More On Your Nerves

In part one of this series I highlighted the connection between the Nervous System and the Immune System.   Previously viewed as two separate entities, these can now confidently be viewed as one interconnected system.  However it is this exact relationship that influences the physical capacity of our nerves and driving the neural symptoms often experienced in the arms and legs.  In part two, we will discuss neurodynamic testing as a tool to evaluate these physical capacities and how they may be restricting our movement patterns.

It may be surprising, but our neural structures are the most resilient human tissue we have.  Think about how adaptive they must be in real time. Every step we take, door we open, or Saturday night dance move we bust is only achievable because our nerves are able to efficiently adapt.  If our nerves did not glide, lengthen, and shift none of this would be possible without eliciting neural tension. A happy nerve demands, blood flow, space, and movement to function optimally and the restoration of these is fundamental to treatment.  

But how do you know which is needed?  Insert neurodynamic testing.

To be effective with neurodynamic testing there has to be an understanding of the science between normal neural mechanics and neural physiology.   In other words, neurodynamics assess and treat the physical health of the nervous system. When pathology exists in either the mechanics or physiology of a nerve it can disrupt the conductivity of the nerve making the communication between the nerves, brain, and muscles inefficient.  This can be difficult to treat effectively, if not identified correctly. However the use of neurodynamic testing intentionally positions and loads a nerve to help communicate where the dysfunction is stemming from.  This testing thereby identifies the capacity of a nerve to slide, glide, angulate, strain or compress efficiently.  

* Fun fact:  A peripheral nerve can lengthen approximately 12-20% to accommodate normal movement, while the spinal cord can elongate nearly an inch!  So, those tight hamstrings may not be due to muscle tightness, if you have symptoms into the legs, it could be a restriction within the nervous system.

Neurodynamic tests are thus designed to bias neural elements more so than the surrounding interfaces. This intentional loading of a specific nerve root, trunk, and localized region of the spinal canal, and/or sympathetic nervous system allows us to grasp a deeper understanding of where the symptoms are being generated from to treat the cause rather than the symptom.   

Here is a video from David Butler to help further explain how our nerves move!  Check it out.

Stay Well, Stay Strong

Keaton

Practical Stress Management: Part 2

If there is one aspect of life that is often undervalued and under-appreciated it is sleep.  Our ability to sleep is essential to allow a full resolution of pain and restoration of our movement.  Our ability to sleep can be correlated to how our nervous system is being activated. We have 2 parts of our nervous system:  sympathetic and parasympathetic. You see, when we are experiencing pain our nervous system becomes sensitized and preferential to the sympathetic nervous system.  Now when this is the case you will see a rise in heart rate, blood pressure, respiration rate, and even anxiety. Sound familiar on those sleepless nights? You can loosely think of this activation of the sympathetic nervous system as if you drank a large cup of coffee or an energy drink right before bed.  Most people would not choose to partake in such behavior because they would be up all night. This is the exact case for many of those who have had or are currently in a pain-cycle however it isn’t perceived as such. People who are experiencing sleep disturbances or find it difficult to become comfortable at night, please realize that the solution is on the other side of the nervous system:  parasympathetic. There are numerous things we can control or change in the activities leading up to bed as well as with the sleep environment that will allow the parasympathetic nervous system to be tapped into.

According to the National Sleep Foundation, sleep hygiene is considered to be a variety of different practices and habits that are necessary to have good nighttime sleep quality and full daytime alertness.  Sounds great, but what does this have to do with resolving pain and improving movement? Well, consider sleep as the foundation of your health and stress management. By purposefully improving sleep hygiene you are taking a step in regaining control of your life.  Here’s how to do it:

1. Be regular and consistent with the time you get up.  

That’s right when you get up opposed to when you go to sleep.  The reason is that this will allow you to improve your sleep efficiency, the ratio of time in bed asleep opposed to in bed and awake.  The first couple of days may be rough and you may feel fatigue during the day, but this should be reflected on the back end of the day because you will feel tired sooner and be able to determine your ideal bedtime.  I guess you can say we are trying to reverse engineer your bed time.

2. Don’t oversleep.  

Many people live by the idea that they can go on little to no sleep during the week and make up for it on the weekend.  This is not the case. You cannot make up for your accumulated weekly sleep debt by sleeping in on the weekends or days off.  What you are actually doing is setting yourself up for increased grogginess and fatigue throughout the day, which in turn could increase tension and amplify your aches and pains.  

3. Create a positive psychological association with the bedroom.  

The purpose of a bedroom is two-fold:  sleep and sex. If you currently reading, watching television, drinking a cup of tea, etc. before bed, work to try to move these activities to somewhere outside of the bedroom and prior to being ready for sleep.  To perform these activities it requires an increase in alertness and attention, which are both associated with wakefulness and thus an increase in sympathetic activity.

4. Substance avoidance:   alcohol, nicotine, or caffeine.  

Alcohol is often regarded as the ideal nightcap beverage given that it is a depressant.  This is true that it is a depressant, but what is often missed is that alcohol causes us to fall asleep faster than we normally would thus miss out on a portion of our REM (radpid eye movement) cycle.  This is important because disruption of the REM cycle can alter the entire sleep-wake cycle and associated hormonal releases that help you both function and recover when injured.

With regards to nicotine and caffeine, they are both stimulants and will make it difficult to fall asleep.  Now if your thinking I drink a cup of coffee before bed every night and don’t have any changes in my ability to sleep.  I am here to tell you that this is likely due to you already being sympathetically driven and in need of a shift into more parasympathetic activity.  Take the caffeine away and see if you notice a difference.

5. Can’t sleep, GET UP.  

If you lay in bed unable to sleep for more than 20-30 minutes get up and perform some form of relaxation:  meditation, breathing exercises, etc. Once you feel tired again return to your bedroom and go to sleep. The goal here is to keep the positive association with your sleeping environment.  

6. Get rid of all your thoughts and worries.  

A lot of people ponder their to do list for the next day or revisit a stressful part of work day that happened this only achieves a rise in heart rate and blood pressure.  Take the 3-5 minutes before going to bed to let it all out in a journal so you can clear your mind before you sleep.

7. Create a sleeping environment.

Try to implement 1 or more of these sleep environment changes to optimizes your quality of sleep once you fall asleep.  

I hope these help you understand and appreciate the role of sleep in our ability to not only manage stress in our lives, but how it can facilitate an improvement in function.  In the next post we will visit the ever controversial topic of nutrition.

Stay Well, Stay Strong, 
Keaton

References:

1. Chouchou, F. and Desseilles, M. (2017). Heart rate variability: a tool to explore the sleeping brain?.

2. H. Craig Heller, P.  (2017.) https://www.thegreatcourses.com/.

3. Hartman, B.  (2017). All Gain, No Pain.

4. sleepfoundation.org.  (2017).  Sleep Hygiene.  [online] Available at:  https://sleepfoundation.org/sleep-topics/sleep-hygiene [Accessed 21 Oct. 2017].

Practical Stress Management: Part 1

Recently we have highlighted the impact that stress can have on our breathing pattern as well as our movement, but how do we effectively manage stress?  This is the first in a 4 part series emphasizing specific behaviors that can optimize stress management. In this post we will discuss the importance of establishing a morning ritual to help set up a day for success.  This will be followed by sleep optimization, nutritional support, and concluded with the benefits of consistent exercise.

Let’s jump into learning the importance of a morning ritual.  This will be the easiest of the four pillars to implement into life immediately.  

What is a morning ritual?

First, I believe that we have to define, ritual.  A ritual, typically associated with religious beliefs, can be viewed secularly as an order of actions arising from convention or habit to support a goal.(1)  It is likely that most, if not all, of us already have some form of a ritual each morning. But is it setting a foundation for success? The key component of a ritual should be the freedom of thought.(1)  We should not have to think about what our next action will be. This is wasted energy and will ultimately lead to fatigue during the day. The brain is only about 2% of our bodyweight, yet it consumes an astounding 25% of our glucose energy supply.(2,3)  In other words, if we reduce decision-making fatigue we can reduce the onset of early morning stress.

Why have a morning ritual?

By reducing morning stress we in turn allow our actions to become more goal oriented whether in regards to movement health, career health, or family health.  I have noticed since implementing my own morning ritual I have been able to restore what I call my daily-margin. If we think about the margin in a book or on a piece of paper, we recognize there is only a finite amount of space.  Now apply this to a day where in today’s society we are jam packed from sunrise to sunset with checklists for our checklists. Ever heard there isn’t enough time in the day? There is no margin. The words we are writing on our piece of paper is our daily stress.  We can only accumulate so much each day before we are maxed out and start developing health complications. Obviously, this is not an ideal situation. When stressed we are less adaptable when faced with stressors that actually matter. Implementation of a morning ritual can be our first offensive tactic to reduce stress at the front end of the day and allow us to tolerate stress in a better way.(4)  

What is my morning ritual?

1. 4:05AM  Wake up and drink a bottle of water
2. 4:10AM Make a cup of Neuro Coffee (best coffee available, no joke! Check it out.)
3. 4:15-4:45AM Read daily bible scripture and meditate on the day’s teachings.
4. 4:45-5:00AM Daily Movement Hygiene
5. 5:05AM Make wife coffee and leave for gym
6. 5:15-6:30AM Workout
7. 6:30-7:00AM Eat, shower, and get to work

What is your morning ritual?

Stay Well, Stay Strong,
Keaton

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References:  

1. Hartman, Bill, ALL GAIN, NO PAIN: The Over-40 Man's Comeback Guide to Rebuild Your Body After Pain, Injury, or Physical Therapy.  William Hartman. 2017.

2. Kuzawa CW, Chugani HT, Grossman LI, et al. Metabolic costs and evolutionary implications of human brain development. Proc Natl Acad Sci USA. 2014;111(36):13010-5.

3. Esch T, Stefano GB. The neurobiology of stress management. Neuro Endocrinol Lett. 2010;31(1):19-39.

4. Swenson R. Margin, Restoring Emotional, Physical, Financial, and Time Reserves to Overloaded Lives. Tyndale House; 2014.

Understanding The NeuroImmune System

The nervous system is truly the most incredible and adaptable biological system ever created.  The nervous system is an intelligent design composed for bidirectional biological communication to ensure survival.  I was fortunate enough to attend a course, Mobilization of the Neuroimmune System, this weekend to enhance my understanding of how to best recognize and approach a comprised nervous system.

Weekend Takeaways:

1. The immune system heavily influences the nervous system
2. Neurodynamic tests assess the physical capacity of the nervous system
3. Active treatment is more than just moving it also includes breathing and learning.
4. The type of biological container implicated matters for treatment approach
5. "Rehab exercises" are not as much about strength as they are about homuncular clarity

In this post I want to explore the first take away to help illustrate briefly how the nervous system and immune system are related.  

The Immune System Heavily Influences The Nervous System:

We got the weekend started by diving deep into the neurobiology of the nervous system and its relationship with the immune system.  Traditionally these two systems have been viewed as separate entities, but that view is now stale, especially when pain enters the picture.  It would now be appropriate to view the nervous system as a neuroimmune organ. Have you ever wondered why you get a whole body ache when you are sick?  Or why your musculoskeletal pain worsens when sick? What about why your pain increases with a weather change? Each of these are due to an elevated neuroimmune system response based on past experiences.  The immune system is a system that knows who you are and will intervene whenever you are not yourself. The immune system is very efficient as there are nearly ten times the amount of immune cells than there are neurons (nerve cells). This is a beautiful and efficient design for protection.

Unfortunately the initial response of the nervous system tends to be inflammation and a painful experience because they are most effective at altering behavior and reducing an imposed threat.  But why does this occur with something as simple as a weather change or going on a walk? Well, the human brain never forgets. It has an amazing capacity to remember and store memories within the hippocampus.  When memories are stored so are the emotions and the environmental context of the time. So when an event or environment is encountered the body will recall memories, the associated emotions, as well as the environmental context to predict an appropriate outcome.  If there was a harmful experience in the past you may trigger an immune response. How? Interestingly enough, your emotions are derived from the amygdala and memories, the hippocampus, both of which are immune system mediators. This means that your past experiences can trigger immune responses and dictate how the nervous system responds.

How the nervous system responds is dependent upon the pathobiological mechanism, or how the brain processes the incoming information.  There are two types of mechanisms: pain and tissue. The pain mechanism tends to be related to central processing and viewed as a top-down process.  When this occurs there has become alterations in the central nervous system causing the brain to become too protective with its’ predications. There has become a belief there is more danger than there is in reality.  Danger will evoke F.E.A.R (false evidence appearing real). Remember your emotions can trigger an immune response even if unnecessary. This in turn begins to make your nerves more sensitive and more irritable for the future.  

Tip:

Often you can determine if there is a central processing issue by placing a hot pack on a painful region.  If you think about it from a physiological perspective this should increase inflammation and make you feel WORSE!  So if heat feels good be thankful because the tissue you think is damaged is likely not as bad as you think!

The tissue mechanism is related to peripheral processing, or a bottom-up process.  This is the typical process during an acute injury and follows the predictable stages of healing.  When a tissue is injured inflammation is sent locally to start the healing process. This inflammation triggers the neuron to fire a signal to the brain. If pain is the output, inflammation will be sustained to allow the tissue to heal.  Remember inflammation is a protector. So when inflammation persists it will reduce the firing threshold of the neurons, making it easier for them to be triggered. This prevents you from further tissue damage, but makes you more likely to experience pain with normally non-painful activities.  Interestingly though this is not just an acute scenario. Once you have healed completely, your body will leave some resident immune cells in the previously injured area just in case. This is why your body can remember your pain so well and allow a “relapse” to occur. Remember the brain never forgets and always predicts.

Tip:

We do not have pain receptors!  We have nociceptors that send a signal to the brain where it is decided whether or not pain is the appropriate response.  This is why tissue damage and pain rarely correlate!

That being said, deciphering if it is a pain or tissue mechanism is not as simple as placing a hot pack and seeing what happens.  Central and peripheral processes occur simultaneously, but which is the dominant player is the critical aspect. In part 2 of this series I will review how the use of Neurodynamic testing can help to illuminate the physical capacity of the nervous system and guide this clinical reasoning process.

Stay Well, Stay Strong

Keaton

Understanding The Airway Part 2

 In Part 1 we discussed the airway and how it relates to the stress response at a general level.  In part 2 we will discuss the airway at the level of the head and neck and how that affects stress and posture.  The primary factors we will look at are Jaw position/bite, tongue position, and the nasal cavities.

The human body is very sensitive to the size of the airway.(1)  The size of the airway dictates the brain’s perception of the environment as being safe or threatening.  A small airway can result in a sensitive stress response as the oxygen demand will more quickly exceed the supply.  Factors such as whether or not a child was breastfed and for how long, when a child was started on hard foods, and if a child uses a pacifier can all be related to the development size of one’s airway.(2,3,4)    First, let’s talk about jaw position.

Jaw Position:

Research has been found that it only takes a two mm shift in jaw position to cause or alleviate sleep apnea.  This is important because sleep apnea, which can lead to a state of low oxygen in the body, is commonly found in individuals with pain complaints.(5,6,7,8)  A state of low oxygen is a massive stressor to the body.  

Tongue Position

If a small shift in jaw position is enough to affect sleep and the airway, tongue size and position is important as well.(9)  Tongues that are restricted because of tongue ties, tend to fall back in the airway easily especially during sleep.(10)  Restricted tongues also affect development of the airway too.  Larger tongues are more likely to fall back and block the airway during sleep.(11,12)  The reason a tongue is large is often linked to how it is being used.  Tongues can become large when allowed to relax and muscle tone is reduced.  However, a tongue that is applying light pressure to the hard palate behind the incisors will actually take up less space and open up the airway.(12)  The caveat is that the tongue cannot do this alone.  It requires nose breathing.

Nasal Cavity

The nasal cavity is extremely important in regards to the airway.  For instance nose breathing in and of itself helps to reduce blood pressure and decrease muscle activity that leads to shoulder and neck tightness.(13,14)  A deviated nasal septum or a hole in the nasal septum is also a potential factor in air way obstruction.

There are many factors related to airway obstruction and how the airway is related to pain complaints.  In this article we addressed three evidence based factors related to the airway and musculoskeletal pain.  Though it is not always a requirement to have “ideal” tongue posture, jaw position, or nasal cavity, it can be important to consider each of these as possible factors related to pain complaints especially when one has had no results or recurrent episodes of pain complaints.  

As always, take care and breathe easy!

Dave

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References

1. Izuka EN, Feres MF, Pignatari SS. Immediate impact of rapid maxillary expansion on upper airway dimensions and on the quality of life of mouth breathers. Dental Press J Orthod. 2015;20(3):43-9.

2. Brew BK, Marks GB, Almqvist C, Cistulli PA, Webb K, Marshall NS. Breastfeeding and snoring: a birth cohort study. PLoS ONE. 2014;9(1):e84956.

3. Page DC. Breastfeeding is early functional jaw orthopedics (an introduction). Funct Orthod. 2001;18(3):24-7.

4. Howard CR, Howard FM, Lanphear B, et al. Randomized clinical trial of pacifier use and bottle-feeding or cupfeeding and their effect on breastfeeding. Pediatrics. 2003;111(3):511-8.

5. Nijs J, Loggia ML, Polli A, et al. Sleep disturbances and severe stress as glial activators: key targets for treating central sensitization in chronic pain patients?. Expert Opin Ther Targets. 2017;21(8):817-826.

6. Köseoğlu Hİ, İnanır A, Kanbay A, et al. Is There a Link Between Obstructive Sleep Apnea Syndrome and Fibromyalgia Syndrome?. Turk Thorac J. 2017;18(2):40-46.

7. Silva A, Mello MT, Serrão PR, et al. Influence of Obstructive Sleep Apnea in the Functional Aspects of Patients With Osteoarthritis. J Clin Sleep Med. 2018;14(2):265-270.

8. Martinot JB, Borel JC, Cuthbert V, et al. Mandibular position and movements: Suitability for diagnosis of sleep apnoea. Respirology. 2017;22(3):567-574.

9. Yoon AJ, Zaghi S, Ha S, Law CS, Guilleminault C, Liu SY. Ankyloglossia as a risk factor for maxillary hypoplasia and soft palate elongation: A functional - morphological study. Orthod Craniofac Res. 2017;20(4):237-244.

10. Harvey R, O'brien L, Aronovich S, et al. Friedman tongue position and cone beam computed tomography in patients with obstructive sleep apnea. Laryngoscope Investig Otolaryngol. 2017;2(5):320-324.

11. Barrera JE, Pau CY, Forest VI, Holbrook AB, Popelka GR. Anatomic measures of upper airway structures in obstructive sleep apnea. World J Otorhinolaryngol Head Neck Surg. 2017;3(2):85-91.

12. Hwang DM, Lee JY, Choi YJ, Hwang CJ. Evaluations of the tongue and hyoid bone positions and pharyngeal airway dimensions after maxillary protraction treatment. Cranio. 2018;:1-9.

13. Gelardi M, Abbattista G, Quaranta VN, et al. Standardization procedure for the nasal nitric oxide measurement method using Niox MINO® and the tidal-breathing technique with velum-closure. J Biol Regul Homeost Agents. 2016;30(3):853-858.

14. Ip MS, Lam B, Chan LY, et al. Circulating nitric oxide is suppressed in obstructive sleep apnea and is reversed by nasal continuous positive airway pressure. Am J Respir Crit Care Med. 2000;162(6):2166-71.

What’s Driving Your Foot Pain?

Heel pain or foot pain can be one of the most debilitating conditions for an individual.  We are designed to operate in a bipedal state. Whether we are standing, walking, running, or jumping, we are meant to be on our feet. But what happens when we experience heel or foot pain and we can’t tolerate these activities?  

Often blamed is the plantar fascia, the broad triangular connective tissue, anchored at the medial aspect of the calcaneus (heel) that spans down to the toes.  Its role is to act as our first shock absorber that dissipates ground reaction forces as we move throughout our environment.  It secures the infrastructure of the foot by supporting the medial longitudinal arch, making it an essential feature for optimal foot health.  But I am here to tell you, plantar fasciitis, is not just a foot issue.  Actually, it rarely is.  Only about five percent of cases don’t resolve conservatively and require surgical intervention.

The plantar fascia plays a big role in our gait efficiency, but so does our pelvis and thorax.  Do these structures function independently of each other?  No, but they do influence one another.  Our proximal dysfunction can actually drive our foot symptoms.  We tend to hurt at our weakest point and not at the point of dysfunction.  This is where most treatments are lost.  It hurts at “X” so let me rub and massage “X.”  Treatment becomes myopically focused on tissue/structure and “damage” rather than addressing the underlying mechanism.  

We need to understand pain isn’t bad and it doesn’t necessarily equate to the degree of tissue damage.  Pain is a perceptual response to a threat.  It protects our bodies by telling us something isn’t right and we need to change a behavior to reduce said threat. 

Now this doesn’t mean we ignore the foot or negate manual therapy application.  It means there has to be an appreciation for the interconnected nature of our body to guide intervention.  

This is why it is important we take a step back from the typical local perspective and appreciate the global perspective that yields a lot more as we recognize both intrinsic and extrinsic risk factors for plantar fasciitis.

It starts at a societal level. Today is all about being able to do more, when in reality we don’t have the capacity to do so.  We, as a people don’t know how to handle more because we don’t have effective stress management strategies. The literature is reporting the highest levels of chronic stress, fatigue, and anxiety and with this comes more chronic flight/fight, or sympathetic nervous system activity.  This is the same part of the nervous system that becomes active when we experience pain.  Coincidence? I don't think so.  Our bodies can't distinguish between stressors. They simply interpret and react to ensure survival.  First order of importance when stressed, shift metabolic resources and assume a survival posture.  It is this stress response though that influences the intrinsic risk factors associated with plantar fasciitis:  big toe mobility, ankle dorsiflexion, calf muscle “tightness”, and hip motor control.  

As our posture changes to a more extended form, we will see backs that are over extended, rib cages elevated, pelvic girdles dropped forward, and calves with an increase in tone.  All of this will inherently limit our movement variability and subsequently overload our feet each step we take.  This survival posture, thus increases the metabolic demand of the plantar fascia.  It alters the function of the big toe and ultimately the windlass mechanism, which is crucial in preventing our arch from collapsing during the mid-stance of gait.  As we achieve a mid-stance position, our plantar fascia tightens thereby pulling the big toe into extension and enhancing ankle dorsiflexion.  When efficient, it will prevent excessive foot pronation (arch collapse), which is present in 81-86% of plantar fasciitis cases.  It truly is a chain effect.   

The chain continues as we move up to the hip.  Our motor control of the mid-stance position is a reflection of foot and hip integration.  However control becomes increasingly difficult the longer we remain overly extended.  This posture poorly positions hip musculature and unfortunately sets the stage for compensation at the first opportunity, the foot.  Our foot is not only the first intimate interaction with the environment, it is our first chance to respond to it.  However, if we don’t have the proximal orientation of the hip and pelvis, we can’t expect our foot to respond efficiently.  Don’t believe the hip has an influence?  Try this. Stand-up without shoes and watch what happens when we squeeze/tighten our butt.  THE ARCHES LIFT!  Every bad foot can be controlled by a good hip.  Our hips and pelvis have a powerful influence over our feet and must not be neglected in the rehabilitation process.

So here is the relevance of this matter.  

Currently 10% of the general population will develop plantar fasciitis in their lifetime and it will most often occur during occupational years.  Given that these years have proven to be the most stressful, we will be more prone to living our lives in a survival posture and thereby overloading our feet.  If left unchecked, we could miss work, lose out on wages, or experience a reduction in work productivity.  Outside of our work field, it could generate fear-avoidance behaviors to avoid the pain experience.  In turn, we reinforce bad behavioral choices and potentially elevate our stress.  Now we are in a pain-cycle searching for a way out.  

The way out of this cycle is not only addressing the aforementioned intrinsic risk factors through position, but also by addressing our extrinsic risk factors.  

As mentioned earlier, pain is an indication we need to have a behavioral change, most notably our extrinsic factors:  poor footwear, prolonged occupational weight bearing, and large increases in activity level.

All extrinsic factors are easily modifiable, but usually hard to adhere too, especially when it comes to our footwear.  Poor unsupported footwear such as; heels, sandals, flats, and some work boots don’t provide enough sensory input and end up reinforcing poor intrinsic factor development.  Despite knowing the benefits of footwear, people still struggle for various reasons:  work, financial, etc.  This is why orthotics are often sought after by the public.  Belief is that an orthotic can be the fix for poor footwear.  This may or may not be the case, but regardless it shouldn’t be the first line.  Establishment of an effective home exercise program has been shown to be just as effective when addressing the underlying mechanisms.  This should be our first line.  

The physical stress of being on our feet also cannot be overlooked, which is why prolonged occupational weight bearing is a risk factor that needs to be considered.  If we are on our feet 40+ hours week for 20 or 30 years straight, we are accumulating a lot foot stress.  Research shows walking just one mile a foot can endure nearly 60 tons of stress.  We need to have efficient foot posture and mechanics to withstand this amount of stress over the long haul.

Relating to tissue overload, large increases in our activity level can also increase our susceptibility to plantar fasciitis.  Although our bodies are adaptable they are more concerned with survival.  So if we make too large of a jump in our exercise regimen, intensity or duration, our body will let us know.  Thus, a strategic application of physical activity to control the purposeful stress of exercise is needed to allow the body to best adapt without any repercussions.  

So to recap, plantar fasciitis is not just a foot issue.  It is a multifactorial issue that demands respect of the body’s natural design.  Proximal dysfunction is most likely the offender and the foot the victim.  The success of treatment hangs on the ability to identify and address all intrinsic and extrinsic factors that are working against our feet.  And the good news?  Most of these risk factors are modifiable.  We are in control.     

Stay Well,
Keaton

References:

1. Ratey JJ. Spark, The Revolutionary New Science of Exercise and the Brain. Little, Brown; 2013.

2. Rathleff MS, Mølgaard CM, Fredberg U, et al. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scand J Med Sci Sports. 2015;25(3):e292-300.

3. Sapolsky RM. Why Zebras Don't Get Ulcers, An Updated Guide to Stress, Stress-related Diseases, and Coping. 2004.

4. Tahririan MA, Motififard M, Tahmasebi MN, Siavashi B. Plantar fasciitis. J Res Med Sci. 2012;17(8):799-804.

5. Thompson JV, Saini SS, Reb CW, Daniel JN. Diagnosis and management of plantar fasciitis. J Am Osteopath Assoc. 2014;114(12):900-6.