One of the biggest mix-ups is assuming that where you feel pain must be where the problem is. We know this isn’t always true; for example, one of the early signs of a heart attack can be pain in the left shoulder, not the chest. With musculoskeletal pain, the same kind of mismatch can happen.

So what do most people do? They laser-focus on the sore spot. They rest it, stretch it, poke it, strengthen it—or they pull back from sport, exercise, or work to “protect” the area. But if the true cause is actually elsewhere, all that effort becomes a kind of well-intentioned detour. It wastes time, money, and emotional energy, and it can leave people feeling frustrated and stuck.

At NWPG, we see this every day. Around 80% of the time, the source of a patient’s symptoms is not in the place that hurts. Research on Regional Interdependence backs this up too: the body is interconnected, and pain often shows up downstream from the actual issue.

Another common belief is that pain and tissue damage always arrive together, hand-in-hand. But modern research paints a different picture. Especially with accumulated strain—tiny stresses stacking up over days, months, or even years—there’s usually a big buffer between when tissue starts feeling pressured and when real damage begins. The brain often sends a warning signal (that familiar “ouch”) long before anything is actually injured.

We also see a lot of confusion around scans. It’s easy to assume that anything that shows up on an X-ray, ultrasound, or MRI must be the culprit. But studies consistently show poor correlation between imaging and pain. Plenty of people have “abnormalities” on scans and feel perfectly fine. Others have significant pain with squeaky-clean imaging. What you see on an ultrasound scan or any other scan doesn’t reliably match what someone feels.

This all circles back to the role of the brain. It’s constantly sorting and interpreting signals from the body, trying to keep you safe. When your system is overloaded, the brain’s warning message is pain—its way of nudging you to change course before genuine damage happens. But if those warnings go unheeded, that’s when injuries like muscle tears, tendon issues, and postural strain can show up.

Seen this way, the brain is less of a troublemaker and more of a guardian—one with a remarkably early detection system. And when you start understanding pain through that lens, it becomes much easier to make meaningful, long-term shifts in both comfort and function.

How to fix pain

Do you want to find the answer to the pain you are experiencing? Book an appointment today!

References

Brinjikji W et al; Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6. doi: 10.3174/ajnr.A4173. Epub 2014 Nov 27.

Girish G et al; Ultrasound of the shoulder: asymptomatic findings in men. AJR Am J Roentgenol. 2011 Oct;197(4):W713-9. doi: 10.2214/AJR.11.6971

If this is always true, why can we feel pain when we have not injured ourselves? 

For example, we feel neck or back pain after sitting for a prolonged periods or a trivial action like reaching for a towel causes severe back pain?
How is this possible if pain = damage? This is confusing.

What The Research Shows

The research tells a different story:

One study ( Brinjiki et al) showed a high rate of ‘pathology’ in lower back MRIs in over 3000 subjects without any pain or dysfunction – and this was in people ranging from 20 to 80 years old.

In the shoulder, many studies have painted a very similar picture. One study (Grisih et al) found that a remarkable 96% of subjects who reported no pain or issues had at least one identifiable ‘pathology’ on their ultrasound scan. 

So you can see that tissue damage does not lead to pain in many cases, and pain can arise without  evidence of tissue damage. This is precisely why we constantly remind our patients that ultrasound scans don’t tell the full story.

The general understanding of pain and injury needs to be updated so that people can overcome pain more easily and get back to living their (best) lives.

A New Understanding of Pain

The new understanding of pain is that it is an output signal created by the brain, as a warning sign. It can be out of proportion to the injury. This serves to change behaviour to prevent further damage, which is often required to fix the problem.

The issue is that most people don’t understand this, and remain stuck with a painful condition because they are fearful to move in case it causes more tissue damage. The problem with this is that people are thinking about local structures, not the whole body. There are compensations and protective mechanisms that can develop in other areas of the body that can contribute to your pain…. Where your pain is located is not necessarily where it comes from.

For example, someone can get knee pain because they had a recent back pain episode that affected the way they walked. The back pain improved, but the knee persisted because of secondary protective mechanisms that have not resolved.

A Whole Body Approach

This is why we look at the whole body and how it works together. We want be as thorough as we can and find all the contributors, both local and remote for your pain. This will enable you to get back to the things you love doing without the pain you have been suffering.

We use a 7 step process (the ridgway method) that will find the main drivers of your pain and fix them quickly. It is scientific, objective and based on the latest neuroscience research. 

If you’re not open to a new understanding of pain, you will remain stuck and restricted by your pain and fear of movement. Are you really willing to let your pain dictate your quality of life? 

Or are you looking for a new approach to regain your lifestyle, independence and get on top of your pain long term?

If you’re ready to take control of your life, book an initial consultation with us. We’d love to help you!

References

Brinjikji W et al; Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6. doi: 10.3174/ajnr.A4173. Epub 2014 Nov 27.

Girish G et al; Ultrasound of the shoulder: asymptomatic findings in men. AJR Am J Roentgenol. 2011 Oct;197(4):W713-9. doi: 10.2214/AJR.11.6971

At Northwest Physiotherapy Group, we use a step-by-step approach to fix your pain.

It all starts with a pre-initial phone call before you attend your first session. We will contact you and ask more about your problem and what your needs are. We will also explain our approach and what to expect in the first session.

At your initial session, we go deeper and find out how your life is impacted and set clear measurable goals as well as your good result and why that is important to you. We both then have a clear understanding of what we are trying to achieve.

We will prepare a written treatment plan and recommendations, answer any questions, outline costs, and discuss any barriers to treatment.

All good physiotherapists will clear red flags — that is, conditions that need to be referred on for further assessment or a specialised opinion. However our experience has shown that neural tension that occurs when the free gliding of your nerves is impaired can also block progress.

At NWPG, we assess and clear nerve mobility in the body through specialised testing first. This simple step restores mobility and gliding to the nerves. When we ensure optimal nerve gliding, we know that progress will be quicker and improvements would be held longer.

A physiotherapist will usually assess the area of pain and surrounding tissues. You may have thought to yourself that they are missing something. When we practiced in this way, we realised that we were missing something, too, and we couldn’t help as many people as we would like.

This is why we became Ridgway Method Practitioners. We find dysfunctions that contribute to pain that are remote from where you feel your pain. The brain is hardwired to protect you and pain is an effective way of forcing you to restrict activities that could contribute to further injury. We know that completing a full body assessment that assesses dysfunctional tissues throughout the body means that we do not miss a key contributor, even one that is remote from your pain.

Standard physiotherapy tends to use patterns of presentation and recognising common conditions. If you follow that approach without being open-minded and curious, you may miss key contributors to your condition.

We thoroughly assess and treat all the possible contributors. We use key movement tests that are related to your pain and use them to measure improvement and to help identify the root cause of your pain. We always assess these key movements at the beginning and at the end each treatment session and plot your objective improvement on a progress graph. This helps assess how quickly you are responding to treatment and gives us great feedback. If the progress graph shows inconsistent or slow progress, then we may have to refer on for further investigation.

When the key movement tests are improving, it means that the brain is reacting to the reduction of load in the tissues of the body as they improve, which leads to less ‘’protective pain’’ and better function.

When managing complex chronic or even acute conditions in standard physiotherapy, treatment often continues even when improvement has plateaued. Or you are told that you can’t be helped.
Our approach narrows down the interventions that have improved your key movement tests to find the primary contributors for your condition: muscles, joints, or nerves that are strained through poor postures, motor control issues, repeated movements, or decreased strength. When we treat the primary drivers, we often find other dysfunctional tissues also improve. The body is interconnected.

Standard physiotherapy treatment can relieve symptoms, but that may be only temporary. The pain is back again before long. To ensure that the improvement holds, exercise is another key part of our process. Once your pain is gone, we also work to improve your tolerance to loading with exercises for strength and motor control. It’s not enough to be in less pain: you must have the capacity to get back to the important tasks that you love such as exercise, sport, and hobbies. This comprehensive process, which we have refined over many years, is what establishes us as one of the top clinics for nerve tension testing in Melbourne.

Once we have achieved your good result we offer a Prevention and Optimisation Program (POP) with regular tune- ups to ensure that you maintain nerve mobility, manage your primary dysfunctions, and progress your exercise program as needed to keep you moving freely and have confidence in your body.

So, do you want to stop trying to fix your pain with  band-aid treatments that only give short term relief? Or do you want to experience a different approach that will get to the underlying cause of your problem and keep you pain-free for the long-term? If that’s you or someone you know, we are here to help!

Contact us at Northwest Physiotherapy Group to discuss your concerns or take our Quiz to see if we are a good fit for you.

Watch our FREE 3-Part Video Series To See Nerve Tension Testing and Clearing in Action…

In this article, we’ll explore how these nerve clearing techniques can effectively address and alleviate chronic nerve tension.

Understanding Nerve Tension

Nerve tension, also known as neural tension or neurodynamic dysfunction, occurs when nerves are unable to move freely within their surrounding tissues. This can lead to a range of symptoms, including pain, tingling, numbness, and weakness along the affected nerve’s path. Chronic nerve tension can result from various factors, such as poor posture, repetitive movements, injuries, or underlying health conditions.
It’s important to understand that nerve tension is a protective response created by the central nervous system.

The Role of Physiotherapy in Treating Nerve Tension

Physiotherapy plays a crucial role in diagnosing and treating nerve tension. Unlike traditional approaches that may focus solely on muscle tension, the Ridgway Method we use at NWPG recognises importance of addressing nerve dysfunction first. This approach is based on the understanding that muscles often tense up or “guard” to protect irritated nerves. Clearing nerve tension first helps to improve the response to treatment and this improvement holds for longer. It also helps to find the primary source of the pain more effectively.

Neurodynamic Testing: A Key Diagnostic Tool

One of the primary tools physiotherapists use to assess nerve tension is neurodynamic testing. These tests involve specific movements designed to apply mobility/gliding of particular nerves or nerve roots. Our team at NWPG assesses this in a specific non provocative way, by passively testing nerve gliding to the first point of a protective response. This is a gentle painless movement test. By assessing how the nervous system responds to these movements, our team can identify areas of restricted nerve mobility and apply specific clearing techniques to reduce nerve tension.

The Ridgway Method: A Unique Approach

At Northwest Physiotherapy Group, we utilize the Ridgway Method, a specialized approach that prioritizes addressing nerve dysfunction before tackling muscle tension. This method recognizes that muscles often tense up as a protective mechanism when nerves are irritated. By first treating the underlying nerve issues, we can more effectively resolve muscle tension and pain. The Ridgway Method is a whole body problem solving approach to solve chronic or persistent musculoskeletal conditions using a 7 step systematic and objective process.

The Connection Between Muscles and Nerves

Understanding the relationship between muscles and nerves is crucial in treating nerve tension. Muscles play a protective role for nerves, and when nerves are irritated and not gliding properly, muscles may become tense or weak. By addressing nerve issues first, our team can resolve muscle problems more efficiently and effectively.

Treatment Progress and Outcomes

Throughout the treatment process, our team uses neurodynamic tests to measure progress. These tests help gauge improvements in nerve mobility and function. With consistent treatment, many patients experience significant relief from chronic nerve tension symptoms, including reduced pain, improved mobility, and enhanced overall strength and function.

Preventing Recurrence of Nerve Tension

Preventing the recurrence of nerve tension is an essential part of long-term management. Understanding why nerve tension develops for an individual is an important part of the process. Our team provide guidance on:

• Maintaining proper posture
• Performing regular nerve gliding exercises
• Implementing ergonomic improvements at work and home
• Adopting lifestyle habits that support nerve health

Conclusion

Chronic nerve tension can significantly impact your quality of life, but with the right approach, relief is possible. Our team offers a comprehensive solution that addresses the root cause of nerve tension, not just the symptoms.

By utilizing advanced diagnostic techniques like neurodynamic testing and employing targeted specialised treatment methods, physiotherapists can help alleviate chronic nerve tension and restore your comfort and mobility. If you’re experiencing persistent symptoms that may be related to nerve tension, don’t hesitate to seek professional help.

Our highly trained team can assess your condition and develop a personalized treatment plan to address your specific needs. Remember, early intervention is key to preventing chronic issues and achieving optimal outcomes.

Take the first step towards relief from chronic nerve tension today by consulting with our team today.

Your journey to pain-free living starts here.

As your pregnancy progresses, your body will undergo significant physical changes. This is a natural part of the journey as your body prepares to deliver a newborn into the world. However, in up to 50% women, these body changes can result in a debilitating condition called Pregnancy Related Pelvic Girdle Pain.

The impact of Pelvic Girdle Pain can not only affect you physically, but emotionally and psychologically as well. You might struggle with everyday function and work. You might feel exhausted and powerless. You might rely on pain medication to get through the day.

Fortunately, there are things that can be done to treat this problem. The sooner you start treatment, the less likely the problem will persist following your baby’s birth and beyond.

How Do I Know If I Have Pelvic Girdle Pain?

Pelvic Girdle Pain is localised to the pelvic region, in the space between your lower back and hips. You might feel pain around your tailbone at the back or even around your pubic bone at the front.

If you have Pelvic Girdle Pain, you will commonly experience pain and restriction with the following:

• Standing on one leg
• Going up and down stairs
• Turning over in bed
• Walking on sand
• Wearing heels
• Squatting low to the ground
• Doing housework
• Caregiving

Why Am I Getting Pelvic Girdle Pain?

There are many factors that influence Pelvic Girdle Pain. The joints in the body naturally become looser during pregnancy to allow the pelvic bones to move and slide apart when it’s time to give birth. However, this extra joint mobility can lead to excessive stress and strain building up in the sacrum (tailbone) and pelvis when it normally wouldn’t.

Your natural body posture also changes during this time. As your baby and belly grows, your pelvis is drawn into an anterior tilt position.

This posture creates further tension on joints of the spine and sacrum. That, combined with the laxity in these joints, can lead to a feeling of instability, weakness, and pain around the sacrum and pelvis.

What Can I Do If I Have Pelvic Girdle Pain?

The first thing you can do straight away is to change any habits that may be aggravating the condition.

• Wear comfortable, supportive shoes when on your feet. Avoid wearing heels as this will further accentuate any anterior pelvic tilt position.
• Take the time to rest and be off your feet. Even that can help relax the tension that has built up in the joints and prevent the pain from getting worse.
• Avoid standing on one leg where possible – for example, sitting down to put on pants and shoes rather than standing. Keeping your weight even between both legs when you stand to prevent one side being overloaded and aggravating the problem.
• Learn how to stabilise the pelvis with specific exercises prescribed by a physiotherapist. Keeping your strength intact over the period of your pregnancy can not only reduce Pelvic Girdle Pain, but even lower the risk of injury and pain after your baby is born.
• Using support garments such as a belt or compression shorts can also help the recovery of this condition. Providing external support to the loose pelvic joints can create a feeling of comfort and stability and improve function. Our Women’s Health physiotherapist can help you fit these garments and advise what’s right for you.

Key Takeaways

Pelvic Girdle Pain is a common but treatable condition of pregnancy. If you notice pain in the pelvic region during your pregnancy, seek treatment with a Women’s Health Physiotherapist as soon as possible, as symptoms can often worsen as your due date approaches.

We can help you reduce pain and get you on track. Call us at the clinic or book in online for a thorough assessment today. The last thing you want is debilitating pain to be on your mind when your baby arrives!

Nick and Andre are 2 AFL field umpires that were referred to our clinic by word of mouth last year (July 2022) due to recurrent calf injuries. They both had similar presentations, with multiple calf tears over several years, which would often occur more than once in the same season. Each time, they would have to miss 3-4 games while they were recovering and rehabbing their injuries. The cost to both of them was lost income, as well as loss of conditioning and opportunities to progress as umpires and secure finals positions. The emotional cost was also significant, with a loss of confidence in their bodies, and a sense of frustration and confusion…”why does this keep happening?”

The management of each injury was with standard sports medicine protocols, including MRI scan to confirm a tear and the grade, rest/deload, local Physiotherapy ( including massage, dry needling, ice, electrotherapy modalities) and a graduated strength and conditioning program and return to sport.

So why wasn’t this approach working for them and why were they having recurrent calf injuries?

Taking a Broader Whole Body Approach

To work out why Nick and Andre were having recurrent calf strains, we had to use a whole body problem solving approach known as the Ridgway Method. The team have all had extensive training in this method over the last 10 years.
This involved performing a whole body assessment looking for muscle knots, joints that don’t slide and nerves that don’t glide. It also involved assessing posture, strength, motor control and importantly a running video analysis.

The main principles of the Ridgway Method are:

1. Where you feel your pain may not be where the problem is located.
2. The structure that produces the biggest and most consistent gains in movement restrictions connected to your problem, is likely to be a primary contributor to the condition.
3. Behavioural change and motor control are important to reduce load on the primary contributor.

The main test movements we noted that were most guarded and restricted with both Nick and Andre were:

1. Lumbar flexion
2. Thoracic rotation
3. Hip flexion
4. Hamstring length

For both of them, there was one side of their body that was most restricted, and this did correspond to their symptomatic side.

After whole body assessment and treatment trials to find the best structures to continue to work on, their body charts looked like this below. These charts only show the unhappy structures that when trial treatment was performed, improvements in key tests were observed.

The Findings

We found the most dysfunctional structures that made the best gains in the movements signs for both Nick and Andre were actually remote from their calfs! In fact they both had segments in their lower back that were very stiff and painful, and working to release these made significant improvements in their movement signs and also released tension in their calf muscles. We labelled these segments, both from the front (anterior) aspect of their lumbar spines, the PCF or primary contributing factors to their calf conditions. For Nick their was also a secondary contributor in the thoracic spine, and for Andre the secondary contributor was the right sacro-iliac joint (SIJ).

The WHY?

So if working on these lumbar segments made the best improvements in key movement tests and also released calf muscle tension, why were these joints so stiff and problematic?

We performed a number of other tests, including strength tests and a video analysis of their running techniques.
Both Nick and Andre had some postural and control issues that we had to correct.
For Nick it is was about being too extended through his thoracic spine, with some rib flare. Nick also ran like this, with his chest up, which loaded his thoracic spine, and put him more in a lordotic posture which increased load on the lumbar spine. Nick also had some strength deficits in the left hip abductors and adductors, hip flexors and latisimus dorsi muscles, as well as poor gluteal activation.

For Andre, he stood in anterior pelvic tilt with knees locked back into extension. He ran with an anterior tilt also and an increased forward lean. This loaded up his lower back and SIJ. Andre also had a left limb apparent shortening, and we had to provide a heel lift for his left leg to regain symmetry through his hips. This was likely the reason his right SIJ was being loaded and had become stiff. Andre also had strength deficits in his right hip abductors and reduced gluteal activation also.

For both Nick and Andre, there were some mindset obstacles we had to address, which were mainly based around a loss of confidence in their bodies and a fear of re injury.

The calf injuries were then just a symptom of a more central problem, which when identified and treated with all contributing factors addressed also, resulted in no more calf strains and greater confidence in their bodies for both Nick and Andre.

The Results

After going through the Ridgway Method problem solving process late last year, implementing all the strategies we identified to be specific for both Nick and Andre, and adjusting their training, they have both made it through the 2023 season without missing any games. Yes, there were a couple of hiccups, but not with calf issues. Mid season, Nick got bowled over by a ruckman during a game, which jolted his body. Andre had an episode in his right lateral leg from a period of increased sitting. We were able to manage both of these incidents and keep Nick and Andre on track.

They both umpired in the finals and went as far as the preliminary final Carlton vs Brisbane at the GABBA (16th September, 2023), which is further than they have gone any any previous year… a real success story!

Other Factors That Contributed to Their Success

1. Both Nick and Andre were dedicated professionals, who attended all appointments including tune up sessions, followed through on all advice, and worked hard to keep their bodies in the best state.
2. They both had a team of support people around them, including AFL medical and physio staff, masseurs and pilates instructors, and their partners.
3. After meeting with their strength and conditioning coach in August 2022, their running training was modified to increase the amount of easy volume in their program. The research based 80/20 rule was adopted, where the percentage of high intensity training above 80% maximal heart rate represents a smaller fraction of their overall running. This is important for recovery from harder sessions/games and building resilience and conditioning in soft tissues. The amount of easy running (long slow running) was tracked and measured.
4. The AFL changed the amount of umpires per game from 3 to 4 during the 2023 season, which meant that each umpire had less ground to cover during a game.

In summary, this highlights the benefits of using a whole body problem solving approach for any injury, particularly persistent or recurrent conditions. The whole body is interconnected in ways that we are still coming to terms with, and local pain, eg in the calf in this case, can have a remote cause or primary driver, in this case, the lumbar spine.

Anatomy and Function

The diaphragm is a thin dome-shaped muscle that sits at the base of the chest and separates the abdomen from the chest. It’s attached to your sternum (a bone in the middle of your chest), the lower part of your rib cage, and your lumbar spine.
It contracts and flattens when you inhale. This creates a vacuum effect that pulls air into the lungs. When you exhale, the diaphragm relaxes and the air is pushed out of the lungs

Diaphragmatic breathing is defined simply as the contraction of the diaphragm muscle downwards into the abdomen to allow the lungs to expand downward and outward while taking a breath in. As the diaphragm drops down, it compresses the organs, fluid, and other contents of the abdomen. The compression of these will cause the pressure inside the abdomen to rise. This is what we call creating intra-abdominal pressure. This increase in pressure presses into the spine and the pelvic joints and provides natural core stability!..4

When Things Go Wrong

Periods of prolonged stress such with limited recovery time can alter breath control
in many ways.
This is characterised by shallower quicker breaths and predominantly upper chest breathing that does not allow the diaphragm to contract and relax fully. To move through its full range of movement. This is typical of a ‘fight or flight response’ of the sympathetic nervous system. This is an important and essential survival response, but work pressures, family issues, and other stressors can keep us in sympathetic overdrive. When mental and emotional factors such as fear, grief, anxiety, or depression start to impact how your breathing is regulated
Physical loading such as prolonged sitting with a slumped posture that is commonly seen in office workers can also affect diaphragm movement. This dysfunctional breathing pattern then becomes the norm.
This then causes overuse of muscles in the neck and upper body that are not primary muscles of respiration and adds to the build-up of strain and potential injury because the diaphragm is not allowed to do its job.

Diaphragmatic Breathing

To improve diaphragm function, breathe easier, and more effectively, and help drive your autonomic response to a more calming parasympathetic bias follow these simple steps.

• Find a quiet place and start by either laying down with good neck support or sitting in an upright chair
• Relax the neck and shoulders and just pay to observe to your breath for a few moments
• Breathe gently in and out through your nose. No mouth breathing
• Rest your hands on your abdomen and feel the rise as you breathe in and the diaphragm lowers.
• Pay attention to how the rib cage expands outwards to the side and backward.
• Gently and slowly breathe out and feel the abdomen fall.
• Aim for an easy unhurried pace is 6 to 8 breaths per minute for 5 to 10 minutes.
• Try for daily practice

If you have difficulty finding that relaxed rhythm we are here to help.
Contact us at Northwest Physiotherapy Group and we can teach you.
Watch out for an update about how the diaphragm and pelvic floor can be involved in low back, hip, and even shoulder pain

References

1. https://www.healthline.com/human-body-maps/diaphragm#anatomy-and-function
2. 3 shocking diaphragm reactions that stagnate patients progress
   and steal therapist confidence. David O’Sullivan
3. https://www.betterhealth.vic.gov.au/health/healthyliving/breathing-to-reduce-stress#abdominal-breathing
4. https://www.cumberlandspine.com/post/diaphragmatic-breathing-is-the-foundation-of-stability-not-bearing-down-or-sucking-in
5. https://my.clevelandclinic.org/health/articles/9445-diaphragmatic-breathing

So, what are you doing to recover?

In this article, we will go through the four fundamentals of recovery. Everybody is different, so an individualised approach is best. It can take a bit of trial and error to find out what works for you, but it’s well worth the effort to be competition ready when you need to be.

The Fundamentals of Recovery

There are four fundamentals when it comes to recovery:

1. Sleep
2. Nutrition
3. Hydration
4. Training Load Management

Sleep

Sleep is the ultimate recovery tool. When we sleep, our mental and physical reserves are restored so we can be in peak condition to deal with the stressors of life and training the next day.

For the average adult, at least 7-7.5 hours per night is recommended. Anything less than that builds up sleep debt. The more sleep debt you have, the more you suffer the detriments of sleep deprivation on your body and mind.

Recent studies also show that adolescent athletes who slept <8 hours on average were 1.7 times more likely to injury themselves than those who slept >8 hours. On the other end of the spectrum, elite athletes have been known to aim for up to 10 hours sleep to maximise their physical condition before competition!

If you want to learn more about Sleep Hygiene, read this article: How To Get A Better Night’s Sleep

Nutrition

Food is the fuel that restores what we use during our training. When your recovery nutrition isn’t right, you may feel more fatigued, have poorer performance, produce less gains in training, and feel sorer for longer.

Eating in the first 60-90 minutes after your session is the most effective time, especially if you have intense training sessions back to back. In terms of what to eat, a mix of carbohydrates to restore energy stores and protein for muscle repair is generally recommended. It’s always best to tailor to what suits your body and digestion.

If you want to learn more about Recovery Nutrition, Sports Dietitians Australia has great fact sheets you can read here.

Hydration

Proper hydration keeps your whole body system working well, from your heart to your metabolism to your brain. Many people don’t realise that if you have a dry mouth or feel thirsty, you are already dehydrated. When you are dehydrated, all of these systems operate less effectively: it can make a workout feel harder, make you feel hungry when you aren’t, and make it harder to concentrate.

So how much water should you drink? A good rule of thumb is 35ml per kg of bodyweight – for the average woman that’s 2.1L and for the average man it’s 2.6L. Bear in mind, if you are exercising or the temperature is high, you may need more than usual so keep that water bottle filled and close by!

Lastly, how can you tell you if are well-hydrated? Check your wee! A hydrated person will have light coloured, odourless urine – a key sign that you are hydrated and to keep drinking water at the same rate.

Training Load Management

Training for big competitions can often spans months, sometimes even years for some athletes. So how do you make sure you can keep this consistency going over an extended period of time without injury?

Managing training load is key. Sudden significant increases in load can lead to pain and injury if the body isn’t able to adapt quick enough. For example, a novice runner going from one 5km run a week to three may find they are stopped quickly by increased tension and pain. Gradual increases in intensity and duration are best – slow and steady wins the race!

The other important reason to manage your training load is to avoid overtraining, also know as ‘burn out’. Overtraining occurs when an athlete trains excessively without resting or recovering properly. After a while, the training begins to have a detrimental effect on the body. You may notice a decrease in your performance or gains despite hard training. You feel sorer, you get injured more often, and you feel unmotivated to exercise. While this may prompt you to train harder, it may actually make you feel worse in the long run.

Incorporating “deload weeks” into your training schedule can go a long way to preventing overtraining as well as improving your gains. Deloading is deliberately stopping or limiting your training for a short period before returning with renewed intensity.

Proactively planning lighter weeks into your schedule can ensure you’re injury-free and feeling at your best as you head towards competition. However, it is important to be reactive if you notice symptoms of overtraining. As always, listen to your body and make time to rest when it needs it.

To learn more about how to load your body safely, read Volume, Frequency And Intensity- The What And Why?

Other Recovery Methods: The icing on the cake

Once you have the fundamentals of recovery covered, then you may want to look into supplementary recovery modalities. Cryotherapy, massage, compression garments, and foam rolling are some of the most common methods athletes put in place. For the most part, the evidence for each is anecdotal – some people find these other methods helpful for recovery while other people do not. Everybody is different, so it’s important to trial these methods for yourself and assess how your body responds.

Don’t forget that there are other factors in our lives can also create “load” on the body. Longer hours at work, stress, moving house are just some of the common lifestyle factors to keep aware of if you are starting to feel the strain.

Plan Your Recovery

Just like with your training itself, being intentional about your recovery will make sure it’s effective!

A proactive approach will reduce the risk of injury taking you by surprise. Identifying what’s missing in your recovery and taking the steps to address it now means you won’t find yourself forced to rest due to injury later. However, be ready to flex if circumstances change! As your training intensity increases, so should your emphasis on recovery.

References

https://www.healthdirect.gov.au/dehydration

https://www.sportsdietitians.com.au/factsheets/fuelling-recovery/recovery-nutrition/

https://www.physio-pedia.com/Overtraining_Syndrome

https://www.webmd.com/fitness-exercise/what-to-know-about-overtraining

https://jamesclear.com/cumulative-stress

Plantar Fasciitis Symptoms

Most people experience heel pain on the inside of the heel bone or extending into the arch of the foot. The pain is worse in the morning getting out of bed, then usually improves. It can recur during the day after periods of non-weight bearing again initially as you start to walk.
It can be worse after running or playing sport, especially after getting up from sitting afterwards.

Anatomy of The Plantar Fascia

The plantar fascia is a thick band of tissue that runs along the bottom of the foot, connecting the heel bone to the toes. It acts as a shock absorber and helps support the arch of the foot. It also shortens the foot during the propulsive stage of the gait cycle. Plantar fasciitis is essentially a biomechanical overload condition, and while there may be inflammation in the early stages of the condition, the pathology is one of degeneration of the fascia with or without micro tears. This can cause pain and discomfort in the heel or arch of the foot.

Is Plantar Fasciitis Causing Your Foot Pain?

Causes and Contributing Factors of Plantar Fasciitis

There are many factors that can contribute to the onset of plantar fasciitis, including:

1. Excessive loading: Overuse or increased loading of the foot is one of the most common causes of plantar fasciitis. This can happen with activities such as running, jumping, or standing for long periods.
2. Age: As we age, the plantar fascia can become weaker and less flexible, increasing the risk of injury.
3. Foot Mechanics: Abnormal foot mechanics, such as flat feet or high arches, can put extra stress on the plantar fascia. Reduced ankle joint dorsi flexion has also been shown to be associated with plantar fasciitis, as well as weakness in the intrinsic foot muscles which leads to less support of the arch of the foot and plantar fascia.
4. Obesity: Being overweight or obese (BMI > 27) can put extra pressure on the feet, leading to plantar fasciitis.
5. Improper Footwear: Wearing shoes with poor arch support or inadequate cushioning can also contribute to plantar fasciitis.

Plantar Fasciitis Treatments

There are many treatments available for plantar fasciitis. Some of these are considered Plantar Fasciitis treatment at home and can be quite effective.

Most of these treatments have been shown to have some impact on the pain:

1. Rest: Resting the foot and avoiding activities that aggravate the condition can help relieve symptoms in the short term. To achieve long-term gains short periods of rest,or modified loading, need to be interspersed with higher loading and strengthening exercises.
2. Ice: Applying ice to the affected area can help reduce inflammation and pain in the early stages
3. Stretching: Stretching exercises have been shown to improve outcomes in this group of patients but outcomes have been improved with the addition of strengthening exercises.
4. Footwear: Wearing shoes with good arch support and cushioning can help reduce stress on the plantar fascia.
5. Orthotics: Custom-made orthotics can be used to correct abnormal foot mechanics and provide additional support to the arch. Compared to sham orthotics, one study found an improvement in pain and function with custom-made and prefabricated orthotics.
6. Medications: Over-the-counter pain medications, such as ibuprofen or acetaminophen, can help relieve pain and reduce inflammation in the short term but do not address the causes of the condition.
7. Corticosteroid Injections: Corticosteroid injections may be used to reduce inflammation and pain in severe cases of plantar fasciitis, but there is limited evidence to support long-term results. Other risks associated with this procedure include rupture of the PF or fat pad atrophy.
8. Autologous blood injections (including Platelet-rich plasma injections) have been shown to have an 80% success rate at 3 months in one study.
9. Shockwave therapy: this procedure has gained more popularity recently and uses acoustic sound waves to penetrate the tissues and create more blood flow, and introduction of growth factors to stimulate healing. Several good-quality studies have shown that SWT can reduce pain and improve function in people with PF when compared to control groups.
   You can learn more about Shockwave Wave Therapy here.

Surgery is rarely necessary for plantar fasciitis and is only considered in severe cases that do not respond to other treatments.

Plantar Fasciitis Treatment At Home

Plantar Fasciitis Treatment- Our Physiotherapy Approach

Good physiotherapy management of PF will involve a careful and thorough assessment of all factors that may contribute to the onset of the condition, including biomechanical , social and any limiting beliefs the patient may have around pain. Once the key contributors are identified, treatment is aimed at addressing all of these, which can involve many of the options listed above, in a measured and coordinated manner.
At NWPG, we know that pain is a protective output from the brain, and where you feel your pain may not be where the main driver of the pain is. We look beyond the foot and leg to assess any dysfunctional muscle or joint in any region of the body that may also have an input to the pain.

Read here about a success story which involved remote contributors to a case of PF.

We also have a SWT unit and can administer this treatment if we determine that it is indicated for a particular person’s condition.

Plantar Fasciitis At Home Summary

Plantar fasciitis is a common condition that can cause pain and discomfort in the heel or arch of the foot. It is more common in middle-aged individuals and women. There are many causes of plantar fasciitis, including overuse, age, foot mechanics, obesity, and improper footwear. The best treatments involve through assessment of all the contributors, and a coordinated approach involving any of the treatments detailed above.

It can be a chronic condition, but responds to the right treatment, which is individual specific. Surgery is rarely necessary and is only considered in severe cases that do not respond to conservative management over a long period.
If you’ve had this condition and it has not responded to previous treatments or plantar fasciitis treatment at home, get in touch with us at the clinic and we’d be happy to discuss your case and how our approach can help you get back on your feet again!

Plantar Fasciitis References

Trojian T, Tucker AK. Plantar Fasciitis. Am Fam Physician. 2019;99(12): 744-750.

Landorf KB, Keenan AM, Herbert RD. Effectiveness of foot orthoses to treat plantar fasciitis: a randomized trial. Arch Intern Med. 2006;166(12):1305-1310.

Rathleff MS, Mølgaard CM, Fredberg U, et al. High-load strength training improves outcome in patients with plantar fasciitis: a randomized controlled trial with 12-month follow-up. Scand J Med Sci Sports. 2015;25(3):e292-e300

Vahdatpour B, Kianimehr L, Ahrar MH. Autologous platelet-rich plasma compared with whole blood for the treatment of chronic plantar fasciitis; a comparative clinical trial. Adv Biomed Res. 2016;5:84.

Lou J, Wang S, Liu S, Xing G. Effectiveness of extracorporeal shock wave therapy without local anesthesia in patients with recalcitrant plantar fasciitis: a meta-analysis of randomized controlled trials. Am J Phys Med Rehabil. 2017;96(8):529-534.