Back In The Running Clinic

21/02/2025

What mechanical factors are associated with Plantar Heel Pain (PHP)?

I’d love to have a clear answer here but it appears the evidence is quite mixed! It seems that association is likely with reduced ankle dorsiflexion and decreased toe flexor strength and PHP has been connected with high BMI in non-athletic groups.

Sullivan et al. (2020) note that the association between heel pain and foot alignment is unclear plus there is limited evidence to suggest heel pain is associated with running mileage or weight-bearing at work.

Each of these factors may influence the load on the plantar fascia so there is value in assessing each on an individual basis.

Both athletic and sedentary people can encounter PHP which may be why research findings can vary as different populations may have different causative factors and treatment needs. The key thing is to recognise this and tailor treatment to the person rather than the condition.

Reference:
Sullivan J, Pappas E, Burns J. Role of mechanical factors in the clinical presentation of plantar heel pain: Implications for management. Foot (Edinb). 2020 Mar;42:101636. doi: 10.1016/j.foot.2019.08.007. Epub 2019 Sep 3. PMID: 31731071.

18/06/2024

07/06/2024

Hot off the press 🔥

Effects of Stretching or Strengthening Exercise on Spinal and Lumbopelvic Posture: A Systematic Review with Meta-Analysis

👉 Stretching of skeletal muscles with restricted ROM represents one of the most popular strategies used to tackle muscle imbalance and postural impairments (https://pubmed.ncbi.nlm.nih.gov/22223616/).

👉 As early as 1997, Spring et al. (https://pubmed.ncbi.nlm.nih.gov/9490434/) recommended it as the gold standard of posture treatment, but convincing evidence for this recommendation is lacking until now.

🤔 A brand-new meta-analysis by Warneke and colleagues (https://sportsmedicine-open.springeropen.com/articles/10.1186/s40798-024-00733-5) examined the effect of stretching or strengthening on spinal and lumbopelvic posture (e.g., pelvic tilt, lumbar lordosis, thoracic kyphosis, head tilt) in healthy individuals.

👫 They included a total of 23 studies with 969 participants.

📊 Neither acute (d = 0.01, p = 0.97) nor chronic stretching (d=-0.19, p = 0.16) had an impact on posture.

📊 In contrast to stretching, chronic strengthening was associated with large improvements (d=-0.83, p = 0.01), but no study examined acute effects.

💪Strengthening was superior (d = 0.81, p = 0.004) to stretching.

📊 Subgroup-analyses found strengthening to be effective in the thoracic and cervical spine (d=-1.04, p = 0.005) but not in the lumbar and lumbopelvic region (d=-0.23, p = 0.25). Stretching was ineffective in all locations (p > 0.05).

💡 In conclusion, the common recommendation of stretching tight or shortened skeletal muscle to improve muscle imbalance and posture lacks scientific evidence (moderate certainty). In contrast, this review reinforces the role of strengthening weak antagonists which, however, was only effective in the thoracic and cervical but not in the lumbar spine (moderate certainty). The authors speculate that hypertrophy would be associated with a larger number of parallel titin-myosin filaments, which could lead to a higher tensile muscle stiffness.

Example exercises (https://www.mdpi.com/1660-4601/17/15/5430) (a) axial elongation exercise, (b) craniocervical flexion exercise, (c) craniocervical extension exercise, (d) rowing exercise, (e) Y exercise.

15/05/2024

12/02/2024

RIP https://www.bbc.co.uk/news/world-africa-68270866

09/09/2023

I continue to read that heel striking is bad for you. Here are 5 reasons, based on science, it simply.. is not! As always.. please...