Today's post is kind of half personal story/half conjecture/half observation(wait, that doesn't add up!). To begin, I have now been wearing a minimalist/zero drop type shoe everyday for both casual use and exercise/running. The only time I wear a shoe that is not completely flat is when I wear my dress shoes with my suit for basketball games.
One of my current favorites
I am a huge proponent of wearing zero drop shoes with a wide toe box and the absence of a "toe spring". I feel this shoe design interferes the least with proprioception, normal foot mechanics, and proper tissue length. Think of non-zero drop shoes as being like a mini-high heel.
Today's post is centered around a patient that I have been working with lately. This athlete is a sophomore collegiate runner that competes in middle distance running events.
History:
This patient is now a 19 year old male that began running in 4th grade. He was in a running club affiliated with his grade school and was soon running around 160miles a year. He began to suffer minor injuries during middle school and somebody had prescribed him orthotics. He struggled with stress fractures, hip pain, and plantar fascia pain all through middle school. Despite these issues, he still managed to run a 4:43 Mile as an 8th grader.
Throughout high school he continued to struggle with injuries such as hamstring strains/tendonosis, spinal stenosis and low back pain, chronic ankle instability and piriformis issues. He also struggled with plantar fasciitis/osis during this time as well.
Once this athlete got to college he tried to transition to minimalist footwear in attempt to "correct" his heel strike. He did not suffer at all until halfway through his first cross-country season when he had a week long flare up of pain that was similar to his previous plantar fasciitis/osis. He was fine again until the beginning of his first indoor track season. The pain became unrelenting despite being prescribed new orthotics and undergoing an expensive shockwave therapy procedure. The patient decided to just cross train and rest for the remainder of his freshman year as a collegiate runner.
This is where I entered the picture and had a few small conversations with this athlete regarding his plantar pain and I gave him a few exercises to perform on his own such as a self-mulligan mobilization with movement technique for ankle dorsiflexion and repeated end-range plantar flexion prior to runs. The patient used these few exercises all summer long until he returned for his sophomore year with good results but was not completely pain free.
I heard that he was still struggling with his plantar pain and offered to help him with a proper evaluation and treatment plan.
I am not sure if the title of this post makes any sense but what I am trying to say is that I am itching to get back into the clinic. All of my athletes(patients) are on summer break and I won't be dealing with any athletes for another two weeks or so. I love being an athletic trainer and I have been reading/watching/learning a lot this summer that I want to use to advance my skills as a clinician.
With no athletes to fix I have resorted to offering a helping hand to others outside of my athletic training world. I work as a barista for a part-time summer job to help foot some of my bills and fortunately for me over the past week this job has been a source for me to help some people with musculoskeletal issues.
Hey everyone, I was about to go for a run today and I thought of the idea of highlighting some of repeated-end range exercises that I have mentioned in some of my recent posts. Today I will show you two of them that I do try to do before every one of my runs. I learned these from Dr. Erson of TheManualTherapist.com so I can't take credit for thinking of them! I must say that incorporating these two exercises has helped me resolve any lingering heel stiffness/pain that I previously had.
It is very easy to find out if these will do anything for you by giving them a try and checking your mobility to see if benefit from them. If you do, great! If not, you might want to try some soft tissue to assist you reach your true end range or maybe just find something that does work for you!
I have been following Dr. Erson Religioso's blog, The Manual Therapist, for quite some time now. I also recently subscribed to his OMPT Channel section where I have learned quite a few evaluation and treatment techniques to add to my arsenal. Dr. E has training in a plethora of different schools of thought and one of them is the Mechanical Diagnosis and Therapy or MDT for short. Part of his MDT skill-set is a various amount of techniques that he refers to as "resets". He often uses them as part of his evaluation, treatment and home exercise programs. I hope I am saying all of this accurately, at least. Here is a couple videos of Dr. Erson Religioso III, DPT, FAAOMPT explaining the what, why and how related to these resets.
This is Dr. E's video highlighting the his favorite resets, and why they work.
An updated but longer video for Dr. E's favorite resets.
The Toe Pain:
I am currently pursuing a post-professional graduate degree so that means I am still a student (will be one for life) and that I still have finals. A couple Monday’s ago I was sitting around with a few of my classmates while waiting to take a final practical exam. One classmate mentioned that she had a very painful big toe on her right foot. She had been suffering this pain for a day or two since walking around Chicago the entire weekend while wearing ill-fitting footwear. She had only had the pain on one side without any direct MOI besides gradual onset related to the shoes and walking. She had pain with great toe extension when toeing-off in her gait cycle.
Dr. E’s videos had been on my mind and I was curious if his resets would really work because they were a foreign concept related to anything I had been taught. I had the idea of doing repeated-end range flexion of the great toe for about 20 repetitions and I asked her if she minded trying out the experiment. She obliged and we went to town with the repeated “resets”.
After I finished with the 20 or so repeats I asked her to stand up and walk around. Alas, she had no pain and no other complaints appeared. I told her that there was a chance that this would be a transient effect and that she may need to repeat this exercise about 10 times every hour. However, her pain never returned that day and hasn’t to date. I believe a week later when I inquired about her toe she mentioned that my “voodoo” had fixed the issue for good. While I don’t think I was doing any magic or voodoo I do think this highlights some merit to these resets on an n=1 level. Half of evidence-based practice is clinical experience and so far my “clinical” experience has been great; although I do wish I had some more extensive training or knowledge about MDT. I was impressed enough with these results that I tried using the repeated ankle plantar flexion reset for my girlfriend’s aunt who has had years of constant heel pain. This was just an offhand encounter at Mother’s Day brunch but it immediately took her symptoms from a wince-inducing 8/10 to a 4/10. I gave her instructions to continue these as a self-empowering home exercise and I hope she sticks to them. I really want to see how she progresses.
Conclusion:
My conclusion about these resets so far is that I like them but I don’t see them as a replacement to my current clinical skill set. I see them as being another tool and a great way to put responsibility into the hands of the patient. I understand the theory and concept as explained by Dr. Religioso. However, I definitely feel and want to learn more about this stuff before it starts to become a mainstay of my clinical practice.
I was perusing the internet today when I came across a couple of videos produced by Dr. Mark Cucuzzella. Dr. Cucuzzella is the director of the Natural Running Center, Professor of Family Medicine at West Virginia University and the owner of Two Rivers Treads in Shepherdstown, West Virginia. Dr. Cucuzzella is a running guru that has been at the front of the natural running movement for many years now. He also brought us this previously mentioned video that highlights the principles of natural running form.
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Caution
All content on this blog is meant as instructional and educational. The author and guest authors of this blog are not responsible for any harm or injury that may result. Always consult a physician or another proper medical professional for medical advice.
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