Our friends at Altrincham Today produce a brilliant periodical featuring local news and reviews. Last issue, our MD Jack Chew debuted the ‘Ask The Physio’ feature which proved popular!

This month we will be answering questions digitally across social media and we’ve decided to add them to this growing FAQs blog.

Julie asked: What’s the best treatment/therapy for plantar fasciitis?

Like many specific diagnoses, an umbrella term is now used to include a variety of conditions that we used to think were distinct. Exit ‘Plantarfasciitis’, enter ‘Planter Heel Pain’. So to treating it! General symptom management involves regular stretching and pain-relieving strategies such as rolling a frozen bottle of water under the affected area and wearing gel heel pads.

Current best-practice aimed at solving the problem involves a detailed look at managing the overall load being put through the plantar fascia and calcaneal fat pad. Also, some breakthroughs have been made in recent years with specific strength training involving a modified calf-raise to transmit forces under the foot to improve load tolerance. More specific techniques such as fat pad taping and shockwave therapy are appropriate in specific cases but, as ever, a thorough examination is the important first step (‘scuse the pun) when suffering with plantar heel pain.

Philip asked: As a polio victim from the early-1950s outbreak here in the UK, is there any exercise I can do to help alleviate post-polio symptoms in the affected arm, shoulder and upper torso muscles?

This is a question we hear on a fairly regular basis regarding polio and other conditions which involve physical deformities and muscle wastage. The simple answer is YES. Especially in recent years we have come to realise that structural deficits or differences from the ‘norm’ needn’t limit pain-free function nearly as much as we previously thought. These are lessons learned from working with Paralympians and Invictus games athletes, as well as a better understanding of how pain and muscle wastage relate to the human nervous system. 

I’ll try not to cop out completely by saying ‘it’s very individually specific’ (though it is!) and give you a clue as to my favourite exercises in such situations. These are large compound movements that target the torso and upper-limbs.

1.     ‘Lawnmower pull’ – Imagine an old-school petrol pull-start mower and simulate that movement with a resistance band. Go light at first and if that is too challenging, break the movement down into parts.

2.     ‘Lift and Press’ – Lift a weight with right hand from the floor infront of left foot, then press to the ceiling. Lift from a chair or only to shoulder height if too difficult, add weight as able.

3.     ‘Bear weight’ – What we call ‘closed-chain-exercises’ are too often neglected in the upper-body. Press-ups are the classic example but are often too challenging, so a modified position on the hands and knees can work well. Bear around 30% of the upper body weight through the arms when on all fours, lift alternate arms out to the side then across the body under the tummy.

Joan asked: What exercise would he advise for Sciatica pain? 😱

The emoji is relevant here! As someone who experienced a particularly difficult bout of sciatica a couple of years ago, that emoji represents my emotions too! ‘Sciatica’ is pain in the distribution of the sciatic nerve (back of the thigh), most commonly caused by nerve root irritation at the lower back. When suffering with sciatica, exercise feels counter-intuitive. The nerve feels angry and in need of rest. Some degree of resolve is required to fight this temptation as exercise has been shown to be good for helping to settle the pain and is essential to avoid a major loss of fitness and function from excessive rest.

Any exercise which feels challenging but not agonising is likely to be good for sciatica, but be mindful that nerve pain can give a latent response to activity so monitor symptoms that night and the next morning to identify a ‘sweet spot’ of intensity and duration. If especially flared up, I tend to advise against end range yoga poses and positions in which the nerve is on a stretch; but even these can offer relief for some people some of the time! The most novel tip that helps many of our sciatica patients is to find a type of aerobic exercise that is tolerable. Some people for example can tolerate flexing over an exercise bike for a work-out, for others, seated weight training at a speed to get the heart going does the trick. Little is known on the mechanism of action for this but cardio-vascular exercise has been shown in multiple studies to greatly help nerve pain regulation.

If even simple exercises or movements are too painful to tolerate, an assessment is greatly advised as it could be that specific medications or investigations are indicated as priorities.

Ceri asked: What advice do you have from someone suffering flu-like symptoms after minimal exercise effort (say 24/48 hrs after the event). With specific regard to myobgobin release and elevated creatine kinase (Krebbs cycle).

There are several reasons as to why such symptoms can manifest post-exercise including some mitochondrial and rheumatological disorders. As you’re mentioning some specific physiological variables and digestive enzymes, it would be clumsy of me to advise on specifics of any case in this context. As a general rule, thorough bloodwork including hormone testing is a good starting off point, then as Physios, we identify how to phase in exercise in a paced manner bearing in mind weekly and monthly workloads.

Should I exercise with arthritis?

Yes you should! In fact, it is THE best thing you can do to help manage your arthritis and to reduce the risk of developing problems in other joints. HOWEVER, I know that this seems a little surprising as arthritis is known to many as being a ‘wear and tear’ process so it is assumed that exercise causes or worsens arthritis by speeding up this ‘wearing out’.

Arthritis is best understood as an internal version of age-related changes such as grey hair and wrinkles. Much like these surface signs, there is a degree of inevitability, significant variation between individuals and plenty of genetic links.

So, think of it this way, the more forces your muscles are trained to take, the better these forces are distributed through your back, hips, knees and beyond. But perhaps most importantly, arthritic pain is clearly linked to many general health factors. Therefore, exercise’s more famous side-effects such as weight loss, heightened mood, sleep regulation and decreased blood pressure will directly help your arthritis.

What type and dose of exercise? Well that’s a question for another day!

But the punchline is that type and dose should be individualised for YOU

My knees make a grinding sound when I squat, are they wearing out?

No they’re not, but I agree that it sounds and feels like it! Our geeky term for this grinding behind the knee cap is ‘crepitus’ and our best description of how it sounds is ‘like crushing crisps’.

The surfaces of the underside of the knee cap, and the groove that it sits within, are naturally roughened with lots of tiny grooves. The joint fluid of the knee is under significant pressure between these two surfaces and as it rushes over the grooves it makes a crackling noise which sounds and feels far more mechanical than it is.

Whilst annoying, this crackling should be largely ignored and certainly shouldn’t stop you doing what you enjoy, including exercise. If fear and dislike of the sound stops you from keeping yourself fit then unfortunately, pain, weakness and other problems could come to join the noises!

Deep, coarse creaking that sounds like a rusty door hinge is a result of a different and much rarer issue and should be assessed by a healthcare professional if accompanied by pain and stiffness.

Like a rumbling tummy, bodily noises are sometimes relevant but more often than not they’re random, embarrassing and forgettable!

How important is the type of footwear for running?

Not as important as we once thought! Not long ago, the scientific and healthcare communities thought that the type of running shoe made a significant difference to both injury risk and performance. This was due to three main assumptions:

1.     Footwear type greatly affects skeletal alignment and therefore running technique. WRONG

2.     There is a textbook running technique that we should all aspire to. WRONG

3.     How flat-footed or ‘over-pronated’ you are should inform shoe choice. WRONG

Great scientific breakthroughs led by Sports doctors, Podiatrists and Physiotherapists have left us in the therapy world regretting many of our previous decisions and the running shoe companies rather frustrated! These assumptions don’t hold up and so instead of worrying about what you should be wearing based on gait analysis and foot shape, COMFORT IS KING once more!

It can be argued though that footwear type is still important, but it’s now important on an individual, not general level so you should wear footwear relevant to your injury history, comfort and functional running needs. So no hitting the trails in slippers just yet!

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