Ankle Pain! Help!

Ankle Pain! Help!

Pinched ankle alert!

I woke up this morning and stepped out of bed…..

When bam!

My right foot wouldn’t work.  Yes, I could stand on it.  Yes, I could walk on it.

It just wouldn’t allow me to walk THROUGH my foot.  I apologize for not being clear, this is a hard one to describe.

Have you ever started walking like a Clydesdale horse after sitting or sleeping for a prolonged period of time? You can’t smoothly roll your heel to your toes when you walk on your foot?

It freaking hurts like the dickens!  On a side note, I wonder how the dickens hurt?

The ankle is made up of three bones: your 2 lower leg bones the tibia (white bone) and fibula (blue bone), and the simulation GIFtalus bone (mustard yellow).

The talus functions like a marble running down a track. If the track gets dented anywhere then the marble does not roll, correct?

This is how the ankle joint works. Please look at the graphic to the right for a visual.

Imagine if you slept on your stomach the whole night the foot would be held in a pointed position, like when you can see all the toes on the graphic.  It literally gets stuck in that position, so when you go to stand up…..

BAM! It can’t because it is stuck in the pointed position.

To fix it is super easy we need to get that bone back into place.  Please watch the video attached below.

Take a belt, scarf, rope and tie the ends together.

Place the knot into a doorway and close the door.

Step your hurt foot into the rope, so the rope runs in front of the ankle joint.  Make sure your foot is nice and snug with the rope applying a firm pressure along the front of the ankle.

Place your other foot slightly in front to prepare to do a mini-lunge.  SLowly bend your forward knee forward and back.  Keep your back (the hurt foot) knee straight the whole time.

You can hit different aspects of your ankle by moving which way your foot is pointing.  You can hold onto a chair or your bed if your balance is not the best.

Do about 10-20 times at about 1 lunge every 3-4 seconds.  You can repeat this exercise as needed throughout the day until the mobility has returned!

This is also great for anyone with stiff ankles, plantar fasciitis, chronic ankle sprains (not within 8 weeks of injury), and ankle swelling.

Please do not do this technique on any active or recent fractures in your foot or ankle.

Simple explanations and more for your pain in future posts.

I purchased the neatest journal this week.  It was labeled, “Some Lines a Day” instead “Diary.  The great thing about this journal is that it gives each page a date assignment, for example, September 1st.  Then it has five lines evenly spaced out on the page about 1 inch apart.   So, you can jot down ideas, funny things that happened that day and reflect back for the next five years on that particular memory.  I think this would be a great journal for my patients that are having a difficult time either physically or psychologically.  It is good to write down three positive things that happened to you, each day whether it be as simple as getting a pleasant letter in the mail or getting more than 50% of green lights on the way home from work or completing all the laundry today.  Whatever the case….reflecting on the positive! It can make a world of difference and help quiet your mind. 

Please check out my Video about Pelvic Pain and How to Correct Pelvic Alignment:

 

 

 

 

RIBS: A Pain in your Neck!

RIBS: A Pain in your Neck!

Nothing is worse than when you wake up with a crick in your neck.

Every time you turn your head…..ZING! BAM!

From your eyeball to your neck to your shoulder blade.

I know. I have had this freaking pain numerous times.  And it is all-encompassing.  I deal with people’s pain all day, but when I wake up with one of these neck things……it is really hard to be a good clinician.  Because my head is about to explode!

Someone out there reading this knows what I am talking about.

But what if I told you it wasn’t originating from your neck?  What if it was coming from your rib?

Your rib, you ask? Ribs are near your chest around your stomach region, right?

Take a look at the picture to the right.  The ribs go all the way to the bottom of your neck. The first rib attaches to T1.  That is the first thoracic vertebrae. That is below C7.  Your 7th cervical vertebrae.  Cervical means your neck.

If you look at the picture and countdown to the 3rd rib.  The 1st through the 3rd ribs can

Posteriorthoracic
Photo credit: https://en.wikipedia.org/wiki/Rib_cage

be like that an annoying piece of food that gets stuck in your tooth and you can’t get out.  Usually, the pain is on one side of the upper and middle shoulder blade, at least initially, then it can encroach to the other side if allowed to fester.

 

Ribs attach to our thoracic spine where they make a joint.  Although the movement is small, there is still mobility.  And necks and backs are not the only areas in our body that can get cricks in them.  Any joint in the body can get a crick!  And the joint between the ribs and thoracic spine house these very sensitive nerve structures that are highly irritable.   Therefore, they can cause ALOT of pain.

There are muscles that run from the 1st-3rd rib that attach to your neck.  Hence, why you can have a sharp pain radiating from your upper back to your neck.  It is like a hectic ping-pong game of nerves angrily firing back and forth between both sites.

Prior to giving any advice on how to get relief, be careful if you have osteoporosis due to compromise to the rib region.  If you have any new traumatic injury within the past year, please consult your physician.  Always consult with your physician when in doubt.

Here are some tips to relieve a crick in your rib.

  • Feel the knot between your shoulder blade and middle back. The painful side should feel like it is sticking out backward.  That is why you always want to massage right there.  And you may get a massage and it still doesn’t go away.

Sit with correct posture and try squeezing both your shoulder blades together.  If you are a woman or not a woman…imagine you are a woman wearing a bra and try pulling your shoulder blades down towards the center of your back.  Your shoulder blades squeeze towards your spine, but down towards that imaginary center bra strap.

If you are trying to squeeze your shoulder blades back and down and feel them going toward your ears.  Try again. Look in a mirror, this should not happen.

Are squeezing your shoulder blades together and feel really pleased with yourself?  Are you pulling your elbows behind your body to squeeze your middle back together? Try again.  Your elbows should not go behind your body.  Try putting your hands in your lap, then squeeze.  You are ONLY pulling your shoulder blades back, nothing else.

Now that you got the hang of it.  Squeeze only one shoulder blade back.  Squeeze the nonpainful side down and back towards your spine.  So, if your left shoulder/neck hurt then squeeze your right shoulder blade.

Pull back and forth 15 times and hold 2 seconds between repetitions.  Do this 3-4 times during the day to release pressure off the painful side.

Stand near and face a doorway. Raise your painful arm up to the level of where your ribs hurt.  So, if the left upper ribs are painful, raise the left arm so your hand is even with your shoulder. And your elbow is straight.  Place your arm to the left of the doorway, gently push into the wall and hold for 4 slow seconds.  If that increases your pain, change the direction you are pushing and move your arm to the right of the doorway.  You can feel the hard knot in your back with your free hand, and resist whichever way the knot feels like it is going forward away from your finger.

Repeat this 5 times.  And repeat this every waking hour until the pain has dissipated.

  • The other tip that is very helpful is taking a hand towel and roll it up longwise. Place the hand towel on the painful side, so it sits directly between the shoulder blade and spine.  It should be directly on the rib.  Lay on your back directly on the towel.  On the floor or carpet is preferable, not your bed, because you want the surface hard. Gently do some small bridges by lifting your butt up towards the sky.  The pressure should increase where the towel is on the ribs.

Repeat 10 times.  You can modify by rolling a highlighter into the towel to increase the pressure or a small bar of soap (<2” wide) or a tennis ball to be point specific.

  • One product I recommend is the Theracane. You can use this to apply direct pressure to the rib in dysfunction and also apply muscle release to the surrounding region. Plus, it makes a great Christmas gift!  Wrap it up like a candy cane!
  • Usually, the rib that is stuck back…is usually the side you sleep on. Make sure to side sleep on the other side for awhile!  And switch the way you lay on the couch to watch TV!
  • Lastly, but most importantly, please consult with your local physical therapist! They can be wonderful with providing manual treatment to get an acute rib dysfunction back on track. Even a chiropractor is great, too!  Just make sure both clinicians provide manipulations to the rib region. Sometimes, all you need is one manipulation to get you feeling like gold.

Guys, I am so excited to talk about my new educational video that Sara and I made on how to treat pelvic, low back, and hip pain!  It is my dream to make a movie and it is everything this blog is about……..taking simple steps to help reduce complex pain.

Please check out Video about Pelvic Pain and How to Correct Pelvic Alignment here.

 

Pelvic Pain and Foot Pain: Connected?

Pelvic Pain and Foot Pain: Connected?

Every body part is connected to another body part, even if they are not anatomically in proximity to each other.

If you have pain in one area of your body, it will span to another area with time.

We all know that our feet are attached to our lower legs, then our knees, then our thighs, then our hips to finally end at the pelvis.

Would you be surprised if I said that foot pain could be correlated with pelvic pain and/or incontinence?

I know this seems far reaching, so let’s step back and simplify it.  You would be surprised with how many patients question why they started having hip pain after a long spell of knee pain.  Well….it originates from the same bone, the femur, so pain can easily be interchanged between the joint above and below this bone.

Let’s span out and expand this a little more……

Pelvic pain can affect your feet and vice versa.  It has been an amazing “feat” how far we have come in medical research with pain management and all medical specialties, for real.  But as we gain more knowledge in a certain specialty, sometimes the big picture gets lost.  We stop looking at a patient holistically and focus on their specific symptoms with their particular body part.  And when that happens, we are chasing symptoms instead of finding the driver for the pain. 

Our body is made up of a complex framework of nerves.

But did you know (great Saturday night factoids to impress your friends)…..

– Our body is made up of 46 miles of nerves.

– Our nerves transmit signals from our brain at a pace of 170 miles per hour!

Nerves are our electric factory keeping us energized. They are always on.  They never sleep.

Nerves come out of our spinal cord and feed our muscles, joints, and even themselves.  They are oxygen eating fiends, too!  Which is why physical activity is so important in helping to reduce pain.

Nerves branch off from our spinal cord and they pass down like rivers to become tributaries then streams to end in their final placement in the muscles.

The sacrum is our upside-down triangle that is sandwiched between our lumbar spine and tailbone.  The sacrum gives off 5 spinal nerve segments and out of those five: S2, S3, and S4 are our generators for pelvic floor muscles.  While similarly, S2 and S3 supply the small muscles in our feet. lumbarsacrumnerves

So, if you have pelvic pain or even urinary incontinence try to spread your toes…. you might find it difficult to do because they share a similar originating home.

There has been a study published on this exact topic.  The link is here.

Many people believe that urinary incontinence is due to getting old and their bladder not working properly.  Or it is their diet.  Or it is because they had too many kids.

Although it is true that all of the above can be factors to incontinence, the main culprit is due to some muscular component, whether it be the muscles in the pelvic floor being too weak or too overactive.  Our pelvic floor is muscles shaped like a bowl inside our pelvis that provides support to our organs to ensure a proficient way to expel our undesired excrement and keeps everything inside, among many other duties.

But like all muscles in the body, they are supplied by nerves.  And nerves run from our pelvis to our feet.

If a nerve is restricted, compressed, or compromised in any way, then the muscle will become under or overactive, as well.

Let’s go on a tangent.  I love to go on tangents…. just ask my co-teacher, Sara Sauder, who sees me do it all the time in our educational courses.

Let’s start with the sacrum, particularly the nerves from S1-S3.  They give rise to the Posterior Femoral Cutaneous Nerve which supplies our sensation to the female labia majora (the skin fold that surrounds our vaginal opening), parts of the scrotum and penis, and the back of the upper thigh and leg.

Nerves can be very gossipy and interact with other nerves.  Like plant roots, they can grow and connect to other nerves.  And the Posterior Femoral Cutaneous Nerve has been commonly known to connect to the Pudendal Nerve (S2-S4) and the Sural Nerve (L5-S1) through what is called, communicating branches.

The Pudendal Nerve supplies the majority of the muscles in the pelvic floor.  They assist with us being able to hold our urine in when we sneeze or cough among other things.

pudendalnerve2.jpg
Photo credit: By OpenStax College – Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013., CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=30148525

 

The Sural Nerve starts below the knee and reaches all the way to the outside of the foot.  This nerve is commonly used for neural stimulation (similar to electrical stimulation) to assist with many bladder dysfunctions.

suralnerve

The take home message is this…..nerves need a stable environment to work properlyIf there is any hitch, catch, injury…. this can cause a snag that affects the whole nerve. 

An ankle sprain.

A back injury.

High arches in your feet and not wearing supportive shoes.

Pain at your sit bones increased with sitting.

Knee injury.

Burning with urination.

Painful ejaculation.

This huge array of traumatic injuries and repetitive microtrauma can result in a compromised nerve making it very pissy.  Meaning you can start having pain anywhere above or below where this nerve irritation is located.  And before you know it, you have plantar fasciitis on your left foot.  And you also notice your urinary leakage with coughing has slowly increased from monthly to daily.  It is a domino effect.

Don’t discount these parallelisms, this isn’t just chance.    

So, if you suffer from plantar fasciitis, Achilles tendon pain, or heel pain…. find a practitioner that will assess you all the way from the foot to the back.  Because if they aren’t doing this, they could be missing a big piece of the puzzle in managing your care.


If you have any questions or comments, please leave them anonymously in the comment section or email me at kjwilson101@gmail.com. 

My company, Alcove Education, is making a video about how to address pelvic pain.  It has completed shooting and is currently in the editing process.  I will keep you posted!

If you’d like to be added to Alcove Education’s email list serve, please ask!


Now, an attempt to share a moment from my personal life:

I am a true blood Houstonian. I was born and raised in Houston.  Nothing has been more devastating than watching the destruction my state has suffered this past week.  My mother, who still lives in Houston, was fortunate to not flood. But she had refused to leave her home.  One of her greatest or smallest (for that matter) attributes is not cooking or having food in her house.  I talked to her the day before Hurricane Harvey hit and asked her what she had done to prepare herself.  She said, “I will be fine. I bought 10 sausage burritos for $4.00 from McDonald’s.” Who has ever heard of anyone preparing for a Category 4 Hurricane this way you ask?  Well, my mother, of course!  About 3 days into Houston being flooded and not being able to leave her house, she admitted she was getting tired of those sausage burritos.  Luckily, she had neighbors that were gracious enough to share their food with her. 

Blessings and prayers to all my fellow Texans! 

And Floridians…..please be careful and evacuate if required with impending Irma on her way.

 

Painful Walk or Sexy Swagger?

Do you have more swing in your hips with walking than the average joe? Thought it was your sexy swagger? Have you ever been told you walk lopsided? Does one pant leg feel longer? Perhaps you were not born with a sexy swagger, maybe there is actually something uneven in the lower half of your body.

Or, if you answered “no” to all the above questions…..don’t stop reading.  Many people have no idea they have this problem going on.

About a month ago, I evaluated a lady that received a total knee replacement three months prior. Her left knee was red, swollen, and hurt constantly throughout the day. It had gotten so bad, she could not sleep through the night.

As I was walking her back to the treatment room, I noticed her walking pattern.  It was as if she had a spring in her step, a painful spring.  Her left hip was higher when she stepped on her left leg, her knee was not able to straighten out as much as the right leg.  She was just off.

I went through my normal orthopedic assessment of her strength and balance. Her strength was decent, her balance, on the other hand, was impaired.  And I am not talking about something really difficult like balancing on one leg.  I am talking about standing with her feet together.  Simple enough, correct? Well, she was all over the place.

I surprise her and ask her about urinary leakage. She admits leakage has increased in the past couple of months.

After many other objective tests, I measure her legs while she is lying on her back from her belly button to her ankles.  I measure her left leg is 1 cm longer.  1 cm!

I tell the patient my findings and she looks at me like I am crazy.  She says and I quote, “What do you want me to do about it?” I tell her it is easy…….she can wear a heel lift in her shoe.  She is not sold on this idea.  It is not her fault.  She doesn’t know me from Timbuctoo. She had a knee replacement, she is here to get her knee treated. I drop the issue because I want her to come back and this information is just too much for her right at this time.

Why is telling someone their leg is 1 cm longer such a far-fetched concept?  I see this more than I would like to admit.  MD’s are taught in school that a leg length discrepancy more than 1 cm can compromise the stability of the low back, hip, knees, and feet.  But many times, this is overlooked in the assessment at the doctor’s office.  Do they assess you walking? Or have you lie flat on your back with your legs straight and compare them? I have seen numerous patients with nonhealing ankle fractures, meniscal tears, and labral hip tears due to an undiagnosed leg length discrepancy. And this could be as small as a 0.5 cm leg difference.  It was small, but it was that particular person’s tipping point, their personal aggravator for re-injury.

What about lumbar spine fusions?  If you have a 9 mm leg length discrepancy you have a 6x greater likelihood of having low back problems.  If you have a longer leg, the force vector to the low back is exponentially greater on that side.  Think about it.  Your right leg is 1 cm longer, you are compressing your hip harder into the pelvis bone, your pelvic bone is jamming harder on the lower lumbar vertebrae.  The vertebral disc is just the padding between the two bones and with time, gets smashed (i.e bulging disc) and results in a fusion.  Hardware is placed in the back but the driver for why the disc bulge occurred was never corrected.  Your longer right leg is going to incorrectly load the fusion site and two things will happen with time.  One would be hardware failure because it’s loading mechanics are wrong or you will begin to break down the level above and below the fusion site. Then anywhere from a few years to longer, you need to get another fusion to correct the unstable segment.  It is an unending saga.

It is hypothesized that more than 60% of the population has some sort of leg length discrepancy.  We are almost all created unequal!  It is easy to screen for leg length discrepancy.  Lie on your back with your legs straight and have your partner or friend gently pull both your ankles equally to even your hips out.  Have your friend put their thumbs underneath the inside ankles and compare how they compare to each other.  If they look uneven, then perhaps you have a leg length discrepancy.

I wish this test was straightforward and you could immediately go to Amazon and purchase a heel lift and all your ailments were cured, but…sigh….it is not that simple.  You may have underlying pelvic obliquity that may need be addressed.

I recommend for you to go to your medical provider and ask for a physical therapy referral for a thorough assessment or an x-ray to measure your legs’ length.  Or if going to the doctor is not an option, there are plenty of chiropractors that can diagnose this as well.

Once a leg length discrepancy is confirmed begin wearing a heel lift whenever you are standing or walking.  If you are a barefoot walker, put them in house shoes. You will need your body on an even playing field.

My disbelieving lady with the total knee replacement made it through 2 weeks of therapy before she was open to the idea of talking about treatment for her leg length.  She started wearing a heel lift and her functional tolerance and pain levels dropped within the first week. Her knee swelling was gone, she could go to the grocery store, she could sit at the computer for 8 hours, and she was sleeping throughout the night.

Oh! And her urinary incontinence stopped.  I will explain this connection in future posts…so keep reading.

And for people with a hip or knee replacement, I have been told first hand by an orthopedic surgeon that gaining up to a 1 inch leg length discrepancy is very common after surgery.

So, the take home message here is…sometimes a complex issue can actually have a simple resolution.  A leg length discrepancy needs to be ruled out for anyone with a reoccurring ankle sprain, knee meniscal tear, excessive arthritis in your hip, knee, and ankle joint for your age, low back pain……really any musculoskeletal disorder or pain in the body, particularly in the lower half!

And last but not least…..leg length discrepancies comes with all ages, young and old!

Simple explanations and more for your pain in future posts.

 

I had the cutest lady come to me for low back pain.  She had a true leg length discrepancy and one way to fix the elevated pelvis is to do a hard leg pull at her ankle while having her lie on her stomach.  Well, I had been working with her for about three weeks and she arrived with a completely new hairdo.  It was a full-blown afro.  It spanned about 4-5 inches around her head. It looked great, but was not what I was expecting at all!

 To do the manipulation correctly, I have a co-worker help stabilize the patient to the table.  Then I have to pull.  Many times, the patient will involuntary tense up their body.  I have to cue the patient to “Relax their leg” and provide tactile cueing like tapping to get them to relax. 

On this day, the lady would not relax.  So, I tapped her leg and blurted out, “Relax! Try to relax!  Relax your hair!”  Boy, did my coworker and patient laugh like all get out.  My patient thought it was the funniest thing she had heard all week. 

Sleeping Posture for a Pain-free Day

Sleeping Posture for a Pain-free Day

Hello!

Welcome to the Pain and Simple Blog, the place where complex issues get simple answers.  My name is Dr. Kelli Wilson PT, DPT, OCS, FAAOMPT and I am a physical therapist that specializes in the whole body.  I am a musculoskeletal expert.  I am a detective.  I see things that we are all guilty of doing each and every day that can cause pain.

Technology has made great strides in assisting us with medical diagnoses, but sometimes it has convoluted what the main issue is and why certain pain patterns are happening.  Too many tests can give an umbrella diagnosis.  Sometimes there are simple answers.

I urge you to go with me on this journey of exploration and explanation of resolving pain with simple advice and changes in your daily life.  Each blog I plan on sharing simple approaches that you can easily incorporate into your life to make you feel better!

I decided my very first blog should be what I preach the most to my patients in the clinic.  I say this to each and every patient the first day they come in.

I used to initiate exercises to implement strengthening to the muscles.  But in the clinic, I have had more success with discussing postural habits.  Think about what position you hold the longest throughout the day.

Guess.

No…..not at your desk at work.

Nope…..not your recliner at home.

For the majority of us, it would be our sleeping position in bed.

Joints move the pathway of least resistance.  If you sleep on the same side with the same top leg bent every night, there are going to be structural changes.

Go with me on this tangent….you are a left sided sleeper that sleeps with two pillows in a somewhat fetal position with your top leg bent.  I find that people that sleep like this have difficulty turning their head to the left or bringing their ear to their left shoulder or at least have loss of motion when compared to the right side.  You will have tightness all along the mid-back, the thoracic spine, from sleeping in a forward flexed position all night, and you will have annoying pressure along the right low back.   The pain to the low back won’t even be pain per se, but an annoying, nagging pressure that causes you discomfort while you sit.

Everyone is different and I am not funneling everyone into this category.  I am simply sharing what I see in the clinic.

What if you are reading this and are in total agreement?  Here is my advice.

Change your sleeping posture.  Change the side you sleep on.  If you sleep with your partner, spouse, or co-sleep with your young children switch which side of the bed you sleep on.  You will need to stop sleeping in the fetal position.  Try to go to the sleep with your mid-back straight and not curved. Sleep with your knees together.  They can be straight or flexed, as long as they are together.

It takes 3 months to change a habit.  You will wake up in the wrong position or your “normal” position. It’s ok.  It will take 2-3 weeks to get used to your new position.  Just be diligent and move into your new “correct” position whenever you find yourself in the bad position.  It will get easier.

If you cannot fathom sleeping with your knees together, put a pillow between your knees.

Bed, Bath, and Beyond have a great hourglass pillow that is inexpensive and really quite comfortable.

Try to make these changes and I promise you…you will be better off in the near future and many years to come!

I look forward to meeting with you every other week.

 

 

Here is my personal favorite story pertaining to sleeping from 1996:

When I was a Sophmore in high school, my Mom woke me up in the middle of the night saying a man had broken into our house. We escaped through my bedroom window which had roses inconveniently planted outside of it to keep me from sneaking out (which by the way Mom….I never did sneak out).  After calling the police from a pay phone, we were waiting on our street corner and I asked my Mom, “What happened? How were you able to get to me?”  While I am trying to forget I am about to wet my pants, she calmly said she heard him come into her room rustling around.  But then he must have gotten tired and laid down with her in her BED!  She then “acted” like she needed to go to the bathroom and came and got me.  Many questions ran through my head…..why would he lie down, how did she crawl over him since she would have been closer to the wall, how did she act like she had to go to the bathroom?  I quickly figured out she had been dreaming, and so did the police.

 

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