, and ice the site of the fracture to reduce swelling
• You should work with you physician to develop a return to activity guideline.  Remember if you return to your regular activity too soon, recovery time lengthens and the fracture could have difficulty healing

What can I do to stay active?

• Participation in any weight bearing activities if the stress fracture is in the leg will be at the discretion of a doctor and should only be participated in after consulting with a health care professional
• Low impact activities such as swimming can typically be performed but should be approved by your treating physician prior to participation in said activities

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Bryan Christie

Injury Tip Sheet: Shin Splints

Learn what you need to know to help treat and prevent this common leg injury

Kathy Weber, M.D., M.S.
Daphne R. Scott, PT, Dsc
Chicago, IL

Fast facts

• Occurs in athletes of all ages
• The majority of shin splints are caused by improper training
• The shinbone (tibia) supports more than 80% of the body’s weight
• Cause over 10% of all running injuries

What you need to know

What are shin splints?

• Pain and soreness along the shinbone (tibia) due to stress caused from excessive running or overtraining.
• Shin splints are considered an ‘overuse injury’ and result from inflammation in the tendons adjacent to the tibia

Signs & symptoms

• Tenderness, soreness, or pain in the lower leg, typically on the outside aspect of the shin bone  at the onset of exercise, which can reduce as the workout wears on
• Mild swelling along the tibia

When should I see a doctor or other professional?

• If you have localized pain, pain that is initially relieved with rest but now persisting with rest, pain with activities of daily living (walking), night pain you may have a stress fracture and not shin splints. Stress fractures are small hairline breaks in the bone and will not heal with simple icing and/or anti-inflammatory treatments
• If you continue to exercise with a stress fracture eventually the stress fracture will go onto fracture requiring surgery

Causes

• Shin splints are caused by an overload of stress on the shinbone itself and the connective tissues surrounding the bone.  This overload can be caused by specific activities such as running downhill or running in shoes with inadequate support
• Shin splints often occur due to overtraining, or a sudden increase in the intensity of a workout
• Shin splints can also be caused by overpronation, causing additional stress on the tendons in your foot and calf

Risk factors

• Shin splints are most common among runners, especially those just beginning running or an extensive training program, such as for a marathon.
• Running in worn out shoes will cause additional stress on your arches, which can contribute to shin splints
• Inadequate stretching will put additional strain and demand on the muscles

What you can do

Prevention

• Adequate stretching prior to and after workouts, especially long training runs, are an important part of preventing shin splints
• Additionally, make sure that you do not increase your mileage too quickly and ensure that your footwear has appropriate arch support
• Athletes should incorporate lower extremity strengthening such as hip, gluteus, and calf raises to help stabilize their lower leg muscles

Recommendations for treatment and rehab

• At the onset of shin splints it is important to ensure you have appropriate foot support and incorporate stretching into your training
• In order to reduce the swelling that is sometimes associated with shin splints, you can ice the area after workouts.  A combination of icing every twenty minutes and, if appropriate, taking an anti-inflammatory medication will help relieve the inflammation and pain associated with shin splints
• Active rest is an important part of any overuse injury
• Your doctor may also refer you to a Physical Therapist to address biomechanical deficits contributing to your shin splints

What can I do to stay active?

• Many runners use this rest time to cross train, incorporating swimming or cycling and avoiding weight bearing exercises
• Minimizing any exercise that increases or reproduces your pain will allow for a more expedient recovery




Bryan Christie

Injury Tip Sheet: Facet Syndrome

Learn what you need to know to help treat and prevent this common back injury.

Kath Weber, M.D., M.S.
Daphne R. Scott, PT, Dsc
Chicago, IL

Fast facts

• Occurs most often in the neck or the lower back
• Most common in individuals over 50 years old
• Along with the elbow and knee joints, facet joints are also known as synovial joints

What you need to know

What is facet syndrome?

• Facet joints connect the vertebrae to each other; there is one facet joint on either side of each vertebrae
• Facets joints, like other joints in the body, enable the spine to bend and move and provide support and stability to the spine
• The facet joints are partly made of cartilage to help the spine bend and move smoothly
• When these joints have been injured or extended too far they can become irritated, causing facet joint syndrome

Signs & symptoms

• Difficulty  turning the head or low back without moving the whole body
• Pain and stiffness, typically in the neck or lower back, and difficulty standing up from a seated position
• If the affected facets are in the neck, this can cause not only pain in the neck but can also result in headaches
• If the affected facets are in the lower back, pain can worsen with extension activity and the back can radiate down into the buttocks and legs

When should I see a doctor or other professional?

• You should see a doctor if the pain and stiffness prevents you from your daily activity
• Only doctors can formally diagnosis facet joint syndrome as diagnoses are made clinically through an appropriate exam.  (Diagnoses are confirmed with an anesthetic/steroid injection at certain facet joints.)

Causes

• Whiplash or sudden trauma that causes extreme extension of the spine
• Repetitive extension activities such as performing a pitch in fast pitch softball
• Research suggests that a common cause of facet syndrome is simply degeneration of the facet joint  over time
• Poor posture or injuries that pinch the nerves near the base of the joints

Risk factors

• Gymnasts or other athletes who spend a lot of time in extension are at risk for facet syndrome
• People with arthritis are more susceptible to increased inflammation and pain
• Older people or people with rapid degeneration conditions are especially at risk for worn cartilage and bone spurs

What you can do

Prevention

• Ensure that you keep your back as strong and flexible as possible.  Strong muscles support the joints and can help protect the vertebrae
• Maintain proper and upright posture
• Avoid an overload of pressure on the joints: maintain a healthy weight and a diet that supports bone strength

Recommendations for treatment and rehab

• Treatment for facet joint syndrome includes avoiding the activity that is causing the irritation
• Avoid extension activities
• Over the counter anti-inflammatory medications (if appropriate) are used to reduce pain
• Physical therapy is often prescribed to regain movement in the joints
• In cases that do not improve with more conservative management (i.e. anti-inflammatory medications, ice or heat, and physical therapy) facet injections with a combination of an anesthetic and steroid are performed under fluoroscopic guidance by a trained physician.  If this does not provide long term improvement then a procedure called radio frequency rhizotomy is performed.  Essentially this procedure ‘de-nerves’ the facet joints and can help reduce pain for up to 18 months

What can I do to stay active?

• Participate in activities that do not reproduce or increase the pain
• If the facet in the neck is irritated avoid activities such as head side-to-side turning in swimming.  Modify activities to avoid irritating the neck i.e. the use of a snorkel and mask
• In the low back, activities that load the spine such as running may need to be decreased, avoid extension-type activity, and typically non-impact activities are tolerated well