Twenty-nine gay men (20 HIV+, 9 HIV-) received daily massages for one month. A subset of 11 of the HIV+ subjects served as a within subject control group (one month with and without massages). Major immune findings for the effects of the month of massage included a significant increase in Natural Killer Cell number, Natural Killer Cell Cytotoxicity, soluble CD8, and the cytotoxic subset of CD8 cells. There were no changes in HIV disease progression markers (CD4, CD4/CD8 ratio, Beta-2 microglobulin, neopterin). Major neuroendocrine findings, measured via 24 hour urines included a significant decrease in cortisol, and nonsignificant trends toward decrease of catecholamines. There were also significant decreases in anxiety and increases in relaxation which were significantly correlated with increases in NK cell number.

In another study, HIV-positive adolescents reported feeling less anxious and depressed, and also had improved immune response:

Immune changes included increased Natural Killer cell number (CD56) and CD56+CD3-. In addition, the HIV disease progression markers CD4/CD8 ratio and CD4 number showed an increase for the massage therapy group only.

In other words, the study participants were less stressed and felt much less anxious and depressed, and had more Natural Killer Cells, which are a major component of the immune system.  Cortisol is a necessary body hormone, but excessive cortisol has a negative effect on the immune system, weakening it.  Lower cortisol levels help the immune system, while NK cells attack viruses, among other things, and as we enter cold and flu season, having a stronger immune system can lead to a healthier you!

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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

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.

In the study, 239 patients were evaluated – these patients either had not improved after diagnosis or treatment for a herniated or damaged disc. 7 of the patients were found to have torn disc related conditions, such as annular tears, and were successfully treated with spine surgery.

The 232 patients who remained underwent a new kind of magnetic resonance technology called magnetic resonance neurography to evaluate the sciatic nerve. 69 percent of the patients – 162 – were found to have piriformis syndrome (where the piriformis muscle traps or irritates the sciatic nerve), and the remaining 31 percent had a number of other nerve, muscle, or joint conditions in varying locations that were not seen by a standard MRI.

Only 62 patients needed surgery to correct the piriformis syndrome – such surgery included Open MRI guided imagery, where the MRI scanner guides a deep injection of a pain medication into the muscle or nerve. This treatment corresponds with what Janet Travell and David Simons recommend in their groundbreaking book, Myofascial Pain and Dysfunction – the Trigger Point Manual. In the book, they recommend a physician inject a local anesthetic into the location of a trigger point, causing its release.

The other patients in the study received manual therapies, such as physical therapy and exercise, and had successful outcomes as well.

A massage therapist who is trained in releasing trigger points can effect the kinds of changes brought on by the Open MRI guided imagery, as well, by using ischemic compression and other techniques. The beauty of science research is that for over 70 years, medical professionals thought that sciatica was caused by damaged or herniated discs. Now we know that the vast majority of cases are muscular in origin, and that other methods of treatment are as or more effective than surgery.

Cedars-Sinai Medical Center (2005, February 2). New Way To Diagnose Sciatica May Point To A Different Cause. ScienceDaily. Retrieved December 12, 2007, from http://www.sciencedaily.com­ /releases/2005/02/050201192443.htm

• Exercise: regular exercise, from a brisk walk around the neighborhood to more strenuous workouts at the gym, to everything in between can help keep one feeling alive and perky! The euphoric feelings that working out provides carry over into the rest of one’s life and can definitely help with feelings of depression and anxiety.
• Nutrition: The Harvard School of Public Health published its Food Pyramid as an alternative to the flawed USDA pyramid. At the bottom of the pyramid is Daily Exercise and Weight Control as the key to good nutrition, but right above that is a diet full of whole grains, plant oils, fruits and vegetables. Good nutrition helps the body function at its optimal state and staves off the winter blues.
• Care of the spirit: A practice of meditation or self-reflection can stimulate the body’s systems to lift mood and elevate one’s spirit.
• Massage: You knew I couldn’t leave this one out, right? Being touched in a caring and compassionate way soothes the body and calms the mind. It’s very good for both client and therapist. Studies by the Touch Research Institute show that massage can “enhance attentiveness, alleviate depressive symptoms, reduce pain, reduce stress hormones, and improve immune functions.”

Receiving regular massage can help keep you feeling at your peak!