Whiplash is a descriptive term used to describe the sudden snapping of the unsupported head. In a car accident, the seat belt will hold the body in place while the head is forced into hyperflexion and extension. This motion is also seen in many contact sports such as football and hockey.

When a quarterback is getting ready to make a throw and a 300 lb lineman hits him hard from the back, the head again is forced into hyperextension just as in a car accident. This is also seen in hockey when a player gets hit from behind. In both sports, the athletes have chest protectors to absorb the impact on the body and helmets to protect the head, but there is nothing to stop the movement of the head on the neck.

Whiplash is a serious injury that can occur in many different ways, but the effects are usually similar and can be chronic and intense if not properly cared for.

Whiplash is present in another serious form in infants, and is better known as shaken baby syndrome. This causes serious neurocognitive dysfunction and in some cases death.

Lateral whiplash injuries to the outer portion of the neck can also happen, usually from a blow to the side of the body as in sports or a car accident.

Photo source: whiplash sports injury

The technical name for a whiplash is a cervical acceleration/deceleration injury, or CAD. There are several structures involved in a CAD.

In the neck we have the ligaments, musculature, nerves, intervertebral disc, arteries, vessels, and boney structures. Given the complexity of the neck, there are many different types of injuries that are possible that are considered whiplash. We will highlight a few of these in this article.

At Mountain View Pain Center in Denver, Colorado we see whiplash injuries almost daily, and the speed of the impact often has little correlation to the pain and symptoms. Often after a small impact in the car or on the field, a player will feel fine and then the symptoms will show the next morning.

Those of you who are athletes can relate. One day you take a minor hit, continue playing with no problem, and wake up the next day feeling as if you were in a car accident.

Causes of Whiplash Injuries During Sports

Image source: Hyperextension/Hyperflexion

During a forced hyperextension, bending the head backwards can cause a multitude of neck injuries. The muscles of the front of the neck that are usually strained are the anterior scalenes and the SCM (sternocleiomastoid).

The SCM is the v-shaped muscle on the front of your neck that moves your head forward and side-to-side. Injuring these muscles makes it very painful to move the head, especially in rotation. A

long with the muscle injury there is also ligament damage. The anterior longitudinal ligament runs over the anterior portion of the vertebrae (the front of the vertabrae, deep inside the neck).  Whiplash can cause a sprain of this ligament or an avulsion fracture (tearing away of the bone, where the ligament tears off a small portion of the front of the vertebrae).

In between the vertebrae are discs that can rupture or herniate during the whiplash injury. At the rear of the neck we have the capsular ligaments (ligaments supporting the spinal joints), which can be injured form the compressive forces.  A compressive force can also damage the facet joints. These joints allow the vertebrae to move in relation to one another. Extreme hyperextension can cause crushing of the posterior portions of the vertebrae.

Hyperflexion injuries such as taking a hit straight to the chest may tear the ligament at the back of the neck (nuchal ligament), which runs from the base of the skull along the tips of the vertabre (spinous process) to the base of the neck. Hyperflexion injuries can also cause disruption to the capsular ligaments or even dislocate the facet joints.

The image on the left demonstrates stretching of the nuchal ligament
and the image on the right demonstrates the stretching of the SCM muscle.
Source: Whiplash Associated Disorder

There can also be neurological damage from whiplash injuries.  The force of the brain’s impact on the inside of the skull can damage the cortex or cerebellum. When the head is forced into hyperflexion the sudden force causes pressure on the brain, which causes a concussion. Concussion symptoms are very common in sports related neck injuries.

Even if you have no symptoms after a whiplash injury it is important to see your doctor to assess the level of possible damage. In many cases after a whiplash injury, a patient will show no objective symptoms nor will they show signs of physical damage on X-ray. Oftentimes, patients may not show symptoms until three months after the initial injury and there can be a fluctuation of symptomatology for up to two years. It is in your best interest to get checked out if you have taken a questionable hit.

If you decide to make the trip to your doctor after getting a whiplash injury be sure to fully describe how you were hit and all symptoms even if you feel they may be unrelated. Be sure to note if the head was rotated to the side, if your head struck the ground, if you lost consciousness, or anything else that may help your doctor set up an appropriate treatment plan.

Common Whiplash Injury Symptoms

Image source: whiplash injury symptoms

After an injury the two most common types of whiplash symptoms are pain and limited motion of the cervical spine (the neck). The pain can be described as a dull ache to a sharp stabbing pain. It is also common to have radiating pain or numbness into the extremities. Many patients describe intense pain in the upper and lower back. Headaches are also a very common symptom after a whiplash injury.

Patients most commonly experience pain from the facet joints in the cervical spine. These joints align the top of one cervical vertebra to the bottom of the vertebra above it. Their biomechanical function is to allow motion in the neck, and when injured, this results in a lack of motion, pain, and an increased chance of degeneration in the future.

Each facet joint has a specific pain pattern that is common in patients suffering from a whiplash injury. These patterns can cause pain in the back of the head, the shoulder and all the way down to the mid back. The most common area of the cervical spine to be injured is C5/C6 and C2/C3.

Pain referral for facet joints

If you have injured your…   then you will feel pain in your…

C2/C3 — middle of the neck to base of the skull
C4 — middle of the neck
C5 — middle of the neck to the shoulder, commonly following the trapezius muscle
C6 – across the shoulders down to the shoulder blade

Image source: pain referral for facet joints in whiplash injuries

Other symptoms related to whiplash include:

• Headache
• Numbness
• Impaired neck movement
• Radiating pain into the arms, hands, and fingers
• Low back pain
• Vertigo
• Ringing in the ears
• Nausea
• Jaw pain
• Pain between the shoulder blades
• Disc herniations
• Loss of proper motion to the cervical spine

Whiplash Injury Recovery

Whiplash injury symptoms often do not show up for three months or more and can last as long as three years; therefore, the sooner you begin treatment for your whiplash injury, the quicker the healing process can begin.

Whiplash Injury Recovery Phase 1 – Inflammation Process

This begins immediately following the whiplash injury and generally lasts up to 72 hours and in some cases up to five days.

It is common for there to be little to no pain after the hit. After a few hours or even the next morning after, the inflammation phase has begun. The muscle will begin to spasm, swell, become tight, painful, and look for range of motion to decrease. The decreased range of motion comes from the body trying to immobilize the tissue to prevent further injury.

During this time at Mountain View Pain Center our goal is to reduce pain and swelling and help control the inflammation process.

Whiplash Injury Recovery Phase 2 – The Repair Phase

This phase generally lasts from three days to three weeks. The importance of this stage of healing is the wound edges will begin to pull together to affectively reduce re-injury.

Whiplash Injury Recovery Phase 3 – Remodeling Phase

This phase lasts three weeks to two years. During this phase collagen begins to form and lies down to strengthen the wounded area. This is what is referred to as scar tissue, which is only about 80% as strong as normal tissue.

The importance of whiplash injury treatment in this phase is to allow the collagen to lay down in the correct area, and reduce scar tissue build up which can create decreased range of motion and lead to instability and pain in the future.

Image source: whiplash injury recovery

Treatment for Whiplash Injuries

After the injury, go to your doctor for an examination. Make sure to fully explain the injury and whether this happened in the car or on the field.

Your doctor will run a series of orthopedic tests to reveal if there has been any damage to the soft tissue or joint function. Your doctor should also run a series of neurological tests to determine if there is any underlying damage. These tests should be repeated as you progress in your treatment so that your doctor can adjust his treatment plan according to your symptoms and progress.

After these tests your doctor may take X-rays or an MRI if he suspects there may be soft tissue damage or the possibility of impingement to the spinal cord or nerves. Often after an injury to the cervical spine, your doctor will take X-rays with your neck in flexion and extension to determine if there is any instability in the spine.

Image source: whiplash injury treatment

After an injury to the neck many people feel they should be put in a neck brace and avoid any manipulation to the spine. Research has shown that wearing neck braces can be detrimental to your whiplash injury recovery. This does not mean, however, that if your doctor recommends a collar not to wear it. If there is any fracture or instability it may be in your best interest. However, long-term immobilization is not recommended.

After the whiplash injury one of the first symptoms is decreased range of motion to the cervical spine. If this is not restored, then there is a list of future injuries you may experience.

With the lack of motion in the lower cervical spine, the upper cervical segments will begin to overcompensate, causing early degeneration, loss of proper posture, and pain. Once the lower segments have begun to lose their motion, the head will begin to drift forward, due to tightening of spastic flexor muscles. As this occurs the muscle on the back of the neck, the extensor muscles, will become stretched and torn.

A good way to check if your own extensors are becoming weak is to have a friend check your posture. A good rule of thumb is to have the ears over the shoulders. If your head has begun to drift forward, press lightly on the trap muscle, if there is tenderness there, then you have weakened stretched muscles that are becoming tender from lack of oxygen and calcium deposition. This leads to further problems such as tenderness, pain, and can lead to shoulder and upper extremity dysfunction.

The reason that a lack of motion in the neck causes pain is because the spine has little sensors called mechanoreceptors which react to movement. If there is decreased motion, the mechanoreceptors receive less information, which increase the proprioceptors (pain receptors). In English this means with lack of motion you are more susceptible to pain.

This is a compelling reason to see your chiropractor or osteopath for cervical manipulation. Early manipulation to the cervical spine will restore motion, decrease pain, and increase the speed of recovery. The early manipulation will also decrease the buildup of scar tissue and future chronic pain syndromes.

Early manipulation does not mean to start stretching your neck and cracking it yourself. If you do this, you will probably cause more damage. Manipulation should not be performed without determining the stability of the cervical spine after such an injury. If you are popping your own neck, then you are moving the already hypermobile segments, or the areas compensating for the restricted ones. This can cause more pain, injury, and increase the degenerative process of the cervical spine. Seek out a professional, and let them treat you.

In the treatment process for whiplash injuries, the first stage should always be decrease pain and inflammation. How long you let this condition go without treatment can have a big impact on your recovery time. If this has become a chronic condition, don’t expect to be cured in one visit. You will have to take an active role in your own treatment by performing the exercises your doctor prescribes. It is important to remember that just because you are out of pain, you must continue the rehab to fix the underlying problems and help strengthen the area to avoid chronic pain or problems in the future.

At Mountain View Pain Center, we provide a series of treatments to assist in the recovery from a whiplash injury. As mentioned above, first order of business is to relieve pain and inflammation. This is done with cervical spine adjustments, electrotherapy, and soft tissue mobilization. At this time we ask our patients to be patient, take a break from physical activity, and allow the body to rest. There are many patients who decide they know best and continue with sports and workouts, which is your choice, just understand you will prolong your treatment process and heal at a slower rate.

Whiplash Injury Rehab Exercises

Once we have the pain under control we begin with the rehab portion of the treatment, which includes a variety of upper extremity and neck exercises.  Do not push yourself. If the exercise causes pain then don’t do it. “No pain, No gain” is not the method here. If you are having difficulty performing simple exercise, then listen to your body, continue with treatment and slowly advance as the body allows.

The series of treatments will be customized to you, depending on your specific injury. For example, if a quarterback visits our office that was struck in the back with his head turned, he may have different injuries than a hockey player hit in the back looking straight forward.

You can begin your own treatment at home by icing 20 minutes per hour on the cervical musculature. Do not use ice cubes directly on the skin as you can cause a burn. You may also find relief from rolling up a towel and placing underneath the neck while lying on your back. This will help relax some of the muscles in spasm.

The rehab portion will focus on the overstretched ligaments and tendons as well as the spastic muscles. Our goal is to release the spasm and lengthen the shortened muscles, and at the same time strengthen the weakened and stretched muscles. The reason we perform both is to stabilize the body, and prevent further injuries. If we just address the spasm, then over time the weak muscles will not be able to hold their resistance, and we will be back at square one.

Along with exercise, at Mountain View Pain Center we also install a stretching program. The stretches are provided to allow the body to elongate the muscle to their natural length, and decrease the buildup of scar tissue that will decrease the range of motion. Make sure you follow the instructions from your doctor.

If you have a spasm in the flexor muscle on the anterior portion of the neck, then we want to stretch that area, and not perform resistance exercises here. If the weakness is in the extensors, then you do not want to stretch an already stretched and weakened muscle. This may provide relief while you are doing it from the release of endorphins, however you will be causing more damage. By improving the range of motion and muscle strength to the neck we can restore normal posture and biomechanical function of the cervical spine.

Some exercises are too painful to perform so we begin with isometric exercises. Isometric exercises allow for contraction of the muscle without movement of the head. In most cases we are working on the lateral flexors or extensor muscle groups. An example of an isometric exercise for the extensors is to stand with your back against the wall, and press your head slowly into the wall and contract the muscles at the back of your neck, and hold for about 5 seconds. You can place a towel in between your head and the wall for comfort. As we progress you will be able to build up the movements and perform exercise with body weight and then resistance.  We also add a series of exercises with the upper extremities as well as a few hand eye coordination and balance programs.

After a whiplash injury, avoid sleeping on your stomach. Your doctor may provide a cervical pillow, as sleeping on your side or stomach may cause you to curl up into a flexed position for comfort. This holds the muscles we are trying to stretch in a shortened position for hours, which we need to avoid.

Whiplash injuries, whether in sports or in the car, can lead to serious complications, so your best bet after receiving such an injury is to go see your doctor to be on the safe side.

Supplements or vitamins that aid in diminishing muscle spasms and inflammation

My personal favorite is a Vitamin called Inflammatone. I prefer this as it is a combination of several herbs that benefit in decreasing inflammation and speeding up the healing process, which cuts down the amount of pills you have to take, which is always an added benefit. If you are browsing your local store or whole foods, keep your eyes peeled for ginger, boswellia, and tumeric, as these are great at decreasing inflammation, and are all ingredients in Inflammatone.

I would recommend avoiding cheap brands from your local grocery stores, as these are either synthetic or significantly lower dosages. The name brands are generally only a few dollars more, and when it comes to vitamins you get what you pay for.

Your best bet is to try to get these from your doctor. In many cases physical therapists and chiropractors will sell vitamins out of their own office, the brands they use are generally lab tested and have been researched extensively. Many doctors will sell these relatively cheaply to provide the extra benefit for their patients. If you know a good naturopathic doctor, they are great resources for brand or specific vitamin advice. Fish oils also work well to control inflammation, and are also good for your body’s overall health.

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This article contains the opinions and examples of treatment plans for whiplash injuries from Mountain View Pain Center in Centennial, CO, and is not intended as a substitute for specific medical advice from a doctor regarding your individual injury or condition. If you have any further questions or concerns feel free to contact our office or leave a comment below.

Dr. Niall McNally is certified in chiropractic neurology and has a strong background in sports injuries and in the rehabilitation of common nagging athletic problems. Dr. McNally also is trained in pediatrics, orthopedics, and nutrition.

He graduated from the University of Central Oklahoma and successfully completed his Doctor of Chiropractic degree at the Parker College of Chiropractic in Dallas, TX. A very active athlete, Dr. McNally played hockey up into the junior level. In fact, it was his love for hockey, and the Colorado Avalanche, that originally gave him the idea to one day practice sports medicine and chiropractics in the area.

Dr. Ihsan Erhuy specializes in motor vehicle accident injures, back, neck, and extremity problems, as well as treating pregnant patients and children. He is certified in the Diversified, Gonstead, Thompson, Upper Cervical, Activator, Sacral Occipital, Applied Kinesiology, Soft Tissue techniques.

Originally from Adana, Turkey, Dr. Erhuy graduated from the University of Arizona and also susuccessfully completed his Doctor of Chiropractic degree, along with his bachelor of science in health and wellness, at the Parker College of Chiropractic in Dallas, TX.

After the game, the Sooners released a statement saying that Bradford had sprained the AC joint in his throwing arm, and may be out for 2-4 weeks.

Now, after several weeks on the sideline, it appears he may return as early as this weekend against Miami.

[Update: The latest word as of Thursday afternoon was that Sam Bradford would not start this weekend -- but could possibly play -- against Miami as he continues to recover from the ac joint injury that has kept him out of action since the opener.]

Photo credit: Nate Billings, The Oklahoman (via newsok.com)

The acromioclavicular joint  (AC joint) is a spongy tissue that connects the clavicle to the scapula, which makes an injury to this area extremely sensitive. In fact, the AC joint is the only area that connects the shoulder girdle to the rest of the body by forming a joint with the clavicle.

Mechanism of AC Joint Injury

Despite having full range of motion in the shoulder joint (the glenohumeral joint), the AC joint provides less motion.

The two most common ways to injure this joint are repetitive stress such as throwing a football or baseball, or an acute trauma to the lateral aspect of the shoulder joint, such as crashing to the ground after been tackled, as happened to Bradford.  

The AC joint is actually the second most commonly injured joint in the body, next to the glenohumeral joint.

In this article we will only be discussing the acute injury. When the force is applied to the lateral portion of the shoulder, the ligament connecting the clavicle to the scapula is either stretched, as in a sprain, or torn, as in an AC joint separation. 

AC joint sprains are typically classified into 3 groups:

• Grade 1 AC joint sprain: A partial disruption of the AC joint, simply a stretch or sprain of the AC joint ligaments.
• Grade 2 AC joint sprain: A partial injury to the AC joint capsule and coracoclavicular ligament (another ligament connecting the clavicle to the scapula)
• Grade 3 AC joint sprain: A complete tear or disruption of the AC joint capsule and ligaments. A disruption or the ligament will require surgery and you will have a noticeable separation of the clavicle to the scapula.

AC joint sprain grades image credit: Earthopod.com

AC Joint Sprain Symptoms and Diagnosis

Common symptoms of an AC joint sprain are pain and tenderness of the AC joint.

To find this area on yourself, use two fingers to feel along the clavicle towards the shoulder. You will feel a noticeable small separation between your collarbone and the stiff boney prominence just before you reach the the head of the humerus, which is the joint space. Press lightly on that area to feel the sponginess of the joint.

Pain in the joint because of touch or movements of the shoulder are the primary indicators of an injury to the AC joint. It is also common to see bruising and swelling of the AC joint after the injury. 

Someone with an acute injury to the AC joint will try to keep the arm close to the body, as if in a sling to avoid movement and pressure to that joint.

Other indicators of an AC joint injury are similar to orthopedic tests your doctor will run to identify an AC joint separation. Any overhead activities will exacerbate the pain, such as incline bench press, or simply getting something in the overhead cupboard.

Another self test you can do at home is to take the web of your hand on your uninjured arm and place it below the bicep of the injured arm and resist yourself trying to bring the injured arm across the body. If there is pain in the AC joint, this is a good indication of injury. 

If you have pain in this joint, it is best to see your doctor to determine if there is an injury to the AC joint, the severity, and the course of treatment. Your doctor will use orthopedic tests, feel the joint, and test your range of motion to come to a diagnosis.

The shoulder is a tricky joint and there can be a multitude of different injuries in this area, so a proper diagnosis is key for a quick recovery. Your doctor will also take x-rays of the AC joint to rule out a fracture, or complete tear of the ligament. It is not uncommon for the doctor to take an x-ray of both of your shoulders to determine if there is a difference from side to side.

Another common technique that we use at Mountain View Pain Center is to take a second X-ray of the injured joint with a weight in the hand to determine if there is laxity of the ligament.

AC Joint Injury Treatment and Recovery

The key to a proper recovery is rest. Dropping weights in your workouts, or simply laying off for a few days, will not correct the problem.

If you want this injury to heal then you must not be involved in any sporting activities at all for at least two weeks, if not more, depending on the severity of the injury.

You should not only avoid sporting activities but all strenuous activities for the shoulder, especially anything that involves lifting or reaching overhead.

When the initial injury occurs, get ice on it immediately. If you cannot get straight to your doctor, then try to keep the arm close to your side as if in a splint to avoid tension on the joint.  This is something you do not want to let go for very long. If there is a small tear in the ligament and you continue to play your sport or work out then you risk a complete tear, and a much longer recovery.

In many cases after an AC joint injury, you may receive a cortisone shot in the tissue around the joint, or directly in the bursa to relieve pain. This may get you on the field without pain for that game; however, for long-term treatment we do not recommend it.

Cortisone shots over time will actually weaken the tendons and ligaments. If we are dealing with an already weak ligament then the chance for further damage increases. Cortisone shots simply mask the pain but do not actually treat the problem.

If you are only planning on getting a shot and continue to work out and play, expect further problems down the road. At Mountain View Pain Center, we commonly work side by side with a pain management doctor to give a shot for the acute pain, while we work to rehab the area to stabilize the joint.

As with any acute injury, the two main problems are pain and swelling. To treat these both simultaneously at Mountain View Pain Center, we use a special treatment called Interferential Therapy around the shoulder joint. This works by removing not only pain, but also the edema (swelling) in the area.

Another therapy we use is called Microcurrent therapy to speed up the healing process of the stretched ligament. Coupled with the rehab exercises, this helps the stretched ligament to heal properly and regain stability.

The next step is to apply kinesio-tape to the area. We prefer kinesio-tape at our office because it will remove swelling from the area without limiting the range of motion.  We tape to hold the AC joint down, so the ligament will shorten and heal, thus preventing further or chronic injury to the AC joint.  This tape can be worn for several days, and even stays on in the shower. You can also apply any topical analgesic or pain relief gel directly over the tape.

For a Grade 1 or Grade 2 sprain, with proper treatment, you should be pain free within about three weeks.  Remember, just because the pain is gone does not mean the instability is gone. You must continue treatment for full rehabilitation.

At Mountain View Pain Center, once the initial pain is reduced, hopefully in the first week, we begin with exercises to restore normal motion to the joint and prevent the buildup of scar tissue. After the injury has begun to heal, you should start with light weight, high repetition exercises of the shoulder joint, such as external rotations, abductions, and retractions.

Do not by any means go straight back to the gym and start doing heavy lifts, such incline bench press, right away. While the initial workouts are a good way to test what you can and cannot do, we recommend staying away from any heavy chest, flyes, and shoulders for another month.

If you are a quarterback or pitcher, you can begin to lightly throw the ball at practice, starting with short passes. Give the shoulder ample time to rest and do not go straight into a game without proper warm up.

We encourage our athletes to return to our office before a game to be properly treated and taped. Also, ice after you are done playing, even if it does not hurt right away. You want to avoid pain and inflammation tomorrow.

If you have a Grade 3 sprain, or complete separation, you may need to be referred to an orthopedic surgeon. 

Nutrition for Soft Tissue Injuries

• Glucosamine Sulfate 1000mg or Glucosamine with MSM
• Max joint Relief
• We always recommend for any inflammation: fish oils, ginger, boswellia, and turmeric.

In any case, an AC joint sprain is not something you want to just let “heal itself” because you are constantly using this joint and the chance of a chronic sprain will increase the longer you go without treatment.

Although a nuisance and a painful problem, this is very treatable and generally you can be back in the game within 2-6 weeks. 

Look to see Bradford back in the game against Miami or Baylor. Depending on how the treatment has progressed and what Bob Stoops and Bradford’s doctors think is best for Bradford’s long term career, we will see. As a fan, I would like to see him back sooner than later; however, giving the shoulder ample time to heal is the most important thing.

It will definitely be a test for the shoulder in either case. Boomer Sooner!

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If you would like further information on supplements or vitamins for similar types of injuries, contact us or we can direct you to www.maxmusclehighlandsranch.com

This article contains the opinions and examples of treatment plans for plantar fasciitis from Mountain View Pain Center in Denver, CO, and is not intended as a substitute for specific medical advice from a doctor regarding your individual injury or condition. If you have any further questions or concerns feel free to contact our office or leave a comment below.

Dr. Niall McNally is certified in chiropractic neurology and has a strong background in sports injuries and in the rehabilitation of common nagging athletic problems. Dr. McNally also is trained in pediatrics, orthopedics, and nutrition.

He graduated from the University of Central Oklahoma and successfully completed his Doctor of Chiropractic degree at the Parker College of Chiropractic in Dallas, TX. A very active athlete, Dr. McNally played hockey up into the junior level. In fact, it was his love for hockey, and the Colorado Avalanche, that originally gave him the idea to one day practice sports medicine and chiropractics in the area.

Dr. Ihsan Erhuy specializes in motor vehicle accident injures, back, neck, and extremity problems, as well as treating pregnant patients and children. He is certified in the Diversified, Gonstead, Thompson, Upper Cervical, Activator, Sacral Occipital, Applied Kinesiology, Soft Tissue techniques.

Originally from Adana, Turkey, Dr. Erhuy graduated from the University of Arizona and also susuccessfully completed his Doctor of Chiropractic degree, along with his bachelor of science in health and wellness, at the Parker College of Chiropractic in Dallas, TX.

All treatment options provided in this article should not be taken as specific advice, but rather as a general guide regarding what is typically done to treat the injury being described.

You should always consult your doctor before beginning any pain management or rehab program.)

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Plantar Fasciitis

After the recent foot injury suffered by Carlos Quentin, the White Sox’s left fielder, we have come to the topic of plantar fasciitis. Last year’s homerun leader for the White Sox was placed on the 15 day DL on May 29th for pain in the sole of the foot. Plantar fasciitis, one of the most common causes of heel pain, can keep a player sidelined for weeks, and if not properly treated will become a chronic issue. This injury is common in football, basketball, soccer, and running. This type of injury will inhibit a player’s ability to sprint.

Plantar Fasciitis Symptoms and Mechanism of Injury

Someone who suffers from plantar fasciitis usually experiences pain localized to the bottom of the foot on the inside of the heel. In an acute injury the patient may be unable to place weight on the foot due to the intense pain. With chronic plantar fasciitis the first few steps every morning will be painful, as well as any pushing off with the foot, including jumping.

Plantar Fasciitis Symptoms (image courtesy of Medline Plus)

The injury is usually a tear of the plantar fascia closest to the heel that causes an area of irritation or a lump to form on the inside of the heel. The plantar fascia is there to help attach the muscles to the bottom of the foot, provide protection to the plantar nerves and vessels, provide shock absorption, and create equal transmission to the biomechanical forces placed upon the foot. With an injury or inflammation to this area any movement that requires a push off of the toes will cause pain.

The injury itself comes from a muscular imbalance in the lower leg, ankle, and foot. The imbalance comes from a weak tibialis anterior (the muscle on the front of your shin) and plantar fascia, as well as a spastic or tight solues and gastrocnemius (the muscles of the calf). This imbalance causes increased tension on the Achilles tendon, which pulls on the plantar fascia causing the stretching and tearing of the muscle. As the micro tears set into the muscle, the pain will develop in the area. If the tears and chronic stretching of the plantar fascia are not treated then the area will become increasingly weakened. In many cases, an athlete will hear or feel a pop in the bottom of the foot followed by intense pain and swelling. This is from the tearing of the fascia.

Plantar Fasciitis Diagnosis

Here are some self tests you can do to determine if you might have plantar fasciitis:

1. Pain on the inside (medial) portion of the calcaneus.
2. Pain during the first few steps in the morning.
3. Localized swelling on the bottom of the foot, or along the plantar fascia.
4. Standing on the toes causes either a band like pain on the bottom of the foot, or increases the pain symptoms near the calcaneus.
5. Pain on the bottom of the foot when pushing of with the toe. Ex. sprinting or jumping

If you are experiencing one or more of these symptoms, it is a good indication that you might have plantar fasciitis. In order to prevent further injury and pain, this would be a good time to consult your physician and discuss your potential plantar fasciitis diagnosis.

Your doctor may take is an X-ray to rule out any underlying fracture, dislocation, or other abnormality. In about 50% of cases where there is a plantar fasciitis diagnosis, a heel spur can be seen on the X-ray. The spur is the body’s way of trying to protect itself. Over time with the chronic strain and stress on the area the body will begin to lay down calcium in the area for stabilization. Once the spur forms it is common to have pain directly over that area.

Plantar Fasciitis Treatment

The most commonly misapplied treatment of plantar fasciitis is to stretch and massage the area. As mentioned above the plantar fascia is already stretched and torn, which causes the pain.

Treatment for Plantar Fasciitis (image courtesy of Spectrum Wellness)

Common sense would tell us that if the fascia is already stretched and torn, that further stretching the area as part of a plantar fasciitis treatment plan would in fact cause more damage than good. When the injury first occurs, applying pressure to the area may actually cause some relief. The reason for this is the pressure on the inflamed, injured area will release endorphins, the body’s natural pain killers. The down side to the unfortunately common plantar fasciitis treatment approach of stretching and massaging is further damage to the injury and a higher probability of recurrent injuries. The stretched fascia is already depleted in oxygen. The increased pressure will further deprive the injured area of essential oxygen.

Plantar fasciitis responds very well to conservative care. If you notice any of these symptoms the best thing you can do is get plantar fasciitis treatment quickly. This condition can easily be resolved with the appropriate care. Many with plantar fasciitis think that they have to live with it, or they are one of the few that plantar fasciitis treatment will not help. This is simply not true. If you get on top of your plantar fasciitis treatment quickly, the pain will generally subside, and the incidence of chronic problems will greatly decrease.

There are several successful treatments for plantar fasciitis. We will now describe the treatments we have success with at Mountain View Pain Center.

Treatment for Plantar Fasciitis

First and foremost, after the initial injury you must get ice on the area immediately. If you wait and try to “walk it off”, the foot will swell and become increasingly tender over the next few days, making even the simple task of walking a real problem. After you have followed the steps of PRICE (protection, rest, ice, compression, elevation), get yourself to someone who deals with sports injuries for treatment. Making a trip to the emergency room for this will be an unnecessary and expensive trip. The treatment you receive there will be some sort of pain killer or shot to reduce the pain and swelling, then a referral to either a chiropractor, therapist, or sports medicine doctor.

At Mountain View Pain Center, when a patient first arrives with an acute injury of plantar fasciitis, we apply a therapy called Hi-volt to reduce pain and swelling to the area, and also wrap the foot with an ice pack during the therapy. The next step we take is to apply a taping method called Kinesio-tape across the bottom of the foot. This method we have found to be a integral part of our treatment program. As local doctors we have the opportunity to work with several sports teams and high school programs. When a player goes down from this injury we immediately apply the tape to the area not only for support to shorten the stretched and torn muscle, but to also pump out the edema and in turn decrease pain and increase plantar fasciitis recovery time.

Plantar Fasciitis Treatment (Image courtesy of Mountain View Pain Center – Denver)

We instruct the patient to leave the tape on for 2-3 days to continue the support and reduction of edema while the patient is at home. This tape can get wet, so the patient can still shower or even apply topical ointment over the tape to help with some of the pain.

At Mountain View Pain Center we have found that within a few weeks the patient will be out of pain and can begin the rehabilitation portion of the plantar fasciitis treatment. As we have stated before, the main cause of plantar fasciitis is from a muscle imbalance in the lower leg. Stretching is still important. However, remember not to stretch what is already stretched.

Part of the imbalance is usually a tight gastrocnemius, so we stretch the calf and Achilles tendon. If you stretch the calf only then the real problem still may not be addressed and a re-occurrence of the plantar fasciitis will occur. You must also address the muscle weakness to correct the problem. You can do this by performing simple toe raises while sitting at your desk at work or while watching TV. Toe raises are not the same as calf raises. This does not mean standing on your toes. You keep your heels on the ground and raise the balls of your feet and your toes off the ground.

If there is a heel spur seen on X-ray, then we can apply some ultrasound to the area to break up some of the calcification. For our athletes who continue to train during treatment for plantar fasciitis, or who have some chronic bouts of plantar fasciitis, we apply the tape to support the area during their events.

Many athletes opt for a quick pain relief and go for a corticosteroid shot in the bottom of the foot. You must be careful here as getting the shot will decrease pain temporarily, but it does not repair the torn tissue or fix the problem. The pain you are feeling is your body’s defense mechanism to protect you from further injuring yourself. If you cannot feel the pain and go out running then you risk damaging the area further. Research has shown that repeated corticosteroid shots actually weaken tendons, damage nerves, and decrease the bone density to the area, which is recipe for disaster.

Supplements as Part of Plantar Fasciitis Recovery and Treatment

• Inflammatone is a specific supplement that contains ginger, bosweilla, and other natural herbs that helps to decrease swelling and pain.
• Vitamin C has been shown to help improve the healing process and decrease scar tissue formation.
• Magnesium is another important supplement for plantar fasciitis as the magnesium helps absorb the calcium into the body and decrease the deposits into the heel(and elsewhere).

If you are interested in any of these supplements, please visit our website. Note: we are still updating the website, so the supplements may not be available immediately. If this is case, find our email address below or leave a comment and we’ll let you know how to get them.

This article contains the opinions and examples of treatment plans for plantar fasciitis from Mountain View Pain Center in Denver, CO, and is not intended as a substitute for specific medical advice from a doctor regarding your individual injury or condition. If you have any further questions or concerns feel free to contact our office or leave a comment below.

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The Trainer’s Room is written exclusively for Midwest Sports Fans by Denver chiropractors Dr. Niall McNally and Dr. Ihsan Erhuy of the Mountain View Pain Center in Denver, CO. You can contact them by leaving a comment below or sending an email to info@mountainviewpaincenter.com.

Dr. Niall McNally is certified in chiropractic neurology and has a strong background in sports injuries and in the rehabilitation of common nagging athletic problems. Dr. McNally also is trained in pediatrics, orthopedics, and nutrition.

He graduated from the University of Central Oklahoma and successfully completed his Doctor of Chiropractic degree at the Parker College of Chiropractic in Dallas, TX. A very active athlete, Dr. McNally played hockey up into the junior level. In fact, it was his love for hockey, and the Colorado Avalanche, that originally gave him the idea to one day practice sports medicine and chiropractics in the area.

Dr. Ihsan Erhuy specializes in motor vehicle accident injures, back, neck, and extremity problems, as well as treating pregnant patients and children. He is certified in the Diversified, Gonstead, Thompson, Upper Cervical, Activator, Sacral Occipital, Applied Kinesiology, Soft Tissue techniques.

Originally from Adana, Turkey, Dr. Erhuy graduated from the University of Arizona and also susuccessfully completed his Doctor of Chiropractic degree, along with his bachelor of science in health and wellness, at the Parker College of Chiropractic in Dallas, TX.