With all of the new iPhones and smartphones and other handheld internet devices that so many people seem to be constantly attached to, it’s no wonder when some come to see me with pain in their elbow.  In some extreme examples, the pain can radiate out from the elbow during flexing the elbow or rotating the wrist under load.  Carrying one’s internet device in the hand and keeping the elbow at a constant 90 degree bend can over time cause Lateral Epicondylitis to develop.  This condition has also been called “tennis elbow” but since most people no longer play tennis, but carry a device instead, let’s call it “iPhone Elbow.”

Massage can be very useful in relieving the pain and tenderness associated with iPhone elbow.  Longitudinal release and Cross-fiber friction will help to relax the forearm extensor muscles, and local compression will help to deactivate any trigger points.  Ice massage will greatly reduce inflammation, and client education in conducting self-care for between massage sessions.

The best way to avoid iPhone Elbow is to carry your device in your pocket, purse, or in a belt pouch when you are not actively using it.  Answer your phone, look up information, send a text, and then put it away.  If you must use it for a prolonged time, say in an extended text message conversation, then find a place to sit down and rest it on a tabletop or on your knees.  You’ll spare your hands and elbows pain, and you won’t be one of those distracted iPhone users who bumps into lampposts and other people.

Let your arms hang freely at your sides when you are not using the device, and do some wrist stretches throughout the day.  Here’s a useful stretch for you:

1. Take one hand in the other and gently flex the held hand’s wrist.  That is, bend the wrist in the direction of the palm of the hand.
2. Straighten that same arm’s elbow.
3. Slowly rotate the forearm so the elbow crease is pointing away from your body.
4. Hold for 30 – 60 seconds.

If you are doing this correctly, you should feel a stretch from wrists all the way up to the outside of the elbow – the lateral side of the arm.  Gradually, you will be able to increase the amount of wrist flexion, and even add flexing the fingers at the closest knuckle to the palm.  Do this stretch three or more times a day, and you will notice a big improvement in the reduction of tightness and pain in the elbow.  Self-care is a great way to help relieve your pain.

Stretching will help, but the services of a professional massage therapist can usually completely relieve the pain associated with lateral epicondylitis, usually in one to four one-hour sessions.  This, of course, depends on the severity of the case, but in mild to moderate cases, a single session usually brings tremendous relief.

Book a massage now and be free of your iPhone Elbow!

Do your heels and the soles of your feet hurt when you first step on them when getting out of bed in the morning?  If so, you may have the most common form of heel pain, Plantar Fascitis.

I should note before we start that none of this is intended to be a diagnosis of plantar fascitis, and if you are experiencing heel pain, you should have your physician examine you to determine what’s going on.

What is the Plantar Fascia?

The plantar fascia (also called the plantar aponeurosis) is a thick band of connective tissue on the plantar surface (underside) of the foot.  It originates on the medial tubercle of the calcaneus bone (a particular landmark on the underside of the heel bone), and continues beneath the other bones of the foot out towards base of the toes.  The plantar fascia is made up of collagen fibers that run mostly along the length of the foot, although some move in other directions as well.  The job of the plantar fascia is to support the bones of the arch of the feet by acting as a tie-rod.  From a mechanical perspective, the plantar fascia supports up to 14% of the load the foot has to bear as we move.  So as you can see, it is one of the most important structures in our feet!

What goes wrong?

There are several reasons why plantar fascitis occurs, but a major cause is overpronation of the foot.  The foot pronates, that is, it rolls toward the center line of our body, as a normal function of our stride.  In overpronation, the foot rolls excessively inward.  You can see if you overpronate by looking at your shoes.  If the outer sole of the shoe tends to wear out near the inside of the ball of the foot, you’re probably a pronator.  If the outer edge of the sole of the shoe, you’re likely a supinator.

There is also an indirect relationship between the calcaneal (achilles) tendon and the plantar fascia, especially in adolescents and younger adults.  There are fibers of collagen that connect these two structures together, but as we age, those fibers disappear.  Nevertheless, tight calf muscles and calcaneal tendons can be a contributing factor to plantar fascitis, by providing excessive plantarflexion of the ankle and increasing tension on the plantar fascia.

Another factor in the severity of plantar fascitis is obesity.  The heavier we are, the more weight the feet have to bear, and this can cause considerably more strain on the foot and fascia than our bodies can handle.

A final factor is in wearing shoes too long after they have worn out.  Shoes that are ill-fitting or old and no longer providing the proper support for your stride type (pronator/supinator) can contribute to the symptoms of plantar fascitis.

Where does it hurt?

The classic symptom of plantar fascitis is significant heel pain upon first rising from bed – those first few steps to the bathroom in the morning.  Typically the pain decreases as the foot warms up from walking around, but often there is a low-level of pain throughout the day.  The pain tends to be most severe right at the heel bone where the fascia attaches to it, and then radiates toward the toes.

Plantar fascitis is self-limiting, meaning that it will generally go away on its own, usually in six to 18 months.

What treatment options are availble?

Physicians will generally prescribe NSAIDS (aspirin, acetomenophen, ibuprofen, etc) to alleviate the inflammation and decrease pain.  As well, they will direct the patient to stretch the calves, possibly do ice massage, and shoe inserts are sometimes also indicated.  All of these things are very useful in reducing the symptoms.

In more severe cases, night splints, casts, or even surgery are options for treatment.

However, I have found that self-care and detailed, thorough bodywork can do wonders in treating plantar fascitis.

Stretching

Two stretches are very important in reducing the pain of plantar fascitis.   The first is one you should do when you first wake up in the morning, and that is dorsiflex your ankles.  Dorsiflexion is the action performed by your shin muscles (tibialis anterior) – bring the dorsal (top) surface of your foot toward your knee.  This will stretch the achilles tendon and calf muscles (soleus and gastrocnemius muscles) and take some tension off of the plantar fascia, and it will help mitigate the pain of the first morning steps.  To do this stretch:

1. Inhale.
2. As you slowly exhale, dorsiflex your ankle by contracting the tibialis anterior.
3. Repeat several times, until you feel the calf muscles relaxing and stretching.

The other strech is another calf stretch, but this one done from a standing position:

1. Face a wall and place one foot approximately 6-8 inches from the wall, toes pointing toward the wall.
2. Place the other foot approximate two-three feet from the wall, toes pointing toward the wall.
3. Inhale.
4. As you slowly exhale, shift your weight from the back leg to the front leg.  Keep your heels planted on the ground.
5. Breathe normally, and hold this stretch for two to three minutes.  You will feel the calf muscles open up, and the tension on the calcaneal tendon relax.
6. Switch feet and repeat steps 1 – 5.
7. Repeat this stretch with the back knee bent for one round, and straightened for another round.  That way, you will target both the gastrocnemius (knee straightened) and the soleus (knee bent), and more thoroughly stretch the calves.

Ice Massage

Fill several 3 or 5 ounce paper cups with water and freeze them.  When frozen, remove a cup from the freezer and peel back an inch or so of the cup, exposing the ice.  Using the remaining cup as a handle, massage the heel and underside of the foot with the ice, in circular motions and with medium pressure, for 10 to 15 minutes.  You will have to continue to peel the paper cup back from the ice as it melts, and you’ll want a hand towel to blot the water as it melts, but this is a highly effective treatment for plantar fascitis.

You can combine ice massage and the second stretch I mentioned above:

1. Ice massage the plantar surface of the foot as directed.
2. Perform the second stretch listed above.
3. Repeat with other foot.

Another way of using ice is to soak the feet in a basin of water and ice cubes in the evening when you get home from work.  Soak the feet for 10 to 15 minutes in this icy bath and after ward, dry them off and do that stretch.

How can massage therapy help?

Highly targeted, therapeutic massage can help by relaxing and lengthening the muscles of the calves, the calcaneal tendon, as well as directly working on the plantar fascia and muscles of the underside of the foot.  This work can be very deep, but highly beneficial because through it, we can help to re-educate your legs and feet to retain their relaxed states.  Many clients see dramatic improvement in three to four weekly one-hour sessions, as the feet and legs receive detailed attention.  Pain can be reduced and eliminated with a combination of self-care and massage.

If you are experiencing the pain of plantar fascitis, massage and self-care can be a huge help!  Why not book a session with me today and get the ball rolling to a pain-free stride?

References:

1. Plantar Fascitis and Other Causes of Heel Pain: 1999 Barrett, O’Malley
2. Plantar Fascitis: Office Management: 2007 Patel, Holman
3. Treatment of Plantar Fascitis:  2001 Young, Rutherford, Niedfeldt

Wow. Just wow. Beside going back to school for more training in 2006, this is absolutely the best investment I’ve made in my business.

Being able to adjust the table height in the fly was utterly incredible; it let me put the client at the perfect height for whatever I was doing to him at that particular moment. I got to use my legs for more power and less for my positioning in relation to a stationary client. My body was much more comfortable as a result and I used less energy to accomplish the same work. So that’s a big win right there.

But it was the mid-split that really made the session outstanding. The front of the table opens up to forty degrees from flat. At around 9 or so degrees, the lower back is put in a mechanically neutral position, and decompresses the lumbar spine. So I started out there for the first part of the session, then increased the angle more and more. I strapped his legs to the table and went all the way open, which took him into a nearly fully inverted position. I could see his back pull apart, and did some deep work that way. Wow, it was incredible to open his back up like that.

All the while he was inverted, his arms were fully supported on the adjustable arm rests, and his head cradled in the sliding head rest, so his neck vertebrae never got compressed at all.

My mind is racing with the possibilities of how to use this incredible tool.

One of the rules of body mechanics for massage therapists is Line of Force. This rule stipulates that all of the transfer of movement from the body of the massage therapist to the client is done with the therapist’s body in a single line of force. This is done by aiming the hips in the direction of the movement, as well as shoulders, elbows, wrists, hands, and fingers. Stacking the joints, as it were.

The primary benefits of Line of Force are greater efficiency in transferring energy and decreased risk of injury. Every turn or bend in a joint wastes energy as the force has to change direction, thus our bodies have to exert more effort to maintain a non-stacked posture. In addition, stacked joints are more stable, as the torque applied to rotated or flexed joints increases the chance of injury. We work smarter, not harder, with good posture and line or force.

A corollary to the Line of Force is the Hierarchy of Power. It says that the tranmission of power via the Line of Force decreases the more joints we travel from the hara, or center. Stacked fingertips cannot transmit as much force as knuckle, palm, forearm, elbow. Or in the legs, the hierarchy is toes, plantar surface of foot, heel, knees. But the increase in power is bought a decrease in palpation ability. The fingertips are vastly more sensitive than the skin covering the olecranon process of the ulnaris bone (although with lots of use and practice, it does become much more sensitive).

Similarly, the broad, flat surface of the forearm is ideal for certain types of strokes, just as the fingertips are perfect for highly detailed work. Every tool has strokes for which it is best suited. It’s sometimes fun to play around and see how to achieve the desired therapeutic result by using different tools and strokes. Something else I like doing is trying to shape my hands to match the shape of the muscle, especially if all I am doing is very obliquely angled strokes. Strokes where my arms are almost completely parallel to the client’s body are excellent for this hand-shaping.

The forearms are great for things as simple as effleurage, and into deeper work, like myofascial release-type therapies. One thing I like to do is open up the erector spinae by pinning the thoracolumbar aponeurosis down with one forearm, and with the other engaging the muscle tissue of the erector spinae in a superior direction, and applying moderate pressure, stretching the muscle apart.

Applying these two important concepts to bodywork marshals a therapists’ energies, and keeps us safe. We are much less tired and sore at the end of the day, and our careers can be long and with fewer injuries.