Article by Carina Rodrigues Nave, Psychologist Soul Bliss
Anxiety
Anxiety is, in fact, a normal response to the presence of threats, and in some situations it can even be useful, preparing us for action! An optimal level of anxiety can help improve our performance in certain situations. The problem happens when anxiety is felt too often, for no apparent reason, and it starts to interfere too much with our life.
The reasons that make anxiety a problem are countless and can vary from person to person. Problematic anxiety may arise:
➔ After a long or intense period of stress and worry; ➔ As a result of stressful and unpleasant life events (such as the death of a loved one, a serious illness, ending a relationship, etc. others); ➔ As a result of our life experiences and how we learn to deal with them; ➔ After a sequence of negative thoughts, such as “I can’t do this” or “I’m going to pass out” ; ➔ When we lack confidence or self-esteem ➔ After being involved in an accident or threatening experience, which can result in feelings of anxiety the next time we are in similar situations; ➔ After a period of depression where we have lost confidence, although we may feel anxious and depressed at the same time.
There are countless theories, techniques and strategies that help to understand and control anxiety. The benefits of seeking specialized help to deal with other problems are already well known. Anxiety is no exception. If you are experiencing these difficulties, seek help. It is possible to get out of this state of restlessness and constant worry and achieve a healthier, more balanced and happier life.
How to measure?
Did you know you can measure your anxiety? Yes it is true!
Anxiety is usually accompanied by a wide range of symptoms (physical and emotional) that help us identify what we are experiencing at the moment. By identifying the frequency and intensity of each of these symptoms, you can measure whether you are feeling anxious.
Answer the following questions, according to this scale, considering how often you have felt each of the symptoms described below, over the last week:
0 = never
1 = occasionally
2 = often
3 = almost always
Ask yourself the questions below, thinking about how often you have felt this in the last week:
Dumbness or tingling,
Feeling hot
Tremors in the legs
Inability to relax or relax,
Fear or fear that the worst could happen,
Vertigo or dizziness,
Tachycardia,
Feeling unstable or inconstant
Feeling terrified,
Feeling nervous
Feeling suffocated
Tremor in the hands,
Feeling insecure or shaky
Feeling afraid of losing control
Experience difficulty breathing
Fear of dying
Feeling scared
Indigestion or abdominal discomfort,
Feeling faint or fainting
Feel your face flushed
Sweating (not due to heat).
Give each answer its corresponding score. At the end, add everything up and check your total score. If you get a score above 20 points, consider that you are experiencing moderate to severe anxiety symptoms. In this situation, consider seeking professional help.
You don’t need to learn to live with this discomfort! You can look for someone to help you learn to overcome it and regain control over yourself, your emotions and your life.
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“Straighten your back!” – this was a phrase I heard many times when I was a child.
“Put your shoulders back!” – this was another one, and, on one occasion or another, I was accompanied by the person putting my shoulders back in the hope that my posture would remain that way.
What did I do? Anything. But I got better. Or rather, I didn’t do anything with the intention of changing it, but I did something.
I started training. Which led me to high competition, training every day. Sometimes bidiaries. I know now that this was not the reason for the improvement.
Causes
The sedentary style, jobs that force us to spend many hours in front of the computer, teleworking mean we spend many hours in the same position. No matter how much we try to have a straight posture, after a while, we end up giving in and leaning over.
But these are not the only jobs. Detailed work in which attention is paid to detail (potters, seamstresses), or others that we might not associate with, such as dentists. Even children wrongly classified as hyperactive, forced to “behave”.
But…
If this condition is related to lack of exercise, why does the morphology of some athletes tend towards this state? Answer: It is and at the same time it is not related.
A sport in which this type of “back” is very common is climbing, however crossfit, bodybuilding, windsurf or kitesurf, Muai thai or others you don’t know, they also show.
How does it materialize in the body?
To explain this I will remember a little anatomy and bio mechanics.
Our shoulders are relatively loose. They have freedom to move. Even now as you read these words you can raise your shoulders. You can pull them back. Bring your shoulders forward. Move them in various directions and directions. The shoulder blade, in addition to articulating with the humerus, articulates exclusively with the clavicle. What maintains the position of the shoulder blade are our muscles, ligaments and tendons.
Now let’s imagine that we have one muscle pulling the shoulder forward and another pulling the shoulder back.
In our body we have many synergies (muscles that work together, that help each other). Agonist muscles (which make a certain movement) vs antagonist muscles (which resist the agonists, and therefore the movement) are the closest example to what I want to describe.
Let’s now visualize in our mind weak back muscles. The rhomboids and the lower bundle of the trapezius (see image). Which have, among others, the function of raising, lowering or rotating the shoulder blade.
Associated with this, the pectoral muscles are tense, strong and/or shortened. What happens in this combination is that our resting position (in which we are not using any of these muscles) begins to tend towards rotated and forward-inclined shoulders, and the back with an increase in thoracic curvature.
But then why do people who play sports, and sometimes a lot of sports, have this condition?
We are talking about relative weakness and not absolute weakness. In a person who does not play sports or any activity we can understand absolute weakness.
In an athlete this is a relative weakness. Your rhomboid muscles cannot match the tension and force exerted by your pectorals. This is why telling someone to straighten their back doesn’t work.
If a person has muscle or fascial shortening, they may not even be in the “correct position” for long. In cases where you can straighten your back, as soon as you stop consciously forcing the posture, your body will immediately return to its comfortable default position.
It is impossible for a person to be aware of their posture uninterruptedly. But when the strength of the posterior muscles matches that of the front ones, you don’t even need to think about it because the posture will naturally be straighter, with the shoulders further back. This requires treatment and strengthening.
If you have this condition or know someone who does, you can book a treatment session.
Call for attention
Superior cruciate syndrome (this is the name given to this difference in muscle strength) is not, however, the only cause of thoracic hyperkyphosis. There are structural situations that are inherent and sometimes very difficult to deal with. This condition that I describe is one that is increasingly common and has a relatively simple treatment.
This is the first of four articles dedicated to this topic.
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Thanks
To Luís Ganso for sending me the photo used on the “cover” To Luís’ sister for taking the photo.
What is Emotional Intelligence, and why does it matter?
Most of us have heard about IQ, that is, the Intelligence Quotient, but beyond this concept there is the Emotional Quotient, the EQ, which is a flexible ability that we can learn. But what exactly is Emotional Intelligence?
“Emotional Intelligence is our ability to recognize and understand emotions in ourselves and others, and it is also the ability to use this awareness in managing our behavior and our relationships “.
– Daniel Goleman
It is a way of seeing intelligence beyond its cognitive aspects, such as memory and problem solving. When we talk about Emotional Intelligence, we are talking mainly about our ability to effectively address others and ourselves, to connect with our emotions, to manage them, to self-motivate them, to control our impulses and to overcome frustrations.
EQ is a pillar for a set of critical capabilities, is the biggest indicator of workplace performance and the strongest driver of leadership and personal excellence (2). It is therefore a useful and important skill for any Human Being who gets along with other Human Beings, and which can help us to have greater tranquility and quality of life when it comes to our mental and emotional life. On the other hand, the combination of IQ and EQ is one of the best ways to get a view of the person as a whole (2).
To find out more about these topics, we suggest below some of the books by one of the most recognized authors on the subject of Emotional Intelligence. Daniel Goleman started as a journalist at The New York Times, and today is considered “The guru” of Emotional Intelligence. Among the several books he wrote within the theme, we have:
Goleman explains that there are four basic dimensions in his approach to emotional intelligence:
Self-awareness
Self-motivation
Social awareness and empathy,
Relationship management.
Why does Emotional Intelligence matter?
Every day, each of us, Human Beings, have to deal with dozens, if not hundreds of people in our daily lives: in traffic, at work, in our personal lives, when going shopping, in gym or medical clinic. The better we can be aware and deal with emotions, the better and calmer our mind and emotional health will be.
The daily challenge of effectively dealing with emotions is critical to the human condition, as our brains are programmed to prioritize emotions. This works like this: everything we see, hear, smell, touch and taste travels through our body through electrical signals, until it reaches the terminal station, the brain. The problem is that, along the way, these signals pass through the limbic system (where emotions are generated), which means that emotion comes before reason, that is, we feel things before thinking about them (1).
Now, according to scholars on this topic, the physical origin of emotional intelligence is related to the communication between our emotional and rational “brains” (even though there is no physical difference between them). It is said that all of our emotions derive from five central feelings: joy, sadness, anger, fear and shame. The more intense the emotions, the more likely they are to dictate our actions.
It has happened to most of us, that we are in the middle of a situation where we say something “hot-headed” that we later realize (and sometimes regret) and wish we hadn’t said, or that we would have said it anyway. another way, more assertive and constructive. But why does this happen anyway? Of “having your heart in your mouth”, as they say in the slang.
Emotions are interpretations of feelings, in turn, the feelings we have emerge from our motivational system. The first reaction to an event will always be an emotional reaction, which means that what we can control are our thoughts, which follow an emotion – as long as we are aware of them (2). In other words, the more deeply our motivational system is engaged in a situation, the stronger the feelings will be (3). Many people try to ignore negative feelings instead of trying to understand them – the so-called “let it go” or “let it go.” However, according to those who understand the matter, to have this attitude is to be missing the opportunity to receive and interpret this valuable information.
Four Dimensions of Emotional Intelligence
1. Self-awareness
Self-awareness is the ability to correctly understand our own emotions as they occur and to understand our tendencies in the course of situations. It refers to our ability to understand what we feel, to be connected to our values, to our essence. It involves being aware of our usual reactions to certain events, challenges and people (2).
A high degree of self-awareness implies that we are willing to tolerate the discomfort that comes from focusing on feelings that may be negative (2). It requires a great deal of introspection and also the ability to internalize the feedback we receive from colleagues, friends and family.
Emotions ALWAYS serve a purpose. Situations that generate strong emotions will always require greater reflection.
People with high self-awareness are admirably clear in their understanding of what they do well, what motivates them and makes them happy (2).
The negative side of self-consciousness is that, in excess, it can reduce self-esteem. It can lead to a person tending to be realistic rather than optimistic, and insecure rather than confident. The opposite is not true: a self-confident and optimistic person does not necessarily have high emotional intelligence (3).
“Conscience Precedes Change.”
2. Self-management
It’s what happens when we act or don’t act, and it depends on our self-awareness. Self-management is the ability we have to use awareness of our emotions to remain flexible and direct behavior in a flexible way, thus being able to guide ourselves towards our goals, recover from setbacks, and manage stress.
When things go wrong in our lives, we tend to be our own enemy. Daniel Goleman suggests that we have self-compassion, as self-compassion is also consistently related to a wide range of measures of emotional well-being, such as optimism, life satisfaction, autonomy and wisdom, and also with reducing stress, anxiety and depression.
In short, we need to treat ourselves as we would a friend, with sympathy and support.
3. Social Awareness
Social awareness is the ability we have to correctly detect emotions in others, and to understand what is happening to them. If we look within, we will certainly be able to recognize that it is easy to get caught up in our own emotions and forget to take into account, or to consider, what is going on in the lives of the other person(s).
When it comes to this area, listening and observing are the most preponderant elements.
Try to remember a conversation you had recently. If you are aware of the entire conversation, you may realize that your interlocutor may have interrupted you before the reader finishes his sentence (or vice versa, too), this is because our brain’s tendency is to finish sentences while still in progress. Before we hear them, we have to anticipate what the other person is about to say or do.
To develop social awareness we have to stop talking, stop the internal monologue of our minds, stop anticipating the conclusion that the other person will say, listening and observing more.
4. Relationship Management
Relationship management is our ability to use our awareness of the presence of emotions, our own and those of others, and thus manage interactions successfully. Achieving this ensures clear communication and effective conflict handling.
Solid relationships result from the way we understand people, how we treat them and the history we share with them. If we want to be heard, we have to practice relationship management and look for benefits in all relationships.
From a work point of view, conflicts tend to be exacerbated when people avoid problems by acting passively (or on the contrary when they are unable to manage their anger or frustration and end up taking it out on someone), because they lack the necessary skills to start a direct and constructive conversation.
How to develop Self-awareness and Self-management?
Plasticity is the name given to our brain’s ability to change, specifically “neuroplasticity“. As in many other things in life, change does not happen overnight, change is gradual, and therefore it is necessary to practice, practice, practice, repeatedly, until what we want to change is already part of us and the our personality, possibly after a few months or years.
a) Strategies for developing Self-Awareness
Start a journal with your emotions.
Stop and ask yourself why you do what you do.
Know yourself under stress.
Know your values.
Stop treating your feelings as good or bad, they just are what they are.
Get closer to your discomfort.
b) Strategies for developing Self-Management
Breathe correctly
Create a list: emotion versus reason
Count to 10
Sleep on it
Talk to a proficient self-manager
Take control of your inner dialogue
Mindfulness and Meditation as strategies
Mindfulness, can help you deal with your current situation and find ways to deal with each aspect. For example, deep breathing (as we talked about above) allows us to stay in the present and have more control to regain balance in our mind and body (in another article we will talk more about this technique).
To practice mindfulness, there are some principles to keep in mind:
Non-judgmental
Patience
Begginer’s mind
Effortless
Acceptance
Let go
Meditation is a practice that not everyone feels comfortable with, but it can be effective if used well. Meditation is not necessarily associated with any religion, but can be related to other forms of practice. Lack of energy is a common factor associated with mental health. Meditation can help with challenges associated with mental health, offering scope and focus, as deep breathing and body movements can be practiced to provide energy. Small changes can lead to big improvements.
Music is a highly subjective strategy, but it has been proven in research to help elevate mood and emotions.
In addition to all this, the use of reflective practice is vital. Reflective practice will facilitate and support the processes. Therapeutically, psychology can be an excellent way to get help in this process.
Meditation is a practice that not everyone feels comfortable with, but it can be effective if used well. Meditation is not necessarily associated with any religion, but can be related to other forms of practice. Lack of energy is a common factor associated with mental health. Meditation can help with challenges associated with mental health, offering scope and focus, as deep breathing and body movements can be practiced to provide energy. Small changes can lead to big improvements.
Music is a highly subjective strategy, but it has been proven in research to help elevate mood and emotions.
In addition to all this, the use of reflective practice is vital. Reflective practice will facilitate and support the processes. Therapeutically, psychology can be an excellent way to get help in this process.
Final note
We thus come to the conclusion that it is very important to become more self-aware and capable of managing our emotions. But how can we become more aware of our emotions, feelings and thoughts? See below some suggestions made by Harvard Business Reviews (3):
When you have negative thoughts, slow down, pay attention to what you are feeling and why you are feeling it. If you feel tense, stop for 10 minutes (or 5, or 1 minute), sit Get yourself alone, and take a deep breath. Breathing deeply and calmly helps us to have greater mental clarity. See our article on Chronic Pain where we present the square breathing strategy. Think about some events from your day. Pay attention to how these thoughts influence how you are feeling (sometimes you have a more emotional reaction like crying or feeling angry, or frustrated – it means you have touched on something important). You may not understand the source of your feelings the first few times you do this exercise, but over time you will become more skillful and more aware, which is the goal. Name your emotions: joy, love, anxiety, regret, jealousy, guilt, disappointment, frustration, gratitude, humiliation, envy, judgment, mourning, fear, worry, anger, longing, loneliness – is an important first step in knowing how to deal with them. Only when we realize What bothers us is that we can outline an action plan to deal with the situation. If you’re feeling hot-headed, it may be helpful to let some time pass until you figure out how to deal with the situation in a calmer, more assertive way.
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Until a physical limitation makes it impossible for us to carry out our daily lives. Pain is, in most cases, the symptom that leads people to seek help from a healthcare professional, be it a doctor, physiotherapist, osteopath or similar, and is considered a very important symptom for the diagnosis of various diseases. .
What is Pain?
We can all feel discomfort for some time – weeks, or even months, depending on each person’s pain tolerance; We may wake up with some pain or morning stiffness, but as these symptoms disappear throughout the day, and from day to day, we go about our lives.
“An unpleasant sensory and emotional experience associated, or similar to that associated, with actual or potential tissue damage.”
It is always considered a personal experience that is influenced to different degrees/levels by biological, psychological and social factors (which is why it is said to have a biopsychosocial or multidimensional origin).
The most important thing to remember regarding this definition is that the existence of pain does not necessarily mean that there is damage (that is, actual tissue damage). This means that a person can have:
pain with damage (tissue alteration),
no pain with a lot of damage,
lots of pain with minimal damage.
Pain is influenced by much more than just body tissue, it is also affected and influences other areas of your life. Emotions, sensations, beliefs about pain and social aspects are related to persistent pain. This way of looking at pain is called the bio-psychosocial model.
It means that all areas of your life can influence pain. This is good news because it means you have many options for treating it.
How to characterize pain?
One of the ways to characterize pain is through intensity on a scale, which can be numerical, visual, or qualitative. The one that is most commonly used is the analogous numerical scale, in which the therapist asks the patient what number he attributes to his pain, from 0 to 10. With the help of this scale, he can make the equivalence between the intensity of his Pain and a numerical classification, with 0 corresponding to the “No Pain” classification, and 10 to “Maximum Pain” (pain of maximum imaginable intensity). The registered value is always whatever you feel.
You can also try to answer the following questions:
What makes it worse?
What relieves?
How does it vary throughout the day?
How does it vary with movements or efforts? What kind of movements/exercises?
Do stressful days at work or in your personal life cause changes in pain?
Acute pain and chronic pain
There are two concepts that you may have already heard about when you go to the doctor, physiotherapist, osteopath or even in conversation with family, friends or co-workers. They are: chronic pain and acute pain. What are the differences between them exactly?
Acute pain is pain that, up to a certain point, has beneficial effects on the body. It is an alarm signal that warns of the occurrence of something that is not right in our body: be it a trauma, a burn, a joint leak or a gastric ulcer, among others. Still, it must be combated so that it does not eventually become a chronic pain.
Chronic pain is pain that persists three to six months after its onset, it has no advantage for the patient It is now known that, in addition to of the suffering it causes, chronic pain has repercussions on the individual’s physical and mental health, leading, for example, to changes in the immune system with a consequent decrease in the body’s defenses and increased susceptibility to infections. In the field of mental health, chronic pain is commonly associated with insomnia, a history of anxiety and depression, and can even lead to suicide in the most extreme cases.
Statistics about pain
2.9% of the population suffered from low back pain or other chronic back problems. 24.1% suffered from neck pain or other chronic neck problems. 24.1% were diagnosed with osteoarthritis. From 16 to 64, 37.8% of people evaluate their health negatively. Only 14.8% of people aged 65 or over evaluate their health positively. The Women evaluate their health status more negatively (45%) than men (55%).
ongoing disease process (by example, autoimmune disease)
nutrient deficiencies
inadequate sleep, among others
Psychological and environmental:
depression
anxiety
post-traumatic stress disorder
social isolation
physical, psychological abuse or trauma
sexual abuse
exposure to diseases, among others
Six steps to reduce the likelihood of having Chronic Pain
1. Maintain a balanced diet and weight
2. Exercise regularly
3. Eliminate unhealthy routines
4. Choose healthy postures for working and resting
5. Learn stress management techniques
6. Consult a doctor or therapist whenever necessary
See our article about Self Awareness, and the Ebook that we prepared for you about Chronic Pain, for more on point 5.
How is chronic pain treated?
From what has been explained so far, we can see that effective pain treatment requires a comprehensive approach, that is, holistic and integrative. If a few years ago we repeatedly heard the expression “this is your head”, when talking about chronic pain, today it is known that the central nervous system actually plays a preponderant role in the origin and treatment of chronic pain.
Many therapists (whether massage therapists or manual therapists, physiotherapists, osteopaths, chiropractors or personal trainers) care for the person in pain typically through a more physical, biomechanical approach and through movement and/or exercise. However, there is growing scientific evidence that shows that the biomechanical approach (through physical therapies, movements or exercises) alone may not fully address the cause of pain, and therefore not effectively cure it.
If you suffer from chronic pain and have tried different therapies, you have probably already experienced physiotherapy, osteopathy, or even the hands of an experienced massage therapist. Possibly not with the results you expected, which is why you are now reading this article. Recent developments in the area of health and pain neuroscience seek to integrate the biomechanical approach considering the multidimensional nature of pain, considering nutrition and even the quality of sleep. As mentioned at the beginning of this text, this approach is called whether by biopsychosocial or integrative.
The integrative approach to pain is relevant because it reflects advances that are being made in the field of pain treatment, but also in the fields of psychology, genetics (and epigenetics), trauma and nutrition. Many people with chronic pain have already carried out their own research, consulted different professionals and, often, arrive at the assessment already aware of these advances in the area of pain treatment and health promotion.
One of the most recent discoveries on this topic is the recognition of new “axes”: the intestine-brain axis, the intestine-joint axis and the intestine-pain axis.
We will try to explain briefly and succinctly. If you want to know more information about these topics you can consult the books “Cérebro de Farinha”, “O Intestino Feliz” or “O Segundo Cérebro”, or “Heal Your Pain Now”. Simply put, this means that there are interrelationships between our brain, the intestine, the joints and pain. This connection is possible through one of the cranial nerves, the Vagus Nerve, which connects the brain and the intestine. Therefore, this also means that in the case of chronic pain, the problem is often generalized inflammation of the body, so-called systemic inflammation.
There is a direct and strong link between nutrient intake and pain. Pain is neither exclusive nor selective regarding the person’s weight, or the fact that they are within the mass index body for age, or above. However, there is a strong association between obesity and pain, due to the ability of excess adipose tissue to increase levels of inflammation. Mineral and vitamin deficiencies, resulting from a highly processed diet rich in fast foods, play an important role in the origin of chronic pain.
Six Tips for Managing Pain Through Food
1. Reduce inflammation and protect your body from oxidative stress (integrate fruits and vegetables)
2. Good fats (omega 3 and olive oil help reduce inflammation)
3. Prevent vitamin and mineral deficiency (mainly Vitamin D, B12 and magnesium)
4. Drink water (dehydration can increase sensitivity to pain)
5. Eat more fiber (fiber is important for a healthy microbiome)
6. Consume less ultra-processed foods and sugars (they have many calories and very few nutrients, increasing inflammation and oxidative stress)
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Do you usually arrive at the end of the day with a tired neck and shoulders, or in pain?
These days, most people have had the opportunity to telework, from the comfort of their homes. But is it always that comfortable? Not always, not for everyone. In this article we will talk about risk factors, some of the causes of shoulder and neck pain, mention some advantages and disadvantages of teleworking, and provide simple strategies to deal with the situation.
The name given to this type of pain, which does not exactly have a defined cause, is Nonspecific Neck Pain. This DCI is defined as pain in the posterior and lateral region of the neck between the top line of the neck and the spinous process of the first thoracic vertebra (pain between the head and the beginning of the shoulders/dorsal spine), without signs or symptoms of major structural pathology. and no or minor interference with activities of daily living. DCI is also characterized by the absence of neurological signs and specific pathologies; such as: traumatic sprain and fracture, osteoarthritis or cervical spondylolysis.
People who have a defined cause for their neck pain, such as: radiculopathy, facet joint pain, herniated discs, or chronic rheumatic diseases are said to have Cause-Specific Neck Pain.
Risk factors
Within a “Bio-Psychosocial” framework, several factors can be considered as contributing to ICD. Risk factors are multidimensional, and can be divided into individual and occupational factors.
Individual factors include:
gender
advanced age
being a smoker
history of previous neck or lumbar spine injury
psychological factors (e.g. stress, expectations and (dis)satisfaction at work, anxiety, depression and lack of social support)
Occupational factors include:
long hours of sedentary or office work,
high workload (increased by being at home),
inadequate workstation (living room chair, living room or kitchen table, laptop)
Nevertheless, the factors considered most predisposing to these symptoms are: being a woman and/or having a previous history of pain in the neck and shoulder region.
As we saw in the article The benefits and importance of Physiotherapy, when you feel pain in your back and seek help, your treatment may include correcting a dysfunction in your foot or learning how to stretch some muscles in your lower limbs. But not only that, as we will see later. One of the methods that can be used for this purpose is Global Postural Reeducation created by Philippe Souchard, French physiotherapist, or his self-posture method, Active Global Stretching.
Nonspecific Neck Pain is a highly common musculoskeletal disorder and one of the main causes of disability worldwide. It is well established that neck pain is not only a risk factor for serious spinal problems and functional incapacity, but which is also associated with a decrease in the quality of life and productivity of workers.
Prevalence rates show that around two in three people will experience neck pain at some point during their lifetime. As mentioned, they show that women are more likely than men to have these symptoms, and even more likely to present generalized hyperalgesia due to recurrent visceral pain. Next we will see what visceral pain is.
Causes of Neck Pain
Most pain in the cervical region, as we have seen, is of non-specific origin, that is, it is not possible to assign a cause. These are normally related to postural changes and myofascial tensions ( muscles and fascia), emotional and mental stress, and/or even poor sleep hygiene. Which means that with the help of therapies (physiotherapy, massage, osteopathy), therapeutic exercise (physiotherapist or personal trainer), and changing harmful habits (fast food, soft drinks, alcohol, tobacco, sleeping a few hours, drinking little water) to healthier ones (healthy eating, meditating, drinking at least 1.5L of water a day, exercising at least less than 3 times a week), relief of complaints can be achieved.
Let’s see how tension can contribute to pain. We normally associate that problems in the neck and shoulders are only related to changes in these same areas. However, one must always consider the possibility of tensions associated with:
Let’s see how tension can contribute to pain. We normally associate that problems in the neck and shoulders are only related to changes in these same areas. However, one must always consider the possibility of tensions associated with:
hand and elbow (due to working with the computer mouse)
to the mouth joint (Temporo-Mandibular Joint) due to stress or teeth problems
muscular dysfunctions and tensions at the level of the transition between the cervical and dorsal spine
loss of mobility in the lower back and hips (excessive tension in the glutes makes it difficult to sit)
In a physiotherapy session you can count on a global assessment, in which the therapist seeks to know the entire history of your injury, as well as other pertinent information (topic to be discussed in another article). When a person complains of neck and shoulder pain, it is always important to look in the clinical history for other signs and symptoms that may lead to suspicion of another type of disease, typically associated with generalized inflammation.
One of the symptoms that can make us suspect other causes is the existence of morning stiffness, which improves throughout the day. In this case, there is a good chance that there are rheumatological conditions (rheumatoid arthritis, ankylosing spondylitis or fibromyalgia), but they generally do not occur in isolation. If it is a rheumatological condition, there is generalized joint involvement, that is, there is the same type of symptoms in several joints of the body. However, to make an accurate diagnosis, it is best to consult an orthopedist or rheumatologist.
Another possible cause for the existence of neck pain is the existence of visceral pathologies (gastric ulcers, fatty liver or other disorders of this organ, or even gallstones). Through the connections between the nerves and the organs, this possibility of pain referred from a distance is justified, that is, neck pain originating in the organs and viscera. To learn more about this topic you can read the book Dor Para Quê.
Understanding (on the part of the doctor or therapist) and awareness of the referred pain are essential for an accurate diagnosis of the source of pain.
Evaluation
The healthcare professional receiving a person complaining of shoulder and neck pain should perform assessments to determine the potential for the presence of serious pathology (e.g., infection, arterial insufficiency, superior cervical ligament insufficiency, or other dysfunction). ) and refer for consultation as needed.
One of the ways to evaluate and measure the symptoms that a person complains about is a scale, such as the Neck Disability Index (Neck Disability Index). On this scale, questions are asked about:
Intensity of pain
Personal care
Lift things
Reading
Headaches
Pay attention
Work
Driving cars
Sleep
Fun
When evaluating a patient with neck pain, check whether there is, for example:
neck pain with mobility deficits
mobility tests for the chest and cervical region
neck pain that causes headache
neck pain with radiating pain
Strategies
There are very simple things we can do throughout our day-to-day work that allow us to reach the end of the day much more comfortable. Let’s look at some:
Have the computer monitor in front of us (not to the side)
Having the top of the screen at eye level. For those who work with a laptop, one of the solutions is to place the laptop on a higher area (with books, for example), and work on a separate keyboard, resting on the desk
Use a vertical mouse instead of the normal mouse
Get up every hour and do some stretching movements with your arms and neck
Perform stretches for all major muscle groups (chest, back, front of thighs, back of thighs and legs) before and after work
Try to have healthy snacks between meals (such as a fruit or a handful of nuts), instead of bread, cakes, or other processed foods
Treatment
Neck pain can be acute, sub-acute or chronic. For each situation, treatment can and should be differentiated according to the latest guidelines published. For more information about chronic pain you can consult our e-book “Chronic Pain – Integrative Treatment“.
Conservative treatments (i.e., non-surgical or invasive) used to help manage Non-Specific Neck Pain are numerous and include conventional (CT) and non-conventional (TNC) therapies:
Physical therapy (which includes manual therapies, electrotherapy, therapeutic exercise and health education)
Pilates, Global Postural Reeducation, Yoga or other type of personalized therapeutic training
Traditional Chinese Medicine (including acupuncture)
Nutrition and/or Naturopathy (nutritional advice and dietary supplements adapted to each case)
Massage
Relaxation techniques and mind-body practices (meditation, mindfulness, or other related practices)
Medication (preferably advised by the attending physician – family doctor, occupational physician, orthopedist or rheumatologist, for example).
What does it mean to be conscious? And how can this help us in our relationships, activities, health and well-being?
Be aware
It’s something that many people take for granted. In fact, it is easy to distinguish between the moments when we are conscious and the moments when we are not, such as when we are awake or asleep.
The question is: how conscious are we really when we are awake?
As we live our day-to-day lives, we participate in a wide range of events and perform a countless number of actions. Without realizing it, we walk down the street looking at the screens of our smartphones, ignoring much of what is around us, we miss snippets of conversations with the people who are important to us while we wander in thoughts and worries, we drive kilometers and kilometers and We arrived home with no idea of the route. We spend hours on autopilot, hours in which many details of life and, who knows, opportunities escape us. In these moments, we may question how aware we are – how present we are to what matters to us.
As we live our day-to-day lives, we participate in a wide range of events and perform a countless number of actions. Without realizing it, we walk down the street looking at the screens of our smartphones, ignoring much of what is around us, we miss snippets of conversations with the people who are important to us while we wander in thoughts and worries, we drive kilometers and kilometers and We arrived home with no idea of the route. We spend hours on autopilot, hours in which many details of life and, who knows, opportunities escape us. In these moments, we may question how aware we are – how present we are to what matters to us.
Mindfulness
Mindfulness means full attention and manifests itself as the awareness we have in the present, moment after moment, voluntarily and without judgment. It does not necessarily mean that we are permanently attentive, but rather that we consciously choose to bring our attention back when we notice that it has wandered. We don’t judge ourselves by our ramblings, we don’t justify the type of rambling or why, we don’t try to make the experience “good” or avoid it being “bad”. We stay present with what is, as it is.
The proposal is to start by paying attention to the way we breathe and the sensations in our body. As incredible as it may seem, most people are unaware of the way they breathe – and how this influences their nervous system and energy levels, but we’ll save that part for the next article – nor the postures in which they put their body. body. The fact is that we spend hours sitting, in unfavorable postures, breathing shallowly, while the mind gains momentum and drags us in an incessant flow of ideas, memories and concerns.
The practices suggested by this discipline have no esoteric or religious roots. In fact, it is currently the discipline of Eastern origin most studied by Western science, having demonstrated countless benefits for our health and well-being. These are practices to strengthen the mind. After all, attention is like a muscle and, like any muscle, it needs to be trained.
Strong attention allows us to be more present and make more conscious choices. And this means that we will be caught by surprise less often in life, that we will manage our time better and remember We better remember that we are going to be less and less reactive and that we are going to take better care of our bodies instead of neglecting them for hours.
The importance of being conscious for psychology
So what is the role of all this for psychology? If psychology and psychotherapy have always been about bringing the unconscious to the surface and making people more conscious and functional, now, more than ever, practices related to attention and breathing are being integrated into their therapeutic approaches.
Being aware brings greater clarity to the mind and a greater focus on understanding the ways in which we process what we experience.
Many of the reasons why people seek help from a mental health professional are related to what is going on in their mind – unpleasant thoughts, dysfunctional beliefs, lack of motivation, difficulty focusing… And here The tools that mindfulness brings us can be very useful. By observing our thoughts without judging them, we can learn to relate to them in a new way. We can observe them as thoughts and not as truths, as products of our mental activity, results of what happened before and not necessarily of what we choose to happen now. We can accept that we feel a certain way, that this is valid, and that we can act regardless, without judging ourselves or increasing our self-criticism. We can simply notice the “baggage” that we no longer need and let it go.
If the objective is change – changing a habit, a behavior or a way of thinking – through therapy, being more aware will allow us to observe when we perform that habit, in what context this most easily happens and what the motivations are internal resources to do so at that time. This awareness thus becomes a powerful supporting element in the therapeutic process. By being more aware, we can start new behaviors and maintain them until they become new habits.
If the objective is to work on our relationships, being aware will be fundamental to understanding how we approach contact with others. How available we are to listen and how our language reflects this availability. How our body communicates all the emotions we don’t communicate verbally.
How we wait for our turn to speak and how we process what we hear before responding, rather than reacting immediately. And, interestingly, by being more present with ourselves, we are creating more presence for others
In essence, being aware opens an infinite number of doors so that we can live our lives in more satisfying, productive and healthy ways. Of course, not everything depends on us, but if we are aware of everything that depends, then our actions will have a much greater impact. So, we invite you to explore yours and, in order to make the process more interesting, we close with some practical tips that you can find below.
“If your mind is not burdened with ten thousand things, this is the best time of your life.”
– Wu‐Men –
4 practical tips to get off autopilot
Mindful eating:
The next time you eat, try to be aware of everything that happens, from your plate to the way you eat each food. The proposal is that you put your cell phone aside for a few minutes and dedicate yourself completely to the eating experience – preferably alone or with someone who is willing to do the same. Try the various textures, temperatures and flavors, notice how you chew, feel the urge to take another bite.
Body Scan:
Sitting or lying in a comfortable position, travel through your body trying to discover what sensation exists in each area. With curiosity, look over your face and notice what sensation there is in your forehead, around your eyes, in your jaw… is there any tension? Continue through the remaining areas of the body and, remember, there are no right or wrong sensations, just yours.
Breathing:
Also sitting or lying down in a comfortable position, the idea here is to understand the way you are breathing without trying to change it. Don’t try to breathe like you think you should. First, observe whether you are breathing through your nose or mouth, into your chest or belly, more deeply or superficially… Try to feel the temperature of the air coming in and the air coming out. Breathing is so much more complex than it seems…
Daily habits:
Choose a habit from your daily life and try to do it as consciously as possible. For example, when brushing their teeth, many people are not aware of how they are doing it. Any habit is valid, as long as it is part of your day. The invitation is to bring awareness to each small moment that makes up this habit. Be curious!
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References
§ Kabat-Zinn, J (2000). Wherever You Go, There You Will Be: The Classic of Mindfulness in Everyday Life. Rising. § Mace, C. (2007). Mindfulness in psychotherapy: an introduction. Advances in Psychiatric Treatment, 13, 147–154. § Williams, M. & Penman, D. (2015). Mindfulness: The eight-week plan that freed millions of people from stress and anxiety. Paper Moon.
Do you usually feel pain in the front of your knee when you exert more effort, or when going down stairs or ramps?
Knee
When we talk about the knee, we must consider that it is a load-bearing joint, made up of 4 bones: tibia, fibula, femur and kneecap. We must bear in mind that, as it is a load-bearing joint, it is also a joint subject to many movements throughout the day, most of which we do not even realize we are doing.
There is a widely accepted theory that there are joints more prone to stiffness, and others more prone to instability, that is, there are joints that benefit more from mobility training, others from stability training. In the case of the knee, it is a joint that tends to suffer injuries due to instability and/or movement dysfunction, and therefore benefits from stability training. But it is not just the knee that matters, as We’ll see later.
Pain in the Front of the Knee
It’s one of the symptoms of a syndrome that affects many people, and there’s a justification for that: it’s called painful patellar syndrome (or patellofemoral syndrome).
Painful patellar syndrome (SRD) is typically characterized by pain felt behind the kneecap and described as being diffuse (Ferber et al., 2015; Neal et al., 2019). When the therapist questions, the person usually places their entire hand on top of the kneecap, and reports feeling this pain in activities that generate overload on the knee in flexion positions, such as going up and down stairs (Neal et al., 2019), and also jumping and running activities (Ferber et al.,2015).
In the general population:
It affects around 15% to 25% of people (depending on the authors consulted)
It is common in teenagers and adults
It is mostly diagnosed in military personnel and athletes whose sport includes running (Ferber et al.,2015)
It is a more typical pathology to be diagnosed in women than in men (relevance to anatomical and strength factors)
More than 70% have recurrent or chronic pain in this joint, with an important psychological and emotional dimension in these cases, with some lack of understanding by their closest family circle
In a more recent study (2019), it is proposed that quadriceps weakness is the only considerable risk factor for the onset of SRD. Rejecting that the gender, age, body mass index, height, lower limb alignment, or hamstring and hip muscle strength are risk factors.
Role of the Physiotherapist
SRD has been studied for decades, and its treatment continues to be a challenge for both physiotherapists and exercise professionals. Even before the beginning of the second millennium, the relevance of SRD was studied. activation of the internal part of the quadriceps (vastus medialis and its oblique portion) at the origin of this pathology. Nowadays we know that to treat your complaints (person / patient) it is important not to limit ourselves to just treating the knee, but to integrate the knee into a continuum of movement and biomechanical analysis that integrates the entire body (foot, ankle, knee, hip and core).
In the case of knee pathologies, specifically SRD but also for any pathology, the physiotherapist plays a very important role in clarifying and teaching the person/patient:
Clear the person’s doubts regarding the medical diagnosis that may have already been made,
Carry out the diagnosis in physiotherapy if there has not been a medical consultation, and refer if necessary,
Evaluate, analyze and demonstrate which movements are most problematic for the pathology in question,
Teach and demonstrate treatment and prevention strategies so that the person can take self-responsibility for the treatment (see figure 2.).
It was doneum studyin which they compared the effectiveness of a knee strengthening program VS knee and core strengthening, with a view to treating patellofemoral pain. In this study they concluded that:
A 6-week strengthening program, with three weekly workouts, targeting the hip and knee resulted in significant improvements in pain, functional capacity and muscle strength
For short-term treatment, the knee strengthening protocol, or knee strengthening protocol combined with hip strengthening, are equally effective
The combined strengthening protocol generated faster improvements, as well as greater gains in overall muscular strength and core muscle endurance
6 Recommendations
Recently (2018) a consensus statement (by experts in the field) about exercise therapy and physical interventions, which resulted in the following 6 recommendations:
Exercise therapy is recommended to reduce pain in the short, medium and long term, and improve functionality in the medium and long term.
It is recommended to combine exercises for the hip and knee to reduce pain and improve functionality in the short, medium and long term, this combination being better than exercises targeting only the knee.
Combined interventions are recommended to reduce pain in adults in the short and medium term. Combined interventions include exercise therapy combined with one of the following: plantar orthoses (insoles), patellar taping or manual therapy.
Plantar orthoses (insoles) are recommended to reduce pain in the short term. In isolation, patellofemoral, knee or lumbar mobilization is not recommended. Electrophysical agents (as exclusive therapy) are not recommended.
Return to activity
Anyone who is limited in their activity, whether daily or sporting, due to pain or injury, has the question in their head “when can I return?”. This is true for the average person, who needs to know when they can return to their day-to-day life without restrictions (someone who works on their feet all day, or who needs to be present at meetings), but it is also especially worrying for top athletes who need to plan their presence at sporting events (or coaches, in the case of team athletes).
The following criteria are recommended to allow a return to sports:
Absence of edema
No pain when squatting or going up or down stairs
Good quadriceps strength, especially vastus internus
Adequate flexibility of the hamstrings
Biomechanics of normal gait
Adequate core stability strength
Good performance in challenging functional tests
The person feels ready and confident in the previously injured knee
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The word epicondylitis derives from the word epicondyle (refers to an anatomical area of the arm bone, the humerus) + the suffix “itis”, which tends to designate some inflammation, in this case located in the elbow. In this type of pathology, one of the main symptoms is pain, which can be felt only in the elbow or along the forearm.
The American Society for the Surgery of the Hand defines epicondylitis as follows:
“Lateral epicondylitis, commonly known as tennis elbow, is a painful condition involving the tendons attached to the bone on the outside (side) of the elbow. (…).”
The pain is felt mainly over the bone on the outside of the elbow, where the upper arm muscles meet the forearm muscles. One of the main muscles involved in this condition is the common extensor of the fingers which, as its name suggests, stretches the fingers of the hand (see image below). Normally, several muscles that attach to the elbow and forearm region are involved.
The degeneration associated with the tendon insertion leads to this area being weakened and subject to greater stress. This fact can lead to pain, which appears in situations where this muscle is called upon, such as lifting weights, or situations in which we need to grab or pull something. I should mention that in scientific articles, the term most described and the most accepted name currently is “tendinopathy”, and not tendinitis, namely Lateral Elbow Tendinopathy (TLC), the name that will be adopted from here on.
TLC affects approximately 1% to 3% of the general population, with greater incidence and risk in people who smoke, manual workers and tennis players. This type of injury results in significant functional disabilitywith regard to work, sporting and leisure activities, and at the same time entails high costs due to loss of productivity and the use of healthcare.
We will soon make a video available on our youtube channel, with some stretches for the hand, wrist and forearm that can help relieve tension in the wrist flexor and extensor muscles.
The pathophysiology (the physiological and pathological reason) of TLC is multidimensional (diverse origins). On the other hand, there is strong evidence regarding the discrepancy between clinical severity and tendon pathology in patients with tendinopathy. This means that just by observing an examination it is not possible to assess the severity of the pain that the person may feel. It also means that there may be cases in which the person has severe pain but the examination does not show degenerative changes. In these cases, the changes may be related to other factors, such as changes in the peripheral nervous system (radial nerve), factors related to body biomechanics and possibly psychological factors.
Diagnosis of Lateral Elbow Tendinopathy
The diagnosis of TLC is essentially based on a clinical examination that aims to cause pain in the tendon affected by the load. Physical examination should reproduce pain in the lateral epicondyle area in at least 1 of 3 ways:
palpation of the lateral epicondyle;
resistance to extension of the wrist, index finger or middle finger;
make the patient grasp an object.
The doctor monitoring the clinical case may consider it pertinent to carry out additional examinations, such as soft tissue ultrasound or even magnetic resonance imaging, however, according to the authors Coombes, Bisset and Vicenzino (2015) in a meta-analysis of MRI studies the authors found that 50% of those analyzed had visible tendon changes on MRI but had no symptoms.
In the same way, a study was carried out in which the tendons of individuals with tendinopathy were analyzed, but at the same time individuals without symptoms were used to carry out comparative ultrasound evaluations. The result of the study was that changes in the tendons were found in 90% of patients with TLC, but also in 53% of individuals who were asymptomatic. In other words, around half of the individuals without symptoms had tendon changes on ultrasound evaluation.
The exception was the case of rupture of fibrils within the common extensor tendon, in which case there was a 100% probability of elbow tendinopathy.
Conversely, negative ultrasound findings can be used to safely rule out lateral elbow tendinopathy as a diagnosis and prompt the physician to consider other causes of elbow pain.
Thus, given this imaging challenge, a more comprehensive physical examination may be necessary to identify (or rule out) coexisting pathologies or other reasons for the existence of pain. This is because an elbow is never just an elbow. The elbow is connected to the hand and shoulder more directly, as well as the spine. This explanation can be left for another article. What I want to communicate now is that in one of their books, Ellenbecker et al. (2013), point out that there are several studies that indicate that elbow tendinopathy is related to movement dysfunctions at the shoulder level, mainly with regard to joint ranges (and respective muscles) of internal and external rotation of the shoulder.
To simply measure and compare the internal rotation of the shoulder, we can make the movement of bringing the hand to the shoulder blade (for ladies, something similar to tightening/unfastening the bra). If the difference is significant or pain appears, it means that there is some change in the shoulder that needs to be evaluated, preferably before causing symptoms such as pain or limitation of movement in everyday life.
Thomas Myers, author of the theory of myofascial meridians, presents several lines or myofascial meridians that unite, in this case, the muscles of the elbow, forearm and shoulder.
In addition to the upper limb, as mentioned in one of the previous paragraphs, the evaluation of the cervical and thoracic spine and the function of the radial nerve should also be a priority, especially when there is concomitant neck pain, or diffuse pain in the arm, or paresthesia ( the familiar feeling of numbness). Reproduction of lateral elbow pain during manual palpation and/or active, passive or combined movements of the cervical spine should raise the suspicion of radicular or referred pain, in which case the cervical spine may need to be evaluated by an orthopedic doctor.
Many of us have suffered some type of pain in the shoulder, arm, elbow or even hand, due to the countless hours we spend at the computer. With this visualization of how these different muscles influence each other, it becomes easy to understand how a change in the shoulder and neck muscles can influence or increase pain and injuries at the elbow level, and vice versa.
If you don’t feel any type of pain, but work long hours at a desk or at the computer, believe me that it is still worth doing some exercises as a measure to enhance your well-being and the health of your muscles and joints, such as the demonstrated in the video above.
One of the things we get asked most about during consultations is about the best posture at the computer. We are saving this topic for another post to be published soon.
Is there treatment? What is the best approach?
Manual Therapy
Manual therapy techniques result in pain relief and improved grip strength.
There is also evidence that manual therapy techniques targeting the cervical and thoracic regions provide additional clinical benefits beyond local treatment of the elbow (…).
Exercise therapy
Exercise is fundamental to treatment, whether as the sole treatment modality or as part of a multimodal physiotherapy regimen (which makes use of manual therapies, therapeutic exercise and electrotherapy).
If the pain from tendinopathy is chronic (more than 6 months), exercise has been shown to lead to faster pain regression, shorter sick leave time, fewer doctor visits and greater work capacity.
Despite the clear benefits, the ideal intensity, duration, frequency and type of load for TLC rehabilitation have not yet been established. In general, the guidelines recommend applying a gradual increase in resistance, focusing on the wrist extensor muscles.
Given the variability of clinical presentation and the pathology itself, it is likely that optimal modes and doses of exercise will differ among patients with different stages or severity levels of tendinopathy.
Discipline
Those who study these matters guarantee that, most likely, the condition will resolve gradually with adequate rest and time.
Activities that cause pain should be avoided, ergonomic advice should be given to minimize work tasks that require postures with the wrist deviated, vigorous efforts and highly repetitive movements.
You should also gradually reintroduce more strenuous tasks and reduce the load on the tendon if it recurs, respecting your body’s limits.
Pharmacotherapy The evidence is conflicting about the role of anti-inflammatories in the treatment of TLC.
There is strong evidence that corticosteroid medication provides short-term pain relief, but leads to worse outcomes after 6 and 12 months compared to a “wait and see” approach or physical therapy treatment, with rates of substantial recurrence.
Depending on the severity of the situation, a mixture of all these interventions may be necessary. In general, for moderate cases, a multimodal physical therapy regimen is recommended as first-line treatment, with the goal of faster pain reduction and recovery of function.
We suggest a minimum of 8 to 12 weeks of individually prescribed physical rehabilitation to target specific physical deficits, including progressive strengthening and resistance exercises and elbow manual therapy, consistent with what has been used in previous studies of tendinopathy side of the elbow.
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Being the base of the body, the feet easily accumulate tension, which can be a source of various changes, and at the same time be related to other dysfunctions in the body, such as in the knees, hips or spine.
In this article we intend to reveal a little about the main causes of pain in the plantar fascia, what this fascia is, what are the most common and effective treatment methods and how to release accumulated tension in the feet through myofascial release.
Plantar fasciitis is the most common cause of plantar heel pain, with an incidence of one million patient visits per year in the United States of America. Another condition that is normally associated with the diagnosis of fasciitis, and which is evaluated on x-rays of the feet, is heel spurs. How plantar fasciitis actually appears is not fully understood. It is currently believed to be secondary to degeneration, micro tears within the plantar fascia, and not due to an inflammatory process. On the other hand, heel spurs are believed to be the result of pulling forces at the origin of the plantar fascia and not the cause of plantar fasciitis.
On this side you may be wondering “what is fascia and where is it?”. Now, fascia is a “component of soft tissue (…), which surrounds all organs, muscles, bones and nerve fibers” and functions as a “tensional force transmission network throughout the body”. We have fascial tissue (fascia) throughout the body In the foot, it is called the plantar fascia. Now, the plantar fascia runs from the calcaneus (heel bone) to the toes, with the majority of our body’s load being placed on the innermost region of the fascia, that is, from the inside of the heel to the first toe.
Plantar fasciitis is a very common cause of pain at the base of the heel that can be triggered and worsened by prolonged standing, walking, running and also obesity, among other factors. With bad postures on a daily basis, a sedentary lifestyle (which will not be your case, we hope), the stress we are subject to, or even with sports, it is quite natural for tension to develop in some muscles, or even even postural changes that are more or less difficult to control. But let’s understand what are the risk factors for the appearance of this pathology.
Risk factors
Most injuries in this anatomical region occur at the origin of the fascia, that is, in the heel area. As the plantar fascia helps support the medial arch of the foot, any load ends up stretching the plantar fascia. The plantar fascia is also tightened by stretching the big toe (1st toe). According to this study, any factor that mechanically loads the plantar fascia can be considered a risk factor for plantar fasciitis.
Risk factors can be divided into intrinsic and extrinsic factors.
Intrinsic factors, that is, related to the person who feels the pain, include:
obesity
flat feet
cavus feet
reduction in ankle dorsiflexion (ankle bending) range
leg muscles with excessive tension
Extrinsic factors, that is, factors related to the environment and training, include:
running on hard surfaces
walk barefoot
sudden increase in intensity and/or volume of running or training
First of all, it is important to define what is meant by “Myofascial Release”. Now, this is the term given to a specific form of therapy, which is intended to have an effect on the fascia. Myofascial therapy techniques can be applied by a therapist, in an office consultation, or they can be self-applied, as we will describe in this article.
Treatment
Treatment is largely non-operative, with 90%-95% of patients experiencing resolution of symptoms within 12–18 months.
Activity modification – Conditioned training, or modification of the activity, is imperative. Especially those that involve repetitive impacts, such as running and jumping, should be avoided during the treatment phase. You can continue to do non-weight bearing activities, such as cycling, swimming and rowing (if you go to a gym) to maintain your cardiovascular fitness. A gradual return to activity may be permitted after you have been symptom-free for 4-6 weeks and no longer have localized tenderness over the plantar fascia.
Ortheses / Insoles
The use of orthoses, including heel pads (small insoles just for the heel) and plantar fascia support insoles are a good and effective option initially to alleviate the pain of plantar fasciitis. In If there are no major biomechanical changes such as flat or cavus feet, prefabricated insoles (purchasable in a store like decathlon or sport zone) are not inferior in their effectiveness to custom-made ones. However, some care must be taken when purchasing: to reduce the load on the plantar fascia when supporting weight, the insole must help support the inner arch of the foot without putting any direct pressure on the plantar fascia. For athletes, semi-rigid insoles are the most practical solution and in this case, ideally they should be manufactured by a podiatrist or other competent professional for this purpose.
Plantar fascia stretching and ice massage
Plantar fascia and leg stretches are inexpensive and easy to learn with the help of your physical therapist. Specific plantar fascia stretching has been shown to be more effective than an isolated Achilles stretching program, and should be performed and held for 30 seconds and repeated at least three times in each session.
A little further down in this article we give an example of how to perform myofascial release on the foot with a tennis ball.
This should be done daily, especially before taking the first step in the morning and before standing after a prolonged period of sitting. Ice massage can also help reduce plantar fascia pain. One way to apply this ice therapy involves rolling a frozen can under the foot with moderate pressure for five to ten minutes at the end of each day, somewhat similar to the first step presented in the video below, regarding myofascial release.
Analgesia
The use of anti-inflammatories to treat plantar fasciitis is a widespread practice that has been questioned since, according to the most recent literature, plantar fasciitis is not an inflammatory process. However, when combined with other treatment modalities, whether nonsteroidal anti-inflammatory drugs (NSAIDs) or simple analgesics, they can help provide short-term pain relief.
Corticosteroid injection
Localized steroid injections (known as infiltrations) into the plantar fascia provide effective short-term relief from plantar fascia pain for up to three months. It must, however, be considered that there is an increased risk of plantar fat atrophy and rupture of the plantar fascia with the application of these injections and, therefore, repeated injections should be avoided if possible.
Focal extracorporeal shock wave therapy
If you have pain in the plantar fascia that is resistant to treatment you can be referred or look for a clinic where ultrasound and shockwave therapy are performed as part of the sports physiotherapy service. This treatment has been shown to be effective for cases of chronic plantar fasciitis that have not responded well to conservative treatment.
This type of treatment is a non-invasive procedure, and requires two treatments one week apart for optimal effectiveness, according to some authors (you must follow the recommendations of the doctor or physiotherapist who is monitoring your case).
How can I apply myofascial release?
Thinking about our most critical and skeptical readers, we want to leave here the safeguard that there is some controversy regarding the effectiveness of this form of therapy/treatment in scientific literature. However, from our experience, its application has mostly beneficial effects, when applied according to clinical reasoning.
To self-apply myofascial release techniques, different materials can be used, however the most recommended are lacrosse balls, tennis balls, or myofascial release roller.
The application of self myofascial release (ALM) techniques allows, with just a few minutes of daily application, improvements in flexibility and efficiency of movements through the inhibition of overly active muscles, reduction of pain and muscle recovery. Myofascial release works through pressure on trigger points, allowing the most tense and contractured structures to relax.
As an evaluation we will carry out the following test:
Barefoot, standing, try to touch the floor with your hands, keeping your knees straight. Analyze and note how far you have reached (example: in the middle of the tibia, known as the “shin” bone).
Self Myofascial Release Technique:
Take 2 minutes to apply this technique to each foot. If desired, apply to the right foot and repeat the initial test, and then apply to the left foot and test again.
With the tennis ball already on the floor and your feet (barefoot) step on the ball with one of your feet, applying pressure to crush the ball and at the same time performing self-massage in the longitudinal direction, thinking about five imaginary lines that go from each one of the fingers to the heel, running them.
When you find points of greatest tension, stop at that point/s and perform flexion and extension movements of the toes (actively raising and lowering the toes), until you feel the tension and/or pain reduce.
This is an exercise to do slowly, as if you want the ball to “bury” itself in your foot.
What are you waiting for, grab a tennis ball, watch the video to better understand the movements required, and feel the well-being that this exercise provides in your feet.
Amazed by the results? We believe so.
Now you have another strategy to take good care of your feet, knowing that they are one of the pillars for good posture, good sporting performance and consequently for your well-being.
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Joseph Pilates was born in Germany in 1883 and as an adult he was a healthy athlete practicing various sports such as skydiving, diving, gymnastics and boxing. However, his passion for sport and the Greek ideal of health (body, mind and spirit) was developed due to having had asthma and rheumatic fever as a child (Pilates Foundation, 2017).
In 1912, Joseph went to England to work as a self-defence instructor for Scotland Yard detectives. Around this time, during the First World War, he was interned, as were many other Germans. During his incarceration, this German innovator trained several inmates in his exercise method, refining his ideas and concepts (Pilates Foundation, 2017).
Later, once free, Joseph returned to Germany where his type of training gained visibility among dance professionals. Until the time of his death, the now known Pilates method was called Contrology. Joseph and his wife, Clara, applied and taught these exercises throughout their lives at their “Body Conditioning Gym” studio in New York (Pilates Foundation, 2017).
This method has some basic principles, they are: breathing, concentration, center, control, precision and fluidity. One of Joseph Pilates’ focuses was, above all, learning to breathe correctly (Pilates Foundation , 2017).
Pilates, according to Pilates Foundation (2017), has the following benefits :
Improve posture, health and physical capacity
Achieve specific physical goals and challenge athletic ability
Rehabilitate after injury, surgery or illness
Return to movement
Expand body awareness
Develop confidence in your body’s capabilities
Look better, feel better, live better
Live a happier life
APPI, an acronym for Australian Physiotherapy & Pilates Institute, was co-created in 1999 by Glenn Withers and Elisa Withers, both published authors and international speakers, considered experts in the area of spine treatment and Pilates. APPI is currently present in more than 16 countries, working in partnership with widely recognized institutions such as: English Institute of Sport, British Military, English National Ballet, NHS, British Bobsleigh Association, Cirque De Soleil, Premier League football clubs – among they are Manchester United, Tottenham, Chelsea and Arsenal (APPI, 2017).
This institute recommends five key elements for its Pilates teaching method:
Side breathing (lower ribs)
Center
Chest positioning
Shoulder blade positioning
Positioning of the head and neck
There are important differences between Joseph Pilates’ original method and the APPI method. Regarding the latter, for example, the neutral spine (instead of imprinting), 25% transverse contraction (instead of maximal bracing contractions), selective movements adapted to each clinical condition can be highlighted. This variability is due to the need that its creators, both physiotherapists, felt to adapt the method to people with pain, pathology and in the rehabilitation phase.
Low back pain is one of the main reasons that leads people to seek the method, whether on their own initiative or on the advice of others (doctor , physiotherapist, trainer, or even a neighbor who also does it and feels better). Pain was, a few years ago, considered the fifth vital sign. According to Morone and Weiner (2013), this fact led to this symptom and, consequently, the patient’s complaints being more valued in a clinical context. However, due to the subjectivity inherent in pain assessment, it created some difficulties and even even unnecessary prescription medication.
If you want to discover more about this method and its inherent concepts, come and try a Clinical Pilates class, and feel for yourself the benefits of this training method.
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Later, once free, Joseph returned to Germany where his type of training gained visibility among dance professionals. Until the time of his death, the now known Pilates method was called Contrology. Joseph and his wife, Clara, applied and taught these exercises throughout their lives at their “Body Conditioning Gym” studio in New York (Pilates Foundation, 2017).