Common Cause of Heel Pain Shown to Improve More with Manual Physical Therapy than Traditional Therapy

Ever have a stabbing feeling in your heel with your first step out of bed the morning after a long hike down the Colorado Trail? The stabbing pain is the call sign of a condition commonly called plantar fasciitis.

The plantar fascia is a strong fan-like band of stiff connective tissue that stretches from the base of the heel towards the toes. This band supports the bottom of the foot and is essential for transitioning the foot from a “shock absorbing state” (pronation), when the foot initially touches the ground, to a “force producing state” (supination) for final push off when walking or running. Intrinsic muscles within the foot also assist in providing muscular support. When these structures become over worked or stressed they cause a sharp pain usually felt in middle of the heel. Occasionally there may also be a component of heel pain stemming from a low back problem.

This condition has been referred to as an “itis,” meaning inflammation, but recent research has reported little evidence of true inflammation. Physical changes in the tissues of the plantar fascia are found instead.

Patients are often treated with orthotic devices, corticosteroid injections, night splints, stretching, and a referral to physical therapy.

Traditional physical therapy interventions have included stretching the Achilles tendon and plantar fascia, ultrasound, iontophoresis, and orthotic devices. However, these interventions are often only effective for short term.

A recent study by Cleland et al. in the Journal of Orthopaedic and Sports Physical Therapy showed manual, or ‘hands-on’, physical therapy, in which specific techniques were applied to mobilize the joints of the foot, ankle, knee and hip, as well as to the soft tissue of the plantar fascia to be more effective than a traditional physical therapy approach for the treatment of plantar fasciitis. Not only was manual physical therapy shown to have excellent short-term effects, but the benefits lasted at least 5 months after the final treatment was completed.

When you first feel the symptom of Plantar Fasciitis, you should begin self-treatment. A simple and effective technique to do at home is to massage along the bottom of the foot. Push deep and firmly into the soft tissues of the foot, gliding back towards the heel, feeling for any lumps or bumps along the way. These bumps may be painful, but working them out will be worth a few minutes of discomfort. Rolling your foot on a tennis ball or a frozen water bottle are also other ways to do this. Then begin stretching your calf and your hamstring.

So, next time you find yourself limping your way to work Monday morning after a long weekend out on the trails, be sure to give these techniques a try. If symptoms are not resolving, make your way to the nearest manual physical therapist for faster and more permanent results.

Chi Running

Chi running is a technique for running involving landing on the mid-foot with an erect posture, a forward lean from the ankles and a more rapid stride cadence. Running like this was recently compared to heel striking in the Journal of Orthopedic & Sports Physical Therapy “A Comparison of Negative Joint Work and Vertical Ground Reaction Force Loading Rates in Chi Runners and Rearfoot-Striking Runners.” The research found that Chi Running reduces vertical loading rates and quadriceps work, but increases calf muscle work slightly. These findings may allow some runners to run more painlessly with the Chi Technique.

Volunteering At The Durango Double Run

I’ll be volunteering at the Durango Double Runs this weekend. Making it to the start line of these races is an accomplishment, as they are long enough to require significant preparation. If you have a pain that came up recently in your preparation, we at Rakita Tomsic Physical Therapy can help you make it to the start line feeling better; sometimes with simple treatment that can be continued at home, with certain exercises. Even during the race, you can continue feeling better without risk.

The Importance of Sitting Posture

I just finished a trip to Fort Collins for my nieces’ wedding, and I was reminded of how important sitting posture is for back pain prevention. Most of us must use support for the low back to maintain its arch while on a long trip. Keeping the knees lower than the hips facilitates maintaining the arch(lordosis). When I did, I had no pain, but without a lumbar roll my buttock, and then leg pain, started.

Need Physical Therapy? Don’t Delay!

It’s a beautiful fall day and you’re out on an awesome bike ride. Suddenly, there is this big rock and it messes with you. You find yourself on the ground, and now your shoulder hurts. Or perhaps you are on a hike or a trial run, and that same rock shows up and you roll your ankle. These are the harsh realities we face in Durango! 🙂

In the world of Sports Medicine, we want to get you back to your activity as fast as possible. Did you know that you can come directly to physical therapy without needing to see a physician? We can evaluate your injury immediately and get you started on a rehabilitation program right away.

If we feel therapy is not appropriate for you at this time, or that you require further testing, such as x-rays, before starting therapy, we will assist you with getting to the right place to meet your needs.

Don’t delay your recovery by waiting to get started. Call the Board Certified Specialists at Tomsic Physical Therapy, we’ll help you get back on track and back to the trails that we in the Four Corners love.

Are All Plantar Faciitis’ The Same?

Plantar fasciitis (bottom of the foot or heel pain)is always a very painful condition, and patients have a hard time figuring out how to ease their symptoms. They read something on the Web, or talk to their friend who suggests a technique or product that ‘cured’ them. They try it and it doesn’t work for them. This is because plantar fasciitis is a broad diagnostic term, and doesn’t address the underlying mechanical problem that causes the pain.

Not all plantar fasciitis’ are the same.

I currently have two patients, each with this diagnosis. Each has a completely different treatment program and both are improving. You need to consult with an advanced trained physical therapist to assess the underlying mechanics of the problem and create a treatment program tailored for you.

Graduate School – Second Semester

After a short break from school I am back in for my second semester. It was very refreshing to not get up at 5 a.am to study every day, but to sleep in to 6 a.m.! I spent a little bit of time in the garden, which has been left on it’s own all summer, and playing with my dogs, Sadie and Sprocket. They remembered me and really appreciated it.

This semester, my course work is focusing on Pharmacology, Leadership, Business Management, and Clinical Case Studies. I am looking forward to more in depth learning of these subjects to be a more effective physical therapist and business owner.

Graduate School-First Semester

Well, I survived my first semester of graduate school in my quest to earn my Doctorate degree in Physical Therapy. I (contrary to how I felt during the semester) earned straight A’s.

The first semester focused on reading, understanding and interpreting medical literature, and how to use this evidence to best treat our patients for the most effective and timely outcomes. This reinforces our mission of advanced clinical expertise in the field of physical therapy.

Durango Physical Therapist Passes Prestigious Specialist Re-Certification Exam

Dave Rakita, co-owner of Rakita Tomsic Physical Therapy and world-class competitive triathlete, passed the Orthopedic Clinical Specialist (OCS) certification examination for the third time.

The OCS certification program was established by the American Physical Therapy Association to provide formal recognition for physical therapists with advanced clinical knowledge, experience, and skills in a special area of practice and to assist consumers and the health care community in identifying these physical therapists.

This was Dave’s second re-certification. In 1993 Dave was one of the first, if not the first OCS credentialed physical therapists in Colorado.

“It was a very difficult test and I feel lucky to have passed again”, states Dave. “I truly enjoyed the preparation process which consisted of hours of studying current evidenced based orthopedic PT treatment methods, theory and techniques. Upon finishing the exam in March, I thought perhaps I had failed, so I was very relieved when I recently received the good news.”

Returning to school after all these years

Dr. Ellen Tomsic - Doctor of Physical Therapy in Durango CO at Tomsic Physical Therapy

I have decided after 23 years of clinical practice to return to school. As with all professions, they evolve and sometimes attending weekend continuing education is not enough to keep up. The goal of the physical therapy profession is autonomous practice by 2020. What that means is all patients, regardless of insurance, can walk into a physical therapy office for treatment without needing to see their physician for a referral. Given that, a physical therapist needs skills in pharmacology, radiology, and differential diagnosis.

When Dave went to school he received a Bachelor’s degree in physical therapy. When I went to school I received a Master’s degree in Physical Therapy. The therapists graduating now are receiving a Doctorate degree in Physical Therapy, in preparation for our changing profession.

Dr. Ellen Tomsic - Doctor of Physical Therapy in Durango CO at Tomsic Physical Therapy
So… Here I am, back in grad school to get my Doctorate degree in Physical Therapy.

School has changed quite a bit since I was last enrolled. ‘Distance learning’ is the key for us ‘busy professionals’. What that means is that you get all your assignments and do all your work over the internet, either really early in the morning before you come to the office, or in the evening after the work day is over. And if you are not technologically savvy, you better hope you have a spouse or good friend who is.

I am two weeks into this endeavor. So far I really like what I am learning and am not too far behind!  It will last one year and I finish at the same time my husband (a tax accountant) finishes his 2014 tax season. I think it’s time to start planning a really great vacation!

Ellen