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Plantar Fasciitis-Symptoms, Causes & Treatments

Here at the clinic, we see plenty of patients suffering from heel pain. They almost always have a similar story:

I have an extremely painful sensation right on the heel of my foot

My pain is always there in the mornings, and after I do any activity!”

I’ve had to stop my running because I just can’t bare the pain

The pain seems to ease as I move but it kills me immediately after”

If I sit at my desk for an hour or so, then get up to move I can’t walk with the pain in my heel!

All of these complaints are those you would expect from somebody suffering from Plantar Fasciosis. You may have heard of this frustrating condition before – especially if you are a runner or work on your feet a lot.

What is the Plantar Fascia?

The Plantar Fascia is a flat band of tissue that connects your heel bone to your toes and supports the arch of your foot.

What is Plantar Fasciosis? Is it the same as Plantar Fasciitis?

Plantar Fasciosis is an overload injury of the Plantar Fascia. It is the degeneration of your Plantar Fascia. This condition has historically been called Plantar Fasciitis because it was believed that Plantar Fascia inflammation was the principal underlying cause. Plantar Fasciosis is a more accurate name for this condition because it involves degeneration of your Plantar Fascia, not inflammation.

Why me? The causes of Plantar Fasciosis

It is very common in runners due to the repeated stress being placed on the fascia – can sometimes be linked to poor running technique but more often than not the process of doing too much too soon is enough to overload the fascia. Plantar Fasciosis is very common among beginner runners who might go from doing no running at all straight into a 5km run.

This is too drastic of a change for the body to handle in such a small space of time and the plantar fascia isn’t used to this amount of stress and becomes irritated and painful.

The One Thing You Should Be Doing

Before I go into detail about all the different treatment options available that don’t work, let me tell you the ONE thing that has been proven to provide long-term relief of this frustrating condition. We need to treat this injury how we would treat a tendon injury – reintroducing load to it. Loading has to be gradual, as too much too soon can only aggravate things, I have attached a video below with some later stage exercises you can do at home to get long-term relief from your heel pain.

Common Treatment Options – What Works And What Doesn’t

Steroid Injections

Whilst steroid injections can provide symptom relief, this is usually only a short-term solution. A 2012 study published in the British Journal of Sports Medicine showed that steroid injections would give temporary relief to one out of three patients, and this relief is unlikely to last beyond 4 weeks. Steroid injections can also be dangerous – they can lead to cell death and a potential rupture of the Plantar Fascia.

Shockwave Therapy

Shockwave therapy has been shown to have some promising results but has failed to show any consistent benefits. It has not been proven to cure Plantar Fasciitis in the long term, and can often only provide short-term relief. There are much cheaper, more effective treatment options available.

Custom Orthotics

Orthotics can sometimes help with symptom relief, and the off-the-shelf ones can be as effective as the expensive custom-made ones. Studies have shown that heel pads/gel inserts are just as effective, if not more so than expensive custom orthotics.

Stretching

Studies have shown that those who stretch their Plantar Fascia and their calf muscles have a greater decrease in pain than those who don’t. However, stretching has been shown to only provide short-term relief.

Anti-inflammatory Drugs

Anti-inflammatory drugs have been shown to provide relief in the initial stages of the condition when there may be some inflammation present. However, we now know that this is not an inflammatory condition. After the early stages, it is an overloading condition that can cause degenerative changes to the plantar fascia, which anti-inflammatory drugs will not help as there is no inflammation.

6 Tips for Plantar Fasciosis

  1. Stretching: Stretching of the plantar fascia and/or calf muscles can provide some people with relief! Try to gently stretch your calf and plantar fascia twice a day and you might see some benefits.
  2. Gel inserts/Heel pads in your shoes: These heel pads can be bought at a relatively low cost compared to more expensive custom orthotics and have been shown to be just as effective – give it a go and see if you feel the benefits.
  3. Ice: Applying ice or heat to the Plantar Fascia has been effective in reducing symptoms short-term in a handful of patients but is not guaranteed to work for everyone. You could start by rolling your foot on a frozen water bottle for 10 minutes every few hours and see if it helps you. Remember to put a towel between your skin and the bottle to avoid ice burns.
  4. Night Socks: There is a range of night socks available – some more comfortable than others, it’s important to find the one that you find most comfortable! Night socks don’t work with everyone however, they are only effective for about 1/3 of people.
  5. Reducing the load on your foot: This is the most important tip we can give you. The act of adjusting your activity levels and reducing the stress on your plantar fascia can bring some decrease in symptoms – the important part then is how we load it back up.
  6. Load it back up: Once the pain has settled a gradual loading program has been shown to be the best way to gain long-lasting relief from this frustrating condition.

Hopefully, this blog gave you some valuable information that you can use to start returning to the activities you love!

If you have any questions or concerns at all don’t hesitate to get in contact with us here at Pain and Performance Clinic by calling us on 086 787 6358.

Top Tips for Calf Injuries!

  1. Don’t neglect to strengthen the soleus muscle
  2. Don’t train the calf muscles daily
  3. Use different types of exercises to rehab, not just the generic calf raise.
  4. Cross-train to keep as much of your aerobic fitness as possible
  5. Keep training the muscles higher in your leg e.g. quads and glutes

We see a lot of calf injuries, many of the tips for calf injuries are also helpful advice when rehabbing from an Achilles injury, shin splints, or an ankle injury. Of course, there are subtle differences. We’ve stated our main tips for calf injuries above if you want to learn why we’ve advised these then read on a bit further.

What is the soleus muscle?

For those of you that don’t know the soleus muscle is one of the two main muscles of the calf. The calf is made up of the gastrocnemius and the soleus. The gastrocnemius is the big muscle that clearly defined when you see somebody tense their calves. It looks different in everybody but it is the “mirror” muscle of the calf so to speak. Soleus is the deeper more central muscle of the calf and they both join at the base to form the Achilles tendon.

Why should you focus on soleus?

Soleus is the bigger of the calf muscles and generates three times the force of the gastrocnemius. It is responsible for the work of the calf when the knee is bent and is often overlooked by many in their training.

The gastrocnemius is mainly made up of type 1 muscle fibres which are mainly for speed. This means the gastrocnemius is a more powerful and explosive muscle whereas the soleus is an aerobic muscle and is used more in longer runs and walking.

The soleus is also highly active when you are cutting and turning during field sports. Strengthening the soleus will help reduce chances of reinjury, and improve performance if you are playing GAA, football or rugby.

Too often field sport players ignore the soleus as it’s seen as a muscle for distance runners. The soleus is important for distance runners as much as it is important for people playing GAA, rugby, or football. Just to be clear when I was distance runners I don’t just mean marathoners, I’m talking everyone out there trying out park run (https://www.parkrun.ie/) or couch to 5km or just jogging themselves for fitness. Any running of a steady pace is going to need some soleus strengthening.

How much strengthening should you do for the calves after an injury?

When it comes to how many sets and reps have to be determined based on your capacity post-injury. Here, at the pain and performance clinic, we advocate for loading and strengthening muscles as soon after an injury as pain will allow. Too many physios avoid pain totally.

One thing I can say for definite is you should not be doing calf exercises every day. Some mobility work or big multi joint exercises like squats and lunges can be done daily.

But, when it comes to isolated calf work, doing calf exercises every day is going to make your calf sore from not giving it rest. That goes for hamstrings and biceps too.

The calves need some good strengthening after an injury but also a day to recover after strengthening work. When it comes to strength training often the recovery is as important as the training itself. Not allowing for adequate recovery and over training is often why we see people in our clinic.

What kind of exercises should I use to strengthen my calves?

There are four kinds of exercise that we generally recommend for calf injuries and calf rehab.

  • Isometric
  • Concentric
  • Eccentric
  • Plyometric

Isometrics are exercises where you hold in one position. You aren’t moving but the muscle is tensing and working. Concentric is the “pushing” portion of the exercise. In a calf raise this would be coming up onto your toes. Eccentric exercise on the other hand is the opposite of concentric. So in a calf raise this would be the lowering portion of the exercise. Finally plyometric exercises are stuff like hopping and bounding.

So which of these is best for calf rehab? Well, it’s all of them a rounded plan should use all to improve your calf strength and get you back walking, running or playing sports pain free.

Of course on top of these strengthening exercises your rehab should also include sport specific exercises too. Depending what you play and even what position you play this will change your rehab. GAA players need to be able to turn and pivot, rugby players need to be able to tackle, props need to scrummage, basketball players need to be able to pivot and rebound and so on…. A good plan should not just include strength or mobility work it should also address the demands of whatever sport you are playing even if it is only recreational. If you enjoy your five-a-side then you need to rehab for it appropriately, even if it isn’t the champions league level.

What is cross training?

No we don’t mean using the “cross trainer” machine in the gym will specifically help for the calves. Instead we mean you should do some training for your aerobic system that doesn’t aggravate your calf and isn’t your usual type of exercise.

For example if you’re a runner with calf injury. You will be doing your calf rehab every second day. The reasons for every second day are outline above. On every other day then it may be a good idea to do some cycling or use an arm-cycling ergometer to train your aerobic system so that you don’t lose your general fitness while you are rehabbing your calf.

Using your injured calf to get out of cardio is a handy excuse. If you’re dedicated you can minimise your loss of fitness elsewhere. Google Sonny-Bill Williams using a rowing machine with only one leg. Some ingenuity there. Where there’s a will there’s a way! When you go back running/playing sports after your calf injury if your aerobic fitness is still good it’s one less area that you are worried about.

Cross training is actually a good idea even when you aren’t carrying an injury. As a runner, adding a light cycling day can help keep fitness up, aid recovery and reduce the amount of mileage you need to run. Or if you’re playing a field sport swimming may be good for you once a week. Swimming is a great aerobic exercise and by not being on your feet will take some pressure off your legs.

Why should I keep training my other leg muscles when my calf is injured?

Too often when we injure one area we start neglect training as a whole. Just because you’re injured doesn’t mean you should let the rest of your body get weaker. Of course with a calf injury it is obvious that you can still train your upper body.

But, you can still train your lower body even if your left calf is out of commission for a while. Firstly you can start by training the opposite side. There’s a phenomenon called the cross over affect when single leg exercises or single arm exercises maintain strength on the opposite side too.

It’s believed to be because of a neural effect within the nervous system. But, even if it all turns out to be fake no harm bullet proofing your other calf so it doesn’t happen to the opposite leg another time.

On top of training the opposite calf you can use this time to work on exercises like single leg glute bridges or single leg squats. And it is definitely safe to work on the hips and quads of the injured side. Hamstrings I’d avoid just because some hamstring exercises can have calf involvement too. But, you can definitely do some seated or lying exercises to keep the quads and hips strong on the injured side.

How long should I keep doing my rehab after I’m back from my injury?

When it comes to continued rehab once you’re back playing sports or back pain-free you need to keep strength training up once if not twice a week for at least 6 months. The biggest risk factor for injury is a previous injury in the same place. It’s not that you are always going to have a “bad” calf because you injure your calf once. This is most likely because rehab is not thorough and fully followed through the way it should be. After you have completed your initial rehab and have returned to sport here at the pain and performance clinic we will always leave you with what we call an “exit plan”. This is in the hopes of reducing your chances of re-injury.

When it comes to calves this exit plan will include five minutes of strength work you can do before training/matches as an addition to your warm-up plus one strength session to be done a week. If you are on a week off from football/hurling/rugby you will generally do two calf-specific sessions to maintain the strength in your calf and prevent the chances of re-injury.

If you were a patient of ours you would have a specific plan to follow but our general rule of thumb advice is;

One dedicated calf strengthening session a week plus calf work in match/training warm ups for 6 months minimum post return to play.

OR

Two dedicated calf strengthening sessions a week for minimum 6 months if you have no sport to play (i.e. never played sport, or an athlete with no training/matches in a given week.)

These are the time frames for calf injuries specifically. This advice will change depending on the location of your injury. E.g. shoulder issues, especially a shoulder dislocation, require consistent shoulder strengthening for far more than 6 months. But, an overuse knee injury from running may need less specific intervention once return to running has occurred pain free but we would still advise runners to strength train in general to improve performance and reduce chances of injury in the lower limbs.

If you have any questions about your calf injury or any injury for that matter feel free to contact us via email, by phone or through our social media channels.

What is causing the pain running down your leg?

What is the Sciatic Nerve? Can it be Compressed? 

We’ll start with the sciatic nerve itself and where it comes from. As you might have read, a  number of nerves leave your spine and join together to form the sciatic nerve. The sciatic nerve  runs from your lower back through your hip and buttock region down the back of your thigh  before branching off towards your foot. 

Now, in very rare cases a problem can occur at the roots of the sciatic nerve (the roots being  where the nerve exits the spine). This problem might be that the nerve has become  compressed by a herniated disc or in even rarer cases a malignancy or infection. This  compression causes the nerve to become irritated, triggering inflammation and sometimes  severe pain down the back of the leg below the knee, along the course of the nerve.  

The Good News 

The good news is that a disc issue such as a bulging disc, slipped disc or herniated disc is very  rarely the cause of a person’s radiating pain down their leg. There is a lot of misinformation  spread about the intervertebral discs in our spine. They are often portrayed as fragile structures  that are waiting to burst upon an awkward movement, when in reality, they are incredibly  robust strong structures that can withstand huge amounts of force.  

What is so confusing about sciatica? 

Today sciatica is used more as an umbrella term. The term ‘sciatica’ is often used by people  who have experienced an episode of back pain along with pain that travels down the back of  their leg. This is not technically correct. In the vast majority of cases, this should be called  referred pain, not sciatica. ‘True sciatica’, also known as radicular pain is due to a compression  or irritation at the nerve root.  

Simply put, low back pain and referred pain down the leg is common but this is rarely due to a  compression at the nerve root.

So, if my Sciatic nerve is not compressed by a Disc, What is causing the pain  running down my Leg? 

As mentioned, it is very common for people to experience low back pain and pain running  down from their buttock into the back of their leg. This pain is most commonly experienced due  to something called somatic referred pain. 

Let’s briefly explain referred pain. Referred pain is when the pain you experience in one part of  your body (down your leg in this case) is caused by the signal of pain in another part of your  body (lower back muscles). 

We have a vast network of nerves throughout our body that make up the nervous system. The  muscles in our lower back can often become tight, sore and even go into spasm. When this  happens, our nerves carry the signal of pain from the muscles to our spinal cord and up to the  brain. However, our vast network of nerves work closely together and there is very often  communication between nerves in adjacent areas. Therefore, there is communication of the  painful stimulus between the nerves around our back muscles and the nerves that travel down  to supply the muscles and skin in our legs.  

Other common examples of referred pain include people with hip arthritis that experience pain  in their knee, or people with neck pain that begin to feel pain in their shoulder region. 

How Can Exercise Help My Back and Leg Pain? 

Firstly, when you exercise you allow your back and leg muscles to contract and relax. In this way  exercise can help release the tension in your back muscles. Secondly exercise encourages blood  flow and oxygen to the nervous tissue. This helps to calm your nervous system down and  reduce the constant signal of pain being sent from your muscles.  

What Else Could Be Causing The Pain Down My Leg? 

There is a number of other issues that can cause people to experience pain down the back of  their leg. These issues range from tendon issues such as the hamstring tendon that inserts into  the back of your pelvis, to issues around the hip joint and muscles. These other possible causes  will be ruled out during your physiotherapy assessment. 

When Does Sciatica Require Surgery? 

As mentioned there are very rare cases when a problem is occuring at the nerve root. This  problem may be due to compression of the sciatic nerve roots by a herniated disc. People that  experience severe leg pain from this cause can experience some shorter-term relief with  surgical intervention. A suitable candidate for such a surgery may include someone with all of  the following: 

  • Very severe raging leg pain that is far worse than their back pain 
  • Pain is constant and unrelenting 
  • Sharp shooting pain 
  • Experience their symptoms below the knee 
  • Severe numb patches down their leg 
  • Severe weakness in their legs  
  • No relief from exercise  

If you would like any further information on sciatica or any pain or injury reach out to us info@painandperformanceclinic.ie

What are the benefits of a Sports Massage?

If you’re stiff, tight, or a little sore but don’t have an injury and think a sports massage would be good for you then here are a few things you might like to know before booking in for a massage with a physiotherapist.

It’s a common belief that lactic acid in your muscle is what causes soreness after a workout. Lactic acid does cause ‘the burn’ while you’re working out but when you get a massage your physiotherapist won’t magically push it out of your system. In fact your body does that for itself clearing out the lactic acid shortly after you stop exercising. Instead, what a sports massage can do for you is help recovery in other ways.

Sports massage can reduce pain in two ways.

Firstly, if you find sports massage relaxing then the sports massage will release endorphins in your body and these endorphins will act as a natural pain killer and help to reduce your pain. Secondly, sports massage works to reduce pain because the receptors under your skin that feel pain are also responsible for your sense of touch. The sensory system feels touch before it feels pain. Therefore, when your physio is giving you a sports massage your body’s sense of touch will block the pain receptors during the sports massage itself.

Sports massage is great as a recovery tool because when it reduces your pain and stiffness that means you then move more freely. Loose, free, thoughtless movement helps the recovery process because if you walk around stiff and tense you are likely to hold onto some of the soreness from previous workouts.

Sports massage can also be a great tool to destress and unwind. Studies show that a lot of injuries are related to stress and anxiety. Neck pain for example is an obvious one most people relate to stress but also athletes with stress fractures were also seen to have higher levels of anxiety compared to similar athletes who weren’t injured.

Sports Massage Sleep!

Another benefit of a sports massage is generally after a sports massage you are more relaxed and get a more restful sleep. Sleep is the greatest recovery tool we have. Often injuries occur because recovery is poor and not because your exercise is bad. Think about it, how often do new parents get injured? What’s changed isn’t their training it’s their sleeping pattern. . .

When thinking about getting sports massage you need to remember that sports massage isn’t a treatment if you have an injury. Sports massage can help reduce pain and stiffness but if you have an injury then going for a lot of sports massages is just keeping the problem at arm’s length without getting to the root cause of the problem. If you think you have an injury it may be better to book in with your physiotherapist for a full assessment and get a plan to sort out the cause of the problem itself.

Things to do before your sports massage

  1. Make sure you’re hydrated before coming in for your sports massage. If you are dehydrated muscle can be stiffer and more difficult to work with. The easier your muscle is to work with during a sports massage the more benefit you will get from it. But, make sure before your sports massage begins that you’ve used the toilet, nothing worse than getting relaxed and after 10 minutes having to get up to use the toilet.
  2. Don’t take pain killers or muscle relaxants before your sports massage. During the sports massage, it is important that the physiotherapist can get proper feedback from you. You need to be able to tell your physiotherapist during a sports massage how their pressure is, if you need more or you need less. If your sense of touch is impaired by medication during your sports massage this will be more difficult.
  3. Your physiotherapist will ask you a few questions before you start your sports massage. They are doing this because a sports massage can be very individual. No two people want the exact sports massage and if you have an idea of how you would like your sports massage to go you should tell your physiotherapist when you get there. If you have never had a sports massage before don’t worry your physiotherapist will work it out with you.
  4. When you get a sports massage your skin may be red afterward, and if you are taking blood-thinning medications it may make you susceptible to bruising. It is important to discuss any medications or medical conditions you have with your physiotherapist before your massage so that they can modify the sports massage appropriately.
  5. Finally, if you book in for a sports massage here at pain and performance clinic don’t be afraid to ask us questions. Among all our physiotherapists they have experience in other fields such as coaching, strength and conditioning, Gaelic football, rugby, athletics, and long-distance running. You can always pick our brains for tips around training, recovery or injury prevention while you’re lying on the table. Although if you’d rather some peace and quiet during your sports massage you can always tell us to stop talking, it won’t be the first time we were told to shut up and we won’t take any offense. 

If you want to contact us with any questions about sports massage or your pain don’t hesitate to contact us via email, by phone, through our social media channels.

Alternativley if you would like to book our Sports Massage Packs €95 instead of €150 your can do so by clicking here https://www.painandperformanceclinic.ie/product/sports-massage-package/

Why is the pain on the outside of my hip not going away?

Pain on the outside of the hip (“lateral hip pain”) affects roughly 1 in every 500 people annually. In a country of 4.9million people that means almost 10,000 people every year have pain on the outside of their hip.

There are many structures on the outside of the hip. Often pain on the outside of your hip is aggravated by sitting for long periods of time, going up and down the stairs, lying on your sore side and doing high impact physical activities. Pain on the outside of your hip is most common in people between the ages of 40 and 60. It is also more common with women than men. 

Does pain on the outside of my hip mean it’s damaged?

The answer to this is the answer everyone hates the most… It depends.

At our clinic the first thing we want to determine is if your pain is as a result of an injury or a trauma. If you do not remember a moment of impact or a pulling sensation when running/playing sports and your pain slowly came on over time it is likely that your hip pain does not equal damage. 

Of course we cannot say this without an assessment whether or not you have damaged your hip. If you think you have an injury or a pathology then you should contact a physio you trust. But, if you don’t have an injury then keeping moving shouldn’t cause any damage to the structures at/around the hip. If anything, stopping everything may be less beneficial. The body needs movement to help heal.

Why is the pain on the outside of my hip not going away?

Often pain on the outside of the hip is mistreated and there are many mistakes that both physiotherapists and patients make when trying to alleviate pain on the outside of the hip. 

Mistake 1:  Too much stretching. . . 

A lot of time stretching can be a nice way to reduce some pain and give you some relief. But, often with pain on the outside of your hip stretches like the piriformis stretch, IT band stretches and any variation of the Pigeon pose used in yoga will actually increase the irritability of the pain on the outside of the hip. Of course in some cases, stretching can help but instead, the focus here should be on strengthening the weaker muscles around the hips, often the glutes. And, modifying the activities that cause the pain.

Mistake 2: Reliant on passive treatments. . . 

Often to treat pain physiotherapists use hands on treatments like massage or passive treatments like ultrasound, laser or dry needling. Hands on treatment can be a useful tool to reduce the symptoms of an injury such as hip pain. But, if your therapist is only using hands on/passive treatment then they are just reducing your pain without addressing the causes. Massage needs to be combined with a unique home exercise program and planning/modifying your activities in order to reduce pain, increase strength and get you back doing what you love. 

There is a lot of research which shows results of patients with hip pain are often better or the same without reliance on hands on treatments. One study had two groups, one group received 18 massages and an exercise program, the other group had 1 visit to the physio where they were given and shown the exercise program. On follow up, both groups had the same results in the end. 

Mistake 3: No education or activity modification. . . 

If you have pain on the outside of your hip and you aggravate it by, let’s say, going for a big run too soon into your rehab process. This is not your fault. It is important that you question your physio so you know why you’re doing certain exercises. What you can and can’t do for the time being and know how your hip will react to certain activities. This doesn’t mean stopping everything and never getting back doing what you loved, this may just mean modifying your activity for a short period of time while the pain settles and you are then able to build back into your activities

Mistake 4: No plan. . . 

Your physiotherapist should always have a plan for the next session based on how you respond to the initial program. If you ask your physio for an idea of this plan they should give it to you. Of course, no plan is set in stone but an idea of the direction the treatment is heading is essential. Be sure to question your physio and ask what their expectations are for the next few weeks. It shouldn’t be acceptable in any health care to just “wing it” or “wait and see”

Mistake 5: No Progressions. . .

Often we see with hip pain that treatment is stagnant, you’re doing the same exercises over and over and when you come to the physio you get a passive treatment or a massage, and then, you’re sent away again without a progression. This mistake is a combination of mistakes 2 and 4. No plan and reliance on passive treatments like massage will mean your exercise programme will not be sufficient to build the capacity to return to doing the things you love to do. 

If you have any questions about hip pain you can always contact us via social media, email, on the phone, or book in for a face-to-face consultation online. If you can’t make it into the clinic you can always book an online consultation instead.

Top five biggest back pain myths!

Back pain is often misunderstood!

90+% of all back pain is not due to damage in your back. There are many external factors that contribute or drive the pain in your back.

One of the biggest factors that increases back pain is the beliefs you hold about your back pain. These beliefs are generally shaped by the people around you. It may be your parents, your friends or even other healthcare professionals. It may even be something that happened to somebody you know and how that was handled (good or bad) that is shaping your beliefs.

We hear in our clinic and get asked about on our social media all the time things that simply aren’t true. We even hear it day to day, well before COVID when you could meet new people, once they find out you’re a physio their back pain is usually the topic of conversation!

Our biggest gripe with back pain is how detrimental poor beliefs, misunderstandings, or myths around back pain are. Fear/anxiety are two things that make pain feel far worse than it should. Fear is often sold by bad healthcare practitioners to try and get you to come back through the doors more than you need to and to feel that you depend on them.

Your physiotherapist should empower you to be independent, not dependant!

Top five biggest back pain myths:

  1. A “weak core” is causing your back pain
  2. “bad” posture is the cause of your back pain
  3. Leg length discrepancy is causing your back pain
  4. Your office set up is the root cause of your pain
  5. The idea of a “slipped disc”

Does a weak core or a weak back cause back pain? No… A weak core is not causing your back pain!

Testing the core muscles is a go to test in the examination of many health care providers when they hear you have back pain. The first issue we have with this here is that the tests for your core aren’t really all that specific.

That aside though; the idea that, strong = pain free, and, weak = in pain, is far too simplistic.

Take for example top level athletes. They have just as much back pain if not more compared with the general population. So are we to believe that these highly conditioned athletes that have a teams dedicated to their training and recovery simply missed out on strengthening their cores and that’s why their back pain came on?

Conversely either you can think of a mother living in extremely famine in Africa, she is very skinny, has very little muscle mass but she still has the strength to carry her child miles to for clean water and then carry the water back home. Why doesn’t her back hurt to the point that she has to stop?

If it isn’t a weak core then it’s a “weak” back that needs to be minded that has been floated to the patient as an idea as to why their back is sore…..

This too is not true and it is also not beneficial in any way! By “minding” your back or “being careful” you are often making your back pain worse. If a “weak” back meant you automatically had back pain then everyone a year older than you would have worse pain than you. As we age we lose about 10% of our muscle mass each decade. That would mean the older you are the more likely you are to have back pain if weakness was the key issue. But, back pain is most prevalent in people around the age of 40 and is actually quite minimal in older age groups.

The back seems to be given special treatment when it comes to injury. The back consists of muscles and joints. If you hurt your ankle you wouldn’t expect for it to go back to normal by doing absolutely nothing for it and keeping it held in the same position all day. You would move the joints and strengthen the muscles and push the ankle to be able to move in all directions. You need to think of your back the same way. Your back needs to move in your rehab!

Your back is more robust than people give it credit for!

What is the best posture for back pain?

There is no perfect posture to sit/stand in. The only bad posture is one which you stay in for too long.

How many times did your mam tell you when you were younger to stand up straight because slouching was bad for your back? As we get older we discover our parents were right about a lot of things that made us roll our eyes as teenagers…. This time though, mam was wrong.

Just because you don’t stand up straight all the time doesn’t mean you will have back pain. In fact many people with “good” posture have back pain and many people with “bad” posture do not have back pain.

There are studies to back this up. In 2016, a study compared people with and without back pain. it found there was no correlation between posture type or range of motion and low back pain.

Another study where a group of researchers took pictures of women that had back pain for up to 16 years and a group of women with no back pain found that using posture alone physios could not identify the patients in pain. They then showed these photos to hundreds of physios. A similar thing was done in multiple countries where physios had to pick out who had the best sitting posture/desk set up out of various photos of patients with and without pain.

There was no agreement between the physios as to what was best.

If us physios (“the experts”) can’t agree on a best posture, don’t let one of us tell you what they best way to stand is and that bad posture will mean pain! This is just not the case and it is often not helpful at all.

Many people we see spend all day and night standing and sitting with “perfect” posture because mammy told them to do so or the doctor told them to do so or a physio told them to do so…. BUT, these people often have back pain as they have been so tense through their lower back all day that when they go to move their lower back in any direction it’s sore and stiff! In fact, studies have found that people who “stand up straight” are more likely to have back pain than those of us who slouch.

Is leg length discrepancy causing my back pain?

We often get asked this at pain and performance clinic. Patients come to us having been told a leg length discrepancy is the cause of their back pain. They are usually looking for a second opinion because this couldn’t be right, could it?

The answer is, no! It is very, very unlikely that a leg length discrepancy is causing your back pain. Physios, chiropractors, doctors… they all like to be able to give you one simple reason for your back pain. But, pain and back pain in particular, is often more complex than one simple cause.

Why is your leg length discrepancy not the cause of your back pain?

For starters, 90% of people in the world have two different length legs. Do you think 90% of the world have back pain? No they do not….

Secondly, if leg length discrepancy was the cause of your back pain why did your back pain only start now? One leg hasn’t decided a couple of years after you’ve finished growing to just grow on its own…

On a similar note, your back pain often comes and goes, but your leg stays the same length. This would indicate to me that the leg length discrepancy is not the cause of your pain.

My final issue with the idea of a leg length discrepancy being the cause of your back pain is that the tests to check for length discrepancy are often full of mistakes. What does your doctor do to check for leg length discrepancy? They pull, poke and prod at your hips, they look at your knees, they use a tape measure, BUT, like I said these tests aren’t always accurate. The only way to accurately determine a leg length discrepancy is to use a scan.

Now if you do use a scan for this and you have a leg length discrepancy for most people this won’t be the cause of their back pain even if a leg length discrepancy is found. Leg length discrepancy’s need to be more than a 2cm difference between legs in order to be “clinically significant” as the doctor would say.

If you’ve been told that leg length discrepancy is the cause of your back pain it may be time for a second opinion, back pain is very treatable. The length of your leg can’t be magically changed, instead we need to find the actual cause of your pain and address that to get you back doing the things you love pain free.

Does my chair or desk set up cause my back pain?

There is a lot of misinformation out there about orthopaedic chairs and standing desks etc. Over the last year we’ve seen countless “proper” chairs brought into homes, we’ve seen numerous standing desks be assembled in a house instead of an office and we’ve seen people still have back pain.

The truth is that there is no evidence to suggest that orthopaedic chairs or the correct desk set up will prevent or reduce back pain. In fact, if this was the case then we would have been able to almost eradicate back pain. Back pain is far more complicated than the chair you are using or the desk you sit at.

Of course sitting habits can be part of what is going on in your back but it is far from the root of all evil when it comes to back pain. Other things that may affect your back pain are fear, stress, anxiety, lack of sleep, your previous experiences with back pain or other injuries, your beliefs of back pain, beliefs/misinformation you’ve heard from other healthcare professionals or friends, your basic strength/fitness levels, a change in exercise habits (either way more or way less).

As you can see there is a lot that can contribute directly to your back pain so if you have acute back pain at the moment it is best to seek the opinion of a physio you trust. If though you are just looking for some tips to stave off back pain and to ensure that bit of stiffness you feel at work doesn’t become a big problem we believe the best solution is to include movement breaks in your day.

Movement breaks mean moving for as little as 30-60 seconds to reset and ensure you don’t get some movement into your back muscles and joints. Movement breaks can be simple stretching exercises or even as simple as getting up and taking 10-15 steps away from your desk and then walking back. This is something that was more naturally built into your day when you went into the office.

Have you been told you had a “slipped disc” or have a friend that’s been told the same?

This is such a common thing people are told to justify their back pain.

Physios/Doctor’s keep telling patients this

BUT

Discs. Don’t. Slip.

The idea that one of your discs can just slip out of place is simply not true. Your discs are the tough cartilage between each of your vertebrae (spinal bones). Your discs are very tightly secured between the bones of your back.

When studying to be a physio we study human anatomy in labs with cadavers. In one of our first lessons here I vividly remember my lecturer discussing the idea of slipped discs. He showed us a human spine and showed us how no matter how much he pushed or pulled he would not be able to simply make a disc slip out from between vertebrae.

There are of course injury’s to discs. But, 90% of back pain/back injury’s aren’t caused by actual damage to the back. It is very unlikely one of your discs have “slipped out”.

Over the last few weeks we’ve been addressing some myths around back pain. This week we want to discuss the idea of “leg length discrepancy” with you.

What are physio’s or doctor’s trying to say when they say “you’ve a slipped disc”. Well it may be that you have a disc injury but their explanation is not clear enough.

Discs like any body parts can get injured. When they get injured they can swell. Much like an ankle would if you sprained it. This swelling in your disc may mean the disc pushing outside it’s normal boundary and pushes on a nerve and that can cause some of your pain or symptoms. This does not mean however that the disc has moved.

If you do have a disc injury, just resting is not going to change things. You may need some time to rest when you first hurt your back but this rest is not your rehab. Generally we don’t say rest instead we say “activity modification”. The difference is with rest, people often stop doing everything if their back is sore. You may need to stop doing some things that aggravate your pain but you need to keep moving as much as you can to prevent stiffness. When your symptoms ease and exercise becomes more do-able for you we then try to work with you to introduce exercises that will strengthen your back and help you get back to doing the things you love.

If you would like more information or need help for you own back pain please don’t hesitate to get in touch https://www.painandperformanceclinic.ie/contactus

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