7 Things You Need to Know About Plantar Fasciitis

Plantar fasciitis is one of the most common and painful foot conditions. It is treatable but the longer you go without taking care of it, the harder it is to get back to normal. Here is a list of seven things you should know if you think you have plantar fasciitis.

  1. What is plantar fasciitis? Anatomists use plantar to refer to the sole of the foot. Fascia is a thin sheath of connective tissue that encases and connects structures in the body. The plantar fascia is located in the sole of the foot and connects the front of the foot to the heel and accommodates them to form the longitudinal arch of the foot. Basically, it is a web-like ligament that provides shock absorption and supports the arch while walking. Whenever “-itis” is added to a word it indicates inflammation. So, plantar fasciitis is inflammation of the plantar fascia.
  2. Stretch the calves! The fascia that surrounds the Achilles tendon and the calf muscles above it connect to the plantar fascia. Stretching the the calves is vital in treating plantar fasciitis. To properly stretch these muscles stand close to a wall with one leg forward and one leg back. Plant the rear heel to the ground with the knee bent. Lean forward with your hands against the wall until you feel a nice stretch in the back of your leg. It is important to perform this stretch at least once a day and to hold for longer than 30 seconds.
  3. Break up scar tissue. Plantar fasciitis occurs when there are microtears in the tissue. These tears are usually the result of repetitive stress and/or a decrease in elasticity. Age, weight, activity, nutrition, injury, and foot shape and function are all contributing factors. When tissue tears, a scar forms which is less elastic and prone to reoccurring tearing. Breaking up this scar tissue is important. To do so I recommend firmly rubbing the sole of the foot over a soft corner of a coffee table or on a frozen knobby water bottle. I will often strip the plantar fascia with my thumb on a willing, if not masochistic, patient. Massage therapists are often happy to oblige in this particular form of torture/treatment, as well.
  4. Ice your foot. Speaking of frozen water bottles, as this is an inflammatory issue, icing it will reduce the inflammation and arrest further tissue damage from this process. As mentioned above, rubbing your foot on a frozen water bottle will not only break up scar tissue but will also ice the sole of the foot. If that doesn’t take care of the inflammation it may be necessary to use an ice bucket. This is its own form of torture but quite effective. You can find more information on that here.
  5. The arch of the foot needs to be addressed. In my practice I often adjust feet. If the joints of the feet are not moving properly, it can put a strain on the plantar fascia and it can overwork the calf muscles. Sole inserts can also assist in correcting the proper mechanics of the foot and reduce the stress placed on the plantar fascia. I recommend trying a non-custom insole that has sufficient arch support and a decent heel cup. I like Superfeet that you can buy at REI or Kaiser but I am also trying out a new company that I will write a product review for if I like them. You can also get a great product from The Good Feet Store but it is an expensive product. If none of those options work, a podiatrist and some chiropractors can fit you for a custom orthotic. I have strong opinions about these and really prefer ones that correct gait. I really do not like posts that only correct the foot while standing. Unfortunately, the vast majority of orthotics are the latter.
  6. Podiatrists can help. A good podiatrist, or foot doctor, can make a big difference in difficult cases of plantar fasciitis. If you have done everything I mentioned above and you are still struggling, you made need more invasive intervention. If a podiatrist tells you to wear a boot for six weeks, I recommend getting a second opinion. This usually just means that they don’t think it is bad enough to do something more invasive and they are too busy to tell you to do more of the above. If it is severe enough, the first aggressive step is to get a cortisone injection. This is not without risk. Cortisone is very effective in reducing inflammation and can be what is needed to put the foot on a healing course. However, it also dries out tissue. As dehydration leads to a decrease in elasticity, cortisone can worsen the problem. At the very extreme, surgery is the last option. Typically the podiatric surgeon will cut the plantar fascia and release the tension placed on it. Yes, it is the last resort but there are times when it has to be done. By the way, I know some really good podiatrists in the area.
  7. Is it really plantar fasciitis? Finally, just because you have foot pain and your GP diagnosed it as plantar fasciitis doesn’t mean that is what you have. I cannot tell you how many times people have told me they have plantar fasciitis and I rub my fingers along the sole of the foot eliciting zero pain. It will absolutely be painful with tiny bumps on the sole of the foot if you have plantar fasciitis. Often times the real problem is that the foot is maladjusted. Getting it adjusted enough can remedy the problem in this case. Sometimes it is an Achilles or calf issue. In that case, stretching and massaging the calf can help. Occasionally, a heel spur is the culprit. Most people have heel spurs and they are rarely the cause. But, I have had patients where it made a huge difference to have surgery to remove them. Lastly, the heel has a fat pad that provides cushion while walking. If it gets injured it is extremely painful. There is not much but rest and maybe cortisone that will help with that.

***Photo by Imani Bahati on Unsplash

Massage and Chiropractic

Just about everyday I get asked whether it would be a good idea to get a massage. Almost always my answer is absolutely! I am a big fan of massage as a healing art and a therapy. As with all professions, there are very good practitioners and some that are not so great. I have, of course, known patients who have been to massage therapists that caused more discomfort and may have even caused some tissue damage. However, most therapists do a good job helping people relax their muscles, free their fascia, move their lymph, etc. Remember, massage therapists in the State of California are licensed and have many hours of schooling and practice and if you go to a reputable clinic, you will be in good hands.

Like chiropractic adjustments, it is rarely bad to get a massage at any time. However, also like adjustments, the type of massage must adapt to the body’s condition. For example, when people ask if they should get a massage right after an auto accident, I am often hesitant to endorse such a therapy. The right kind of massage can help flush out inflammation and soothe really sore muscles. However, if the massage therapist is too aggressive the muscles might spasm completely. In addition, massaging recently injured tissues can cause more swelling. On the same note, massage, when muscles are in spasm, requires a special touch. Most massages will help settle down spasmed muscles. Notwithstanding, if the muscles are spasming, chances are they are doing so to protect an injured joint. Take away what is protecting the joint and there are often painful consequences that could prolong healing.

Another question that often comes up is whether it is better to get a massage before or after an adjustment. Most people think that getting massaged before getting adjusted means they are relaxed for a better adjustment. While that is true, as a chiropractor, often times I find that if the muscles and the joints are too relaxed, it can be difficult isolate the stiffer joints and get them to move properly due to the laxity of normal functioning ones. In general, I prefer to adjust people before they get massaged. Adjustments can settle muscles that are tight while protecting joints that are not functioning properly. Personally, I much prefer to get massaged after getting adjusted because it allows me to enjoy the massage better. At the end of the day, it really comes down to preference whether one gets adjusted before or after an adjustment, but more often than not, I would choose to get adjusted before getting a massage.

Regular massages are wonderful thing. How often and how long you need to be massaged is a great discussion to have with your therapist. Additionally, people respond to different techniques and therapists. I have had many massages throughout the years from various massage therapists. I have also enjoyed some styles better than others. Some massages I enjoyed the results much more than the process. To that point, some people feel a massage has to hurt to be of any benefit. I disagree. Sometimes the body needs to be worked over significantly and sometimes it just needs a light touch. A good massage therapist who is intuitive and willing to listen to the patient will know what to do and when.

***Photo by Toa Heftiba on Unsplash

“Do you accept Kaiser?” “Yes, we do, sort of…”

We get calls every day asking if we take Kaiser patients. Of course, we do! However, we are not contracted with Kaiser so that is a bit of a misleading statement but let me explain. Kaiser Permanente is one of the largest health care providers and insurance companies in California and its innovation has become revolutionary. Kaiser is both an insurance company and provider of healthcare which has given it a unique way of managing the growing costs of healthcare while still providing quality care.

As a provider, Kaiser does not actually provide chiropractic care. They have acupuncturists, physical therapists, and, of course, all of the traditional medical professionals. At least, as far as I know, they do not employ chiropractors to perform chiropractic care. As an insurance company, they have some policies which include chiropractic care. Kaiser does not actually manage chiropractic benefits for their clients. Instead, they contract out chiropractic benefits to a company named ASH or American Specialty Health. If a chiropractor wants to be on the list of providers for the people who have chiropractic benefits on their Kaiser policy, they must be contracted with ASH.

I am not contracted with ASH nor do I have plans to become contracted with them. ASH is an HMO or health management organization and their model of business is not compatible with mine. HMO’s are willing to cover patients in acute pain who have an injury on their list of conditions suitable for chiropractors to treat. They have models that require justification for care through paperwork. I like more flexibility in treating my patients and I hate extra paperwork. HMO’s have done well in reducing the cost of care for insurance companies. In theory, this means lower premiums and copays for patients.

So, how exactly do I take Kaiser patients? I am glad you asked. First, most Kaiser patients do not actually have chiropractic benefits. So, it makes no difference whatsoever to see an in-network or out-of-network chiropractor. We have a great practice with very affordable fees and super friendly staff. Why wouldn’t you want to see us over anyone else?

For the patients who actually have chiropractic benefits through ASH we can still help. I may not be contracted with ASH and therefore have the privilege of taking a reduced fee in exchange for a policy that will tell me that I can only see a patient six times before having to file another report to get a few more visits until they decide that the patient should be better so they are not paying anymore; then, by the time I get done writing reports and fighting the insurance company, I have wasted enough time and money to make it completely not worth it; but, I can see patients with Kaiser/ASH at no additional cost to the patient.

I routinely accept patients’ regular copays as full payment for care. Compare that to a doc who will take that copay for the six visits the insurance company gives and then charge full price once the insurance company deems their lingering issues resolved. Of course, sometimes patients prefer my monthly care agreement because it works out to be less expensive than paying their copay every time. Either way, it is a better deal for the patient because they are not under the scrutiny of the insurance company but still enjoy the contracted copay or less. In addition, they get great care and it can be completely customized without strict policy guidelines. In that way, we are happy to take care of Kaiser patients and everyone else who has insurance whether we are in-network or not.

***Photo by Miguel Bruna on Unsplash

Thoughts On the Coronavirus and All Infectious Diseases

As with anything that dominates the twenty-four-hour news cycle, the Coronavirus or COVID-19 has a spectrum of concern. Please educate yourself on this virus by checking out the CDC’s website. I am writing to give my thoughts from a holistic healthcare provider and, hopefully, a reasonable perspective to help you navigate the fear while still protecting yourself.

You are starting to see memes about surviving the latest end of the world. Let’s be honest, every few years the news goes crazy about some infectious disease that could wipe out entire populations. The disease runs its course, many are infected, several die, and the disease gets under control and passes from global consciousness. Some diseases, particularly the ones they create a vaccine for, stay in the public consciousness because of the shot. These are, generally, very nasty viruses. There is definite cause for concern. However, we need to step back and avoid panicking so we can really fight the spread of such diseases.

Many have written articles about how to protect yourself. I would echo those which encourage you to wash your hands often and avoid close contact with potentially infected individuals. However, we still need to live and function in society. The best defense is not a mask, gloves, or boarding yourself up at your house, but a stellar immune system.

Antoine Bechamp in the 19th Century claimed that it wasn’t germs that cause diseases but that leaving our bodies susceptible to disease was the problem. He argued that there are always germs in great supply about and around us and that until we give them a place to thrive, they stay under control. To prove his point he drank a glass of water infected with cholera and never got sick, so the legend goes. He lived into his 90’s so he, at least, had something going for him.

I am not suggesting that anyone take a flight to China, not that there are any available, to prove the superiority of your immune system. However, we can and should do all we can to keep our immune system performing well. I could write a whole article on keeping your immune system healthy. I will sum up some good ways by saying you need to eat well, drink plenty of water, exercise, get enough sleep, avoid sugar and alcohol, and get adjusted.

I know, I am a chiropractor and I always figure out some angle to work adjusting into the solution. The truth is that chiropractic adjustments have been shown to significantly boost one’s immune system.

Right now, the Coronavirus is not really prevalent in our area. There are a few cases that have been quarantined. Health officials are doing a good job of educating people about what they can do if they suspect an outbreak. In our office, we are taking the normal precautions to ensure that we are not a source location. Please, keep up on your care. Staying healthy, like I mentioned earlier, is still the best defense.

 

When Adjusting the SI Joint Isn’t Enough

If you have never had SI joint pain, you are probably wondering where this particular joint is located. If you have had or currently have SI joint pain, you know it can be a pain in the butt, literally. The Si joint or sacroiliac joint is formed by the sacrum, the trapezoidal bone below the lumbar spine and above the coccyx, and the pelvis, or ilia. There are two joints on either side of the sacrum. The movement of the SI joint is called nutation and it is pretty slight. One does not really even notice the movement until it gets stuck and then it is all too obvious.

A chiropractic adjustment can do wonders to relieve the pain associated with an SI joint that is not moving properly. I have found that using the drop table is particularly effective. I usually follow it up with a side posture adjustment. Sometimes, however, that is not enough. On occasion, I find a stuck SI joint even after the adjustment. In these situations, I look to the pubic symphysis.

The pubic symphysis is a tricky joint. It is formed where the pelvis meets in front. It is a cartilaginous joint that is planar. What I find when something is wrong is one of the pubic rami is higher than the other. Because the pubic symphysis is on the opposite side of the SI joint but still the same bone, if it is not moving right, the Si joint will have problems, too. I use an activator to adjust the pubic symphysis. This is a fairly sensitive area so using the activator makes it more comfortable both physically and socially.

So if you are having problems getting the results you need from a typical SI joint adjustment, have your chiropractor check your pubic symphysis. As with all treatment, it can take several visits before you see significant results. Still, you should start seeing some signs of improvement fairly quickly to help you know you are on the right path.

 

5 Things to Consider When Looking for a Chiropractor

It can be tough finding a chiropractor that you can trust and who will be the right fit for what you want and need. This list is by no means comprehensive but over the years I have noticed trends that can help you pick the right doctor of chiropractic for you and your family.

  1. What style of Chiropractic do you prefer? Chiropractors have a fairly broad scope of practice and have expertise in many different styles and methods. Do a little research on the doctor before you go in. Read the doctor’s bio. Look at how they practice. Some chiropractors just adjust, which is what we do in our office. Some emphasize nutrition. A lot of chiropractors really want to treat the whole body and have a lot of extra equipment and programs to help improve your health on all levels. Others only focus on pain relief. Every chiropractor has their own individual style but there are also various technique systems. There is Gonstead, Applied Kinesiology, Activator, Sacro-Occipital Technique, and the list goes on. If you know you like a style, look for a doc who practices that way. If you have no preference, in terms of style, look for someone with similar values or who is likeminded.
  2. What type of care do you want/need? There are basically three types of care and some chiropractors do all three and some only do one or two. The three types of care are acute or symptom care, corrective or rehab care, and maintenance. It can be frustrating to see a chiropractor who only wants to do long term corrective care if you only want to focus on your symptoms. Likewise, it can be a problem if you really want corrective care and to rehab from an injury and the doctor only wants to see you when you have pain. On that same note, some patients are put off by chiropractors who recommend nutritional supplements, orthotics, pillows, or other corrective equipment. Other patients want and need a bigger commitment to improving their health. Finally, some chiropractic offices have physiotherapies like electrical stimulation, lasers, ultrasound, heat, massaging tables, and ice packs. Therapy takes longer to utilize. Some patients like the extra time spent in the office. Others just want a quick treatment. The type of care may change based on your symptoms and healing progress so be sure to find a chiropractor who can either adapt or is in line with what you need at the moment.
  3. How far away is the doctor’s practice from where you live or work? This may seem obvious but I see people all of the time who come from a long way away because their friend referred me or they didn’t put in their location in the search parameters before they read my reviews. Most chiropractors will want to see you more in the beginning sometimes as much as every day. Travel time and gas costs add up. It is best to decide early if commuting to get adjusted is worth it. You also need to consider if it is better to find a doc closer to your work or to your home depending on your work hours and the doctor’s schedule.
  4. Do the doctor’s hours work for your schedule? Most people lead busy lives. There is a lot to do in a day. You need to consider whether your doctor’s hours and schedule work for your lifestyle. Does early work for you or do need someone open late? Are they open on the weekend? Further, do they require an appointment or do they take walk-ins? Most doctors prefer to make appointments for new patients and some always require an appointment. You need to decide if it is better for you to have scheduled appointments or not? On that same note, if the doctor only takes appointments, do they run on-time?
  5. Do the doctor’s fees work for your budget? Healthcare these days is expensive. Doctors have a lot of overhead because of licensure, regulation and the cost of rent and payroll. Because of that, doctors’ fees range greatly. A good rule of thumb is to ask how much an adjustment costs. Chiropractic Economics Magazine puts the national average cost of an adjustment at $65. Most docs will charge more for therapies and other services, so keep that in mind. Whatever the fees, make sure you have a way to pay for the cost of the care you need. Most chiropractors have plans that can help save you some money if you pre-pay. Insurance can also help but is not always very reliable. Going in with a fair idea of what it will cost definitely helps you make a good buying decision. If money is a concern, discussing fees with the doctor after they have a good idea of what you care will look like is very important.

Time Vs. Expertise

There is a story about a remote research facility that was having a problem with their generator. They tried to get a few technicians to fix it but it never worked right. Finally, they brought in an expert. The expert looked at the generator, tapped it twice and it ran perfectly. He sent the bill for $2002.00. When the scientists saw the bill they were incensed at the price for so little work on the part of the expert. They demanded an itemized statement. The expert sent one which read: $1.00 per tap x 2 taps = $2.00 + $2000 for knowing exactly where to tap.

I tell this story to help people understand that when you meet with an expert it is about their skills, knowledge, and experience, not their time. I have patients come in who are surprised at how much an adjustment costs considering how little time it takes. We are especially expedient in our office. To those patients I say, you are not buying our time, you are buying our expertise.

Most patients love that they can come into our office and get a great adjustment in a short amount of time. It does not take us long to figure out what is going on with a patient and adjustments by their nature are quick. We don’t do therapies like e-stim and ultrasound. We are not nutritional counselors. I have no problem with chiropractors who do that but that is just not how we choose to practice. We focus on giving good adjustments that help people with their busy lives.

In addition, the greatest benefit of chiropractic is not an adjustment but regular and consistent adjustments. We really encourage patients to get adjusted often and regularly by making it convenient and quick to come in. We also make it very affordable to get adjusted a lot. The price per adjustment if you just come in once in a long while is expensive. However, if you want to come in regularly, the price per adjustment is downright cheap in our office.

We will always strive to spend as much time as you need to give you a great adjustment. We are here to listen to your concerns. We never want patients to feel rushed. That saying, care in our office is not based on time. Care is based on service done with skill and care.

***Photo by Veri Ivanova on Unsplash

3 Types of Chiropractic Care

Not everyone will fall into one of the categories specifically but, in general, there are three types of chiropractic care. The key is deciding what results you want from chiropractic care. From there, we can determine the frequency and mode of treatment.

The first type of care focuses on symptoms. A chiropractor will see you as many times as needed to reduce your symptoms to a level you can manage. This is usually short term care. Some people will stop here, deal with the manageable symptoms, and then come back when they flare up again. Pain, by the way, is the most common symptom but there are many others, as well, including, but not limited to, numbness and tingling, weakness, blurry eyes, tinnitus, heartburn, etc.

The second type of care takes into account the larger picture and seeks to restore function. I call this rehab or functional restoration care. The plan is generally the same for most people because restoring function is more predictable than reducing symptoms. While we restore function, symptoms will reduce naturally but we continue care to reinforce proper function and actual healing. Most people will need about three months of care. The frequency tends to be three times a week for about a month tapering down to twice a week for a month then once a week. By the end of three months, most people have healed enough to the point of feeling better and functioning as best as can be expected. There is variability in this care and some conditions take a lot longer.

The third type of care is maintenance. Once you have put so much effort and commitment into being your best, I feel it is best to maintain through consistent chiropractic care. Once a week is needed for some and some lucky patients can get away with once a month. Less than that and most patients are coming back with symptoms which begs the question if they are actually maintaining or just chasing their tale? We make maintenance a high priority in our office and make sure it extremely affordable.

Your results will depend on what type of care you engage and how consistently you are engaged in that care. You cannot get rehab results from a few visits of symptom care. Likewise, you cannot maintain something you have attained. Sometimes, patients want to negotiate to get rehab results by coming in once a week. I would love to be able to do that but that’s just not how the body works. For me, the ideal way to treat a patient who is injured or has chronic dysfunction is to complete a course of rehab care and follow it up with continuing maintenance care around once a week.

5 Causes of Sciatica

Sciatic Back Sciatic NerveFirst, let us define what sciatica actually is and is not. Sciatica is, very specifically, pain along the sciatic nerve stemming from irritation of that nerve. The sciatic nerve is formed from a conglomeration of spinal nerves in the low back which binds together into one sheath. This nerve runs under the piriformis muscle in the pelvic area, then runs in between the two parts of the biceps femoris, also known as the hamstrings. It has become common to call any pain in the leg which is suspected to come from the back, sciatica. However, sciatica is a nerve pain which is the same feeling you get when you hit your “funny bone.” Most leg pain, and consequently what most people call sciatica, is actually referred pain. That is a different post. To be a true diagnosis of sciatica, it must be nerve pain that stems from the lumbar spine and runs into the buttock and/or down the backside and middle of the thigh. Now that we have that out of the way, let’s talk about what causes it!

  1. Disc Injury. Disc injuries are the most common back ailment. When a disc bulges or herniates, it can occupy the space where the spinal nerves exit from the vertebral column. If a disc bulges too far it can push against the nerve root causing pain to travel down the sciatic nerve and beyond. Sometimes, the bulge will hit the nerve and then pull back enough so that the sciatic pain is not constant. If the disc is in constant contact with the nerve, one can experience pain, numbness and tingling, weakness, and other symptoms. Chiropractic can help, but these can take a long time to heal and consistency makes the difference. Traction, rehabilitation exercises, physical therapy, and stretching can also help if done properly. If it comes to it, cortisone injections and surgery may be last resort options.
  2. Inflammation. With injury comes inflammation. Though the disc is the most common injury, there are several other structures in the area of the nerves that make the sciatic nerve that can be injured. Inflammation is toxic and can cause its own set of issues. Nerves are especially sensitive to inflammation. Icing, NSAIDs like ibuprofen, Chiropractic, and steroids can all help reduce inflammation. When the inflammation is in check, the back and sciatic pain will diminish. When the area with the sciatic nerve or nerve root is inflamed. The symptoms will remain constant.
  3. Sacro-Iliac (SI) Joint Dysfunction. The sciatic nerve crosses the SI Joint just after it forms the large nerve. If the pelvis shifts or is not working properly, it can irritate the Sciatic Nerve through direct pressure, inflammation, or by causing muscle tightness or spasms from the imbalance. Adjusting the SI joint will help reduce inflammation and muscle guarding, as well as move it away from contact with the nerve if that is the case. Chiropractic is by far the best thing for this case but a clever physical therapist can help, too. Exercise, stretching, and icing may help but can irritate it, as well.
  4. Piriformis Syndrome. This diagnosis has become pretty popular. I find that it is misdiagnosed more often than not. The piriformis is a little pear-shaped muscle (hence the name, piri means pear), that spans the SI joint. The Sciatic Nerve runs underneath it in most individuals. If this muscle tightens, it can compress the sciatic nerve and cause sciatica. The piriformis can tighten for various reasons including any of the above-mentioned maladies. Usually, I find the piriformis is a secondary issue. Sometimes, however, it can take on a life of its own after the other condition has resolved. If it is, truly, piriformis syndrome, the best thing to do is have a specialist perform a muscle release on it. Active release, myofascial release, Bowen, Rolfing, massage, etc. can all help if done right. Be aware that if it only helps for a little while, then there is probably another issue that is still causing the muscle to tighten or guard.
  5. Direct Contact. Because the Sciatic Nerve runs through the buttock and down the back of the leg, the way one sits can cause sciatica. The most common cause is a wallet in the back pocket. Additionally, a seat that curves upward along its lip can put pressure on the legs and irritate the nerve. Unfortunately, I have seen this most often in vehicles. The solution for these is obvious. The trick is to figure it out before it causes problems more difficult to remedy.

There you have it. Probably not a comprehensive list but definitely the most common causes. Sciatica is actually rarer than it seems. When you have it, however, it is very painful and can be difficult to treat. If you are experiencing sciatica or any type of pain or other symptoms down the leg, chiropractic can help. And, like all conditions, being prompt and consistent makes for better and quicker healing.