GGH Route Map on Google

WHEN: 31 January 2010, from 11am to 3pm
WHERE: Kirkham Street and 15th Avenue, at the base of the stairway.

Yes, 2010 is seeing a continuation of our fun and successful Stairway Walk Tours – this time we’ll be going to the neighborhood of Golden Gate Heights, full of curving streets, and interesting vistas of the Pacific Ocean, Golden Gate, and San Francisco itself.  Also, the delightful Grand View Steps, a once-boring set of concrete steps that neighborhood artists and activists transformed with a truly stunning tile mosaic on the risers.  Photographs cannot adequately describe the beauty of the mosaic – you simply must see it yourself!

An event invitation exists over on Facebook, but if you do not have a Facebook account, you can RSVP by commenting to this blog entry.

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

Ankylosing Spondylitis (AS) is an inflammatory condition of the spine and other parts of the body, related to various arthritis conditions. It affects men 3:1 over women, and generally starts within second or third decade of life. Its initial symptoms typically include pain and inflammation in the hips and low back caused from inflammation of the sacroiliac joint. Over time, this inflammation can lead to fusion of the SI joints, as well as fusion of vertebrae, resulting in the inability to bend the spine and pain and loss of range of motion, sometimes known as “bamboo spine.” Also, AS can affect other organs of the body, including the liver and kidneys and eyes (iritis). In women, AS can start in non-vertebral joints, or the cervical spine instead of the sacral or lumbar spine. The inflammation often leads to a flattening out of the lumbar spine, which has the tendency to make the curvature in the upper spine become more pronounced, causing the person with AS to look hunched over, or looking down all the time. Extending the spine becomes increasingly difficult. This increased curvature of the thoracic and cervical spine collapses the chest cavity, decreasing lung capacity and making breathing more difficult and shallow.

Medical treatment for AS typically involves the administering of NSAIDS (asprin, ibruprofen, etc), physiotherapy, and prescribed exercise (typically swimming and breathing exercises). Firm mattresses and thin pillows, encouraging patients to sleep on their back to increase spinal extension are also recommended.

A client in his mid-30s diagnosed from childhood with Ankylosing Spondylitis came to me recently seeking relief from his back pain and to try to regain some flexibility. He has lost appoximately 40% of the range of motion in his spine. He works and has a relatively normal life, but doesn’t enjoy swimming, so has little physical activity outside of normal life activities.

My goal for him is going to be to work on lengthening the hip flexors (iliopsoas), and spinal flexor muscles (rectus abdmoninus, sternocleidomastoids, etc), as well as work on relaxing spinal extensor muscles. AS sets up a serious tug of war between the spine and the muscles that move it, and the increased flexing of the spine causes chronic shortening of the flexor muscles, which cause the extensors to have to compensate by increasing contraction to maintain as upright posture as they can.

So, our first session was performed in sidelying and supine positions, and focused on relaxing the erector spinae muscle group, some work in the sacral ligaments, then work in opening up the chest with work in the pectoralis major and minor to assist in increasing chest capacity.

At the end of the session, client was observed to have slighly improved range of motion in spinal extension. Client also reported that he felt some of his kidney stones start to move during the session, and later that evening he passed three stones. Kidney stones are not uncommon with people who have AS.

Recommended to the client a start of regular bodywork sessions to improve range of motion and pain relief.

Current Mood:  amused

Winter is nearly here, and with all the shortening of the days comes the winter blahs. Fortunately, there are easy ways to fight off the blues.

• 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!