7 Helpful Tips To Help With Lower Back Arthritis

Hey everyone, welcome to the Stay Healthy El Paso Podcast. I'm your host Dr. David Middaugh, specialist physical therapist over at El Paso Manual Physical Therapy, and today we're covering the top seven tips for lower back arthritis.

Now we see people here with lower back arthritis in the clinic all the time. It's one of the most common things that we help out. And typically, people have a combination of arthritis and stenosis and sciatica. When they're looking for help initially, they don't really know what they have going on. But maybe they've got an X ray and MRI, frequently people bring those in with them. And they'll point out on the MRI or on the X ray where it says Look, look at L-5 or L-4. I have arthritis, osteoarthritis!

When they've got that, then they are concerned because it's like I'm getting older and I've got arthritis, that stuff doesn't go away. It just stays with you for life. And they are always worried about how to begin to get help, and they're not sure who to see, or if they're going to need surgery someday. That's always a huge concern for people, especially once their back starts hurting, then they think, I don't know what to do about this and how am I going to protect this from getting worse, and I've seen my parents, they had arthritis too, and their backs are all messed up and they're on a walker on a cane or they're taking medications all the time getting injections.

If you have any of that stuff going on, you are going to want to hear these seven tips on how to get started on fixing your lower back arthritis problem. Now, just the way this works, it's not really fixing it. I'll tell you more about that here in a second. But arthritis is generally something that comes on as we age, and it can be painless. In some instances, it can be painful in other instances, it just depends if it flares up, but think of it more so as like getting gray hair or wrinkles.

As we age, we get gray hair and wrinkles and they don't really hurt. They don't hurt physically but it might hurt emotionally for some people. But if we look on the inside of our bodies with an X ray or an MRI, then you'll see that as we age and people that are older, they just tend to have more arthritis. And it's okay, it's normal. It's not it's not a bad thing necessarily.

What we're concerned about is when it becomes too severe, when it becomes out of control, that's typically a sign that there's a bad forces going through those joints, there's bad stuff happening. It's usually the way that the muscles are pulling on the joints. That's why there's bad forces on there. That's what makes the Arthritis situation progress faster and become more severe.

But anyways, I'm going to cover those top seven tips for you right now. And that way you can learn about what you can start doing right away at home. Right now, as you're listening to this podcast, you can try out some of this stuff for beak or your plan to stop doing that some of these things, because I'll tell you what to avoid as well. I think this will be helpful for you. So let's get to it.

Let's talk about the top seven tips to help out lower back arthritis.

Tip Number One Core Strengthening Exercises.

A lot of people say just go get exercise, but to be specific, we have to strengthen the core and it's typically the abs muscles, but I would also throw in the glutes, just about every single time. It's pretty rare, I'd say 9 out of 10 times, it's just an ab problem. It's an abs and a glute weakness problem that contributes to a lower back arthritis situation.

So, if you haven't really worked on your abs, and that's something you want to get going on. If you are confused about how to do it, or maybe you have already been trying it out, and it's been hurting your back more than helping your back. Then I encourage you to go over to our playlist on lower back videos in our channel for El Paso Manual Physical Therapy. There are tons of videos in there that talk about specific exercises for lower back problems and start with those. Those tend to be pretty safe and easy to do.

And if you are still having trouble, you need to get some professional help to make sure that you are doing your core exercises correctly. Because it is proven, I see it in the clinic all the time. That's how we help people is by strengthening certain muscles, in addition to all the hands on work that we do, but core strengthening is going to be your number one place to start fixing a lower back arthritis problem at home.

Number two simple stretches.

When I talk about stretches, you want to just stay in this forward and back motion. Like going towards your toes and going backwards can be beneficial. I would, there are certain stretches that I would want to avoid. That's actually tip number three. I'll cover that in a second. But its stretches where you feel like you are bending your back all the way forward or all the way backwards are generally okay to start with.

Now, what I want to point out with stretches is, they can be overdone and can actually become harmful after a while. So use them sparingly, but it's a good way to relieve the backache to relieve some tension off your back and possibly avoid taking pain medication in the short term. Just to kind of get you by for a period of time. But I wouldn't look to do stretches to cure a back problem. It's just going to get you started and allow you to avoid taking the harmful medications.

Number three, avoid twisting motions.

Typically, and this is related to those stretches, avoid twisting motions. Some people like to twist all the way around one way, and the other way, and maybe you enforce a joint to pop or click. And that can be relieving sometimes, but I would avoid it if you have a low back arthritis problem, because chances are, there's a bunch of stiff joints in the lower back because of the arthritis. And there's usually one or two joints that are compensating for all the stiff joints. And you might be over twisting that one joint that's moving way too much in creating a disc problem or a pinched nerve problem later on.

I would avoid the twisting motions. Our spines are just not designed to take a lot of twisting and repetitive twisting. So, make sure you avoid daily twisting motions, as well like twisting while doing little things, at home activities, like chores in the yard at home. If you have to stand with your feet pointed in one direction you twist over one way, or if you are sitting at a desk or cooking in a kitchen and you find that your feet aren't really going with the upper body, make sure to just reposition your feet so that they are in line with the rest of your body so that you avoid twisting through your spine. So, keep away from those twisting motions.

Tip number four drink lots of water stay very hydrated.

Our joints are reliant on our hydration so if you feel like you have not been drinking enough water over the past few months, and you are back arthritis problem is just getting a bit worse, it could very well be affected by your hydration levels. Cartilage is over 60% water up to 70% water and you have tons of cartilage. Discs in your spine are also highly dependent on hydration. And then there's fluid inside the little spine joints. The rosette joints is what they are called in the lower back. And that fluid needs to be there in order to properly lubricate the joint surfaces. So drink plenty of water.

I know the side effect is that you have to get up and go to the bathroom frequently. But I would weigh that if you are having a problem with having to go frequently versus potentially having some surgery some day because this arthritis problem was managed properly. You got to weigh those risks. So just think about that I would I'm always going to lean on the side of drink plenty of water and it's okay if you had to get up every now and then go to the potty. Just make that trip counted as exercise.

Tip number five, avoid shoes with heels.

Now this goes for both men and women. Of course, women are probably the ones that are typically going to wear heels more so than men. But men do wear heeled shoes here and there. You know smaller heals typically with like in boots or dress shoes, but that little elevation even if it's a small amount, it changes the way that your ankles are positioned when you walk, which influences the knees and hips and can translate all the way into the lower back. And generally, the bigger the heal, the more forces are going to be disrupted and affecting your back & neck.

Really, so it just doesn't allow the muscles that control the spine, the lower back to properly operate and give you the stability that is needed for everyday motions. If you have a chronic back problem, if you have arthritis in your back, I would definitely stay away from the heels until that problem gets resolved.

Now, let me put a disclaimer in here. I'm not against heels forever. I think if you are healthy, and if your back is fine, you don't have any other issues that are affected by the heels. Wear heels all you want, and it should be just fine for you. But if you are trying to avoid medications, injections and having a surgery, get off those heels in the short term and let's fix the back problems so that you can get back to her in the heels as you might like want as you want to later on in life.

Tip number six, avoid walking for exercise.

I put this tip in here because a lot of people that I meet here in the clinic and out in public, they say hey, I want to start exercising and stretches, start with walking, right? That's kind of the easiest thing to do. You just get out and put on your walking shoes and go for it. And yeah, it's an easy thing to do and it was pushed a lot back in, in the 90s and even early 2000s as a great way to start exercising. I think it's still generally accepted as a great way to start exercising.

If you don't have any sort of back problem, I'm okay with it. But if you are dealing with back arthritis, lumbar arthritis, it is not a good thing to go walking for 20 minutes, 30 minutes or more to cover many, many miles because there is a decent amount of twisting that happens through the spine when walking. And if your joints aren't moving properly, because you have arthritis in there that's preventing the motion, then you are technically doing a repeated twisting motion over and over again, and it can aggravate the back problem.

We have seen people come in here in the clinic that say, I started walking and it kind of felt better because it's stiff. I understand and my back eased up some. But then it started to bother me as time went on and I just didn't enjoy going for walks. So, if that's you stop the walking right now. There are other exercises that you should be doing. And then walking can begin to happen for regular exercising if you choose to. If you like to go hiking or you are just an outdoors person like to get out every now and then it's not a forever thing kind of like with the heels.

You want to just put a pause on the walking beyond what you'd have to normally do for everyday living, walking within your house and for work. But walking for exercise like where you go on a dedicated walk, I would avoid if you are trying to correct a low back problem, an arthritis problem in the low back.

Tip number seven, get expert help.

This is by far the quickest way to make sure that the lower back arthritis problem gets under control and managed properly. Now the reality of what we've discovered in the healthcare field over the past 20 years is that arthritis in the past, is actually Okay, as we age, it's expected as we age.

Think of it as like rust on a on a car, if you look under an old car like from the 60s or 70s, or even before that time, if there's bits of rust here and there, it's not going to impede the function of the car, your car's still going to run and you can go enjoy a cruise. But if there's a massive hole that is rusted out on the frame or on some important part of the of the undercarriage of the car, then you should get some concern and you should think Am I going to be able to enjoy my rider? Is something going to break or is this crazy? We're going to start then you got a problem. It's the same thing.

If you are looking at the arthritis in your spine, it's all over. It's just there's tons of it. Just like there's a lot of rust on the bottom of a car. You are going to have some likely long-term back issues and you can still get under control and manage it so it's not worse and avoid a surgery or having to rely on medications. But the fact of the matter is, it's just affected more joints, more cartilage in the spine. But if it's just a little bit of arthritis, in other words, if they told you that you have mild arthritis, even moderate arthritis, then I wouldn't get too concerned that's like looking at a 56-year-old car.

And if it just has mild amounts of rust or even moderate amounts of rusting but everything still works, then you have an excellent shot at getting back exactly to what you were doing before, without having to worry about having surgery one day or having to rely on injections or medications.

But getting expert help really just speeds up that process to make sure that you are doing the right exercises that you are not doing the wrong stuff. And that you are thinking about this properly so that you can learn how to take care of your back arthritis for the rest of your life. So I strongly encourage you to reach out to an expert like a manual physical therapists to make sure that your lower back arthritis problem gets under control and handled properly.

Hey guys, thanks for listening, I really appreciate it. If you thought that this podcast was helpful for you, I encourage you to leave us a five star review, that would be super awesome. If you tried some of this stuff and you had a good outcome then please leave us a bit about your story in a review, we'd love to hear that. That's always encouraging that we're helping people that are listening in El Paso, or in the area or even around the world, around the country.

We always love hearing people sharing their stories about how we might have helped them. If you are thinking that we might be able to help you out if you're in the El Paso area, call our clinic if you think that you want to get help by us, our numbers 915-503-1314 and if you just want to learn more, find out about us you can Visit our website at www.EPmanualPT.com and there's tons of free resources on there. Our blog is full of helpful information for back problems and other issues as well. You can go check it out and find more details. But anyways, I hope that you have a wonderful day and we'll talk soon.

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Most Common Causes For Swelling In The Knee

Hi everyone! Welcome to the Stay Healthy El Paso Podcast. I'm your host, Dr. David specialist, physical therapist over at El Paso Manual Physical Therapy. Today we're going to be talking about knee swelling, specifically the top five reasons for knee swelling.

If you're listening and you've ever had a swollen knee, or in the past you've dealt with swelling around your knee, whether it was just a onetime thing, because you twisted your knee, finding your banged it on something, or if it was a more chronic thing, where you get recurring swelling if you overdo it. We're going to talk about the top five reasons for that kind of knee swelling.

Here in the clinic, we often get people with knee problems. And almost always I can't think of a time recently when they didn't have swelling, but almost always they have swelling, and they've got swelling either on the inside on the front on the outside or the back of the knee or sometimes the entire knee around the knee joint. It's swollen, or sometimes it's on the muscle right above the knee joint as well. There are different places to get swelling, sometimes it's a little bit of swelling. And it's not a big deal.

At the time, it's quite a bit and especially with ladies that were more form fitting pants, they can feel the difference on one knee versus the other. Or with certain, like pantyhose or stockings, things like that. It'll feel different on the swollen knee versus the other. And then sometimes the knee swelling can get so bad that it affects how the knee works, then you won't straighten out or bend all the way. We'll go over and we'll go over the top five reasons that people get knee swelling.

Reason number one in meniscus injury.

Some people know about the meniscus, some don't. So I'm just going to explain to you what the meniscus is. If you think about the thigh bone, coming to meet the shin bone to form the knee joint, of course the kneecaps kind of sit in front of those two, there's a big layer of cushion that's made up of cartilage, right between the thigh bone and the shin bone. And that's called the meniscus, you actually have a pair of menisci, meniscus is in each knee. So you have what's called a medial and lateral or inner and an outer meniscus. They are c-shaped structures like this, and they are huge chunks of cartilage.

The concern with a meniscus injury is that because it's cartilage, it just heals slowly and potentially doesn't heal properly, if it's not helped properly was not treated properly. If you have a meniscus injury that can definitely cause swelling in the knee, and the way that that typically presents, the way that it shows up in an knee, is right where the knee bends, usually kind of behind the kneecap. It wraps around the sides of the kneecap. It's always wrapped around all the way to the back of the knee and it can hurt directly on the back of the knee.

That is a common presentation for swelling related to the meniscus. And this is a serious thing if you have swelling and it's like what I described, and it's related to the meniscus. You don't want to treat this lightly. Wearing a knee brace typically just doesn't help a whole lot. It may alleviate the pain but taking away the problem for the long term is not going to be helped by the knee brace. It typically requires being seen by an expert and getting expert advice and treatments on how to fix that knee problem.

Now if left untreated, if you keep getting recurring swelling because of the meniscus problem, you have the potential to face a meniscus tear and maybe even need surgery someday, which hopefully you can avoid at all costs. But it is possible to have a painless meniscus tear in other words. A tear that happened that isn't bothering you at all, because it's under control and your knee is working fine. You can have a painless meniscus tear.

Just think about that. If you have a meniscus problem right now, get it taken care of, go get some help right away. Don't wait too long. Injections won't fix it, that just takes away the pain for a temporary amount of time. And so does pain medications that you take by mouth. So, make sure to get professional help if you think that you have a meniscus related knee swelling problem.

Number two a ligament injury.

There are tons of ligaments in the knee. What a ligament is. It's what we call connective tissue, basically a structure that attaches a bone to a bone. So, going back to that example of thigh bone on the shin bone, you have a bunch of things that tie them together so that the bones don't just fall apart. Those are ligaments in the knee. You have some massive ligaments deep inside. The most famous one is called the ACL. The anterior cruciate ligament, there's also the PCL, the MC, and the LCL. There are some other ligaments as well, but those are the main ones that people typically injure.

What can happen to those ligaments is, they can get overstretched or even completely torn or partially torn, and you bet that causes swelling. Now, if you have an ACL tear, or sub tear, like a partial tear, or even just an irritation to that ACL ligament, then you can have some pretty significant swelling in the knee.

The way that looks is your knee blows up, typically it swells kind of evenly all around the knee where the joint is, where the thigh bone meets the knee bone, where the thigh bone meets the shin bone. You get swelling on the front of the knee, on the back of the knee, even on the sides of the knee, but typically in the front and back are where people feel at the most.

Absolutely, there's a loss of motion too. People can't fully bend or strain their knee. And if it's really bad, they might feel like they need to get on crutches for a while. While these types of ligament injuries are typically a result of some sporting accident, like football is a classic one, basketball, volleyball are classics as well. Car accidents, bike accidents, a bad fall can also cause an ACL injury, or some other ligament injury.

Those are all typical reasons for having a ligament injury. But it is possible to get a ligament injury slowly over time without ever having an accident happen. If that's the case, what you might feel are clicking sensations inside the knee, or feeling the knees going to give away, like you stand on it and you're not confident in your knee when you go to bend on it or kneel or stand on one leg. You just don't feel confident in that knee.

That's typically a sign that you have a loss of stability because your ligaments aren't 100%. So if you have those signs, the good news is, as long as it's not torn, you have an excellent shot at getting better without surgery. Medications in the short term might help to mask the pain but they are not going to fix that ligament. Typically, that needs to be braced with a knee brace. And you need some professional help to make sure that the knee brace is only used for a certain time period.

You don't want to be relying on the knee brace with a long term that's not good. And you want to make sure that you don't have anything that's fully torn, that may require some sort of procedure by a surgeon, or somebody professional that handles that kind of thing. But consult an expert if your ligament injury is not fully going away.

We see people ligament injuries all the time, and they get 100% better, it takes some management typically, if it's not too bad, but within a month or two, they get a lot better. If it's really bad, it could take three to four months. But it shouldn't be an ongoing problem that people have for many, many, many months or even years. If you think you've had a ligament problem for years. I strongly suggest you get some professional help to nip it in the bud, and make sure your knee gets back to normal as best as possible.

Left untreated, because you don't have the good stability in the knee, you can begin to irritate the meniscus, you can begin to develop arthritis over time. It's just not a good thing to leave. And it's not a good injury leaving your knee untreated because it will begin to cause other problems.

Number three, osteoarthritis or commonly known as arthritis.

There are different types of arthritis. People generally refer to osteoarthritis as arthritis. What that is, its changes usually age related, I think it's force related, is what I would call it. But it's changes to the surfaces of the joints. So where the bones meet together, if you think of the thigh bone and the shin bone, and then also the kneecap where it touches the thigh bone, where it moves the chain, there's changes to the surfaces of those bones that caused the surfaces to become not as smooth as you're supposed to be.

Joint surfaces should be very smooth, very lubricated so that all the motion can occur there freely without causing you any problems. But if you begin to lose a cartilage, if it wears down and you get what's called a bone on bone situation, or if the surfaces get bumpy because there's torn cartilage, or the bone is growing and appropriately like a bone spurs some extra bone growth under the cartilage, then you don't have a smooth surface anymore. Friction becomes a problem within the knee joint. That's the situation that begins to develop into arthritis.

This happens slowly over time, generally. So, people tend to develop arthritis symptoms as they pass 50 into their 60, 70s and beyond. And it progresses pretty far. People typically have a big loss of motion, they can’t bend their knee all the way or they can’t straighten the knee all the way. And sometimes it'll lock, it'll kind of stay in position because of those bumpy surfaces, it doesn't let it move properly.

What needs to happen is, we need to look at how the forces are going through the knee and then need to be normalized. Now that's a process that takes a while. Treating arthritis is not a quick thing. If you're out there and you have arthritis, you might benefit a lot from this program that we offer. It's called the 28 Day Knee Health And Wellness Boost Program.

You can find out more about in the description here. And that program teaches you how to begin to move better, if you have a knee arthritis problem, as well as a meniscus problem, a ligament problem, it helps out a lot of knee injuries. But especially if you've been dealing with a chronic knee arthritis problem, I strongly suggest you check out that program and consider starting it so that you can begin to fix your knee problem on your own at home.

If that program doesn't help you out, then I strongly suggest you go get professional help so that you're not in a tough situation later on in life, or that knee arthritis progress so far that you might be talking about a knee replacement with the surgeon.

Reason number four, a cartilage problem.

We talked earlier about the meniscus, that's a big chunk of cartilage, but we kind of separate that out from other cartilage in the knee. There is tons of cartilage in the knee. The most common cartilage injury that you get outside of the meniscus in the knee, is the cartilage on the back surface of the kneecap, on the patella. The kneecap sits directly against the thigh bone, and when you go to bend and straighten your knee, that kneecap travels over the end of the thigh bone. And there's cartilage on both surfaces on the kneecap and on the thigh bone, that needs to be there to allow free motion within of the kneecap against the thigh bone.

That cartilage can get worn down and cause that bone on bone situation. And let me just go into that for a second, because I want to make sure that your mind picture your perception of what bone on bone is, is accurate because sometimes people go visit the physician or their orthopedic surgeon, and as soon as the doctor says, “You got a bone on bone in your knee”, what I see as a physical therapist patients come in here to tell me that their perception is that there is zero cartilage left, there's nothing there, and your knee needs to be replaced. And that's just not the case.

In rare circumstances. The cartilage is massively lost throughout the entire joint, but it is extremely rare. I mean, you're talking one in a million. What is way more likely is that there's a spot a tiny spot, maybe like a pinhead at most like an eraser head of a pencil that is missing some cartilage. And the bone is now being exposed because of cartilage is so gone there. But well, we've been able to do here in the clinic.

We do it all the time with patients that have that bone on bone situation, because we can change the way they are moving, change the way that they are putting forces to their knees. We look at muscle imbalances, we're looking at all kinds of other things. And when they begin to move better, and have better strength and muscles that were lacking it for decades, they take pressure off that spot that's bone on bone, and begin to put it where it's supposed to be within the knee joint, where the cartilage is thickest, and they feel better and they move better. And they begin to recover from that bone on bone situation naturally without medications, injections or surgery.

Cartilage problems can be a huge reason for swelling in the knee. The way that it'll look, if you have swelling related to cartilage, on the kneecap specifically, you'll feel swelling right around the kneecap, that's the most common presentation, it'll be tender. If you press the kneecap down and you put some light pressure on it against your thigh bone, that feels terrible. So. if you try that out in yourself, just do it very carefully. As soon as you have a small increase in in pain or discomfort, you can be pretty certain that there's a cartilage problem behind your kneecap.

Reason number five swelling in your knee a muscle strain.

There are tons of muscles that are right above the knee, and then some below the knee, mainly on the back of the leg in the upper calf area. It is possible to strain those muscles to basically overdo some activity. Maybe in an instant, like if you took a bad step and caught yourself, or if you exercise, like if you run or bike or maybe even just walk too much.

If you're not used to walking as much as you did that one time, it is possible to get a muscle strain. Now that will typically cause lots of intense soreness at the muscle where it hurts and some swelling usually on the muscle itself. So that's easier to manage. Muscle thankfully heal pretty quick with a question that I would ask, if you get repetitive swelling in a muscle, is there something wrong with the way that you're moving potentially, or an imbalance of muscle strength around your knee, possibly even up into the hip or down into the foot.

If you get recurring swelling and it's in the muscle, like in the thigh muscles, the quads or in the calf muscle, there's something not right about the way that you're moving. And that means you have an imbalance of strength somewhere. Here, I would talk to an expert about getting that addressed. If it's just a onetime deal, you swell once that time you went hiking, then I wouldn't worry about it too much.

As long as you're not going to be regularly hiking, and it's not getting better, you're not getting stronger or better in shape to tolerate doing that hike. But if you do the same hike and you're just getting worse, you're swelling more each time, it's not a good situation. Get some professional help for that. A brace typically doesn't help for that much. You have to make sure that you switch the way that you're walking or change the strength around your knee to fix that situation.

 

Thank you so much for listening to our podcasts on the top five reasons for knee swelling. I hope that this information was beneficial for you. If you are in the El Paso area and you are thinking that we might be able to help you with your knee swelling and knee pain problem, I strongly encourage you to visit our website at www.EPmanualPT.com and try out some of the free resources we have on there. We have an eBook that you can download instantly, we will send it to your email that has tips for knee pain problems.

You can also go to our blog on the same website, just click the blog tab at the top of the website, and you'll find tons of blogs that we have written that go over different knee problems and why they might be there, what you can do about them. Some of them have exercises and other things you can try, home remedies and all they're all of course, expert produced tips and resources. And you might be able to find something that you can do at home before having to reach out to anybody.

But if you do feel like you'd want some professional help so you can make this problem go away faster, get under control faster, and hopefully avoid surgery, injections ,and having to rely pain medication so that you can be active again, be normal, get back to your usual exercise routine or you're taking care of your house, or your yard work, or your gardening, whatever might be that you love to do. But spending time with family with kids with grandkids, you can go to a website to learn more about how to get in touch with us. Or you can call us directly at 915-503-1314 and we'll be happy to begin a conversation about your knee problem and see if it's the type of knee problem that we can help out. Thanks so much and have a wonderful day. Bye

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Top 4 Reasons Why You May Get Knee Pain From Walking & Running

Hey everyone, welcome to the Stay Healthy El Paso Podcast. I'm your host Dr. David Middaugh, specialist physical therapist from El Paso Manual Physical Therapy. Today we are going to talk about the top four reasons for knee pain from walking and running.

The reason why we made this set of tips and advice for knee pain from walking and running is because, since all the shutdowns everyone stayed at home and had to miss going out to the gym, had to miss accessing their treadmills, and all the normal workout equipment they might have at the gym if they were going to the gym.

There has been an obvious increase in people out in the streets, out in the sidewalks, running and walking for exercise. And as a result of that, we've seen more patients in the clinic here with knee problems, hip problems and foot problems but the big one has definitely been knee pain. So, I'm going to cover with you today the top four reasons for knee pain from walking and running.

Reason number one, bad form

A lot of people don't realize how terrible their running form, or even their walking form is. And every time we get somebody with a knee problem here in the clinic, that's one of the first things we cover. You probably have been walking for years and years of your life if you have been lucky enough to have functioning legs. You have been walking and probably even running, and you wouldn't think twice about how you did it, the way that you stepped, which muscles you used, how much you raise your knees, how hard you step.

There are all these different factors that we go into depth, when it comes to walking form and running form. And then it changes at different speeds. There is likely a huge chance that the way that you are running, the way that you are walking even, is affecting your knee problem. If you take thousands of steps, even just hundreds of steps, it can put some bad forces through tissues that aren't designed to take those forces.

Because you have a running form issue, or a walking form issue, it just overloads that tissue. It might be a ligament, a meniscus, it could be a muscle or tendon as well. If that tissue gets overloaded, then it's easy to just irritate the tissue, eventually possibly tear the tissue. Definitely get some swelling in the area. But at the lowest level, your body lets you know, by just reporting pain, you just feel some pain in the area, sometimes the joint, the knee will get hot as well. And sometimes it just gets achy.

There are times when the knee won't hurt during running or walking, it actually might feel better. But then later in the day, the knee starts to ache, maybe even at night. That is a sign that there's some knee problem going on when you are running. It typically is a sign that it's a cartilage problem or a ligament problem as well. Versus if you get pain during running, it's more likely going to be a tendon or muscle problem.

That's not a hard and fast rule. Those are just likely reasons for the problem that you are facing. But if you are having any sort of pain around the time that you are running, whether it's during running, right after, or later on in the day, then there's likely going to be some running form problem or walking form problem. The best thing to do to fix your running form, or your walking form is definitely to talk to an expert, especially an expert Physical Therapist, we deal with movement.

With running and walking, there are lots of moving parts that we can address for you. And it's not a big fix, most of the time, it's just tiny tweaks that you can make instantly and begin to reduce that pain problem that you are facing in your knee.

Reason number two, too much too soon or overloading

Let's assume that you have great running form and great walking form. If all that's fine, it may be that you are doing too much too soon. In other words, you weren't walking as much as you started to walk recently. And you feel good, you felt fantastic. You enjoy the fresh air, you enjoyed the sun and everything around you. If you are on a hike, you are enjoying your hike, and you just overdid it, that can definitely cause pain in your knee.

What you have to look at is giving yourself smaller amounts of walking or running. And then gradually building it up over time to the distance, or the time that you desire to do so its going to sustain for the long term. If you are going to begin a running program or a walking program for exercise, and you want to work up to three miles for instance, you won't be able to cover three miles. I wouldn't go into doing three miles the first time you go run or walk. That's going to likely overload your tissues, and you are going to do too much too soon, and you are going to have some knee problem very likely.

You got to start out with maybe a half mile to a mile at the beginning. Do that for a week or two. It just depends on how out of shape you are. Then work your way up to a mile and a half to two miles, and then work your way up to two and a half to three miles over time. This might take you a month or two months or three months. It just depends on your specific situation.

But you need to consult an expert on this. If you are confused about how to do it. There is a lot of information online that is very helpful. You might start there too. And if you have a running friend that's gone through marathon training successfully, or half marathon training, or even ten-k training, they might be able to help you quite a bit, based on how much to walk or run at the beginning, and then how to work into as you get better and stronger.

Reason number three for any pain from running and walking is your footwear

Your shoes, especially for walkers, because people that walk may not always wear the right shoes. You definitely want to have some sort of athletic shoes or running shoes is ideal. But if you are wearing your casual shoes that don't have a whole lot of support, you might switch those out for some more athletic shoes that offer you plenty of support.

Here's why it's important. You are running, you are on your feet, you are walking, you are on your feet, there are muscles in your feet and there are muscles up into the leg that just get tired as you do more. And what those athletic shoes do for you is, they help support the position of your foot, which affects the position that your knee and hip and all the way to your low back. And if your muscles get way too tired because you are pushing yourself, then they won't support you the way that they are supposed to, because they are just not strong enough yet. But that shoe can give you that that little boost that you can last as long as you need to.

Another common mistake, related to shoes is, people just wear their shoes out. If your shoes are pretty old, or you just put a lot of mileage on them, you have walked around on them quite a bit, then it's time to get new shoes. And, there is all kinds of debates about every six months or every 12 months, or even if you didn't use them for six months, the I've heard that the materials kind of wear out. There is all kinds of debate. What I would go by, for you specifically is what feels best for you.

I can tell you from experience, I've been an avid runner myself, and I tried switching it out every six months and I tried other times as well. I couldn't find something specific. I just went by the feel I had. Some shoes I used for over a year. Currently I have some shoes that are probably two or three years old, that I still use to exercise in, and they still give me good support. They give me what I need, and they are in decent shape. I don't find a reason to get new shoes at this point me personally. But as soon as I feel like those shoes aren't supporting me, you bet I'm going to go get some brand-new shoes. And I'll be just assessing as I go on.

That's what I encourage you to do. If you are walking out there, and you are thinking to yourself, oh, gosh, these shoes that I'm about to put on are five years old. But then you might rationalize yourself and say, Well, I haven't been on a running program or walking program in five years, so maybe they are going to be okay. I'd say give it a shot.

But if you got knee pain, and you can't quite solve it, definitely go get some new shoes, it's not going to hurt, it's only going to help and that might be the fix that allows you to continue your walking routine and your running routine without having to go visit a doctor get medications or injections or anything like that. Running shoes is always a good, easy fix for you.

Reason number four old unaddressed injuries

Many people had knee problems back when they were in high school, when they played sports, and they played volleyball or football, or they were running before. They may have suffered injuries back in the day, but they never really fully got them addressed. They just laid off of them. And then now they are picking up a walking routine or running routine. They are kind of coming back but were never fully addressed.

Typically, what we find in physical therapy is that there's some muscle imbalance or some improper joint movement that is hard to feel or find out. Or it doesn't really come on unless you stress the joint like when you go on a walking program or running. But in normal everyday activities, it just wasn't enough to bother you. Those old unaddressed injuries now get magnified for you, especially if you are going to be more intense with your walking or running routine.

What I would strongly urge you to do is talk to an expert about this. Because if you can address subtle injury at the beginning of your new walking or running routine, it's going to go a lot smoother for you than if you keep running through it or walking through it, and it festers into an arthritis problem or some tear in some tissue that isn't ready to take what you are going to put it through. I strongly encourage you to talk to some experts like myself about this knee problem, so that it's not going to stop you from reaching your goals from being able to run as much as you want or walk as much as you want.

If you are unable to get to an expert, there's nobody in your area, or you just want to stay at home, make sure that you are safe at home, then I strongly urge you to consider checking out our 28-day Knee Health And Wellness Boost Program. This 28-day structured program will show you how to get stronger in your knees, strong in your hips, even your feet. It's a structured program to make sure to boost the health of your knees and make sure that you know how to address your knees strength moving forward, and how to maintain it so that you are not having recurring knee problems. Check out more about that program by visiting the link in the description here.

Thanks so much for listening to our podcast. I hope that you learned a lot about all these reasons for knee pain from walking and running. If you have more questions or you just have some specific questions about your specific problem, if you are dealing with a knee pain problem, you can reach out to us. Our phone number is 915-503-1314.

Of course, if you are in the El Paso area, we can help you directly. Now if you are looking to find us online, you can find us at www.EPmanualPT.com and you could see our website there, find all our free resources right on the homepage. You can go into our blog and find more tips and helpful advice for knee problems. I hope that this podcast was helpful for you, and we'll talk again soon. Bye

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Misdiagnosed Plantar Fasciitis – How To Figure Out Heel Pain

Hey there, El Paso! This is Dr. David Middaugh, specialist, physical therapist over at El Paso Manual Physical Therapy, and I'm your host of the Stay Healthy El Paso Podcast. Today we're going to talk about misdiagnose plantar fasciitis, and specifically how to figure out your heel pain. Because if you really don't have plantar fasciitis then what the heck is it? What's going on? And how do we feel?

Get this out so that you can get back to being normal, get back to being active, healthy, and mobile in your foot and ankle without having to rely on pain medications, injections and of course, dreaded surgery.

Let's get into some specifics about how plantar fasciitis is typically diagnosed, what healthcare professionals are looking for, as far as symptoms, signs that that are classified or diagnosed as plantar fasciitis. And then what kind of treatment options are out there. I'm going to get into the controversial stuff, the misdiagnosis, and how we look at it here in the clinic at El Paso Manual Physical Therapy, and how we find misdiagnosed plantar fasciitis.

Almost every time we see a plantar fasciitis patient, somebody that comes in saying they got plantar fasciitis. So let's get into it. First off, the biggest symptoms that people have, whenever they go to see their physician, or their foot doctor, or whoever it is they are seeing as a healthcare professional for their heel pain.

When doctors, physicians, foot specialist diagnose plantar fasciitis, the number one sign they are looking for is when you get up in the morning. Your first few steps, if you have sharp stabbing pain in the heel, that tends to get better as you walk around more, but maybe never goes away or maybe it does if it's not that severe. But the classic telltale sign is that sharp stabbing pain with your first few steps in the morning.

That is often called plantar fasciitis. And there may be some associated limping that goes on. If you can't walk normal. You have to walk very, very carefully, holding on the furniture, holding on to things as you get up. And then some people report swelling as well. They get swelling around the heel area.

They get a different sensation. At the bottom of their foot, on the heel side of their foot, and some people perceive it as swelling. The last patient we had in here with these kinds of symptoms said that she felt like the pad at the bottom of her of her heel was flat. Like it lost its air, like a tire on a car. Like she said, she was like I have a flat tire and I'm stepping on the bone, instead of the cushion, the meat of the foot under the heel. That's kind of the description people have. And it can get better and worse without ever really knowing or understanding how it happens.

As far as treatment, once you tell a physician that you have this, and then they are going to automatically start writing down plantar fasciitis treatment. There are tons of ways to go with this. Of course, physical therapy is one of the treatments. I'll talk more about that later. But let's talk about other treatment options that people go towards if they have plantar fasciitis.

The simplest easiest one that people do is ice, they start icing their heel.

They will just get a bag of ice or some sort of cold thing that you can buy the story to those, those gel packs. The other thing that's commonly done is they will get a water bottle that they freeze. So it's like a cylinder shaped ice block essentially. And they will roll it on their heel and the arch of their foot. And that can be quite beneficial.

Actually, the reason for that is because it numbs the tissues, and everything under the foot and can be relieving, but it doesn't solve the root problem. Which I'll get into more about what the root problem is. But let's just go through these treatment options.

The next one is braces.

People often try all kinds of braces, the ones that you lace up the ones that have struts, metal struts or hard plastic struts on the sides. There are braces that you just wear at night. Those are called night splints. You may not use anything during the day. But there are special plantar fasciitis braces that you wear at night.

The reason why they are special is because they typically have this fabric strap that hangs off the end of the toes that is attached to the shin area of the brace. So it holds your foot and toes up, like you're lifting your toes up, and it puts a stretch on the bottom of the foot into the heel. And some people report they feel a little bit of relief with that.

Another more invasive treatment option is injections. Injections are commonly done for plantar fasciitis symptoms, specifically cortisone or corticosteroid injections because that drug is an anti inflammatory and pain reliever. The thought is that the plantar fascia, which is a tissue, and I'll go more into it in a second. It it's inflamed, and so if we inject anti-inflammatory medication, then it would help with the pain and with the long-term outcome.

The problem is that the plantar fascia is made of connective tissue. And corticosteroids are known to degenerate connective tissue with prolonged use. So, it's very much a short-term solution. And then, in extreme examples, you can have surgery. There are plantar fascia release surgeries where a surgeon will go in there and cut the plantar fascia to relieve pressure.

Now I'm not 100% sure on exactly how this is done, as far as if they cut the entire plantar fascia or a portion of it. This isn't a common surgery. So it's not something that I know a lot about because we just rarely see it. I've seen it in two people before and where they cut it on the scar, it looks like it's only a partial cut not a complete cut of the plantar fascia. I think that's how they are doing it is he just cutting an edge of it to lengthen it a bit. Just to relieve some pressure. But they will cut it the whole way is my is my hunch.

Anyway, as far as the way I think about the body mechanically, I doubt that a surgeon would completely cut the plantar fascia. In most cases when they are going where they are looking to do surgery on the plantar fascia.

Okay, so we're going to get into the PT treatment discussion about what is done in physical therapy for plantar fasciitis. But real quick, let's visit what plantar fasciitis is, physiologically, what's going on in the body so that listeners can understand how this all works.

Let's start off with the plantar fascia itself. The plantar fascia is connective tissue that attaches from the heel of the foot. And if you want a visual of this, it's easy to just go plantar fascia, Google will probably autocorrect if you have trouble spelling it. Because it is a little difficult to spell and click on the images tab, and you'll see tons of pictures of plantar fascia. It's all over the internet.

Anyways, it's a white tissue, a connective tissue. It's white because it has a low blood supply. And its job is to help maintain the arches of the foot. There are actually three arches in the foot. The main one that everybody talks about is a medial longitudinal arch, but there are a lateral longitudinal arch and a transverse arch. But its job is to primarily help hold up the medial lateral longitudinal arch.

The theory, and I say theory because this is this is not proven. This is how most healthcare professionals are operating. The theory is that plantar fasciitis develops because it's getting overly stretched out. So if you have flat arches, it's tensioning the plantar fascia. And if you do that too much, then it begins to irritate the plantar fascia at the insertion point at the heel. And that's why it's tender at the heel. And that's why people get these symptoms when they first stand up, it hurts a lot right in the heel.

That's why the treatment options are such that's why they do the surgical, the plantar fasciitis releases, that's why the braces The idea is that it's too short and needs to get stretched out as well at the heel. That's the thought process with normal plantar fasciitis. But what most healthcare professionals don't think about, that I need you to be aware of, is that the plantar fascia is not the only structure in the heel, which means it's not the only thing that can cause pain or discomfort or some problem.

You also have a pretty substantial fat pad, under the heel. There are bones there, the calcaneus in the heel bone. And there are tendons that pass in the area. Tendons are what connects the muscles to bones. They help to transfer forces to pull on things and make them move. And then the biggest culprit of heel pain in my opinion is nerves.

Nerves cover our entire body. And specifically, in the heel. There are several nerve branches that cover the heel and there is one that runs right over the insertion point of the plantar fascia. So when I do my testing, when I have a plantar fasciitis patient here in the clinic, one of the first things I do is, I do something called a wineglass test and I do a modified version of it. I'm looking to put some tension on the plantar fascia. And then I have to poke on it. And now what we'll do is we'll poke on it without tension and poking it with tension.

The idea here is that if it is truly plantar fasciitis, if it is the plantar fascia that is affected when we put tension on it because it's connective tissue, it's designed to maintain some tension to hold certain body parts together, in this case, the arches of the foot. It stresses the tissue a bit, and then if we apply pressure on it, that stresses the tissue a bit more. It should theoretically hurt most at the plantar fascia. If we apply tension to it and put pressure on it with it with the finger versus if we take tension off, we put it on slack and then apply pressure it should hurt less consistently.

When I get a patient with plantar fasciitis, I do this one last test and it is negative. In other words, it shows that the plantar fascia is not the culprits. And then I'll cross references tests with the nerve tests, where we feel and tension and affect the nerves that run into the heel. And those tests become positive. I have to make the call the diagnosis with the patient that the heel pain is not plantar fascia driven. Its nerve driven.

Now this changes everything because if its truly plantar fascia driven, then the treatment is going to look different. Now we have to ask the question of if it's a nerve problem, do we need to be stretching? Do we need to be splinting it? Do we need to be bracing it? Is injections going to help? Is doing a plantar fascia release surgery going to be effective for a nerve problem in the heel?

I always ask the question of, did the doctor that diagnosed you with this plantar fasciitis do these tests? And it's always no because they just aren't aware. It's just not something that they are trained to do or have figured out to do. And I don't expect it of other healthcare professionals. This is our profession as a manual physical therapist. So it's our specialty.

But we can figure out if it's truly more nerve or more plantar fascia or something else, there are issues in the joints of the foot that can also contribute to heel pain. And we looked at that and then there are also a situation where you can have a combination of things. So we have to judge that scenario as well and then make the proper treatment recommendations for the patient moving forward.

But what we'll settle on here is about nine times out of ten, when we get a plantar fasciitis diagnosis here in the clinic, patients coming in saying I saw a doctor, they told me about plantar fasciitis. I googled the symptoms and all over the internet, it says heel pain, limping and swelling or symptoms. So I'm Dr. Google's confirm for me and a real doctors confirm for me and I have the paper here from the doctor saying that I have a plantar fasciitis syndrome, then I'm thinking to myself, I'm not going to I'm going to take this with a grain of salt. I'm going to check it for sure, but let's check the nerves too and other things so that we can know exactly how to treat this.

Now, if it's plantar fasciitis, if it’s true plantar fasciitis, physical therapy treatment is usually focused on improving the arch. Which makes sense, because you want to take pressure off of the plantar fascia using muscles and other structures in the foot to alleviate the pressure on the plantar fascia.

But if it's not plantar fasciitis, and if it's a nerve problem, and we're doing a treatment that's treating plantar fasciitis to better support the arch, we're going to miss the boats and people can experience a situation where they go through physical therapy. Do all the foot and ankle and toe exercises, they typically will do heel raises, calf raises is another name for it, whether tippy toeing, they might do it in different ways, maybe seated to do a live version of it standing to do a harder version of it, with weights to do an even harder version of it, on a foam pad to add a balance aspect to it single legged.

They will do ankle stretches where they stand against a wall and push their heel back and put a stretch to the achilleas in the foot and the heel. They will do toe exercises as well. A common one is where they have to scratch up a towel with their toes, or pick up marbles with the toes, or I've seen some people have to pick up pins or other objects with their toes and it always makes people feel like a monkey because you're having to use your toes like fingers.

It can help to alleviate some of the symptoms, even if it's a nerve driven problem. Simply because we're just getting more motion to the foot and the heel. Motions that haven't been done before. But to truly fix the problem for the long term, so that it's not coming back in three months, or six months or a year, we've got to look at the entire length of the nerves that end up in the heel, and typically it's the sciatica nerve.

One of the questions here is the misdiagnosis that I'm talking about. One of the questions that I have to ask every patient, whenever they come in with heel pain, is do you believe you have, or do you have minor amounts of sciatica or low back pain? Because the nerve that ends up in the heel that is commonly affected, it's a branch of the plantar nerve, which is a branch off the tibial nerve, which is a branch off this sciatic nerve which starts up in the back.

So, do you have pain in your butt area, your thigh, your calf? Do you have any cramping that occurs in the calf and the thigh up in the hip? Do you have any shakiness? Have you had any back problems? Or maybe it's not really painful now but in the past have you had issues?

I'm also looking at the way their back moves, any other muscle imbalances that might be further up the chain. And I'm putting all this together to formulate the best diagnosis which will then lead us to the best treatments. And time and time again, it happens where we find an issue we, find a some sort of back pain, and usually the heel pain is so intense and so limiting that our patients often forget that they have back pain. It's not something that they are worried about.

And if they are on pain medication for the heel, that lower level sciatica pain, or back pain kind of diminishes, and they just don't even think about it. They are completely focused on getting rid of the heel pain. That they just don't pay attention to the back or thigh pain that they've been having. But have to dig there. And then I'll do some nerve tests. And once we do those nerve tests that are biased and tensioning nerves into the heel, if those tests are positive, if they create some sort of symptoms, then it's absolutely a nerve driven problem.

Then the treatment for that is completely different. We're doing some foot exercises, some foot, hands on treatments, that I have to look at the knee, we have to look at the hip, the thigh and the lower back. And oftentimes, we're doing treatment on the low back, hips, and knees in addition to the foot and that's what truly clears up the heel pain. I wouldn't even call it plantar fasciitis at that point.

The last client that we had with this, she came in and she's been having heel pain for a while. She is an active individual. She's in her 60s, late 60s I believe. She loves to do housework, gardening work. She takes care of her elderly mom, who's gone through some health conditions. She is active and wants to vote. She's a grandmother and is trying to spend time with her family. She's not really a couch potato. And she's been doing that for a long time. She helps out her husband with a business and is on her feet quite a bit for that.

So this active individual all of a sudden was put down by this heel pain and she just kind of muscles through it, but it has to grit through pain and discomfort all the time. And the biggest problem she had was when her mother was at her sickest, she's gotten better. Thankfully. Her mother was waking up at night often and our patient would have to get up to go check on her at night often, and it was just killed her, it would hurt her heels so much to have to take those first few steps at 1am and then at 3am, again at 5am again. And so it was just so painful and aggravating.

When you're in that much pain and that much discomfort, you just don't want to get up, you lose focus, you aren't thinking clearly, you want to take medications, you're grumpy. It's just a bad situation. What she found is that wearing shoes helped. It didn't completely take away the pain. Wearing shoes, it had a little bit of a heel helped.

It also didn't take away the pain though. And she tried doing normal physical therapies, she tried doing ice. She hadn't done injections or surgery and thankfully. She tried braces and splints. And it all kind of helped but didn't really solve the problem. So that's why she ended up visiting us. And once she saw us, she was convinced it was plantar fasciitis. A doctor told her it was plantar fasciitis and she's googled it, and it was plantar fasciitis.

She has all the symptoms and when I look at everything on her, I found that she had a significant back condition that is going to put pressure on nerves and can mask a plantar fasciitis symptom, but it really is a nerve symptom. So as we've gone through treatment for a nerve symptom, not plantar fasciitis. She's done phenomenal. Her getting up in the in the middle of the night is less of a problem and getting up in the morning isn't a big deal.

Now where she's at, we're about a little over a month in. She is really only getting pain or discomfort after she's been on her feet after a long day. Which is a great place to be because now it's just a matter of getting stronger in certain muscles. In her specifically, the biggest weakness that she's got wasn't in the foot. It wasn't in the lower leg anywhere near the heel. It was her abdominals. By strengthening her abdominals, what I determined is that we can take pressure off her back, because that's where she's getting the most pressure on the nerve.

So, by strengthening her dominance properly and having her use them throughout the day properly, that alleviates pressure in her back, which unintentionally, the nerves beginning at the roots in her back, which then will allow more nerve freedom all the way down into the heel. So far we've been successful and I know she's going to be fantastic as she continues to strengthen, and then doing her busy, active lifestyle, gardening, taking care of the house, taking care of family members won't be a thing for her. It won't stop her this heel pain.

That's how plantar fasciitis is often misdiagnosed. It's just taken for words from the healthcare professionals that have its heel pain, if it hurts in the mornings, especially if there are some limping or swelling going on. Then it is plantar fasciitis. But it's not dug into more than that simply because most doctors or physicians, foot specialists just are not specialists looking at the nerve aspect of this.

And if you're out there, you have heel pain and you tried the braces, the splints, you've tried taking over the counter pain medication, maybe even prescription strength pain medication, or worse yet, you've had injections or maybe even a plantar fasciitis release surgery, and you still have the problem. I'm willing to bet that you've probably got a nerve problem that hasn't been addressed. And you've been misdiagnosed, unfortunately, with plantar fasciitis when really you have what I call radiating nerve pain. That's what that means.

And no amount of orthotics or insoles will fix this problem either. It'll help, don't get me wrong. I'm not against orthotics or braces or splints. It will help but I'm talking about long term resolution of this problem. We've got to address a number of symptoms and we've got to look all the way up the chain of joints and muscles, and oftentimes it ends up being in the back and the hips.

So that's our podcast episode for today. I hope you learned a lot if you have plantar fasciitis symptoms, heel pain, and you suspect that this problem might need a deeper look into it. You can definitely reach out to us here at El Paso Manual Physical Therapy, and we're happy to talk to you about it to see what can be done about it, if it can be helped, if we're the right people to help you for that.

We can we can begin that conversation. You give us a call at 915-503-1314 and we're happy to hear about your heel pain story and want to learn more about it and see if we can help out. I hope you have the best day ever today. Bye.

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