I ran across a video the other day and thought I'd write a post about it because it gives a good example of just how much bad advice there is out there among "certified" physical therapists and so on.

Before I start, I want to say that I know (and have used) some excellent PTs, and I certainly do not want to say that everyone in the field is a quack or anything like that. There are definitely some good people out there, and if you have access to a really competent PT, he or she can often work miracles. But on the other side of the coin, just having a certification (of any sort) doesn't necessarily make you competent in your job. And a lot of people get fooled by labcoats.

Personally speaking, I've received enough bad advice from "body professionals" over the years that nowadays when I have to see one I always try to assume that they know what they're talking about...but I also always ask some pointed questions, just to make sure. I hope that this blog post will make you think about things a little, and encourage you not to blindly accept what you're hearing the next time you go in for some "body work".

I'm not going to link the video here, but you can find it on YouTube. Just go to the YouTube site and type in /watch?v=pn6i-_dTX0g after the www.youtube.com part of the URL. The video's less than two minutes long, but if you don't want to watch the whole thing I'll give a brief summary below.

Strengthening a tendon

The video shows a PT who tells you how to "strengthen" an apparently healthy woman's achilles tendon by using a stretch band. The woman is sitting on a therapy bed and takes the band, loops it around her foot, and then proceeds to exercise the foot against the band by pointing and relaxing her toes.

All this is fine, and the PT makes sure to cover some good points about getting in a full range of motion and so on. The problem is that the band only provides about five or ten pounds of resistance, and the woman in the video who uses the band has got to weigh at least a hundred and twenty.

This may not seem relevant, but think about it for a second. If she weighs 120lbs, that means that every step she takes she is putting 120lbs of pressure on her achilles tendon. How is a band with ten pounds of resistance going to strengthen a tendon when that tendon has far more stress put on it just when the woman walks? (We won't even talk about how much more than 120lbs each step really is because of acceleration/deceleration forces.) If you can bench press 200lbs without any problem at all, you're not going to develop more strength by working out with 20lbs.

What's the point?

So what's the point of using a very weak stretch-band for this? Basically, unless the woman was injured and spent so much time off her feet that her achilles tendons atrophied to the point that they can no longer support any weight (which would mean that she couldn't even stand up), there is none. Maybe a polio victim would qualify, but exercising an achilles tendon in any realistic scenario will involve using a decent amount of weight, one that equals a significant percentage of the exerciser's bodyweight.

Yes, if the woman was injured or is recovering from surgery it makes sense to monitor her level of pain and start out using a lighter weight. But not this light. Using a weak band like that reminds me of the housewives who walk into gyms, start using the one- and two-pound dumbbells, and then wonder why their bodies don't change. It's not hard to understand when you realize that the average bag of groceries weighs more than the "workout" weights! They're not using enough resistance to have any effect on the muscles.

One other point about the video is that the PT says that the stretch band provides "constant resistance" so long as the hands holding the other end of the band remain stable, but this isn't really true. If you stretch a rubber band out, there is going to be more and more resistance the further you stretch it (until it breaks, anyway). The resistance at the beginning is light, and gets progressively heavier the more you pull.

Admittedly, this is pretty minor. The range of motion that a foot has isn't very great, and so there won't be a lot of difference in resistance between the beginning and the end of the motion. But it's disturbing that a trained and certified PT would say something like this in the first place, when a simple, "Be sure to keep your hands in the same place" would be fine. I think that a lot of times people in positions of authority like doctors and physical therapists have a need to justify what they're saying to their patients, and sometimes this can lead to a little trouble.

Think for yourself!

In any case, please, if you have a problem with your achilles tendon, plantar fascia or anything else, don't just blindly trust what someone in a labcoat tells you. Use your common sense and try to think critically about what's being said.

You ask what people have tried and the cost and effectiveness of those treatments. I've taken prescription NSAIDs ($10 per month, thanks to insurance). I've tried inexpensive shoe inserts from the store, which didn't work. The thing that helped most was PT exercises which I found online (free). Unfortunately, that only lasted six months, then things got worse and I talked to my doctor ($20) who ordered an MRI (my share was $315, since I'd already met my insurance deductible). The doctor then referred me to a podiatrist ($20). The podiatrist had me get $50 orthotics and follow up in two months ($20). Those orthotics didn't help, so the doctor measured me for $400 custom-made orthotics (not covered by insurance) and had me follow-up in another two months ($20), and again a year later ($30). Another four months later ($30). Along with the custom orthotics, I bought three pair of good-quality shoes that the orthotics will fit into ($170, $145, $110). I'd rate the effectiveness of orthotics about 80%, so long as I wear shoes all day every day. This requires extra carpet shampooing since we don't typically wear shoes in our house. Add to that all the time and fuel required to go to all those appointments, the time to do the exercises, and ongoing pain. Recently the pain has increased, so I have another appt with the podiatrist scheduled, and might be told to try another expensive, ineffective treatment.

The page that the quote comes from is here (the second "reply" down from the top). Note that this person (a) has what appears to be some pretty good insurance and that (b) even though this list still isn't exhaustive, it totals up to more than twelve hundred dollars (none of which, I'll bet, came with a money-back guarantee). And the condition still isn't healed.

Why? Well, I can't say for sure, but I think I have a pretty good idea. Let me use a completely different example to make a point. Imagine that you have a toothache, and that the only remedy is to pull the tooth. You go to a dentist, lie back in the chair, get shot up with novocain and have your left bicuspid extracted. Now, if the problem was really with your left bicuspid, you're golden. But if it was really the incisor that was causing the pain, you're going to be in for an unpleasant surprise when you get home and the novocain wears off.

I've said it before, but since the Mayans were wrong and the world is still here I'll say it again: The reason so many people fail to find relief from "plantar fasciitis" is that they don't have plantar fasciitis in the first place. If you're calling a condition by a name that suggests one problem but in fact you actually have a different problem, it stands to reason that no matter how many "cures" you try, you're not going to get any better.

Here's the deal: Any kind of "~itis" indicates inflammation, and inflammation by itself is usually pretty short-lived. A week or two at the most. If you've had plantar fascia pain for longer than that, the chances are very good (like, 95%) that your condition is plantar fasciosis, not plantar fasciitis. (Of course, you could have both at the same time. But in that case it's the ~osis that's causing the ~itis to flare up for so long.)

This is the main question for most people with persistent PF pain, so I created a quick and easy (and free!) plantar fascia test to help them make a more informed judgement on the matter. The test only takes a minute, and as you can see from the above, it might just save you a lot of time and money.

About the author:
Alex Nordach has been involved in the health and fitness industry for over 30 years.  His ebooks, Target Tendonitis and Target Plantar Fasciitis have sold thousands of copies world-wide and been translated into other languages.  If you have had tendonitis or plantar fasciitis for more than two weeks, chances are that your problem isn't an "itis" but an "osis" – as in tendonosis or plantar fasciosis.  Check out the links above to learn more.

Just wanted to share that one of my articles got quoted on Business Insider. One of the leading websites on pretty much everything related to business.

Why would a business website feature information on tendonitis?

Well, users of my eBook and video products range from professional bodybuilders to housewives to business executives. The fact is, tendon pain can affect literally anyone. And one of the most frequent problems people encounter nowadays is thumb tendon pain from using Blackberries, smart phones and the like. I know, this doesn't have anything to do with foot or ankle tendon/fascia problems. Sorry! But tendons are tendons no matter what part of the body they're in, so the principles are the same. Check out the article here:

http://articles.businessinsider.com/2011-08-01/tech/29966407_1_iphone-users-blackberry-thumb-thumb-typists

Thanks,

Alex

I found your e-book incredibly helpful!  The videos were great-- I don't think I would have been able to do the exercises properly [without them].  They have been a lifesaver.  I was diagnosed with achilles tendonosis back in 2010 and the doctor had basically told me to just rest it for awhile and then use an anti-inflammatory and ice it after I run.  (I do sprint distance triathlons and 10k runs.)  But it wasn't helping at all.  I took a year off running and still didn't get any relief.  In fact, sometimes it hurt horribly just to walk.  I was pretty desperate for some kind of help, anything, because I wanted to be able to run again.  Within two weeks of using your exercises I was completely pain free while walking.  I took up running again (though doing shorter distances) and I continue to use your exercises as "maintenance."  I still have some pain, especially during and shortly after a run, but the exercises do help me to keep participating in my races, something I was afraid I would never be able to do again.

Thank you!!

Heidi Johnson

I get stories like this all the time.  A person starts to feel tendon pain, and they try to ignore it.  Eventually it gets so bad that they go to a doctor, and 99% of the time the prescription is the same: ice, rest, and some kind of anti-inflammatory medicine.  (In Heidi's case, this was in spite of the fact that the diagnosis was tendonosis, not tendonitis.  Why use anti-inflammatories if there's no inflammation?) Although I don't consider myself an expert at internet marketing or anything like that, I have sold thousands of copies of my ebooks at this point. It's for one reason: they work.

While no therapy is going to be 100% effective for every single person, the techniques given in Target Plantar Fasciitis and Posterior Tibial Tendonitis have a huge amount of both scientific and anecdotal evidence behind them.  Simply put, if you have long-term tendon or fascia pain that has not responded to conventional treatment, they are your best bet short of surgery.  I have also created a test that is free and will take you less than a minute to complete.  If you're experiencing tendon or fascia pain that won't go away, take a moment and fill it out.  It may just save you a lot of time and frustration.

Me:  How's your diet?

Client:  I am definitely a slow healer, but my nutrition is good, to my knowledge. I stay trim and try to eat a balanced diet.

Me:  Okay, so for example.  What's a typical day look like?

Client:  Breakfast: Quaker oatmeal squares or Wheat Chex.  Lunch: Variable, but balanced cafeteria lunch, with main course and two vegetables.  Dinner: Usually light, such as salad with chicken, or peanut butter sandwich, or fruit and nuts and yogurt.

Be honest now: how many of you out there think that the above is a good diet?  Admittedly, it's basically not too bad, and certainly a lot better than eating at McDonald's three times a day.  But there are two big problems here:

Problem number 1:  A lack of protein.

Assuming that the client had 8oz. of skim milk with his Wheat Chex, and the chicken salad (the highest protein choice of the ones listed), this client gets maybe, at the most, 80g of protein on a typical day.  For a normal-sized "trim" adult male, let's say 190 lbs, he's getting about half of what he needs for optimal recovery and healing.

Fascia and tendons are made of collagen.  Now, if you read some other sites, they will tell you that taking extra collagen as a supplement is beneficial.  This isn't any more true than the cosmetics industry telling women that extra collagen is going to make their skin better.  Collagen is formed from protein.  If you're protein-deficient, your body simply will not have the materials necessary to create new collagen to replace the old worn-out stuff.  And thinking that orally ingested collagen is going to make it through the digestive processes of the stomach, intestines and so on and somehow be "put in place" in your fascia and tendons... well, that's about as medieval a notion as the belief that eating bull testicles will improve a man's virility.

Problem number 2: Virtually no good fats.

While science is just starting to recognize the role that essential fats play in healing tendonopathies (see for example this abstract, which talks about the lack of evidence so far), there is no doubt in my mind, after a few decades of dealing with these issues, that they are very beneficial.  And most people don't eat enough of them by any means.

Dr. Udo Erasmus, probably the world's leading expert on good fats and what a lack of them can do to your body, has a long list of pervasive problems that can occur when there's a deficiency in your diet.  (Here's a link with the list.)  While there hasn't been much formal experimentation done yet, in my experience you can add tendon and fascia pain to the list as well.  Any dietary deficiency that leads to joint pain, skin problems (skin is supported by collagen), organs falling apart and general inflammation is probably going to have an effect on your connective tissue as well.

In the sample diet above, the only foods listed that have a decent amount of good (ie, Omega-3 and Omega-6) fat were the peanut butter and nuts that my client sometimes has for dinner.  (Assuming they're the right nuts; chestnuts aren't much help.)

Omega-3 and Omega-6 profile for various nuts

If he had whole milk with his cereal in the morning, he might also have gotten a little from that.  But overall, there is a clear lack here.

No wonder my client thinks he's a slow healer.  He's not getting enough in the way of building blocks to allow his body's natural repair processes to do their job.  If you've had long-term fascia or tendon pain and can't seem to get rid of it, one thing to look at is your diet.  If what you're eating looks like the sample above, you may have found the culprit.

As you get older, it takes more to heal properly.  More time, more care, and more int he way of good nutrition.  It's just a fact of life.

A recent study conducted in Melbourne, Australia and reported in BMJ (which used to stand for British Medical Journal, but now is just "BMJ") shows that cortisone injections, while possibly good for a bit of plantar fasciitis pain relief in the short-term, just aren't effective after about a month or so.

The study tracked 82 people who had plantar fascia inflammation, but not overall systemic inflammation.  These people were divided into two groups, with one group receiving a shot of dexamethasone sodium phosphate (a cortico-steroid, just like cortisone) and the other group getting a placebo shot.  The group that got the real shot reported a 10.9% percent decrease in pain at one month, but no statistically significant pain reduction at the two- or three-month markers.

The study concludes that cortisone injections are good for pain relief in the short-term, but not for the long term.  In other words, you can fool your body for a little while with these things, but not forever.

Okay, so here's the good stuff.  First, the above has been reported pretty widely, but what I found most interesting wasn't included in the study abstract.  If you get into the study itself, you'll find that (1) about 75% of American physicians recommend using cortisone shots to treat plantar fasciitis, and (2) nowhere in the scientific literature has it really been established that these shots actually work.  (In fact, cortisone shots have been shown to be genuinely dangerous, but that's another subject that you can read about in this post.)

Kind of strange, huh?  I mean, you would think that if all these doctors were recommending a particular kind of treatment, that treatment would at least have some pretty good science behind it...right?

Turns out that this isn't the case.  I'm not going to go into all the reasons that your doctor might have for recommending something that doesn't really work, but let's face it: doctors are human and they can make mistakes just like anyone else.  A lot of times, they confuse plantar fasciitis with plantar fasciosis, which is a significant mistake when you're trying to treat something.  Also, they're really really busy, which doesn't allow them to keep up with the latest research and studies.  (But if you're reading this, and a doctor tells you to get one of these shots, now you can whip out the results of the best study done so far and see what s/he says.)

Sure, you might get a little pain relief for a short while...but let's face it, even the people who reported an improvement only got about a ten percent reduction in pain with the shots.  And that was only for about a month.  After that the pain came back and they were just as badly off as they were without the shots.

Wouldn't it make more sense to go with a treatment technique that actually has quite a bit of scientific evidence behind it?  And one that would actually get rid of the plantar fascia pain once and for all, rather than just temporarily "relieving symptoms"?  Fortunately there is such a treatment, and it's available to anyone who has a little time to tend to their feet.  It doesn't require any special equipment, and anyone can do it at home (or anywhere else, if you don't mind showing your bare feet to strangers).  Furthermore, it comes with a money-back guarantee for 60 days, which is something that no doctor I know offers!

Of course, I'm talking about the ebook+video package that I sell on this site.  It's called Target Plantar Fasciitis and Posterior Tibial Tendonitis, and I think that it's the best thing going if you really want to take control of your foot pain.  But I don't recommend it for everyone.  If you're interested in buying it, please take the short (and totally free) one-minute test here before you do. It will show you what kind of PF pain you have, and whether or not the TPFPTT package will help you or not.

Ryan Mattheus to visit specialist, will miss two weeks at worst

"By Adam Kilgore (Al Behrman - AP) Nationals reliever Ryan Mattheus will visit a specialist in Baltimore on Tuesday to determine the severity of plantar fasciitis in his left foot. Depending on the diagnosis, Mattheus could either return in time to ..."

http://www.washingtonpost.com/blogs/nationals-journal/post/ryan-mattheus-to-visit-specialist-will-miss-two-weeks-at-worst/2012/05/22/gIQARzBzgU_blog.html

So what's so intriguing here?  Well, one, the Nationals are confident that Mattheus is going to be cured of his plantar fasciitis within two weeks.  That's not much time.  And two, it doesn't matter how severe his condition is.  Two weeks is all it's going to take.

Admittedly, Mattheus is a professional athlete, relatively young, and has access to some really good trainers.  But still, if you've been suffering from PF for weeks or months on end, you have to ask yourself why.  You've probably been to doctors and maybe done some internet research, but you still have the condition.  The answer is pretty simple: professional sports teams have access to better information than you do.  Or at least, they know which bits out of the overwhelming amount of conflicting data are really relevant and effective.

You could try getting in touch with a professional sports team trainer (very expensive, if you can even get to see one), or you could take a look around this blog and see that there's very little hype and that everything is supported by science.  And then you could take a risk-free trail (everything is 100% guaranteed for 60 days) of the Target Plantar Fasciitis ebook + video package and see just how easy it is to get rid of long-term plantar fasciitis when you have the right information to work with.

Lots of people complain about "ankle tendonitis", but what does this really mean? If the pain is in the back of the ankle, just above the heel, then you have a problem with your achilles tendon. If it's on the outside of the foot, running up the ankle, then you're looking at some kind of peroneal tendon pain. And if it's on the inside, running from the instep, under the ankle bone and up the leg a bit, then it's probably a posterior tibial tendon problem.

Of course, calling any of these conditions "tendonitis" also might not be accurate. If you sprained your ankle and then developed some tendon pain, yes, you likely have short-term inflammation and need to do things like icing and taking aspirin to help combat it. But if you've had the pain for more than a couple of weeks, and it seems to be gradually getting worse without any kind of traumatic injury, then it's much more likely that you have ankle tendonosis.

If you look at the top right of this blog, you'll see a tendon/fascia test that you can take to determine which one you have. It's free and will only take a minute – literally. There isn't even an opt-in, so go ahead and do it now. The results may just change the way you think about your ankle tendon pain.

You don't hear about it a lot, not like the Achilles tendon problems, but the fact is that quite a few people fall prey to peroneal tendon pain every year. And it can be really difficult to rehab, since the peroneal tendons are smaller and more delicate than the other major tendons in the ankle and foot. So not including the peroneus sisters was an oversight on my part, and I recently received an email from a somewhat dissatisfied customer who suffers from peroneal tendon pain. In order to make things right with him, I have just finished a video that will be available to anyone who purchases Target Plantar Fasciitis and Posterior Tibial Tendonitis (from this website; the videos are NOT included in the Kindle version of the book) starting today. And for anyone who has bought it in the past and wants to see the new exercise, just send me an email at the address listed in the book and I'll hook you up.

Along the same lines, if there's something else that you'd like to see in the book, make a comment here and let me know.

Alex