Відео

yes

I believe it! These muscles are rarely used!

Sounds like you have plantar fibromas. They slowly grow but can get to the point where they cause pain. Get them checked out if you haven't. There is some correlation to various conditions. Injections can help shrink them

It can still heal significantly but depending on the presentation you may need to be aware of it ongoing. If pain starts worsening, really go back to supporting it, taping it etc. Assuming you got it x-rayed/checked out? How long ago was it? Heel fracture would be something I would want to rule out immediately if someone came in with this presentation.

you are welcome!

Happy it helped!

I really hope I did!

The theory is that is "softens" the calcium deposits to allow for more flexibility. The main mechanism it can help with is decreasing pain that allows for more motion so you can rehab the shoulder more successfully.

@@PeakFormHealthCenter I just got my shockwave machine and I notice if I spread the joint open then use the gun I get way better results. I have bone chips in my hands from being a fighter when I was young and when I pulled each finger to open the joint and did the treatment and the result shocked me! Have you tried to stretch the joint open then did treatment?

@@scottbentley2825 Interesting! I will have the patient move the arm (foot, knee, elbow) in different positions while I keep the applicator in the same spot which seems to help. Fingers would be pretty easy to "gap" so that sounds like a great idea. If I had an assistant with me I could see maybe pulling the knee into traction or shoulder inter traction while doing it....

@@scottbentley2825 Just out of curiosity. Where did you get your machine? What model?

@@PeakFormHealthCenter Amazon I will get model # later for you

D-Actor 100 Storz medical through Kinas medical

Keep holding with hands. Pretty easy to use. I have thought about using a Theraband or strong rubber band to keep it locked in but honestly probably more hassle than to just use your hand

Not sure what you are referring to or asking. This short is our long video sped up. Taping in general, for most areas there are various ways providers tape to help... I just find this one to be the most effective for fat pad.

@@PeakFormHealthCenter alright thanks. Have you had fat pad syndrome before?

@@alexgberg1991 yes almost 15 years ago

@@PeakFormHealthCenter and it hasn’t come back since? How did you get it and what did you do to keep it away

Did a Half Ironman and ran in a new pair of shoes with a much lower heel drop than I was used to (this was well before they really listed what those measurements were and I didn't know anything about that stuff yet). Developed fat pad syndrome, PF, and my calves were messed up. Took me 3 years to fully recover; I got over the fat pad syndrome in about 8 weeks with proper footwear. I also couldn't run at the time due to so much pain in my calves so I am sure that helped.

Fat pad syndrome can go away, you just really have to protect it so it has time to heel up. Do you have plantar fasciitis? Usually pain with fast running will exacerbate PF. Fat pad usually just hurts all the time and then worse with jumping, hard heel striking when running. Carbon plated shoes/high stack will put more stress into the plantar fascia and Achilles, so possibly related. Also, I would discuss the custom orthotic with a run specific provider. Depending on what it is addressing, what materials, etc. can cause more force into all those same areas... Hard to offer and specific advice, but it all comes down to load management. You can train through all those types of pain but it is a balancing act of not doing too much but also not doing too little. So working on volume/intensity and how it relates to symptoms is huge to be able to run consistently and avoid excessive time off. Strength training is huge as well to help support the calf/achilles/Plantar.

@@PeakFormHealthCenter I saw a podiatrist she thought it was a mix of pf and fat pad, but all the pain is only in the center of the heel. I ran two fast halfs in the vaporflys 1:18 and 1:19 and I think that started the injury but I’m not sure. As for a run person do you mean like an ortho surgeon or a podiatrist who specializes in running?

@@alexgberg1991 Someone who knows running injuries, and treat running injuries regularly. Most commonly a Physical therapist, Sports chiro, a good running coach (who also knows strength and conditioning). In my experience orthos and podiatrists have very poor skills (or don't want to spend the time)at discussing a training load management plan, go through the specific exercise progressions etc. For specific orthotics, injections, procedures, 100% podiatrists/orthos are the way to go but that doesn't sound like what you need at the moment.

@@PeakFormHealthCenter I’ve been going to the chiropractor as well so I’m doing exercises. They seem to agree that the insoles I bought are good cause I tend to over pronate a bit and it’s got like that heal thing in the back like a heel raise piece. Vaporfly seems to hurt it more but I need them to go fast in. Just wish it would heal

@@PeakFormHealthCenter what kind of exersizes are best for fat pad sydrome?

yes

That is really funny 😂

@PeakFormHealthCenter I have to laugh, it's a defense mechanism. This really hurts and makes work as a machinist difficult. Thanks for the informative video.

You are welcome :) happy to hear it helped!

Honestly just cadence... He had pretty low cadence to begin with so over stride, too much sinking down, foot drifting to midline. Quicker steps reduced all of that. Still see him out running, still no injuries!

Sorry to hear that :/ we keep records of patients that have success, it stays right around that 80% rate, which the available research shows as well. There have definitely been a few patients that had zero benefit after following the protocol. We have only used shockwave for metarsalgia a couple of times and it hasn't worked, I now discourage patients that ask about it for that specifically. Hopefully as more research comes around for plantar fasciitis, they will be able to determine patients that should have a more positive response. Have you been working on exercises around the foot/lower leg? Have you been walking regularly/running? Just curious, clearly I do not know your history.... seems like if both those areas are causing pain that there are other things going on with the function of the entire leg... addressing the foot but also a significant dive into full body movements would be the route that I would recommend. Let me know if you have other questions or pertinent history information that may be helpful.

Sounds like it might be too low. The pull with the neck in slight flexion offers better traction. BUT if it feels productive and you get relief, probably is set up just fine. Try a little higher, assess, then do what feels best 👍

@@PeakFormHealthCenter thanks for the quick reply! I will try it a little higher :)

You are welcome. We will keep adding videos so stay tuned :)

Happy to hear it helps!

Sounds like you have fat pad syndrome. Sides of the heel and bottom usually represent that. Are you still feeling the pain?

Will not grow back cartilage with any significance, but can substantially reduce pain which allows for more exercise and thus preservation/conditioning of the tissues around the knee.

You are welcome :)

lol ease into it! you can try hooking a towel around the ankle to make the stretch more accessible!

Tape along the fascia on the bottom, put a small piece across the arch close to the heel. You can try a couple pieces in each of those directions. It can help take the edge off, and you need time to heal and eventually loading the fascia/foot/leg to get the tissue stronger/more supportive. Hope that helps!

@@PeakFormHealthCenter Thanks.

Thank you, I appreciate the feedback!

Great job sticking with the routines! If you have done through week 6, I recommend trying the intermediate workouts! ua-cam.com/video/-5yiTzbtHxY/v-deo.html I have been getting good feedback so I am considering adding more as well :)

It should help quite a bit. Start with short holds and see how it does. Long standing/high grade spondy sometimes causes more pain but easing into this decompression can really help with symptoms long term.

So off the bat, unfortunately there are no guarantees. We show about 80% improvement rate which is right on to what the research shows. A few things to keep in mind. We find treatment 1x per ~5 days works best; we used to do 4 but have seen better results with 6. We use as high of energy as the patient can tolerate, usually quite uncomfortable...some patients have said they had shockwave and it didn't hurt at all... I think those people had something different or the provider used too low of a setting. Usually people report temporary reduction in symptoms for 1-2 days, then it may increase slightly before returning to baseline. Each treatment increases the healing response at the injured site. The true effects of shockwave are 4-6 weeks AFTER the last treatment. That is when the pro-inflammation is highest, and angiogenesis (increased capillary formation) occurs to improve the healing in the area further. For plantar fasciitis, it is very important to perform loading exercises daily for the calf and plantar fascia (even with pain, your provider should be able to coach you through that). If you walk or run, we encourage that as well (within pain parameters) because we want to stimulate the area with shockwave the get the greatest healing response. Last note, we have had several patients report 0 improvement after 6 sessions, but during the follow up report 75-100% improvement in the follow up 5 weeks later. Some have said "thats natural history" but some of those patients have had planter fasciitis for 2 years with no signs of improvement... until we did shockwave and exercise. I hope that gives you some hope. Discuss those points with your provider if you are not receiving proper loading strategies. Good luck! Happy to answer any other questions you might have :)

@@PeakFormHealthCenter I really do appreciate the detailed response. It does help me understand the mechanism a little better to try to mitigate this frustration while the treatment is ongoing. Due to a long history of tendonitis and surgeries in the area, I can no longer run (at least not right now.) The plantar fasciitis I can walk through, although generally I keep it under 3k steps a day, but it tends to warm up and provide relief with activity. The problem is the metatarsal sprain, which is the opposite, and gets worse with activity. So Unfortunately I have to wait out the MTP sprain before doing PF exercises, as it is a much more significant injury. The MTP is a very pesky ligament. I had this issue before and it took 3 months to heal a basic grade 1 sprain. I did talk to another patient who had a partially torn medial plantar fascia band, which was causing severe pain even at rest. They did 7 shockwave sessions and the pain was gone about a month after. I guess one drawback is, if it takes months to see results, skeptics can say the injury was healing at its regular trajectory anyway, but then the shockwave gets the credit. It is difficult to attribute correlation or causation when the patient heals months after the shockwave is over.

@@crispycruiser4654 Ah I forgot about the met ligament. I got caught up reading about the PF. That does at a bit of a twist to it all. Can you tolerate isometric loading at all? I would try to be crafty/specific with foot position that you can do long holds with less pain in the forefoot. Hang in there, keep doing what you can, it will pass

Good question. I would aim for these workouts 2x per week. I generally recommend combining them on days when you run. Run first, strength later in the day if possible. The idea is that you make your training days hard so then you can fully rest on your recovery days. If you do something every day, you run the risk of causing too much fatigue long term.

Yes, we have many patients how have significant arthritis that do well with shockwave. It doesn't change the arthritis in the shoulder per se but decreases pain and allows the patient to be more functional

Sciatica/radiculopathy can cause heel pain. Sometimes patients have nerve entrapment that presents as heel pain with they keep their leg straight, pull the foot towards them (dorsiflexion), and bend forward towards the straight leg. If it increases the heel, its often nerve entrapment.

Glad you enjoyed them. I am considering adding more since the feedback has been great :)

Sorry no

I've had limited experience treating the big toe with shockwave. Two patients that had plantar fasciitis and big toe arthritis had resolution of symptoms in both areas... So haven't treated a big toe by itself. But shockwave is beneficial for arthritis in general so it should be helpful at the big toe as well; research is fairly limited.

Yes, just a press of a button

Radial

Totally fine, as long as you feel a stretch in the foot/ankle area. If not try to bring the heels towards each other and see if that helps. Or back off the stretch slightly then try bringing the heels towards each other