The Plantar Fascia is thick connective tissue (fascia) which supports the arch on the bottom of the foot. It runs from the tuberosity of calcaneus (heel) forward to the heads of the metatarsal bones (bones between each  toe & mid foot bones).  In Plantar Fasciitis, the Plantar Fascia begins to tear away from its attachment sites resulting chronic inflammation & a build up of inappropriate scar tissue.  Walking is painful, particularly first thing out of bed or after a rest.

Causes are varied: chronic pronation, a sprained ankle, pregnancy, a hip/knee injury… or something else.  Expecting a cortisone injection to permanently fix a biomechanical change is a long shot and it may cause other health complications.  Time & financial resources are often better spent on correcting the dysfunction and then addressing the build up of inappropriate scar tissue that has built up.

Here’s a plan that may offer you relief…

The expectations around Prenatal Massage are confusing at times.  The list of what “not to do” is far greater than the list of specialty things “to do”.  It is strange how often I see resistance from the Expectant Mom about revealing their pertinent medical history of accidents and illnesses which is typical for my intake of any new patient.  “Oh that doesn’t matter – I just want a Prenatal Massage,” they say.  In my opinion it is all the more reason to disclose where you’ve been to make the journey into labour and delivery that much easier. 

I’m reminded of a very interesting story I’ve recounted to multiple pregnant patients recently.  A petite late 20’s patient arrived with complaints of immobilizing, shooting back pain that had her bedridden.  Prior to conception she was active and fit, experiencing life in a carefree pain-free manner.  This new agony she was experiencing was not the pleasant, glowing experience all the books promised her pregnancy to be.

She had visited multiple doctors to no avail.  No one knew how to help her and given her delicate condition, she could not take any medication to dull the pain.  She was frustrated and scared… and then she showed up in my office.

I took the very same medical history that I take with every new patient.  I inquire about aches and pains everywhere, not just what was bothering her today.  I wanted to know about past injuries and illnesses, surgeries, accidents… the whole gamut.  Yes, it seemed to her that it was overkill.  Could I not just start rubbing her back and give her some relief please?  I assured her that this was an important part of the process to help her out quickly and effectively.

As I read her form which included various minor issues, one thing caught my eye: An elbow fracture at age 12.  How could her elbow possibly be affecting her back today?  Because she required a bone graft from the crest of her hip for it to heal properly.  The technique was effective to get proper healing on her elbow, but ultimately invasive on her hip and pelvis.  Because she was fit and of an ideal weight going into pregnancy, she never really noticed any negative effects of the hip operation… until she started to gain weight and her center of gravity changed as baby grew.

When we repair an injury (a bruise, an incision, a tear, etc), we repair with highly disorganized tissue that resembles a bird nest or spiders web.  As it adheres, it attaches to the fascia of other structures in the area including other muscle, tendon, ligament, bone, organ, skin, membrane, etc.  This means that the newly healed tissue is dragging along all of this opposing structures like a boat anchor causing weakness, a lack of endurance and potentially pain. 

In the case of my pregnant patient, the incision across the crest of her hip was tied into structures that wrapped into her back, glutes and abdomen, causing pain as she gained weight (stretching tissues) and her center of gravity changed.  The good news is, we addressed these inappropriate scars with myofascial release, cross fibre sport techniques, stretching and other applications from osteopathy and applied kinesiology and her pains disappeared.  None of these techniques would be considered to be “Prenatal Massage” so to speak, but the ultimately helped her prenatal pain condition.  My patient went on to happily complete her full term pregnancy and give birth to a healthy baby girl.  She has since had a second child and has not had a recurrence of this issue so far.

The question often arises around whether this issue would ever return for her now that the area has been treated.  The answer lies in the thoroughness of the treatment and the future agenda of activity.  If the issue is addressed only once, then likely a 15 year injury’s repair may still pose future problems.  If the issue is resolved in completion to extended weeks or months between treatment without pain, then likely there will be little to do with it down the road.  Should future activities become aggressive (training for an endurance race as an example), repetitive biomechanics play a role (new job) or another accident occur that affects that area, then deeper layers of this 15 year old injury may require further attention.  Conversely, if a person becomes bedridden and ceases to move, any existing adhesions naturally become worse.  Therefore, it is about striking a balance between activity and rest without excess on either side.

The moral of this story is to disclose your complete history to your therapist as you never know how something seemingly off the wall might be the key to your Secret Garden of Wellness!

 These are quite often the two most common questions I get in a week.  As some of the techniques that I use are quite aggressive, it is necessary for the body to be given an opportunity to heal and regroup before another session is attempted.  Treating again too early can cause more damage and result in a prolonged recovery just as waiting too long can be equally detrimental.  I find for the style of work that I do the ideal window of opportunity is four to ten days – ideally where I see them again before the symptom recurs or gets worse.  I regularly work with long histories of scarring, adhesion and myofascial restrictions therefore since the body is constantly healing, we want to allow it to recover from the session but not allow it the opportunity to put too much scar tissue down again before the full soft tissue alignment has occurred.  Otherwise, we would have to redo what we just accomplished.

On the topic of how often, let’s say that a patient is highly motivated to get better.  Following the suggestion above, let’s say they decide to come twice times in ten days and feel pretty darn good.  Their symptoms aren’t gone, but their quality of life has drastically improved.  What happens next?  We use an educated guess as to when to revisit the situation… say a week.  If that turns out well, we push it to two weeks, and then three, four, etc.  Perhaps this patient gets all the way to an eight week cadence and drags themselves in saying, “Wow, that was way too long.  I’ve been looking forward to this appointment for two weeks!”  Well, that tells us that though they can sometimes make it to two months, they do better consistently by their own admission at six weeks.  This might change seasonally due to their activities where they need more or less treatment, such as with golfing, hockey or snow boarding.

 This guideline, while not perfect, has seemed to suit people well over the years.  It is self directed and non-demanding.  The choice is the patient’s and is made with the understanding of the implicatations of how they maintain themselves at home and on my table.

Best of luck!

Dena Liebrecht, RMT, SMT(cc), CBP, ESMT

BODY KNEADS

It’s sometimes difficult to determine when our intuition is real or just wishful thinking, especially when we’re concerned that our emotions might influence it. I know my intuition is “on” when I get consistent proof of it.

After taking a detailed history and going through all kinds of orthopedic assessments on a client I usually have a pretty good sense of what’s going on with them and then how I might be able to help them. These choices are based on my left brain remembering the contents of the classes and text books of college but also the sum of my experiences as a therapist over eleven years.

But sometimes I am lead to explore a thought or a feeling with someone that I have no explanation for other than, “It seemed like a good idea at the time.” For example, someone comes in for a hip problem and while I’m working in the expected area I am drawn to work on the skull or the shoulder. The “proof” I alluded to is when you test a theory and its proven accurate based on the result of pain diminishing or resolving entirely. Sometimes needing to know “why?” something worked gets in the way of simply accepting the healing from it.

I’ve been practicing as a Registered Massage Therapist in Okotoks since 2001 and added Certified BodyTalk Practitioner to the mix in 2006. Melding these two modalities continues to support my clients and practice in new an interesting ways. It’s not that BodyTalk and intuition are the same thing, but rather that in working with BodyTalk my intuition has become better honed. We all have the ability, but not everyone makes effort to develop it. As with any skillset, the more you practice it, the more you trust it, the better it becomes.

And what about you?  Are YOU working with your own intuition?  I find that people are most untrusting of themselves when it comes to their own health care.  They dismiss the cues that would lead them to an earlier and full resolution.  The take their practitioners’ view as gospel even when deep down they know that something is not right.  You know your body best – and if you don’t, you should!

It does become disheartening when we go to doctors or practitioners time and time again to only have our concerns dismissed.  I believe there is a difference in having your fears calmed and to know that it really is “nothing” versus feeling written off because they are too busy or someone else’s appointment is more important than yours. 

 Keep looking for the proof to illustrate that you know what you know and remember that you don’t need a reason for why you know it… you just do.  You have two voices and you should use them!  Your inner voice has great wisdom, but your outside voice is the one that will get you noticed.  Trust what your body is telling you and speak up – As they say, “The squeaky wheel gets the grease!” 

Happy healing!

Dena Liebrecht, RMT, SMT(cc), CBP

The media speaks to society wishing to never get old with all of the anti-aging products and services that are available to consumers. Perhaps it might be more accurate to suggest that we DO want to age as no one wants to die young, but we want to AGE GRACEFULLY and not appear like the senior on that signage.

The reason that the joints revert to flexion with aging is due to the build up of myofascial restriction in the body. Inevitably, “What’s that?” and “What can I do about it?” are your next two questions.

Well, myofascial restriction is what happens when inappropriate repairs occur repeatedly in the body as a result of repetitive strain, injury, surgical incisions, sedentary activity among other reasons.  The good news is that this build up can be reversed and then maintained with consistent but relatively easy effort on the part of the patient.

These repairs are highly disorganized fibrous matts that don’t just attach to what you have injured, but also adhere to other muscle, tendon, ligament, membranes, skin and even sometimes organs around it.  This means that once your injury is healed, the muscle is now attached to these other structures which limit its ability to fully contract or stretch which results in the change in posture as well as pain.

As the decades pass and you continue to give your body reason to tear and repair, more and more of it builds up like the rings of a tree. Though it’s easier to reverse when the repairs are fresh, it can always be reduced with techniques like Myofascial Release.

The road to recovery is sometimes a little longer and bumpier than we have patience for, my friend.  Of all joint replacements, knee patients often bounce back fairly quickly but everyone’s timeline is a little bit different and dependent upon the rest of their medical history.

My first question would be around your level of activity — have you been doing your exercises consistently?  Are you continuing to push yourself a little?  This is not a suggestion that you should be signing up for the Calgary Marathon in May this year, but the 5km Family Walk might be a good goal for you if you’ve been cleared for exercise by your doctor.

Joints and the structures around them are meant to be moved.  The less we move them, the less the want to move because adhesions begin to build up regardless of a surgical intervention.  In your case, you also have some large incisions (likely from the lower part of your thigh through the center of your knee cap) which will also become stuck to the muscles and tendons below.  This can create a “tight” feeling and is a common complaint area when doing stairs.

Soft tissue manipulation techniques like myofascial release and myofascial cupping are excellent at kick-starting the process of flexibility however it is not just up to your therapist to make things happen.  YOU are your greatest asset!  Consistent movement like stretching, yoga, aquafit, walking, biking, stair climbing will keep things progressing between appointments.

When our recovery takes longer than our neighbor’s or is greater than our doctor expected it to be it is easy to become discouraged.  If you have real fears around the success of your procedure, I suggest that you have an honest heart-to-heart with your surgeon and express your concerns.  Try not to be confrontational with your doctor as this may result in a defensive response.  Instead, be candid about your concerns and ask for confirmation that what you’re experiencing falls within your surgeon’s expectations.  Suggest that you are concerned that your activities might be making it worse and be honest about what you are doing or not doing.  This is truly the best way to clear the air and get you in a position to move forward with progress.

If your doctor confirms that your surgery has been a success and you’ve been cleared for all therapy and movement, it might be time to reassess what you have been doing.  As Albert Einstein said, “Insanity is doing the same thing you’ve always done and expecting a different result.”  If you’re not as far along as you’d hoped at the 9-month post-operative, it might be time to shake it up.  Try a new therapy… or try a new therapist.  Sometimes a new opinion and breath fresh motivation and renewed motivation into a patient.

I’d also question the extent of your existing treatment — are you just getting your knee worked on or are you addressing the front and back of the thigh and calf?  Your glutes (buttocks)? Your other leg? The circumstance that lead to your knee replacement was likely a progressive degenerative process which had detrimental effects on your knee as well as all the structures around it from a strength and flexibility perspective.  Therefore, as you have been adapting to your new joint, you still have some “old junk” in other tissues that might need to be overhauled.  Have your therapist check out anything else that might be altering your gait and contributing to your pain cycle.

Perseverance pays.  Don’t give up.  Give me a call and I’ll do my best to help you out!

SCENARIO:  You’ve taken the long diving trek home for Christmas vacation and have enjoyed the luscious perk of warm leather seats for the whole 2 hour+ journey.

How could either scenario be anything but therapeutic goodness for the muscles or the senses?  My friend, chronic pain lurks in them there seats!

Being on the slopes all day using your hip flexors to dodge ski bunnies and moguls alike is an awesome work out.  Enjoying the crisp air and the fluffy snow is a great way to work up a sweat and use some muscles that may otherwise sit fairly stagnant over the winter.  When it is time to stop for the day, icing those recently taxed muscles is the better way to prevent the tender stiffness of tomorrow, but that just somehow seems wrong to us mentally after spending a day in the snow.  Creating a constant heat source adds to the recent inflammation in your hip flexors from the day’s activities and creates a hip flexor contracture.  Inflammation is pressure and  pressure is pain.

In the second scenario the damage is done without extensive exercise but the result is the same.  Heating any body part excessively still creates congestion in the area.  Congestion is where blood gets into the area but doesn’t easily get out, thus creating a reason for that onset of back stiffness after the long drive.  This is made worse by the fact that you’re sitting still for extended periods of time (hours) which then does not allow for natural lengthening and shortening of these muscles.

There is no doubt that the season of cold weather brings in an onslaught of car seat heater “injuries”.  I know — just like you, I too enjoy the perk in my leather seats, however I have seen the judgement error in having them in use for too long or too often which leads to an ugly end — chronic back pain from a hip flexor contracture, specifically the iliopsoas muscles.

A wiser use of this vehicular option would  be to turn them on until they are warm (10 minutes or so) and then turn them off.  This will take the chill off but not be long enough to create any damage.  If you suffer from back pain regularly already, you might want to omit using them altogether.

Tendonitis is not just inflammation in the area but also actual fraying of the tendon when the muscle is repetitively over-loaded & torn more often than it ought to, ie: a repetitive strain.  This tear/repair cycle causes the area to build up scar tissue that further affects the efficiency and strength of the area.  Techniques like Myofascial Release or coarse cross-fibre frictions actually change the damaged tissue which can be followed with flushing or cryotherapy (ice techniques) instead of medications to manage resulting inflammation.

There are three common kinds of elbow tendonitis — Golfer’s Elbow (inside forearm flexors), Tennis Elbow (outside forearm extensors) and Triceps Tendonitis (back of the upper arm).  Sometimes Triceps Tendonitis is misdiagnosed as Golfer’s/Tennis which is why manual therapy techniques specific to those types don’t resolve the issue.  Proper orthopedic assessment is important so that time and money are not wasted in taking inappropriate measures.

Because the nerves and blood vessels that feed the arm and hand originate in the neck & shoulder, it is absolutely necessary to address these areas as well.  Consider how the flow of traffic on a freeway is reduced or stopped by an accident or construction.  This is what happens to the neurological signals or the blood cells meant to feed, fix or take out the trash from your arm and hand.  Clearing up these traffic jams higher up the chain is critical for a timely resolution.

Sufferers who become completely sedentary with the problem area as part of their “recovery” are often disappointed when the symptoms return once activity is resumed.  Complete rest from the culprit activity is not always necessary but sometimes temporarily recommended while a critical and specific stretching & strengthening program is followed.

The medication your physician has prescribed is likely meant to reduce the inflammation, but not affect the scar tissue, strength or flexibility factors which is likely why you are not getting the complete resolution results you desire. Consider also that by medicating to reduce inflammation you effectively fake your body into thinking you are more well than you are which causes you to continue to use the limb in a way that creates more damage.  This means that you are potentially causing more damage rather than encouraging a speedy recovery.  Medications can be a useful part of the plan, but not the whole plan.

While there are no guarantees, a tendonitis should resolve fairly quickly in my experience when the right regimen of therapy and home-care homework is followed.  Please give me a call if I can help.  Good luck!

Most likely, yes!  There are several factors to consider with your daughter’s case: the mechanism of the initial injury, how much she has grown since, her sport activities, and other accidents. When we injure ourselves (regardless of age) we create matted repairs that connect structures that should not be connected called myofascial restriction, and when multiple injuries occur over time these restrictions layer like rings of a tree.  Consideration needs to be given to growth spurts in injured children as this complicates the healing process as tensions are skewed further in unlikely directions. One thing I would be suspicious of with your daughter is looking at the sacrum, the sacroiliac joints, and the lumbar spine as it relates to the occiput (back of the head), jaw joints, and the cervical (neck) spine. Though at first glance it may appear that these structures are too far apart to be related, this could not be further from the truth!  In fact, they act as reciprocals to one another according to principles outlined in Applied Kinesiology, CranioSacral Therapy and BodyTalk.  I have seen many chronic cases of low back pain or jaw/headache issues make seemingly miraculous recoveries once their counterparts are addressed.

The biomechanics of an aggressive tee-off are decidedly different than the more gentle putting stroke, so I am sure it strikes you peculiar to be in such agony with a fairly minor physical effort by comparison.

The first 45º of hip flexion from a neutral standing position is controlled by muscles while hip flexion from 45º to 90º is supported by ligaments.  Given that your complaint is in putting, it is quite likely that your struggle is primarily muscular with possible posterior dural tension.  From a muscular perspective, your challenge may be a shortened pair of hip flexors called Iliopsoas.  Its two-part referral pattern is: A tear-drop beginning from the lower ribs down to the top ⅓ of the glute area;  Diffuse or “tooth-ache-like pain in the top half of the upper thigh.  Though the pattern has been well documented, people don’t always experience the entire pattern and often complain of sharp “ice-pick” pain in the SI-joint area, particularly in the first few steps after rising from a seated position.

While you’re not noticing any impact in your major golf swing, my suspicion is that this is only a matter of time.  Iliopsoas is a hip flexor and a core stabilizer that works in triad with both the abdominal and groin groups.  This triad, like a three-legged stool, is off kilter when one of the three components is compromised.

You state that you are an avid golfer so this tells me that there is likely a degree of repetitive strain that has been built up over time.  Myofascial Release, Myofascial Cupping and some Advanced Sport Massage might be ideal to assist you with this.  All three work with adhesions that build up on the outside of our frame through repetitive strain and trauma.

This is not the only kind of adhesion that could be causing your challenges — I also mentioned that there might be posterior dural tension inside your spinal column.  The dura is the membrane that surrounds the brain and spinal cord, housing the cerebral spinal fluid.  There should be about 2″ of flexibility in the average person which allows for supple bending of the spine. For Gymnasts to excel at their sport there is no negotiating less than 2″ of flex to achieve that walk-over successfully!

ANALOGY:  Tuck your oxford shirt deep into your pants and then try to touch your toes without the shirt escaping from your pants at all at the back.  This feat is impossible.  This is why similar dural tension on the posterior side of the dural membrane would negatively impact your ability to bend forward.  CranioSacral Therapy is exceptional at loosening adhesions and tensions which allow more fluid spinal movement.

My suggestion — if you enjoy your game golf game and want to make the most of this season, take the time and make the effort to get this problem looked after before you waste all this great weather icing random body parts from your couch.  Ice is best enjoyed in your favourite refreshment on the 19th hole!

Dena Liebrecht, RMT, SMT(cc), CBP, ESMT

Helping Okotoks & the Calgary area achieve their ultimate healing through Integrative Healing (& therapeutic massage)!