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Handling Foot Fatigue and Plantar Fascitis

by Pain Doc | Apr 23, 2011 | Foot and Ankle Pain

As you age, the tendons and ligaments in your body get weaker/looser, which changes the dynamics of your joints. It’s probably related to the decrease in human growth hormone levels as we age.

Tendons attach muscles to bones, while ligaments attach the ends of bones forming a joint. The area that you will notice first when your ligaments weaken are your feet, as they bear all the body’s weight when standing.

I’ve noticed that my feet have flattened over the last ten years (I didn’t have big arches to start with). When your feet flatten, a couple of things can occur:

1. You will walk slower. The foot arch is like a mechanical spring device that is integral to bipedal locomotion: in mid-step, it loads up potential energy (using the plantar fascia– a broad ligament in the sole of the foot), and in toe-off helps push off the foot from the ground and initiates forward leg swing (think of a steam catapult on an aircraft carrier, assisting jets to take off and fly). When your feet flatten, you lose a lot of this ability and have to rely more on your leg muscles to walk.

2. You can develop calluses under your metatarsal joints (ball of the foot). The flattening effect places more pressure on these joints when you stand.

3. You can develop foot pain and fatigue.

4. You can develop ankle, knee, hip, and lower back pain.

#s 2, 3 and 4 are more likely if you are overweight.

If you have any of the above symptoms, and have flat feet, here are the things you can do to lessen the effects:

1. Take joint supplements that support healthy connective tissue.

2. Eat bone broth soup to give your body a ready supply of the building blocks of collagen, which is the main component of connective tissue.

3. Get foot reflexology treatment. I go to this local Chinese massage center that does Asian foot massage. It is one of those painful pleasures– after soaking your feet in a hot water tub for 15 minutes, the therapist kneads out all the sore spots under your feet, including the small muscles of the toes. My feet feel great afterwards.

4. Roll a golf ball under the sole of your feet: back and forth, and in circles. Do this while you’re sitting, and control the deepness of the massage by varying the amount of pressure you place on the golf ball. Great exercise to do while sitting at your desk; your co-workers won’t even know you’re doing it as they pass by.

5. Walk barefoot outside, as much as you can. This exercises the intrinsic muscles of the foot, and all the small joints. You do not get this benefit if your feet are constrained in a shoe.

6. Consider wearing a foot shoe, like the popular Vibram Five Fingers brand. This lets your toes move independently when walking, which exercises the foot muscles, and is the next best thing after going barefoot.

Simple Exercise to Combat Hand Pain and Fatigue

by Pain Doc | Apr 1, 2011 | Hand and Wrist Pain

If you use your hands in a repetitive fashion at work or at play and notice your hands and wrists are feeling achey and fatigued, it’s partly because the muscles in your hand are out of balance. Usage of the hands is predominantly a flexion action, where the flexor muscles of the arm contract to bend the fingers inward. This is true for gripping and typing.

So what happens is that the extensor muscles of the arm, which are the ones that straighten out the fingers and bend the wrist upwards, are “overwhelmed” by the action of their reciprocal muscles, the flexors (flexor digitorum, flexor carpi ulnaris and radialis). The action of the joints in a flexor-dominated repetitive activity puts excessive wear to the same, small area on the joint surfaces and can gradually lead to stiffness and pain in the hands. And, it de-conditions the extensor muscles over time; meaning, makes them weak and less responsive. That explains the fatigue factor.

The solution is to do exercises for the extensor muscles to counteract the amount of flexion you do. A simple yet effective exercise is to use a thick rubber band (like the ones that hold together broccoli in the grocery store) and place it around your fingertips and thumb. Open your hand (extend your fingers till they are straight at the knuckles), about one repetition per second. Do about 50 every hour, four hours per day; depending on how much you use your hands. What you’re trying to do is work the extensors as much as your flexors to ensure both groups are getting an equal amount of work out. This will keep the hands strong and resistant to weakness and pain from frequent use.

Depression Can Make Knee Pain Worse – Study

by Pain Doc | Mar 25, 2011 | Uncategorized

A recent study in The Journal of Bone and Joint Surgery showed that people who had mild to moderate knee osteoarthritis and were depressed rated their pain as severe, the level which others in the study who had x-ray documented advanced osteoarthritis reported.

I’ve always believed that there is a “mind-body” connection, and this is yet another study that supports this. The thoughts that you allow to enter your mind can have a definite effect on your physiology, whether it be blood pressure, heart rate, respiration rate, digestion, strength, immune response, or pain. Check out this cancer treatment center’s use of visual and music therapy to help with treatment.

Jon T. Giles, MD, an assistant professor of medicine at Columbia University and rheumatologist at New York Presbyterian Hospital in New York City, says this study adds further weight to the existing medical literature highlighting the effect of psychosocial issues on pain responses.

“Painful sensations are relayed through the brain in a very complex way, and can be modulated up or down,” he says. With stress, poor sleep, anxiety and depression, which are known to influence pain levels, “stimuli feel more painful than they would in someone without the adverse psychosocial factors. This probably explains in part why the largest effect of depression in the study was seen in those without much OA to see on X-rays.”

The study recommends that patients fitting this profile get psychiatric evaluation and treatment, including anti-depressant drugs, in order to help alleviate their pain.

The study does not outright say that only “clinical” depression can make pain worse. If you have pain, persistent negative thoughts are more likely to make it appear worse than it actually is. Remember, the perception of pain is a complex neurological pathway that is not entirely understood.

I can sympathize with those experiencing chronic pain– it can be a terrible cycle, where the pain itself can push the patient to negative thoughts and depression, embedding it further and further into the body’s central nervous system. Speaking as a human being, and not just a health care provider, I can offer the following suggestions to break the cycle. And I’m sure it’s not all new, but worth repeating here:

1. Don’t hang around negative people. Their negative energy will bring you down. Instead, hang around those with “positive buoyancy,” the ones who can lift you up emotionally. Most small children fit in this group.

2. Similar to #1, avoid negative stimuli in your environment– crime shows, news, reality TV, newspaper headliners, internet news, etc.

3. Find something to keep your mind occupied; something that requires active brain usage (not passive, like watching TV). Social activities that involve interacting and working with other people is a good choice; especially if it is for a good cause. Arts and crafts is another good choice.

4. Get a pet. There’s nothing like a dog who exhibits unconditional, total loyalty to you.

5. Eat only those foods that nourish the body. The nutrient dense foods that occur naturally; i.e. plants and animals are the best for a body experiencing pain: fruits, green leaf plants, sardines, lean meat, nuts. Definitely avoid cigarette smoke, alcohol, corn syrup, sugar, and food preservatives.

6. Get out in the sun. Take of your shirt, expose your trunk to the sun several times throughout the day.

7. Stay active, as much as your pain will allow. Tai chi and yoga are good if your body can’t handle the forces of running , jumping, and lifting weights. Walking briskly is good, too.

8. Get fresh air. Drive to your nearest nature preserve, far enough away from the city and suburbs and get some negative ions (the only good, negative thing if you’re in pain!) and clean oxygen in your lungs.

Knee Pain, Roosters and Osteoarthritis?

by Pain Doc | Mar 22, 2011 | Knee Pain

Osteoarthritis occurs when the cartilage lining the articulating (contacting) surfaces of a joint gets damaged or wears out, exposing nerve endings inside and leading to inflammation. Since a joint is a precision, biological mechanism the slightest change in any of its components will eventually lead to breakdown, much like car engine.

As the cartilage thins, bone on bone contact occurs. Since bone is living tissue, it will respond to this irritation by forming osteophytes, better known as bone spurs. The osteophytes compound the problem by disrupting proper joint movement and irritating surrounding ligaments. And to make matters worse, the joint fluid, called synovial fluid gradually loses its ability to cushion the joint. Synovial fluid to a joint is like motor oil to a car engine’s cylinder: it enables “near frictionless” movement. It forms a thin, lubricating buffer between the ends of the two bones that make up a joint; for example in the knee, the tibia (lower leg) and femur (upper leg).

The knee is perhaps the most common joint to experience osteoarthritis. It is a large, primary weight bearing joint that takes a lot of punishment in the course of a day. Basic activities like walking, running, going up stairs, stepping down from a curb, exercising, and sports really put the knees to task. Those who have advanced osteoarthritis in the knees realize how important they are to a normal life.

I ran across this treatment for knee osteoarthritis that involves a single injection that can last for six months. It is called Synvisc-One, and it’s made from the combs of roosters. Apparently, the substance found in rooster combs is similar in biochemical make up to that of synovial fluid. If you’ve ever pressed or bent a rooster’s comb, you can see why– it is soft, cushiony, and rebounds quickly to its original shape.

synvisc injection into the knee joint

The procedure is a relatively quick outpatient procedure. After filling out the necessary forms to ensure you have no contraindications, especially any known allergies to birds, the doctor injects the Synvisc into your knee joint using a large caliber needle. There, it occupies the capsular space just like motor oil occupies a car engine’s cylinder. The substance cushions the knee joint surfaces (distal femur-proximal tibia articulation) and lubricates the space to minimize abrasion of these surfaces.

Synvisc is indicated for the treatment of pain in osteoarthritis (OA) of the knee in patients who have failed to respond adequately to conservative non-pharmacologic therapy and simple analgesics, e.g., acetaminophen. It can be an option for total knee replacement for some people.

The drawback is that you have to keep getting them. But for those who have severe osteoarthritis in both knees and can’t afford or do not desire knee replacement surgery, six months of less pain is a pretty big deal. As with all forms of treatment options, a lot of it is personal choice. Not everyone’s situation is the same.

Check out our Self Treatment for Knee Pain video for non-drug, non-surgical therapies to manage osteoarthritis of the knee.

Whole Body Vibration for Back Pain

by Pain Doc | Mar 21, 2011 | Low Back Pain

Whole body vibration, or WBV is popular in the fitness, health, and beauty industries. It involves standing stationary or doing exercises on a motorized platform that vibrates at different frequencies and amplitudes (basically, different speeds and intensities).

Research on the benefits of whole body vibration are mixed, but a significant number of studies point to definite benefits including increased muscle strength, increased blood circulation to the leg muscles and skin, increased bone density, reduced muscle atrophy following bed rest and in space, improved postural control in older individuals, and reduced chronic lower back pain. However, at least one study warns of potential adverse health effects of “excessive” whole body vibration training.

The WBV machine consists of a platform, handle grips and control panel. You do exercises like squats with both feet on the platform, or alternating lunges with the front foot placed on the platform while it vibrates at a set frequency. Depending on the model, a WBV machine can vibrate in the z-axis (or straight up and down direction– most intense), x and y axis (front to back, side to side), or teeter-totter (like a seesaw action). Amplitude (height differential of the platform in one vibrational cycle) and frequency (number of cycles per second).

Two popular models are the durable, commercial-grade PowerFit VB588 Whole Body Vibration Machine and the less expensive but lower quality home use model, PowerFit PFM002. If money is not an option, you can get the Power Plate – Pro5 – Model 565273 which is the brand that is found in exclusive fitness centers throughout the world.

There are generally three classifications of whole body vibration machines: High Energy Lineal, found mostly in commercial vibration training studios and gyms. The vibration direction is lineal/upward eliciting a strong stretch-reflex contraction in muscle fibres targeted by the positions of training program. 2. Premium Speed Pivotal, (teeter-totter movement) used for physiotherapy work at lower speeds and exercise workouts at “premium” speed, up to 27 Hz. Both commercial and home units are available. 3. Medium Energy Lineal, the majority of lineal platforms produced. These are usually made of plastic; some have 3-D vibration which is low quality. They give slower and less consistent results. 4. Low Speed Pivotal units. These can give “therapy” benefits. Other machine types are low Energy/Low amplitude lineal and Low energy/High amplitude lineal with varying uses from osteoporosis prevention, therapy for improved blood circulation and flexibility and limited fitness training. I am not certain if this classification system is used by the various manufacturers of WBV machines.

So, should you try whole body vibration if you have chronic back pain? My advice is to check with your doctor first. If you are cleared by your doctor, start conservatively– low amplitude, and only for a minute or two; standing only. Take note of how you feel. Most of the studies done thus far on these machines involved fairly extensive time periods, like 6-12 weeks of daily usage, so if you plan to use WBV to reduce back pain your body needs to be able to take it. If you are able to work up to 5-10 minutes on the machine without feeling nauseous, more pain, dizzy or any other adverse symptom, do it for a week and re-evaluate. If all is OK, try exercises like simple squats on the platform. If you feel improvement in your lower back pain, then congratulations, your particular situation responds to whole body vibration. However, there are no studies that I am aware of that track the long-term effects of WBV therapy on chronic lower back pain. So, a good rule of thumb is to do it daily for at least two weeks, symptoms permitting; and then do it less periodically for maintenance. Obviously, at the first onset of any adverse reaction from using WBV, stop immediately and report it to your doctor.

Some of the possible ways whole body vibration resistance exercises can help reduce back pain is by increasing blood flow to the muscles, exercising the muscles, and bombarding sensory input to the back muscles thereby breaking any “learned” abnormal neurological patterns to the muscles.

Even if you don’t have back pain, whole body vibration offers other proven health benefits like improved blood circulation, decreased muscle weakness from body inactivity, and improved postural balance. It would therefore make a nice addition to your home exercise equipment.