Plantar Fasciitis: All About Physical Therapy

Plantar fasciitis is an overuse injury involving the plantar fascia, a strong, thick band of tissue that runs from the heel(calcaneum) up to the toes. An overstretched or overused injury of the plantar fascia will lead to pain and inflammation at the bottom of the foot which makes walking more difficult. This band of tissue provides arch support as well as a shock-absorber of your foot. Plantar fasciitis affect both men and women, but more to active men aged 40 to 70. The involvement can either be one foot or both.

Possible Causes and Risk Factors:

This foot condition develops as the result of repeated small tears in the plantar fascia resulting to inflammation and degeneration of the connective tissues in the fascia. Plantar fasciitis is more likely to develop if you have:

• Flat feet and high arches of the foot.
• Certain occupations that requires prolonged standing.
• Obesity or a sudden weight gain.
• Engaged in long distance running and other intense activities or exercise.
• Tight TA will raise the arches of the foot.
• Incorrect shoe fitting that doesn't support the arch of the foot because this puts more stress on heel.
• A sedentary lifestyle and you do lots running, walking, and jumping.
• Certain type of arthritis, particularly among the elderly people.

Symptoms:

Anyone with plantar fasciitis will likely experience:

• Pain and tenderness at the bottom of the heel with the first step in the morning or even after standing/sitting for a while.
• Limited ankle dorsiflexion secondary to tight TA.
• Mild swelling or redness of the foot.
• Limping or may attempt toe walking to decrease pain which might also develop foot, knee, hip or back problems later on.
• Painful with barefoot walking on hard surface or even stair climbing.
• Pain after an intense activity such as running, jumping, and other related activities that repeatedly put stress or pressure on the tissues.

Diagnosis:

• Physical examination should include patient interview.
• An x-ray may be taken to rule out other problems.
• An ultrasound scan usually shows thickening and swelling of the fascia.

Treatment:

Start your treatment as early as possible before it gets worse. Go and see your doctor. Here are some recommended treatment approach if you have plantar fasciitis.

• Take time to rest your feet , at least for a week. Limiting or even stopping an exercise or activity allows better healing of the tissues
• Apply ice for 15 minutes, at least twice a day, to relieve pain and inflammation.
• Avoid any form of the heating your foot during the first 2 to 3 days.
• Flexibility and strengthening exercises to ankle and calf muscles.

1. Standing with both hands touching the wall at shoulder level. Feet slightly apart, with one foot in front of the other foot.Begin by bending your front knee while keeping your back knee in a straight position and then move forward by leaning on the wall. Hold it for a few seconds and then release. This exercise will stretch your calf muscles. Do this again by switching the position of the two feet to stretch the other calf muscles.
2. Long sitting on the floor. Loop a towel around the ball of your one foot. Pull the toes towards you while keeping your knee straight. Hold this for a few seconds. Do this exercise with the other foot.
3. While sitting on a chair, place a water bottle, a tennis ball, or a drink can under the arch of your foot. Slowly roll the bottle from the ball of the foot to the heel. The massage effect helps reduce pain in the bottom of your foot.

• Athletic shoes or shoe with a well-cushioned sole are usually good choices.
• Heel cups or shoes inserts give added cushion and comfort to your foot.
• Resting night splint may be used to stretch the TA while sleeping.
• Try to reduce weight. Enrolling in a weight-reduction program helps a lot.
• Acetaminophen and Ibuprofen will help reduce pain and inflammation.
• Extracorporeal shock-wave therapy. Better discuss this procedure with you doctor.
• Foot surgery may be needed if all nonsurgical treatment didn't work out.

Preventive Measures:

• Do stretching prior to any activities or exercises.
• Avoid doing exercises on hard surfaces.
• Try to lose some weight if you are obese.
• Change your type of sport. Go into low-impact sports like swimming instead of running or jogging.
• Always check your shoe physical condition. Don't wear worn out shoes.

Morton's Neuroma

Morton's neuroma, also known as Morton's metatarsalgia or interdigital neuroma, is a painful foot condition affecting the nerve passing under the ligament that connect the metatarsals. This foot condition often affects the third and fourth toes, may sometimes develop in the second and third toes. Also, it either affects one foot or both feet. A constant irritation or an excessive pressure on those areas of the foot or both feet develops a thickening of the tissues that surround the nerves leading to the toes. As a result, one may experience a sharp, burning pain at the ball of the foot. The sensation is feeling like as if you are walking on a pebble, a common description of this foot condition. Although it can occur at any age, the condition is more notable in runners and in middle-aged women who loves to wear high-heeled shoes. Besides, the incidence is higher in women than in men.

Causes

Although the exact cause remained unclear, many experts believed that Morton's neuroma is usually associated with irritation or pressure of the nerves between the toes. Aside from wearing high-heeled shoes and participating in high-impact sports like running, anyone with foot deformities such hammertoes and flat feet will also have this foot condition.






Symptoms

A sharp, burning pain felt at the ball of the foot often worsen with activity and wearing tight shoes.
Unpleasant tingling sensation at the toe.
Pain increases over time.

Diagnosis

Examination may show a palpable mass at the toes, which is tender when pressed.
X-ray may help to rule out bone fracture.
A test on the range of motion to find any arthritic or an inflammatory condition of the joints.
Ultrasound and Magnetic Resonance Imaging are both good in visualizing the soft tissues, though quite expensive.

Treatment

The treatment is towards the symptoms. A conservative treatment is the first approach before going into an invasive intervention.

Wearing a orthotic device, those with foot deformities, will help relieve pressure on the toes.
Shoe change will help reduce pressure on the nerves, particularly the athletes.
Avoid high-heeled and tight shoes as well.
Foot massage provides pain relief.
Placing an ice pack at the sole provides pain relief.
Weight reduction  for obese persons to reduce strain on the feet.
Over the counter pain relievers and injections of steroids may help ease the pain and inflammation.
Surgical removal of the thickened tissues deemed necessary if all conservative treatments haven't worked. Although the surgery is successful in most cases, one may still experience the permanent sensation of numbness but not painful.

R.I.C.E Therapy

For the benefits of those who still have no idea on to how handle recent soft-tissue injuries, let me share with you the advantage of RICE therapy and how it promote faster recovery. Anyone, particularly the athletes and other physically active people, can have muscle strain, ligament sprain, bruise, and other soft-tissue injuries. RICE therapy is recommended on acute cases, usually the first 24 to 48 hours after injury. It doesn't mean RICE therapy is already enough, especially serious injuries. Better see your doctor for proper evaluation and management, like drug prescription and physical therapy. RICE, which stands for rest, ice, compression, and elevation, help reduce pain and swelling.

Rest

Right after the injury, take some time off from your activities. Stopping or limiting an activity promote faster soft-tissue healing. Remember, continued stress on the injured part will lead to further damage. If the injury is on the leg or ankle, crutches will help you move around without putting pressure on the injured part.

Ice

This treatment approach help control pain and inflammation. Icing works on reducing the size of the blood vessels, thereby decreasing the bleeding, the swelling, and easing pain. Never apply ice directly over the skin on the injured part, instead, wrap it around with a towel or any clothes. Commercially, there are cold packs available in medical shops. Apply icing for 15 to 20 minutes and repeat the procedure as long as you want. Icing works best during the first 24 to 48 hours after injury.

Compression

Compression,using a bandage, help reduce swelling as well as support to the injured part. Just remember not to wrap too tight to avoid cutting off blood supply to the injured area as well as more swelling below the affected area.

Elevation

While applying the ice, like sitting or lying, elevate the injured part above the heart level to help reduce swelling.

Transcutaneous Electrical Nerve Stimulator (TENS)

Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacologic and noninvasive treatment for pain from a variety of painful conditions. A small, portable, battery-powered device that has leads connected to electrodes. Electrodes (sticky patches) are placed on your skin using self-adhesive pads. 
The TENS unit sends painless electrical impulses through the electrodes to the nerves under your skin, which you feel as a tingling sensation. The electrical impulses can block or reduce the pain signals going to the spinal cord and brain, which can help reduce or relieve pain or muscle spasm. TENS devices also help stimulate your body to produce higher levels of its own natural painkillers, called "Endorphins".

For most people, TENS is a safe treatment with little or no associated side effects. It is available for home use. You should always follow the manufacturer's specific instructions to be safe. Have your physical therapist or doctor to show you the proper way to use the machine, and follow the instructions carefully.

Types of TENS:

1. Conventional(High frequency stimulation) - This high rate and most common mode of TENS can be applied during the acute or chronic phase pain. Onset of pain relief is relatively fast but lasts only for a shorter period of time. Tolerable to most patient. Duration of treatment is 20-60 minutes.

2. Acupuncture-like(Low-frequency stimulation) - A strong low rate TENS can be applied during the chronic phase of pain. Duration of treatment is 30-40 minutes and duration of pain relief is long-lasting(an hour or more). More uncomfortable and less tolerable type.

3. Burst Intense(Pulse burst) - A combined characteristic of both high and low rate TENS but more tolerable than low rate TENS. Onset of pain relief is similar to low rate TENS. Duration of treatment is 20-30 minutes. Duration of pain relief is long-lasting(hours).

4. Brief Intense(High-intensity) - This mode provide rapid onset, short-term pain relief during painful procedures(wound debridement, deep friction massage, joint mobilization or passive stretching). Duration of treatment is usually 15 minutes.         

Electrode Placement:

• Over the painful area
• Over the nerve supplying the painful area
• Acupuncture sites
• Proximal or distal to pain site, or even on the opposite side of the body
• Segmentally related myotomes
• Trigger points

Indications:

• Postoperative pain
• Chronic pain
• Arthritis
• Sports injuries -  bone fractures
• Period pain
• Acute pain relief during labor and delivery
• Phantom pain

Contraindications:

• Cardiac pacemaker or another type of implanted electrical device fitted
• Epilepsy or a heart rhythm disorder(consult your doctor)
• During first trimester of pregnancy
• Allergic reaction to the electrodes (it's possible to get hypoallergenic electrodes)
• Broken skin, varicose veins, recent scarring in the area, or over areas of reduced sensation
• While driving or operating machinery
• Near water, such as in the bath or shower
• Over lower abdominal/uterus during pregnancy
• Over the anterior transcervical area - the front or side of your neck
• Cause of pain is not known or is not diagnosed.
• In the mouth, close to the eyes, or temple area

Procedure:

• Check the area to be treated for contraindications and precautions.
• Check the unit - batteries, knobs, electrodes.
• Turn the control knobs to the off position before you start.
• Use rubbing alcohol to clean the skin where the electrodes will be placed. Let your skin dry.
• Position the self-adhesive pads either side of the painful area, at least 2-3 cm apart.
• Switch on the machine slowly and turn it up gradually until you feel a tingling sensation.
• TENS machines are designed so that you can move around with them working.
• At the end of the session turn the machine off and disconnect the electrodes from the machine.
• Check the area being treated for irritations; clean the area with soap and water.
• Clean the rubber electrodes with soap and water to remove the gel; Do not wash the self-adhesive type of pad.
• Remove the battery from the TENS and replace it with a charged battery. Charge the battery so that it will be ready for another treatment.
• You can use TENS throughout the day for as long as you like provided you do the same process as mentioned above

Bronchitis - Acute and Chronic

Bronchitis is a respiratory disease characterized by an inflammation of the lining of your bronchial tubes. These tubes are large and delicate  that carry air in the tiny branches and smaller cells of the lungs after this air has passed through the mouth, nasal passages, and trachea and then back out from the lungs. Breathing is more difficult  when the bronchi become swollen due to irritants or infections. Bronchitis sufferers also tend to have much more mucus and phlegm. People with asthma may also have asthmatic bronchitis, inflammation of the lining of the bronchial tubes.

The two main types of bronchitis are Acute (lasting from one to three weeks) and Chronic (lasting at least 3 months of the year for two years in a row).
    
                                                                           




ACUTE BRONCHITIS

Acute bronchitis is a type of bronchitis that is short-lived, usually lasts about two weeks. However, coughing may still be experienced for a few weeks even if the infection is gone. Most people recover with no permanent damage to the bronchial tree. Lung irritants or infections may cause acute bronchitis. Infections can be viral or bacterial in origin, but viral origin account in most cases. Influenza, Respiratory Syncytial Virus (RSV), and Rhinoviruses are among the viruses that causes acute bronchitis, while Mycoplasma and Pneumococcus bacterial agents also causes to develop acute bronchitis.

Cause

• Acute bronchitis is generally caused by infections or lung irritants. In most cases, it is viral in origin while others are from bacterial infection. A short-term, high-level exposure to chemical irritants or substances like inhaling or exposing to cigarette smoke (including secondhand smoke), dust, inhaling solvents, or industrial air pollution may lead to acute bronchitis.

CHRONIC BRONCHITIS

Chronic bronchitis is an ongoing, serious long-term condition characterized by an inflammation of the lining of the bronchial tube secondary to constant irritation. This condition often requires regular medical attention. A productive cough  that produces a slimy mucus is usually present for 3 months during two consecutive years. Chronic bronchitis is one of the conditions included in chronic obstructive pulmonary disease (COPD) that the majority of people diagnosed with the disease is 45 years of age or older. Patients with chronic bronchitis are often called "blue bloaters".

Cause

• The most common cause of chronic bronchitis is heavy, long-term cigarette smoking.

SIGN and SYMPTOMS of Acute Bronchitis or Chronic Bronchitis

• Persistent cough which may last up to 20 days. A cough may produce a clear, slimy mucus (sputum). A green or yellowish mucus may indicate bacterial infection. In most cases, the infection is viral in origin. Coughing lingers for several weeks after the inflammation of bronchial tube resolves
• Wheezing is a high-pitched whistling sound made while you breath. The sound is most obvious when you breath out (exhale)
• Slight fever may include sore throat, stuffy or runny nose, vomiting, and headaches
• Chills and malaise
• Chest discomfort
• Shortness of breath (Dyspnea) especially with physical exertion.

RISK FACTORS

• Acute bronchitis are at higher risk for older adults, infants, and young children may be because of low resistance
• Cigarette smoking, second-hand cigarette smoke, and having an existing lung disease greatly increases the risk for bronchitis.
• Repeated exposure or contact with dust, chemical fumes, and vapors from certain  occupations
• Air pollution, infections, and allergies can worsen the symptoms of chronic bronchitis
• History and repeated bouts of acute bronchitis
• Women are more than twice as likely as men to be diagnosed with chronic bronchitis.
• It occurs more often in people who are older than 45 although anyone can have the disease. Also, many adults who develop chronic bronchitis are smokers.

DIAGNOSIS

Medical History

• Presence of symptom - How long been coughing, presence of mucus, breathing problems, chest discomfort, sleeping or work problem, wheezing sound, and fever
• Smoking - Daily consumption  and period of time been smoking
• Ask for another medical condition
• Type of job that constantly irritate the lungs
• Drugs and supplements currently using
• Records of vaccination against pneumonia or annual flu shot

Physical Examination

• A stethoscope is used to hear wheezes, and a prolonged exhalation which are signs of airflow obstruction

Test

• Pulmonary function test - A spirometer is used to measure the amount of air inspired and expired by the lungs
• Blood test (CBC)
• Chest X-ray help rule out other lung problems (pneumonia and bronchial obstructions).
• CT scans of the chest
• Measurement of arterial blood gas
• Sputum Culture

MANAGEMENT

Early diagnosis and treatment, combined with avoidable risk factors such as quit smoking and avoiding secondhand smoke, provide a favorable prognosis. The main goals of treatment are to relieve symptoms and make breathing easier.

Get enough rest, drink plenty of fluids, and aspirin or acetaminophen for fever if you have acute bronchitis. The antibiotic may not work if you have a viral infection. 

Bronchodilator

• This medicine relaxes the smooth muscles that encircle the bronchi, which allows the inner airways to expand making it easier to breathe. It is usually inhaled using an inhaler, but is also available in pill form.

Theophylline

• This medicine relaxes and open the airways to help you breathe better
• Indicated for shortness of breath, wheezing and chest discomfort for patients with chronic bronchitis and for other COPD. They are available in tablet, capsule, solution or in syrup.

Steroids Medication

• Works to reduce the inflammation which in turn decreases the bronchial swelling and secretions, making improve air flow. You can take steroids either with an inhaler or in pill form.

Antibiotics

• As a whole, antibiotics cannot help chronic bronchitis while others prescribed antibiotics during acute exacerbation of chronic bronchitis. May be prescribed if it is from a bacterial infection, but not from a viral origin.

Supplemental Oxygen Therapy

• This will help to get more oxygen supply needed to breathe better. Usually prescribed for severe chronic bronchitis and if the medicine doesn't show improvements. A small finger oximeter for monitoring blood oxygen levels at rest and with activity is helpful.

Exercise

• A regular strengthening exercise help improve strength and general body endurance. Begin with light exercise and slowly progress over time. An exercise frequency of at least 3 times a week is usually recommended. Start with slow walking  and progress the duration and speed later. Consult your doctor or a physical therapist for the appropriate exercise program.

Breathing Techniques

1. Pursed-lip breathing

• This technique will also help to feel better from shortness of breathing. This is done by taking a deep breath (inhale) and then breath out slowly (exhale) through the mouth with pucker lips. Stay relaxed and exhale normally. No holding of breath.

2. Diaphragmatic breathing

• This technique uses the primary muscle of respiration, the diaphragm. To do this, lie down on your back with both knees flexed and supported. Place the hands on the abdomen and notice the marked expansion of the abdomen rather than the chest when breathing.

Over-the-counter (OTC) cough suppressants

• Drugs like Dextromethorphan  and Guaifenesin may be helpful in reducing cough symptoms.

Alternative Remedies

• It is advisable to consult a health care professional before using any of these products.

Medical Complications

• Dyspnea is a medical term to describe shortness of breath
• Respiratory failure will happen if there is not enough oxygen that passes from the lungs into the blood
• Pneumonia is an infection that causes inflammation of the air sacs in one or both lungs.
• Cor pulmonale is an abnormal enlargement and weakness of right heart ventricle due to lung disease
• Pneumothorax is an abnormal collection of air or gas in the pleural cavity of the lung causing lung collapse
• Polycythemia is an abnormally increased concentration of red blood cells needed to carry oxygen),
• COPD (Chronic Obstructive Pulmonary Disease) is a lung disease characterized by chronic obstruction of lung airflow that affect normal breathing and is not fully reversible. These diseases include the emphysema and the chronic bronchitis. Tobacco smoking is the most common cause of COPD.
• High mortality rate 

Preventive Measures:

• Do not smoke and avoid second-hand smoke
• Vaccination - Flu shot every year and pneumococcal vaccination every 5 or 6 years
• Wear an appropriate mask to high-risk areas to limit exposure to chemical fumes, dust, second-hand smoke, and pollution
• Wash your hands to limit viral and bacterial infections
• Maintain a physically active lifestyle and eat a balance diet

Charley Horse - Muscle Cramps

Charley Horse, otherwise known as muscle spasm or cramp, is a painful involuntary muscle contraction that doesn't relax for several seconds or more. In other words, the muscles become hard, stiff, and sore.I think almost everyone experiences muscle spasm, at any age, and occurring any time of the day. It can occur in any muscles, but they are most common in the calf and foot. Muscle spasm also occurs in the thigh, the hands, arms, abdomen, and on muscles in the rib cage area. Normally, spasm usually not prolonged or recurring, but if it continues to persist, better see your doctor to determine the cause and implement appropriate treatment.

Causes and Risk Factors:

Muscle injuries as a result of bruise or contusion
Muscle fatigue
Performing an exercise in excessive heat or cold
A strenuous exercise or overuse of a specific muscle during exercise particularly the calf muscles among athletes.
Stress plays a part and is most often in the neck muscles.
Not having or insufficient stretching prior to actual exercise or activities.
Inadequate blood flow to the leg muscles
Pinched nerve from compression injury of the spine
Side effects to an individual on diuretics may lead to low potassium levels
Deficiency with potassium, calcium, and sodium in blood
Deficiency with calcium to a pregnant woman, a common complaint.
Obesity
Smokers
Older adults and infants

Remedies and Prevention:

Keep yourself hydrated throughout the day.Water alone is not sufficient. Sports drink will help replenish lost minerals.
Heating pads will promote muscle relaxation
Ice pack to follow later on to manage pain
Nonsteroidal Anti-iflammatory Drugs (NSAIDS), like ibuprofen, given if the pain continues to persist
Antispasmodic drugs may be given in severe cases
Nerve irritation may require surgery and physical therapy
Massaging or stretching the foot, ankle or knee in the opposite direction of the spasm may relieve pain.
Eat a well-balanced diet, rich in potassium and calcium
Stretching before and after exercise
Stretching before bedtime will also help
Do not overdo an exercise to the point of fatigue