Avin Patel

Plantar Fasciitis

The plantar fascia is a layer of connective tissue on the sole of the foot. When it becomes inflamed, you have plantar fasciitis (PF).

Plantar Fasciitis

Symptoms of Plantar Fasciitis

The bone of the heel is called the calcaneus. PF usually starts with a sharp pain at the front-most tip of the calcaneus. It may be located more towards the inner arch than the centre of the foot, and pain may radiate towards the toes. It may be worse when stretched- so walking can be painful. However, as you continue to walk, it may ease up. Symptoms return after rest.

There are a number of conditions that behave similarly, such as problems with a nerve. Your osteopath can give you a diagnosis at your appointment.

What Happens in Plantar Fasciitis

Fasciitis is inflamation of the layer of tissue between skin and muscle. There is a thick layer of fascia on the sole of the foot (the plantar aspect) which behaves like a tendon to some degree. Plantar fasciitis may begin with micro-tears to the tissue, similar to what happens in a ligament with a minor sprain. This may be an injury associated with sports, or it could be the result of normal ageing and degeneration. The symptoms become more significant if they don’t self resolve. Some consider it a degenerative condition leading to inflammation, rather than an inflammatory condition in itself. This is not to say that there is no way out of it- improving local tissue health will enable better healing.

Sometimes it is called “policeman’s heel” in reference to the repetitive trauma of persistent walking. You may also hear people talk about “heel spurs” in reference to plantar fasciitis, but this is misleading as heel spurs are protrusions made of bone, and not present or relevant in all cases.

Plantar fasciitis is a common injury in runners, but it also affects 10% of the non-athletic population. Onset does not have to be traumatic as such, but wearing unsupportive or restrictive footwear can play a role. Flip flops and high heels are noted as common factors in the development of PF.

Treatment and Advice

Dry needling and acupuncture have been investigated as potential treatment methods, and results suggest that they may provide some benefit. In the same paper, manual therapy was found to be more effective than corticosteroid injections for plantar fasciitis.

PF can take a while to clear up, so it’s worth doing everything you can to help it on its way. Your osteopath can help you with the details, but the NHS recommends avoiding shoes that are tight or lack support, and to limit the time you spend standing.

If you’re suffering with foot pain, book an appointment now.

Meniscus Tears

The main joint of the knee is the hinge joint between the femur (thigh bone) and tibia (shin bone). On the top of the tibia sit two c-shaped pieces of cartilage, called the menisci (singular: meniscus). Their roles are to provide stability and cushion the joint.

Medial meniscus and lateral meniscus

Meniscus injuries commonly happen with a twisting movement while weight bearing. They are relatively common among footballers, as this movement can occur in the planted leg while kicking a ball.

Possible Meniscus Injuries

There are a number of different tears a meniscus can suffer. The type of tear plays a role in determining which symptoms arise. The shape of your tear will likely not change the treatment plan, but the severity may. Straight forward meniscus injuries will probably not be imaged to confirm the exact features of the tear.

Longitudinal and Bucket Handle Meniscus Tears

A tear along the length of the c-shape is called a longitudinal tear. This may be asymptomatic initially, or be indicated only by low level inflammation. One study suggests that around 60% of middle aged people with a meniscus tear do not have symptoms of it. Tears like this where nothing is out of place may be the kind that make up this percentage.

The “bucket handle tear” is so called because the cartilage can flip out, like raising the handle of a bucket. When the cartilage is in the correct position, you may be largely symptom free. When it displaces, there may be unexpected pain or locking on some movements. This unpredictability can make it one of the more annoying injuries to sustain.

Radial and Parrot Beak Meniscus Tears

In contrast to longitudinal tears, radial tears are when the injury cuts into the C shape. If this tear becomes long enough, and begins to tear at an angle, it resembles a beak. By this point, it has become more unstable and is more likely to cause symptoms.

The Unhappy Triad

Alongside a medial meniscus tear, it is not uncommon to also injure two ligaments at the same time. These are the Medial Collateral Ligament (MCL) and Anterior Cruciate Ligament (ACL). This triple injury is known as The Unhappy Triad and is caused by a force hitting the knee from the inside while the leg is planted. Therefore it is often seen in contact sports, but it can happen in other settings. As ligaments are injured, there will be more instability in the knee than a meniscus injury alone.

Management

In the acute phase, your osteopath may want to focus on making you comfortable and reducing swelling. Cartilage is slow to heal because of its poor blood supply, so some swelling is useful to help bring nutrients and immune cells to the area. You may feel like your knee needs to be kept still and rested, but gentle movement is the best thing you can do for the health of the cartilage. It is no coincidence that these injuries often occur alongside osteoarthritis, so managing the health of the whole joint is very important.

The longer term treatment plan will build on the progress made earlier, and focus on rehabilitation. The incidence of meniscal injuries increases as we age, so regular knee treatment may be useful. Keeping the joint healthy and the surrounding tissues strong can only be a good thing.

Your osteopath may have ideas for preventing a recurrence of this injury. Avin has a special interest in sports injuries, so if you’ve sustained a meniscus injury in sport, you’re in good hands. Discussing the nature of the accident itself may highlight things you could change about your sport- such as technique or equipment.

Book in now to get started on your knee pain.

Diastasis Recti

During pregnancy, the abdominal wall separates to make room for the growing bump. This is normal, and it’s not the same as a muscle tear. There is a line of tissue that runs from the sternum (breastbone) to the top of the pelvis called the Linea Alba. This tissue holds the left and right sides of the anterior abdominal wall together. This is still the case in pregnancy- it stretches, it doesn’t break. The definition of diastasis recti is murky, but the general consensus is that it refers to this separation to a significant degree after pregnancy or weight gain.

Diastasis Recti

After giving birth, it takes around six weeks to get through the early healing phase. Immediately after birth, we expect the linea alba to remain stretched, and the bump to still be quite significant for a few days or weeks. As the uterus shrinks back down, the bump does so too- but remember that the uterus is a muscle, and the linea alba is much less elastic. There is no point in assessing for a diastasis until six weeks post partum at the very earliest.

Symptoms of Diastasis Recti

A mild diastasis can go unnoticed for years, especially because it is a topic we don’t hear much about. The clearest sign is “doming” of the abdomen when under pressure. It’s easiest to spot during actions like performing a sit up.

The doming will be in the same area as the diastasis, which could be anywhere along the length of the linea alba: the bottom of the breast bone to the pelvis.

There may also be a link between pelvic floor issues and diastasis, although the research is inconclusive. The pelvic floor is under a lot of tension in pregnancy, and can be injured during birth. Added instability in the nearby abdominal wall may add extra pressure to the area. If this is suspected, we can refer you to a specialist to help.

Research is also inconclusive about the link between diastasis and lower back pain. Contrary to popular belief, there is no clear link between “core strength” and back pain either.

Testing

Your osteopath can test you for a diastasis. They may ask you to lay on your back with your knees bent and tummy exposed. When you lift your head, engaging your abdominal muscles and increasing intra abdominal tension, there may be visible doming. They may also want to feel along the linea alba as you do this. This allows them to assess the length, width, and depth of the diastasis.

Management

For all but the most severe or complex cases, a diastasis can be managed with exercise. Your osteopath can help you develop an exercise routine that suits you. They will take into account the different actions of the various layers of muscles, and avoid any exercises that put too much pressure on the abdomen. With these points in mind, sit-ups and crunches are generally not recommended for people with diastasis recti.

It may be the case that there is always a vulnerability at the point of your diastasis, or it may be that the separation never totally heals. But what we’re aiming for is an abdominal wall that is strong enough to function well. When the gap becomes more narrow than two finger widths, some definitions would say that you no longer have a diastasis.

Book now to assess and manage your diastasis.

Ergonomics

We often talk about the patterns of dysfunction we see in our patients who are stuck at a desk all day. Hunched shoulders with tight pectoral muscles, and stiff upper backs are a couple of the most common ones. But we know that for a lot of people, working at a computer is unavoidable, and even moving to a standing desk does not resolve all problems. Looking at your ergonomics is a good place to start.

Typical Desk

Chances are, if you have to work at a computer you have a traditional desk and office chair. If you work from home, hopefully you have a table and chair to work with, but maybe you’re perched at the breakfast bar or even working from the sofa. There are improvements we can make in the way you sit, and possibly in your hardware too.

“Ergonomics” is a word thrown around a lot, and although it might sound like a definitive answer, really it just refers to a set of guidelines. A desk that is perfectly set up for one person will not suit another. Even a desk perfectly set up to ergonomic guidelines might not be the best for you- be prepared to make changes to get it just right.

Basic desk ergonomics

Desk Ergonomics Guide:

If you sit in an office chair to work at your computer, you can get started with these points:

  • Make sure your feet are supported. If you can’t reach the floor, find something to put under your feet. A small box or pack of printer paper might do. When your feet are unsupported, there is more pressure on the back of your thighs from your chair, which can cause leg or knee pain.
  • Ideally, you want your hips to be at just over 90°. This won’t be possible in some chairs, but could be something to aim for if you’re out to buy a new one. You may be able to adapt flat-seated chairs with a small pillow.
  • If your chair has arm rests, try to put them to the same height as the desk. You might have them slightly lower so you can tuck the chair under, but this encourages pressure on your wrists from the desk. This in turn could lead to carpal tunnel syndrome.
  • Ensure that the arm rests support your forearms at natural elbow height. To meet both this and the previous guideline, you may have to elevate the whole seat.
  • The top of your screen should be at eye level or just above. This discourages you from dropping your head to look down at the screen, putting strain on the neck.

The Ideal Chair

The best possible office chair will almost certainly have a lot of moving parts. To follow the above guidelines, you need a chair that can have its arms adjusted to the height of your desk. Rather than directly changing the arm height, this may be best achieved by changing the height of the whole chair. Raising the arms may cause you to hitch your shoulders up, which can lead to shoulder and neck tension.

If possible, the arms of the chair will only be half length too. This allows you to get close to the desk and use the keyboard without having to sit on the edge of your seat.

Make sure there’s no padding in strange places. Some office chairs have extra support for the upper back, which pushes forward on the part of your back that sticks out most. Similarly, a high-backed chair with cushioning at the back of your head will also push you too far forward. Padding in the small of your back or neck is more likely to complement the natural position your body wants to take.

Standing Desk Ergonomics

Many of the above guidelines ring true for a standing desk. You still want to have your screen at the right height to keep your head in a neutral position. Your shoulders still need to be relaxed, and you want to avoid pressure on your wrists.

If you are transitioning to a standing desk, it might be easiest to spend a bit of time standing and the rest sitting to begin with. Changing your whole day’s activity from sitting to standing is a significant shift for your body to manage. You may also want to look at “anti-fatigue mats” for standing desks. These may prevent foot pain and any compensations you make further up to make that more comfortable.

A standing desk doesn’t necessarily need to be ruled out if you work from home. Rather than buying a whole new piece of furniture, you can pick up a standing desk converter. This simply raises the screen and keyboard so you can keep using your original desk or table.

Movement Above All

Ergonomics is a good start, but the real solution is to keep moving as much as possible. Anything from moving your printer to the other side of the room or making sure you get up for a drink every half an hour or so will make a difference. Importantly, you need to keep moving at your desk itself too. If you sat in a perfectly ergonomic position for 8 hours straight, you definitely wouldn’t be comfortable. It’s alright to lean into one side for a bit, then cross one leg over the other, then hunch forward. In fact, this cycling through “bad” postures is probably less likely to cause you aches and pains.

More movement gives the body less of a chance to build these patterns. For the residual issues, we can treat you as they appear or we can get into a regular treatment routine.

Book now for treatment of work-related aches and pains