Thursday, September 24, 2009

Plantar fasciitis or not?

I recently had a patient that I was evaluating and treating for a completely unrelated problem, a two year history of plantar fasciitis. I spent most of my time assessing her current complaint but continued to question her about how her diagnosis of plantar fasciitis was made and what had been done over the past two years. The amount of treatment and assessment was rather extensive without there being any change in her symptoms. Typically, the primary complain of this condition is difficulty walking when getting up out of bed or after prolonged sitting. The patient described hobbling around for 10-20 minutes until the pain subsided and this occurs on an everyday basis.

I simply explained that it may not even be plantar fasciitis but perhaps an internal derangement in the ankle/foot complex. The patient had excellent concurrent signs. Every day when they wake up, they have “searing pain” for 15-20 minutes. They were given one corrective exercise that is common for derangement in the ankle/foot complex and was to perform this exercise 10 times every hour. Upon return, the patient quite happily responded that today was the first time that they had gotten out of bed and walked without any pain in their foot in two years.

The patient has continued with the one corrective exercise and is able to function without pain or limitations. The moral of the story is that diagnosis labels can often be misleading. We basically need to prove that derangements do not occur before accepting some of these clinical diagnoses.

So, plantar fasciitis or not? I think not.

Thursday, September 17, 2009

Shoulder extremity pain

The McKenzie method or “mechanical diagnosis and therapy” which is currently being used has expanded beyond neck and back pain. It now includes all the extremity joints. Some of the findings in treating extremities have been quite dramatic. In most cases it is important to rule out the cervical or lumbar spine as a source of referred pain which is easily done with history taking and a quick screen of the spinal motions. I had a recent patient with constant upper arm pain which persisted for 6 months and was not improving. She was unable to lie on this shoulder or lift her arm secondary to pain and did not respond to over the counter medications or rest. She had an x-ray which was negative and her cervical spine was cleared out of the source of her symptoms. She also presented weakness in the shoulder.

After only 4 visits, almost all of her arm pain was gone and a significant increase in motion was noted. Within 7 visits, her range of motion was within normal limits and now she is being seen periodically for strength training to improve strength and prevent any reoccurrence of these symptoms. The most interesting observation is that all of this was performed with simple “mechanical diagnosis and therapy” testing and treatment without the need for a MRI study, surgery or even injections. The patient was quite amazed how rapidly her symptoms could change and only wished she could’ve started her treatment much sooner. The extremity joints particularly the shoulder do present some difficult variables as there are so many ranges of motion in this joint and we essentially use our shoulders everyday for most of our functional activities.

We will continue to keep your updated with various spine and extremity stories that have responded successfully to mechanical diagnosis and therapy.

Thursday, September 10, 2009

Cervical Headaches

Robin McKenzie’s first “Mechanical Diagnosis and Therapy of the Cervical/Thoracic Spine” text published in 1990 sites that the specific epidemiological data on the subject of cervical headaches was rather sparse. He references a study by Frykholm that of all headaches in practice, headaches of cervical origin were the most frequent. This certainly holds true in our practice. With the increase use of laptops and computerized workstations, forward head postures and loss of the ability to retract the cervical spine and extend the thoracic spine certainly contributes to mechanical derangement of the upper cervical region.

I am once again amazed by the rapid reversal of cervical headaches as I had a patient this week with a two and a half week history of constant headache which was simply relieved with a sustained cervical retraction position. With the use of joint mobilization and exercise to increase her flexibility, she is able to keep her symptoms abolished with relatively simple posture correction and exercise.

How many people out there suffer from cervical induced headaches that continue to rely on medications which do not resolve mechanical headaches?