Tag Archive for: shockwave therapy

Plantar Fasciitis

Enjoy Flip-Flop Season: Strategies to Prevent and Treat Foot Pain

Flip-flop season is officially here – but unfortunately – that also means we are about to see an influx of foot pain – otherwise known as “plantar fasciitis”.

Here’s a question someone asked me just the other day… “I’ve been wearing my flip-flops for the past week and notice that the pain in my arch and heel has acted up. Is there anything I can do? Or do I need to just not wear flip-flops anymore?”
While wearing more supportive shoes would certainly help, staying on top of your plantar fasciitis and/or preventing it altogether means flip-flops don’t have to be an issue, and you can continue enjoying them all season long.

First – What is Plantar Fasciitis?

Quite simply, it’s inflammation of your plantar fascia—the tissue that makes up the arch (bottom) of your foot. Your plantar fascia runs from the base of your heel, down the length of your foot, and into your toes. It’s responsible for both the mobility and stability of your foot, enabling you to propel yourself during walking and running. When you land on your foot, your arch falls or flattens—this is called pronation. In response, your foot then stiffens or supinates, providing the power to push off. If any part of this mechanism is not functioning properly, your plantar fascia can become stressed and overworked, leading to what we call “plantar fasciitis”.

How Do Flip-Flops Contribute?

Footwear can either “protect” your arch or cause it to overwork. Technically, if your foot mechanics are sound and the arch of your foot is strong and mobile, footwear should have a negligible impact on your plantar fascia. However, due to prolonged sitting and limited barefoot walking, the bottoms of our feet are not as conditioned as they should be. This is the real problem—not so much what you put on your feet. If you’re used to wearing supportive and cushioned shoes and then suddenly switch to flatter, less supportive flip-flops, it can shock your foot. And if you’re already prone to plantar fasciitis, it will flare up easily and quickly.

What Can You Do?

The best way to prevent and treat plantar fasciitis is to not neglect your feet. Consistent mobility exercises for your toes and ankles are key, as is conditioning for the strength and stability of your arch. Balance exercises, toe exercises, and plyometric (jumping) exercises are all important. Additionally, make it a point to walk around without shoes as often as possible. Incorporating pelvic floor and core training exercises is also beneficial because the function of your deep core has an impact on your foot mechanics.

When Your Pain is Too Severe

If your plantar fasciitis is too painful, jumping into exercises may not help and could even aggravate it more. One effective treatment modality for particularly painful cases is something called Shockwave Therapy (Extracorporeal Pulse Activation Technology or EPAT). During a shockwave treatment, high-pressure sound waves are delivered directly to the affected tissue, bringing blood flow and accelerated healing to the injured and inflamed area (in this case, your plantar fascia and surrounding muscles). The treatment is non-invasive and penetrates deeply. Pain reduction can be seen in as little as one shockwave session, but research shows it to be most effective after a minimum of six. Shockwave therapy can significantly reduce pain and swelling from plantar fasciitis in the short term, allowing you to tolerate the exercises required to keep your plantar fasciitis at bay in the long term.

When addressed correctly, plantar fasciitis doesn’t have to be chronic, and it doesn’t have to dictate your footwear selection. If you’ve tried various treatments already for your plantar fasciitis without success, consider working with an expert who can accurately identify where your plantar fasciitis is coming from. They can also help you decide if incorporating something like shockwave therapy – in addition to the necessary exercises – is what’s needed to finally resolve your plantar fasciitis and get back to enjoying your flip-flops again.

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Pain expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch – or inquire further about Shockwave Therapy – CLICK HERE.

How Regenerative Shockwave Therapy is Helping Injured People Stay Active and Mobile

Regenerative Shockwave Therapy

Arthritis, degenerative joint disease, and general wear and tear of our bodies are all a normal part of aging – and these things tend to become more problematic once we get into our 50’s and beyond.

A lot of people falsely believe that as these ailments start to rear their ugly heads, it means you need to slow down, or even cease, some of your favorite activities. This couldn’t be farther from the truth. But as you get older, what is true is that you’re probably going to need some aid and assistance to keep doing all the activities you love – especially if you’ve had an injury.

Aside from mastering the basics… drink plenty of water, get adequate sleep, fuel your body with wholesome nutritious food, and exercise/move daily… There is something else I’ve found that can really make a difference in how active and mobile you’re able to get (and stay) once you’ve hit your fifties. It’s called regenerative shockwave therapy – a treatment that utilizes high-energy “shock waves” (or soundwaves) to trigger a biological response that helps to aid and accelerate the healing process of your soft tissue (anything that isn’t bone). I only came across this revolutionary technology a few months ago. And while I was initially skeptical – I’ve since become a huge fan. Why? It’s safe and non-invasive, it aids the body’s natural healing process, it’s backed by research, and I’ve seen it work remarkably well to help with pain relief and soft tissue healing. 

Here are just some of the ways regenerative shockwave therapy is helping injured people (especially those aged fifty-plus) stay active, mobile, and doing the activities they love.

Pain Management:

One of the main reasons people reduce their physical activity is due to pain. But movement and exercise are actually an essential component (in most cases) for pain relief. But let’s face it, when you hurt, you’re just not as motivated to move. This is where regenerative shockwave therapy comes in. It quickly penetrates deep into your soft tissue to help bring blood flow and healing properties to a targeted area to reduce pain. And it keeps working even after the treatment is over. As your pain reduces, you feel more confident to move and resume your favorite physical activities faster.

Improved Mobility:

As you approach age 50 and beyond – you may notice your joints naturally becoming stiffer. Stiffness on its own might not seem like a big deal – but it becomes a problem when it leads to compensatory movement patterns – which can eventually lead to pain. Shockwave therapy helps to promote collagen production, the protein responsible for maintaining the suppleness and flexibility of your soft tissue. Good mobility helps you move better and feel better – and shockwave therapy can be a valuable companion in this process.

Blood Flow Stimulation:

Good blood flow and circulation are essential components to quick healing of any soft tissue injury. Shockwave therapy aids in this process with vasodilation – ensuring that the injured or degenerated tissue receives a higher influx of nutrients – which speeds up the recovery process. As we get older, the integrity of our soft tissue can suffer, so anything that can stimulate blood flow is going to help you heal – and get you back to your favorite activities faster.

Reduces Scar Tissue:

It’s not uncommon to meet folks in their 50’s (and beyond) with at least one or two orthopedic surgeries under their belt. While I consistently advocate against resorting to surgery, there are times when it’s necessary and beneficial. But a mismanaged scar can ruin everything. Scars don’t act like your original tissue and if they aren’t managed properly – will cause mobility restrictions that worsen over time. Shockwave therapy can help to break down scar tissue and stimulate the production of new, healthy tissue – which can restore any discomfort or dysfunction that the scar was causing – getting you back to your activities faster.

Accelerated Recovery:

At the end of the day, and for all the reasons already stated, shockwave therapy helps to speed up your body’s own natural healing process and thus – recovery. Consider it a companion and “best friend” to any rehabilitation protocol. With increased blood flow, reduction of scar tissue, and improved pain and mobility – you tolerate things with more ease and can progress more quickly. When you’re younger – you have a lot of this naturally on your side already. But as we age, everything slows down, including our body’s natural recovery processes. Shockwave therapy steps in to fill this gap so you don’t have to miss out for too long on your favorite physical activities.

If you’re currently injured and avoiding exercise – consider adding regenerative shockwave therapy into the mix to help reduce your pain, improve your mobility, and get you back to your favorite activities faster. Who knows, it could be the missing link to your healing that you didn’t even know existed.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, email her at [email protected].

plantar fasciitis

Best Treatments for Persistent Plantar Fasciitis – According to Science

Ever had nagging foot and heel pain that’s so bad it feels like you’re walking around on glass? Yep – that’s called plantar fasciitis – and it impacts over 2 million individuals in the United States every year. 

Plantar fasciitis occurs when you have inflammation of your plantar fascia – the tissue that makes up the arch (bottom) of your foot.

Your plantar fascia is responsible for both the mobility and stability of your foot so that you can propel yourself during walking and running. When you suffer from plantar fasciitis – it’s not only annoying and painful – but can be quite debilitating. It keeps runners from running, walkers from walking, and eventually will cause problems up the kinetic chain (think knees and hips) when left untreated. Typical treatments for plantar fasciitis include everything from rest, ice, cortisone shots, orthotics, braces, exercise, and stretching. 

But which treatments are best? 

Depending on who you ask – you’ll get a lot of different answers – so let’s see what the science and research says. 

Cortisone Shots:

While there is plenty of evidence to support the use of cortisone shots for reducing pain and inflammation – it’s important to consider the consequences of how cortisone works. When you’ve got damaged, painful tissue from overuse or overstretching – such as what can occur with plantar fasciitis. The cells in your tissue respond by releasing certain factors designed to recruit blood vessels, stem cells, and healing factors. The inrush of these fluids causes temporary swelling and pain, but it also stimulates the laying down of new collagen. Collagen, a naturally occurring protein in your body that helps tissue to heal and become strong again. Cortisone works by shutting down this cellular process. Which is great because it stops the swelling and pain from occurring. But by doing so – it inhibits your body’s natural healing process.

This can result in weakened tissue that stays in a weakened state. Leaving you susceptible to repeated and sometimes permanent damage over time, especially if you keep getting cortisone shots. So while cortisone injections may appear to be the miracle quick-fix you’re looking for – it’s crucial you consider the long-term consequences that inhibited tissue healing could cause.

Extracorporeal Shockwave Therapy:

Unlike cortisone shots, this therapy aids in the tissue-healing process instead of inhibiting it. And there is good research and evidence to support its use with plantar fasciitis specifically. While it’s been successfully used in Europe for decades, it didn’t surface in the United States until around the year 2000. Shockwave Therapy uses acoustic sound waves to stimulate the same natural healing process described above. This can be especially useful in tissue that has already experienced damage. What I like about Shockwave Therapy – is that it’s completely non-invasive – compared to something like platelet-rich plasma (PRP) injections (another popular treatment for plantar fasciitis). With injections, there is always a risk of infection. You don’t have to worry about that with Shockwave Therapy. That, combined with promising evidence for significant pain reduction in as few as six sessions, makes this a wise treatment choice for plantar fasciitis.

Stretching and Strengthening Exercises:

For most musculoskeletal injuries (plantar fasciitis included) the research overwhelmingly supports the use of stretching and strengthening as an effective and long-lasting means of treatment. So why does this approach fail so often? And make us quick to resort to injections, surgery and other types of medical procedures to resolve musculoskeletal-related pain? The biggest problem I see is not with the stretches and exercises themselves, but with exercise prescription. That’s why you can’t just go to Google or YouTube and look for “the best exercises for plantar fasciitis”. Finding great and appropriate exercises isn’t the issue.

The problem is that you won’t know when and how to perform them – and you risk making your plantar fasciitis worse or resorting too quickly to a more invasive treatment option because you think the exercises just didn’t work. With plantar fasciitis specifically, the type of stretching and exercise you choose has to match the stage of tissue healing. You have to load the tissue just enough to cause the appropriate amount of tissue damage that will elicit remodeling of tissue fibers – but not so much that you elicit an inflammatory cycle, which will disrupt the remodeling process. The only way plantar fasciitis truly heals is through remodeling the damaged tissue. And this requires a perfectly prescribed stretching and exercise protocol – which can take up to 7-9 months to work.

So be cautious of the quick fixes, work with an expert, and be patient in this process – because stretching and strengthening really do work when done correctly for Plantar Fasciitis.

In the battle against plantar fasciitis, a prescribed combination of stretching and strengthening exercises, along with non-invasive passive modalities that work to enhance your body’s natural healing process tend to be the most effective. Stay away from ice, rest, and other invasive procedures that disrupt healing or interfere with tissue remodeling.  If your plantar fasciitis is chronic, understand that there’s still hope, but it may take some time. My advice is to talk with an expert who is up to date on the latest research, and who has a good understanding of tissue healing and remodeling.

Because ultimately – the best treatment for plantar fasciitis must involve a combination of these two things. 

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media group. To get in touch, or to inquire further about Shockwave Treatment, visit her website www.cjphysicaltherapy.com or call 603-605-0402

Shockwave Therapy

What is Shockwave Therapy and Should You Consider it?

What is Shockwave Therapy and Should You Consider it?

If you’ve been reading my articles for awhile – you’ll know that I’m generally not a huge fan of passive modalities – especially when used in isolation. However, every now and then one comes along that grabs my attention. A few months ago – Shockwave Therapy treatment did just that – so I started doing my research…

Shockwave Therapy is a revolutionary, non-invasive treatment protocol that utilizes high-energy acoustic (sound) waves to treat chronic musculoskeletal pain conditions, as well as soft tissue/sports-related injuries. To give you an idea of how powerful it is – it was initially used by urologists to treat and break up kidney stones. Over the last few years, the orthopedics and sports medicine practitioners have started to apply the technology in their respective fields, and are happy with the results.

So what is Shockwave Therapy and how does it work?

Shockwave therapy – otherwise known by its technical name of Extracorporeal Shock Wave Therapy (ESWT) – utilizes high-energy “shock waves”. These Sound-waves promote and accelerate the body’s own natural healing process. When the shockwave treatment is applied, there is a transference of energy from the shockwaves into the targeted tissue area. This triggers a biological response that helps to aid and accelerate the healing process. The biological responses include stimulation of cell regeneration, improved blood flow, and formulation of new blood vessels (neovascularization). All are designed to speed up soft tissue healing and provide relief from pain. Some folks feel pain relief right away, for others it takes a few sessions. 

Research is still being done to evaluate the full effectiveness of shockwave therapy – but so far we are seeing really good results for persistent, chronic conditions such as plantar fasciitis, tennis elbow, patellar tendonitis (runner’s knee), and shoulder tendonitis. Anytime you have a chronic condition involving tendonitis, the treatment protocol required to get true healing and rehabilitation is highly specific and generally takes 7-9 months. You also want to avoid things like ice and anti-inflammatories because it impedes the healing process. This can be hard for a lot of folks since chronic tendonitis tends to be painful. This is one of the reasons I love Shockwave Therapy. It not only enhances the healing process of tendons and other soft tissue – but it helps to relieve pain at the same time.

Ok – now that you know a little bit more about Shockwave Therapy. Is this a treatment you should consider for yourself?

Have you been suffering from a chronic or persistent soft tissue injury or tendonitis? Are the treatments you’re currently trying not quite getting you back to 100% as fast as you’d like? Then this might be something valuable to add into the mix. It could very well be the missing link needed to give your soft tissue healing the boost required to get you over the hump you’re currently at.

Another great reason to consider trying Shockwave Therapy is that it’s very safe and completely non-invasive. It doesn’t require any kind of incision, use of  anesthesia, or needle punctures such as with steroid injections. This significantly reduces the risk of any type of infection or complication after your treatment. Plus, the treatments are short. They only last about 15-20 min to get significant pain relief and powerful tissue healing.

The last thing I’ll say about Shockwave Therapy is that although it’s very safe and designed to reduce pain, there can be some short-term pain and discomfort associated with this treatment. As well as temporary skin redness and minor swelling. For those with extremely low pain tolerance, this treatment can take some getting used to. Shockwave Therapy is also very noisy. The treatment is administered through a handheld device that pulses and makes a noise throughout the duration of your session. That – combined with potential temporary pain/discomfort – causes some to shy away from giving Shockwave Therapy treatment a try. But luckily the treatments are short, so it makes these minor adverse side effects more tolerable.

So, if you haven’t yet heard of Shockwave Therapy, hopefully this helps you have a better understanding of what it is.

And most importantly, decide for yourself if it’s something worth considering. Especially if you’ve been suffering with a persistent soft tissue or tendon injury for quite some time. While it’s not a miracle cure by any means, I have seen fantastic results since beginning to incorporate this technology into my own practice. I like it because there’s a lot of scientific evidence to support its efficacy. Plus it’s a safe, non-invasive alternative to so many other pain-relief techniques that is designed to leverage the body’s own natural healing response.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, or learn more about Shockwave Therapy, visit her website www.cjphysicaltherapy.com 


Tendonitis vs. Tendinosis – The BIG difference and why it matters

If you’ve ever suffered from tendonitis or tendinosis – then you know that it can last anywhere from a few weeks to several months!

Tendonitis is an acute, short-term, inflammatory condition typically caused by repetitive overuse of your tendon. Tendinosis, on the other hand, is a chronic, degenerative condition of your tendon that involves deterioration of collagen, a structural protein in your tendon.

While the two conditions sound very similar and are often used interchangeably, they couldn’t be more different. When tendonitis isn’t caught early enough or treated properly it can turn into tendinosis. The treatment for acute tendonitis is very different from chronic tendinosis.

Let me explain…

Tendonitis is an acute condition. The best treatment is to rest, apply ice, and sometimes take anti-inflammatories to control pain. From there, you want to figure out what caused the tendonitis to occur in the first place and address that.

Typically, it’s due to some sort of mismatch between muscle strength and the activity you need to perform, leading your body to compensate and put unwanted stress on your tendon. Once you figure out and correct this pattern, it’s very easy to get rid of your tendonitis!

The most common areas for tendonitis to occur are your elbows, rotator cuff (shoulder), patella (knee), and Achilles tendon (ankle).

When you don’t manage tendonitis properly, and it goes on longer than a few months, it can result in tendinosis. Tendinosis is a very different condition where the fibers in your tendon actually start to break down. The first thing to note is that tendinosis no longer involves inflammation of your tendon. So using ice every day, resting it, and taking anti-inflammatories will not help you. I can’t tell you how many times I’ve spoken to people still doing this 6-8 months later…

Second, since tendinosis involves disorganization and degeneration of the fibers that make up your tendon, you have to “re-organize” those fibers in order to resolve tendinosis and get your tendon functioning properly again.

Passive treatments like ice, rest, and medicine will not help tendinosis. They might help to relieve any pain you’re having from overdoing it or under-treating it… but the tendinosis will continue to progress. Unresolved tendinosis leads to progressive weakening of your tendon over time – making it easily susceptible to full blown tears. This is how so many folks tear their Achilles or rotator cuff, for example, “out of nowhere”.

Once I speak with them, they often report that over the years they had recurring bouts of tendonitis in that area. In other words, their tendonitis wasn’t managed properly and it led to chronic tendinosis. Making them an easy target for a torn tendon.

So how do you treat tendinosis and prevent more serious problems from happening down the line?

You have to re-organize those fibers so your tendon can work properly again!

Sounds easy, right? Well technically it is, but the biggest problem is that this process takes time – up to 9 months in many cases. And most patients I come across simply don’t have the patience for this. Or they simply aren’t told about it.

The other issue is that if you’re expecting an insurance company to cover your treatment – they typically don’t want you in physical therapy for more than 6-12 weeks at a time. This is not long enough to properly treat tendinosis.

The only way to re-organize those tendons is to put stress on them – and over a period of time. You have to put just the right amount of stress to cause a little bit of pain. However, not so much stress that your tendon gets inflamed again. A properly trained physical therapist that is well-versed in tendinosis will know how to do this.

You basically have to retrain the fibers to withstand force again – and this process takes time. The good news, however, is that if you rehab your tendinosis properly, you can get back to all the activities you love as if nothing ever happened!

If you’re confused after reading this don’t worry. So is half the medical community.

The take home points to remember are these:

Tendonitis involves pain and inflammation, there is no damage to your tendon, and it only lasts about 4-6 weeks. Treatment for this should involve passive modalities like ice and rest. The focus should be on what causes the tendon to get irritated innitially.

But if problems in your tendon have gone on longer than 3 months, you MUST suspect tendinosis. This no longer involves inflammation but instead, a breakdown of your tendon.

Passive treatments will NOT work and could actually prolong your problem – so stop icing and resting.

To get rid of tendinosis, it requires carefully prescribed loading strategies. These will properly re-organize the tendon so that it can be strong again! This is extremely challenging to do on your own, so we recommend working with an expert who is well-versed in this diagnosis.

Luckily – we’ve introduced a brand new treatment modality in our office. It accelerates the healing of soft tissue and tendon injuries.

It’s called Shockwave Therapy and we are currently accepting new patients for this service. If you’re already a client – you will get this service at no charge. Just ask your specialist next time you’re in and see if you’d be a good fit for this treatment.

But if you’re not a current client – and are currently suffering from something like plantar fasciitis, tendonitis, or some other soft tissue strain or injury – you could be perfect for this treatment! Studies have shown about 70% reduction in symptoms in as little as 6 sessions.

While this won’t completely “fix” your tendon or soft tissue problem – it can have a significant reduction on your pain which will allow you to more easily do the work that WILL fix your problem.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, or request a free copy of one of her guides to back, neck, knee, or shoulder pain, email her at [email protected].