Muscle Activation During Gait Video

Want to know what muscles are working during walking? Click on the following video to find out more.

Maybe it’s not Plantarfasciitis but Heel Fat Pad Syndrome

Do you have heel pain? And think it is Plantar Fasciitis?

Maybe not, it might be another type of heel pain called the Heel Fat Pad Syndrome.

What´s the difference between the Plantar Fasciitis and Heel Fat Pad Syndrome?

As shown in the illustration, both structures are in the same area of the heel whereas the plantar fascia (illustrated as plantar apponeurosis) is covered by the fat pad. The plantar fascia attaches at the toes and forms the medial (longitudinal) arch of the foot. It provides static support of the medial arch and dynamic shock absorption. The main functions of the fad pad is shock absorption of stress during heel strike (heel contact during walking).

While both the heel fat pad and plantar fascia can be a source for heel pain, the contributing factors, clinical signs and symptoms and management for them differ.

Plantar Fasciitis

Plantar fasciitis is an overuse condition of the plantar fascia.

Contributing factors: It is often seen in people with foot deformities e.g. flat feet (low arches) or pes cavus (high arches). This deformities can lead to an excessive strain at the fascia during walking and hence cause pain. Other risk factors which can lead to increased stress in the fascia are inappropriate or non-supportive footwear, reduced ankle mobility, obesity and work related weight bearing.

Clinical signs and symptoms: A typical clinical sign is swelling of the plantar fascia and can be confirmed by ultrasound investigations. People with plantar fasciitis classically have a gradual onset of symptoms and feel their pain more on the inner side of the heel. Further symptoms are acute tenderness of the inner side of the heel, a tight plantar fascia and pain during stretching of the fascia. Especially the first steps in the morning or after rest are painful. The pain seems to decrease after a few minutes, and returns as the day proceeds and time on the feet increases.

Management: Due to the tightness of the plantar fascia that leads to pain, treatments involve stretching and massaging to release the tight fascia and calf muscles. Other management include avoiding aggravating activities (e.g. wearing heels), cold therapy (R.I.C.E), anti-inflammatory drugs, taping to to relief pain and lastly it is crucial to strengthen calf muscles that have weakened during the pain process. Some patients who are still symptomatic after conservative treatment might need surgery.

Heel Fat Pad Syndrome

Heel fat pad syndrome is often caused by a decreased elasticity of the fat pad. A fall onto the heel from a height or chronically excessive heel strike with poor footwear can also lead to heel pain.

Contributing factors: Increased age and weight decreases the elasticity of the fat pad.

Clinical signs and symptoms: Compared to plantar fascitis, fat pad related heel pain is felt more at the outer side of the heel especially when the heel gets loaded (heel strike). MRI investigations will reveal changes in the fat pad showing signs of swelling.

Management: Treatments aimed at unloading the heel by avoiding aggravating activities. In an acute situation the R.I.C.E. rule (Rest Ice Compression Elevation) should be applied and anti inflammatory drugs are given. Further treatment includes taping, the use of a silicone gel heel pad and use of appropriate footwear.

References:

Brukner, P & Khan, K 2007, Clinical Sports Medicine, 3^rd edition, Tata McGraw Hill, Australia .
Cole, C, Seto, G & Gazewood, J 2005, 'Plantar Fasciitis: Evidence-Based Review of Diagnosis and Therapy`, American Family Physician, vol. 72, no. 11, pp. 2237-42.
Thomas, JL, Christensen,, JC, Kravitz,, SR, Mendicino, RW, Schuberth, JM, Vanore, JV, Weil, LS, Zlotoff, HJ, Bouche, R & Baker, J 2010, ´ The Diagnosis and Treatment of Heel Pain: A Clinical Practice Guideline–Revision 2010`,The Journal of Foot & Ankle Surgery, vol. 49, pp. 1-19.

Mathias Puhr

Education

Masters degree in Musculoskeletal and Sports Physiotherapy from the University of South Australia
Bachelor of Health (physiotherapy) from the Hogeschool van Amsterdam
German diploma for physiotherapy

Career Highlights

Associate Principal Physiotherapist at Core Concepts Group
Physiotherapist at German Private Practices since 1999, treating patients with musculoskeletal, orthopaedic & neurological conditions

Quick Facts

Mathias is a certified therapist for manual therapy, manual lymphdrainage (lymphedema therapy), Brügger-therapy and PNF. Within the last years he has developed a strong interest in acute and chronic pain management..

Exercise and Scoliosis

We often hear people say that if one has scoliosis, they can’t participate in exercises, is that true?

The answer is no. One can usually participate in any type of exercises with scoliosis. Note we are only talking about participation here, not being GOOD at it. Due to the posture and muscle changes in scoliosis, some movements will be harder to achieve, and some will be restricted due to poor flexibility or poor muscle control. For example, one can still play golf, but turning of the trunk may be slightly restricted and that makes a swing slightly harder to perform. Another example is when someone with scoliosis runs, his/ her running pattern may be different due to the posture change.

Caro Photography
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Exercise endurance sometimes can be affected by reduced lung capacities but this is rare in individuals with idiopathic scoliosis. The main reason for reduced exercise endurance is believed to be a result of lack of regular sports participation. For those who hesitate to participate in sports because they worry about their curves may be worsened by exercises, they can be well assured that it is unlikely that exercises would have any adverse effects on the curve. The reason is that in order for the spine’s growth to change, one needs to exercise continuously for up to 18 hours a day, which is almost impossible for any sports.

If exercises that did not hurt before are now giving you pain, please tune down on the intensity of exercises for a few days. If the pain does not go away, you may need to consult a Dr. or a physiotherapist. Most likely the cause of the pain is that the exercises you are doing has aggravated the muscle imbalance too much, which creates too much joint compression on one side, and too much joint traction on the other side.

Can swimming help reduce the curve of scoliosis?

Swimming is frequently recommended for patients with back problems because the spine is less loaded in the pool with the help of buoyancy. That makes it a natural question “is swimming also recommended for patients with scoliosis?”

The answer is people with scoliosis do benefit from swimming. Besides the fact that swimming is good for general strengthening of the back muscles, it is also good for breathing function. This makes swimming exceptionally suitable for scoliosis as lung capacity and exercise endurance are likely to be affected among the individuals with scoliosis.

Scoliosis involves uneven development of the spine and the back muscles, as swimming targets generally on the whole back, it would not be able to specifically help reduce back pain caused by muscle imbalance. It does not help reduce the curvature too.

Why high-heel wearers hurt walking flat foot?

If you know of women who wear high-heels most of the time, you will notice that they often stand and walk tip-toe even when barefooted. This is because the women complain that it hurts to walk flat footed. This feeling of pain has been often theorized to be the result of a shrunken calf muscle. So Marco Narici from Manchester Metropolitan University, UK and Robert Csapo, from the University of Vienna, Austria sought to test the theory.

Source: Flickr lanier67

But what Csapo and Narici found was not shrunken calf muscles that causes pain when stretched. Using MRI scans, they found the volume of calf muscle between women who wore high-heel shoes were about the same as those of women who wore flat shoes. But what they did find was shorter muscles fibers in women who wore high-heels. About 13% shorter on average. While this would imply poor function, does it make it harder for the high-heeled women to walk flat footed? It didn't appear so.

Turning to the achilles tendon, the tendon attachment the calf muscles to the heel. What Csapo and Narici found were thicker and stiffer tendon in women who wore high-heels. While the tendon was not stretched longer than the other group, the thicker-stiffer tendon helped compensate for the shorter calf muscle.

It is this thicker and stiffer tendon that causes the discomfort when walking flat-footed as it cannot stretch enough.

References

Csapo, R., Maganaris, C. N., Seynnes, O. R. and Narici, M. V. (2010). On muscle, tendon and high heels. J. Exp. Biol. 213, 2582-2588.[Abstract/Full Text]

Does sitting slouched and slanted cause scoliosis?

Question: My daughter sits with a slouch, and sometimes sits with her body slanted to one side, will that cause scoliosis?

No. Sitting with a slouch or in any other bad posture does not lead to scoliosis. When we discuss about scoliosis, we typically mean idiopathic scoliosis, a form of scoliosis caused by genetic factors which lead to uneven growth of the spine. Curvature of the spine from bad posture is known as postural scoliosis and is reversible.

Source: Cartoon Church
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Posture and scoliosis

Human skeletons are mainly supported by muscles and ligaments. The center of gravity of the skeleton varies when its alignment changes, which in turn affects how much the muscles have to work to maintain its stability. Therefore, “bad postures” refer to postures in which the body structures need to work harder in order to maintain a particular position, and “good postures” refer to postures in which the muscles work the least.

In an upright posture, the ideal posture is one that if looked from the side, the ear is right above the shoulder, and the shoulder right above the hip. Any posture that deviates from which would be requiring more effort from the muscles. So, sitting slouched or slanted to one side would require more muscle work on one side of the body, which may lead to overuse and tightness of those muscles.
In the case that one stays in a faulty posture for long and causes muscle imbalance, the spine may be slightly curved due to uneven muscle tension. This type of curve is called postural scoliosis, which is not the same with scoliosis that is caused by bone deformities. If taking a spine X-ray in lying, this type of scoliosis will disappear on the X-ray film.

So, bad posture may cause postural scoliosis, but it will not cause bone deformity. The good news is that postural scoliosis is completely reversible by exercises and posture re-training.

Ankle Overpronation and Injuries video

Have you wondered why overpronation (rolling inward) of your ankles can cause injuries? Click on the video to find out more.

How do I know if I have scoliosis?

What is scoliosis?

Scoliosis refers to a medical condition in which the spine curves sideways. On an X-ray film, the normal spine looks straight, but the scoliosis spine will look like a “C” or “S”.

Source: X-ray Famin
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Source: Bistol Chiropractic
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I suspect that I have scoliosis, how do I tell?

Besides looking at X-rays, one can look at his or her posture in order to look for possible signs of scoliosis.

Signs that may indicate scoliosis are:

Head not centered to the body Uneven shoulders (either one is in front of the other or one’s higher than the other)
Uneven shoulder blades: one is more prominent or higher
Uneven waist angle: the gap between arm to trunk is wider on one side
One hip is more prominent than the other or the hips are not leveled
The spine line is not straight

One can use the picture below for a quick self test of scoliosis:

Source: Whateverlife
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You can also perform a Forward Bend test (also called “Adam’s test”) to detect for possible scoliosis.

Standing with the feet together, then bend forward as far as you can with your palms together, fingers pointing at between your toes.
Look at the back, one side of the back (either upper or lower back region) will be higher than the other side

Source: Medlineplus
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Hard Core Muscles for Mummies (Part 2)

In the previous article on "Hard Core Muscles for Mummies (part 1)", we have touched on the importance of strong core muscles. Now let us look at some simple exercises (that do not require equipment) people can do at home to help strengthen their core muscles.

Exercises should be done daily for 3 -4 weeks to see results.

Seated leg lift
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Seated Leg Lift

Sit on a chair with your back flat (do not arch your back) and feet flat on the floor.
Resting your hands over the lower abdominal muscles, pull in your lower abdominal muscles and pelvic floor muscles while breathing normally. Do not hold your breath.
Keeping the contraction in your lower abdominals and pelvic floor, gently raise one knee so that the foot is about 5-10 cm off the floor. Hold the position for 5 seconds, making sure the pelvis and the spine remain level. Make sure you are still sitting firmly on your buttocks and not shifting your weight to one side, neither should you shift your upper body in any other directions. The upper body should be still with the pelvis level while doing the exercise.
Repeat 10 times with each leg. Gradually increase the hold to 10 seconds or more for future sessions.

Lower abdominal strengthening
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Lower abdominal Strengthening

Lying on a mat or firm surface, flatten the small of your lower back into the mat. This movement will tilt your pelvis back, putting it in a neutral position, thus protecting your back. You should not feel any gap between your lower back and the mat.
Next, bend your knees and raise your feet of the floor till the thighs are perpendicular to the mat and the lower legs are parallel to the mat.
Then, while keeping the lower back flat and breathing normally, pull in your lower abdominal muscles and slowly extend the legs until you feel your back is about to unflatten or arch. Hold your legs in that position, feel the lower abdominals drawing into your spine while keeping your lower back flat for 5 seconds, then bring your legs back to the starting position. Be sure all movements are slow and controlled, and that you are not holding your breath.
Repeat 10 times. Gradually increase the holding time to 10seconds and the repetitions to 20 times.

Prone hip extension
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Prone Hip Extension

Lie face down with your lower abdominals pulled in. you may put a pillow under your hip for comfort.
Place fingers between hip bone and the floor. Feel pressure on each side.
Keep the leg straight and slowly float the leg up 5-10 cm. Ensure the pressure on your fingers remains exactly the same, side to side when you move your leg. Hold position for 5 seconds.
Return leg to starting position and repeat with other leg.
Repeat 10 times for each leg. Gradually increase holding time to 10seconds.

For Swimmers : Common Injuries, Treatment and Prevention tips

Do you swim leisurely or competitively? If yes, continue to read on.

Recently, one of our physiotherapists, Chng Chye Tuan was interviewed by Style:Men on the common musculoskeletal injuries face by swimmers in the July's issue. Do read on to find out what he has to share.

swim-1
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What are the common problems competitive/regular swimmers face?

The most common swimming injury is the rotator cuff impingement / tendonitis.

Ball joint of the shoulder compress the tendon against the roof of the socket (acromion) in 2 phases of freestyle – the pullthrough and recovery phase.
Pull-through phase in the freestyle stroke involves the arm pulling against the resistance of the water. The outstretched arm with internal rotation of the shoulder stresses the tendon and pinched it against the acromion. The pinching can irritate the tendons and give a sudden catching kind of pain.
The recovery phase involves a body roll and raising the elbow up and out to allow the upper limb to recover out of water efficiently otherwise the shoulder will be working harder at an awkward position to pull the hand out of water.
Repeated pinching will give rise to inflammation and fraying of the soft tissues.

What are the usual causes?

The usual contributing factors are mainly due to over training, poor technique, poor core muscles and unilateral breathing.

Over training – when muscles are fatigued, the stabilising component from the rotator cuff muscles becomes compromised thus increasing the chances of the humeral head translating upwards and impinging the rotator cuff tendons. The ball component has to be centralised within the socket of the shoulder to optimise stability and muscle function.
Technique – the freestyle and backstroke requires the swimmer to roll their trunk such that the drag is minimise and the propulsion force can be maximised. Too much drag will increase the resistence, tiring out the shoulder muscles sooner.
Strong core muscles and truck control enable the swimmer to do a body roll along the longitudinal axis so that it is easier for the shoulder to pull the upper limb out of water.
Unilateral breathing can develop a muscle imbalance leading to improper muscle activation and overuse.

What kind of treatments do you recommend?

An assessment of the shoulder girdle, spine and core strength will be performed to be able to properly manage a swimmer’s shoulder.

A key treatment to approach the swimming shoulder is to rehabilitate the rotator cuff muscles to be able to centralise the humerus at different shoulder positions.

Exercises will be prescribed to specifically target these rotator cuff muscles, correcting any imbalances. These exercises include strengthening the weak muscles to improve dynamic support and also stretching exercises to the tight muscles pulling the joint out of position.

As most competitive swimmers will not be able to cease training completely, kinesiotaping complements the rehabilitation therapy by improving the rotator cuff’s ability to stabilise the shoulder joint via better joint awareness from the corrective

Are there preventive measures that swimmers can take to minimise such problems?

Regular stretching exercises, core stability training and work on the techniques. During the early stage of feeling the impingement (catching or pinching) pain, seek help from a sports physician or physiotherapist as soon as possible.