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Very interesting website

Posted by wendyn on 2/19/02 at 22:09 (074361)

http://www.nbcolympics.com/x/f/frame.htm?u=/x/m/int/torson/torsoncomplete/TorsonMainNav.html

Hmmm - I hope this works...this is a really neat website with views of different muscles and bones.

Re: Very interesting website

Laurie R on 2/20/02 at 00:12 (074366)

Hi Wedyn , This is so cool , I just checked it out ... I will book mark it for when I have time to really look at everything .... Thank you for sharing it .....Laurie R

Re: Very interesting website

DR Zuckerman on 2/20/02 at 00:14 (074367)

Very cool and helpful to understand plantar fasciitis as a repetitive motion injury

Re: Very interesting website

john h on 2/20/02 at 09:14 (074385)

Wendy: Interesting site. I bookmarked it. one recomendation seemed to differ from all we read and that it is a recommendation for stretching to 'stretch' the fascia which I do not think stretches.

Re: Very interesting website

Glennx on 2/20/02 at 10:52 (074400)

Hey John: I read this, and nodded my head at the screen in agreement, recalling my own understanding and that of others.

But then I paused to wonder and shifted my thoughts some. I think maybe the plantar fascia does stretch. It must if it's purpose is to absorb or tension foot forces. Otherwise nature would have equipped us with a bone there instead.

Perhaps the big difference is that, while the fascia stretches, it does not lengthen with stretching. If it did it would inevitably fail its purpose.

PF seems a fascia that's lost it's 'flexibility,' it's ability to tension. It may be that stretching the fascia will not restore that flexibility, but rather further aggravate and limit it -- and that rest, or anything that allows the fibers to relax and repair and recover their glide properties (like ESWT or arch supports) is the only sensible treatment direction.

Any stretching that does have a positive outcome does so only because the achilles complex lengthens, and lessens strain on the fascia.

However, with a chronic condition, I have not found any stretch that can isolate the calves from the plantar fascia. The only safe stretching direction that seems to work for me is gentle to a fault. Light, non-weight-bearing ankle flexes like Julie teaches, and the night splint -- again, lightly applied.

Re: Very interesting website

Julie on 2/20/02 at 11:24 (074401)

As usual, Glenn, you describe it well: 'Any stretching that does have a positive outcome does so only because the achilles complex lengthens, and lessens strain on the fascia'. This is why non-weight-bearing movements - and night splints that maintain gentle dorsiflexion for long periods - are eventually effective when aggressive stretching usually (for most people) isn't.

I would add only that the problem with the plantar fascia in PF, whether or not it can 'stretch' (whatever we mean by that) is that it has begun to tear away from the calcaneus, which means that any aggressive stretching technique that involves the gastrocnemius, soleus and achilles, which tails off into the fascia, is going to aggravate the tearing, delay healing, and - for most people - make matters worse.

Re: Very interesting website

john h on 2/20/02 at 11:47 (074404)

As the fascia is a tendon it would seem it does not stretch as tendons in ohter parts of the body seem to always tear. Perhaps they mean when you stretch the other connecting muscles you in effect lengthen the fascia by allowing the foot to flex more before putting tension on the fascia.

Re: Very interesting website

Glennx on 2/20/02 at 11:59 (074405)

Julie: Right on. This might be one of the most resistant lessons chronic PF-ers need to learn (and one of the most valuable lessons you've helped me with). This is particularly true since the consequences of over-stretching the fascia rarely reveal themselves right away. It took me months to finally get it. The fact that so many health professionals speak so convincingly of the benefits of stretching doesn't help.

I do wonder if a fascia that's been rested and babied for a long time loses some natural 'flexibility' and needs coaxing. Or might a healed fascia conform quickly to its purpose?

Two other questions (at least) remaining for me are, what role does icing REALLY play in healing a chronic condition? And does the body lay in any 'foreign' substances like scar tissue and/or calcium deposits that also need different attention?

Re: Very interesting website

Glennx on 2/20/02 at 12:13 (074406)

Maybe too the fascia is functionally able to absorb, say three times body weight. When we stand and walk 'normally' that strain strictly affects the fascia through tension between the heel bone and toe bones.

A too-tight achilles complex could add dramatically to strain on the fascia. Using leverage, it would pull backwards while our foot bones are internally pushing the fascia outward from front to back. In effect the achilles complex acts like a Sears strap wrench on the fascia.

Re: Very interesting website

john h on 2/20/02 at 12:45 (074407)

I would wonder if iceing would heal at all. It would seem to primarly reduce swelling. This may aid in the healing process or speed it up but as a direct cause I wonder? Perhaps, after the ice is removed and the blood rushes the area you might say this aids in the healing.

Re: Very interesting website

wendyn on 2/20/02 at 14:34 (074411)

Actually - I was mostly just looking at the cool muscle pictures....

Re: Very interesting website

Glennx on 2/20/02 at 14:52 (074414)

I wonder too. Sometimes I think we do it quite simply for one of several questionable reasons: It's 'action,' and we humans like to be taking action. It accomplishes something ( reducing swelling), which may or may not be wise. It's been recommended for a long long time and has a 'treatment' life of its own. (We did leeches for a long time too). 'RICE' is catchy. It can feel good. ???

Blood flow may or may not improve overall. Certainly the cold itself constricts blood vessels and inhibits flow. (And I believe I recall that RICE is only recommended for 24 hours or so)

Our body is reacting by swelling for a reason, and I wonder if icing may only really be good for us if we want to immediately minimize swelling so we can quickly get 'back in the game' -- and a swollen 'whatever' is more vulnerable to aggravation.

Or perhaps the ONLY benefit is it feels good.

I've never heard of an injured animal heading to the nearest cold stream to soak their pain.

Re: Very interesting website

Carole C in NOLA on 2/20/02 at 15:44 (074417)

I haven't found icing to be helpful at all, except to reduce swelling immediately after a re-injury. Beyond the 'first aid' function it doesn't seem to be of any help to me.

Carole C

Re: Very interesting website

Ed Davis, DPM on 2/20/02 at 22:21 (074456)

Biomechanics of injuries is often difficult to envision. I wish we had this type of animation available to us on a regular basis to understand and explain these concepts---something I have been waiting for...

The one thing we may not talk about enough is 'tissue quality.' Just how elastic or stretchable should the plantar fascia be? What is the role of poor tissue quality, that is, fascial tissue that is too non-compliant thereby being prone to strain. Part of the ESWT concept is to induce remodeling or rebuilding of the tissue, hopefully replacing tissue which is too stiff/brittle with tissue with better vascularity and stretchability/compliance.
Ed

Re: Very interesting website

Glennx on 2/21/02 at 09:59 (074499)

Be mighty helpful if there were a device that could assess fascia tissue quality along its entire length. I wonder if the Dornier aiming ultrasound can do this? How else could it really help aim the treatment head? Or can a MRI do this evaluation?

Re: Very interesting website

john h on 2/21/02 at 12:06 (074525)

talking about cold baths this morning on one of the major network shows they discussed some new findings published in the New England Journal of Medicine. The have found that after a heart attack if a person has their body core temperature lowered to 92 degrees there is an enormous benefit in reducing heart damage. The findings indicated this should be done ASAP. Three methods to reduce the temp were and the newest method of inserting a catheter into a major artery and circulate a very cold solution through the body. The results were so good that this may become standard protocol.

Re: Very interesting website..tissue quality

Ed Davis, DPM on 2/21/02 at 18:46 (074593)

I think that diagnostic ultrasound and MRI gives us some clues about tissue quality but they are somewhat indirect....thickness of the fascia is easy to measure, density of the tissue to a lessor extent. The machine head on the Dornier unit will probably be aimed at the thickest and most dense area of the fascia. Realistically, that area will be the same or similar most of the time. A small head with a very specific vector or direction of energy would give the edge to the ultrasound based aiming but considering the size of the available heads and relatively broad area of energy dispersion I don't see Dornier having a significant advantage with current applications. Lateral epicondylitis, the indication that Sonocur is going for, probably would benefit from the ability to aim at a smaller, more precise area.
Ed

Re: Very interesting website

Laurie R on 2/20/02 at 00:12 (074366)

Hi Wedyn , This is so cool , I just checked it out ... I will book mark it for when I have time to really look at everything .... Thank you for sharing it .....Laurie R

Re: Very interesting website

DR Zuckerman on 2/20/02 at 00:14 (074367)

Very cool and helpful to understand plantar fasciitis as a repetitive motion injury

Re: Very interesting website

john h on 2/20/02 at 09:14 (074385)

Wendy: Interesting site. I bookmarked it. one recomendation seemed to differ from all we read and that it is a recommendation for stretching to 'stretch' the fascia which I do not think stretches.

Re: Very interesting website

Glennx on 2/20/02 at 10:52 (074400)

Hey John: I read this, and nodded my head at the screen in agreement, recalling my own understanding and that of others.

But then I paused to wonder and shifted my thoughts some. I think maybe the plantar fascia does stretch. It must if it's purpose is to absorb or tension foot forces. Otherwise nature would have equipped us with a bone there instead.

Perhaps the big difference is that, while the fascia stretches, it does not lengthen with stretching. If it did it would inevitably fail its purpose.

PF seems a fascia that's lost it's 'flexibility,' it's ability to tension. It may be that stretching the fascia will not restore that flexibility, but rather further aggravate and limit it -- and that rest, or anything that allows the fibers to relax and repair and recover their glide properties (like ESWT or arch supports) is the only sensible treatment direction.

Any stretching that does have a positive outcome does so only because the achilles complex lengthens, and lessens strain on the fascia.

However, with a chronic condition, I have not found any stretch that can isolate the calves from the plantar fascia. The only safe stretching direction that seems to work for me is gentle to a fault. Light, non-weight-bearing ankle flexes like Julie teaches, and the night splint -- again, lightly applied.

Re: Very interesting website

Julie on 2/20/02 at 11:24 (074401)

As usual, Glenn, you describe it well: 'Any stretching that does have a positive outcome does so only because the achilles complex lengthens, and lessens strain on the fascia'. This is why non-weight-bearing movements - and night splints that maintain gentle dorsiflexion for long periods - are eventually effective when aggressive stretching usually (for most people) isn't.

I would add only that the problem with the plantar fascia in PF, whether or not it can 'stretch' (whatever we mean by that) is that it has begun to tear away from the calcaneus, which means that any aggressive stretching technique that involves the gastrocnemius, soleus and achilles, which tails off into the fascia, is going to aggravate the tearing, delay healing, and - for most people - make matters worse.

Re: Very interesting website

john h on 2/20/02 at 11:47 (074404)

As the fascia is a tendon it would seem it does not stretch as tendons in ohter parts of the body seem to always tear. Perhaps they mean when you stretch the other connecting muscles you in effect lengthen the fascia by allowing the foot to flex more before putting tension on the fascia.

Re: Very interesting website

Glennx on 2/20/02 at 11:59 (074405)

Julie: Right on. This might be one of the most resistant lessons chronic PF-ers need to learn (and one of the most valuable lessons you've helped me with). This is particularly true since the consequences of over-stretching the fascia rarely reveal themselves right away. It took me months to finally get it. The fact that so many health professionals speak so convincingly of the benefits of stretching doesn't help.

I do wonder if a fascia that's been rested and babied for a long time loses some natural 'flexibility' and needs coaxing. Or might a healed fascia conform quickly to its purpose?

Two other questions (at least) remaining for me are, what role does icing REALLY play in healing a chronic condition? And does the body lay in any 'foreign' substances like scar tissue and/or calcium deposits that also need different attention?

Re: Very interesting website

Glennx on 2/20/02 at 12:13 (074406)

Maybe too the fascia is functionally able to absorb, say three times body weight. When we stand and walk 'normally' that strain strictly affects the fascia through tension between the heel bone and toe bones.

A too-tight achilles complex could add dramatically to strain on the fascia. Using leverage, it would pull backwards while our foot bones are internally pushing the fascia outward from front to back. In effect the achilles complex acts like a Sears strap wrench on the fascia.

Re: Very interesting website

john h on 2/20/02 at 12:45 (074407)

I would wonder if iceing would heal at all. It would seem to primarly reduce swelling. This may aid in the healing process or speed it up but as a direct cause I wonder? Perhaps, after the ice is removed and the blood rushes the area you might say this aids in the healing.

Re: Very interesting website

wendyn on 2/20/02 at 14:34 (074411)

Actually - I was mostly just looking at the cool muscle pictures....

Re: Very interesting website

Glennx on 2/20/02 at 14:52 (074414)

I wonder too. Sometimes I think we do it quite simply for one of several questionable reasons: It's 'action,' and we humans like to be taking action. It accomplishes something ( reducing swelling), which may or may not be wise. It's been recommended for a long long time and has a 'treatment' life of its own. (We did leeches for a long time too). 'RICE' is catchy. It can feel good. ???

Blood flow may or may not improve overall. Certainly the cold itself constricts blood vessels and inhibits flow. (And I believe I recall that RICE is only recommended for 24 hours or so)

Our body is reacting by swelling for a reason, and I wonder if icing may only really be good for us if we want to immediately minimize swelling so we can quickly get 'back in the game' -- and a swollen 'whatever' is more vulnerable to aggravation.

Or perhaps the ONLY benefit is it feels good.

I've never heard of an injured animal heading to the nearest cold stream to soak their pain.

Re: Very interesting website

Carole C in NOLA on 2/20/02 at 15:44 (074417)

I haven't found icing to be helpful at all, except to reduce swelling immediately after a re-injury. Beyond the 'first aid' function it doesn't seem to be of any help to me.

Carole C

Re: Very interesting website

Ed Davis, DPM on 2/20/02 at 22:21 (074456)

Biomechanics of injuries is often difficult to envision. I wish we had this type of animation available to us on a regular basis to understand and explain these concepts---something I have been waiting for...

The one thing we may not talk about enough is 'tissue quality.' Just how elastic or stretchable should the plantar fascia be? What is the role of poor tissue quality, that is, fascial tissue that is too non-compliant thereby being prone to strain. Part of the ESWT concept is to induce remodeling or rebuilding of the tissue, hopefully replacing tissue which is too stiff/brittle with tissue with better vascularity and stretchability/compliance.
Ed

Re: Very interesting website

Glennx on 2/21/02 at 09:59 (074499)

Be mighty helpful if there were a device that could assess fascia tissue quality along its entire length. I wonder if the Dornier aiming ultrasound can do this? How else could it really help aim the treatment head? Or can a MRI do this evaluation?

Re: Very interesting website

john h on 2/21/02 at 12:06 (074525)

talking about cold baths this morning on one of the major network shows they discussed some new findings published in the New England Journal of Medicine. The have found that after a heart attack if a person has their body core temperature lowered to 92 degrees there is an enormous benefit in reducing heart damage. The findings indicated this should be done ASAP. Three methods to reduce the temp were and the newest method of inserting a catheter into a major artery and circulate a very cold solution through the body. The results were so good that this may become standard protocol.

Re: Very interesting website..tissue quality

Ed Davis, DPM on 2/21/02 at 18:46 (074593)

I think that diagnostic ultrasound and MRI gives us some clues about tissue quality but they are somewhat indirect....thickness of the fascia is easy to measure, density of the tissue to a lessor extent. The machine head on the Dornier unit will probably be aimed at the thickest and most dense area of the fascia. Realistically, that area will be the same or similar most of the time. A small head with a very specific vector or direction of energy would give the edge to the ultrasound based aiming but considering the size of the available heads and relatively broad area of energy dispersion I don't see Dornier having a significant advantage with current applications. Lateral epicondylitis, the indication that Sonocur is going for, probably would benefit from the ability to aim at a smaller, more precise area.
Ed