Tag Archives: Plantarfascitis

Elite PT Newsletter April 2018 – Running Injuries Part I – Foot/Ankle

Running Injuries – a Spring time tradition

Like the rest of you I’m done with the cold and snow and ready for some nicer weather. It’s that time of year to start thinking about summer which usually means being more active.

For you runners out there it will mean getting outside more and probably increasing your mileage.

For you athletes, it’s time to start thinking about what you’re going to do this summer to make you a better athlete for next year.

Luckily, we’ve got something this month for both of you!

Common Running Injuries
1. Patello-Femoral Pain Syndrome (anterior knee pain)
2. Achilles Tendinitis
3. Plantar Fascitis
4. Hamstring Tendinitis
5. Shin Splints
6. IT Band Syndrome (pain at the hip or lateral knee)
7. Stress Fractures
8. Patellar Tendinitis
9. Lower Back Pain

These are the most common running injuries I found searching running sites and this order is fairly consistent from site to site. We see our fair share of each of them here at Elite PT.

These are also known generically as ‘over use injuries’ – meaning that they are caused over time by repetitive stresses that gradually break down the various tissues involved (tendon, muscle, fascia, bone, etc).

These are also the most common injuries we see in high school sports that involves a lot of running, i.e football, soccer, basketball, track and cross country. So if you’re an athlete of any kind, at some point you are either going to be dealing with one or more of the above OR you should be working to prevent them.

Prevention starts from the ground up

How your foot and ankle function are huge for preventing the obvious conditions in that area but also those further up the chain in the knee, hip, and lower back.

The joints of your foot and ankle must move appropriately and the muscles must do their job to stabilize those joints as your foot hits the ground and then progresses to push off. This is a two pronged approach since the joints require adequate mobility and the muscles must stabilize at just the right times.

This month we’ll cover a few ankle/foot exercises you can use to prevent injury or to rehab from it. Sorry if I get a little deep in the ‘why’ sometimes but I do think its important to know ‘why’ you should perform these exercises.

Ankle Mobility

Here’s a great example of what good ankle mobility looks like. The knee should be able to travel 4″ past the big toe without the heel coming up or the arch collapsing.

Athletes need this much ankle mobility to squat deep, sprint, jump, cut, and so on. If you don’t then your body is going to find a way to compensate around that so you can still squat, sprint, jump, etc. Our compensations are usually what get us into trouble. In this case the common compensations are:

  •  arch of the foot collapses (excessive pronation)
  • foot turns out
  • heel comes up too soon
  • knee collapses inward

There are others but these are the easiest to see. Watch anyone with stiff ankles try to squat deep – its not uncommon to see all of the above.

These compensations put the tissues of our foot, knee and even higher up the chain into more stressful positions. With repetition, i.e. lots of mileage, this will eventually catch up with most athletes causing pain.

What to do about it?

There are two main reasons why your ankle joint may not move enough:

tightness through the muscles of the calf (will feel like stretching in the back of the lower leg)
limitations involving the ankle joint (will feel a pinching sensation in the front of side of the ankle when bending it all the way)

Tight muscles are something you can deal with fairly effectively yourself. Using foam rollers or massage sticks to loosen up the calf muscles followed by stretching are the easiest things to do. Working on ankle mobility in a kneeling posture as in the picture below is one of my favorites.

Kneeling Ankle Mobility

The goal is to get your knee as far past your big toe as possible without your heel coming up. Placing the stick at your 5th toe and taking your knee around the outside of the stick forces you to work the muscles of the foot and keep the arch high. I prefer shoes off so you can actually see what your foot is doing. It could also be done standing if kneeling causes knee pain.

If you experience that pinching sensation in the front or side of your ankle – that is going to be a tougher fix. That’s usually not something you can stretch out on your own. It’s actually a good reason to give us a call because you will need some manual therapy to deal with that stuck joint.

In conclusion

What is happening at your foot and ankle affects every other joint in your body so this is a great place to start. See how far your knee can go past your big toe – if it’s not 4″ (heel down and good arch) then it’s time to get to work.

If you want some other ideas, catch the video below featuring our former student Scott McKeel (who just ran the Boston Marathon this week) demonstrating some great ankle mobility drills.

And even if you don’t consider yourself a runner or an athlete, you still need a mobile ankle and stable foot to walk normal, go up and down stairs, and balance. These are for you too!

If you’re struggling to make gains or you do have that ankle pain I mentioned earlier, feel free to give us a call (231 421-5805). We can set up a free 30 minute assessment to determine if you just need more advanced exercises or you may need physical therapy to break through and get moving again.

I’ll leave this offer open through the end of April so get cracking!.

Have a great rest of April and be sure to look for the next article in our series on running injuries.

Joe Heiler PT

Hip Flexor/Ankle Dorsiflexion March

Elite PT June 2017 Newsletter – Dry Needling for Ankle and Foot Pain, Athlete Updates, and more…

Welcome to this month’s issue of the Elite Physical Therapy and Sports Performance newsletter.  Check out the short article and demo videos on dry needling, see what some of our graduating athletes will be up to in the Fall, as well as our ‘Exercise Tip of the Month’:

I can’t believe it’s already June and school’s just about out!

Here’s what’s new at Elite Physical Therapy this month:

Kristy Ockert MSPT just completed her first Functional Dry Needling course down at Grand Valley State University a few weeks ago.  She had a great time and learned some cool new techniques.  Since then she’s been practicing on Lydia and myself to fine tune her skills.  Follow the link below to see how its going!

We’ve seen numerous clients lately with calf pain, Achilles tendonitis, and plantarfasciits who’ve had great results with the combination of dry needling, Graston Technique, and exercise.  Here is what one of our clients with Achilles tendonitis had to say:

“I had issues walking at work and limited mobility in the ankle before therapy.  I can now walk all day at work and have no pain or swelling in the ankle area.” – K.W. from Grayling

In this case, PT was the last option prior to surgery.  Thankfully we were able to avoid surgery and get her back to work without pain.

There are certainly plenty more conditions that can benefit from dry needling in addition to the other physical therapy techniques that we employ.  Relieving pain and improving muscle function are big benefits of this technique.  To see more on dry needling, how it works, and a demonstration for treating neck pain and headaches, click the link HERE to check out the video on our home page.

If you have any questions about the technique or if you’re wondering if dry needling may work for you, feel free to give us a call at 231 421-5805.  Ask for Joe or Kristy.
Athlete News

I want to acknowledge some of our past and present clients that will be moving on at the end of this school year to further pursue their athletic dreams.  These guys are a hard working bunch and will be missed!

Chris Kolarevic from St. Francis High School – will be playing football at the University of Northern Iowa.
Michael Hegewald from St. Francis High School – will be playing football at the University of Dayton.
Alec Trautman from Elk Rapids High School – will be playing football at the University of Dayton.
Will Russell from Traverse City East Middle School – will be attending the Steamboat Mountain School in Colorado skiing on their U16 Alpine Team.


Exercise Tip of the Month

We’ve been talking about treatments for the lower leg and foot the past couple months so I thought I’d stick with this commonly injured area one more time.  Last month I showed a great way to improve the way the foot and ankle move – if you missed it just let me know and I can re-send that to you.  This month we’ll look at an easy way to begin strengthening.

Ankle Marching with mini-band

Place the band around your feet with the feet just wide enough that there is a small amount of tension on the band.  Bring the knees up toward your chest and flex the ankles back as far as possible.  Kick one leg out straight but keep the opposite leg motionless.

Hip Flexor/Ankle Dorsiflexion March

Hip Flexor/Ankle Dorsiflexion March – Start Position


Hip Flexor/Ankle Dorsiflexion March

Hip Flexor/Ankle Dorsiflexion March – Finish Position

The leg that remains motionless will actually be the leg that is working the hardest.  Do not let this leg follow the other!  Not only will you feel the muscles in the front of the lower leg working hard but you’ll also feel your hip and stomach muscles.  This exercise is typically done after stretching out the calf muscles and is done for 2 sets of 10 on each side.

Have a great month and talk to you again in July!

Joe Heiler PT



Ankle Mobility Drills for Runners

This is the last in our series of dynamic warm-up drills for runners that we use here at Elite Physical Therapy and Sports Performance.  In this video Scott McKeel demonstrates some of our favorite ankle mobility drills to get those ankles moving which will help with a number of common injuries like plantarfascitis, Achilles tendinopathy, IT band syndrome, knee pain, and low back pain.


We do small group, and even individual, training sessions for runners which includes the Functional Movement Screen plus other critical tests to find the weak links in mobility and flexibility, strength, and running technique.  If you’re interested contact us:  joe@elitepttc.com

Dynamic Warm-Up for Runners Part II

Part II of Scott McKeel’s series on dynamic warm-up drills for runners.  In this episode Scott takes you through some of our favorite lower body warm up and run technique drills here at Elite Physical Therapy and Sports Performance. These drills are great for those who have been battling common running injuries like plantarfascitis, hip bursitis, IT band syndrome or low back pain.


We do small group, and even individual, training sessions for runners which includes the Functional Movement Screen plus other critical tests to find the weak links in mobility and flexibility, strength, and running technique.  If you’re interested contact us:  joe@elitepttc.com

Dynamic Warm-up for Runners

I’ve made it a practice to have my PT students contribute to the Elite PT blog and SportsRehabExpert.com so without further delay this is my most recent student, and ridiculously good runner, Scott McKeel, demonstrating some of our favorite dynamic warm-up drills.  In this episode, Scott will hit on the upper body warm-ups and then in subsequent episodes we’ll work through lower body warm-ups, running technique, and ankle mobility drills.


Running Performance and Injury Prevention Clinic

Are you a runner? Are you interested in preventing annoying injuries that may sideline you from training? Are you interested in improving your performance? If you answered yes to any of the above questions, the Running Performance and Injury Prevention clinic sponsored by Elite Physical Therapy and Sports Performance, Crystal Lake Clinic, and Running Fit is where you need to be on June, 6th from 9:00am to 12:00 pm!

This clinic will give attendees information on common running injuries, ways to prevent them from happening, and ways to manage injuries while training. This clinic will also give insight on race day performance, proper warm-up techniques, and foot typing to make sure you as an athlete are in the right shoes on and off the course.

This clinic will be split into two sessions. The first half will be a lecture and discussion format while the second half will be divided into break-out sessions to learn by performing.

Everyone is welcome whether you’re a weekend warrior, an avid runner, a coach, or someone looking to begin running. This clinic is for everyone!

Where: Traverse City West High School Practice Gymnasium

When: June 6th, 2015 9:00 am-12:00 pm

Cost: Prepaid: Adult=$10, Students= $5
Door Price: Adult= $15, Students =$10

What to bring: Clothes to exercise in, water bottle, energy, notebook and pen for notes, and your energy!


Jake Flynn MD (Crystal Lake Clinic) – Race Day Performance

Scott McKeel SPT (Elite Physical Therapy and Sports Performance) – Common Running Injuries

Joe Heiler MSPT (Elite Physical Therapy and Sports Performance) – Optimizing Movement Quality for Running Performance Enhancement

Victor Sellinger (Running Fit) :  Happy Feet – Foot Wear and Foot Typing

Breakout Sessions:

Dynamic Warm-Up

Self Myofascial Release Techniques

Foot Typing

Adults – use the button below:

Buy Now Button

Students – use the button below:

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Barefoot or not Barefoot… That is the Question

Originally posted on SportsRehabExpert.com

Andy Barker PT

Barefoot training has taken off in recent years. Whether in the gym or out on a track or field, the number of people training barefoot has increased. But why? This post will look at the benefits of barefoot training and in addition the importance of foot position when training.

Barefoot training

As the name suggests barefoot training involves wearing no footwear. This could be to lift weights in the gym or indeed used for running training. There has been many a discussion in the training community as to the advantages and disadvantages of such training, although there isn’t much decent clinical evidence on whether this type of training is beneficial or not.

Why use barefoot training?

Having bare feet ultimately is going to give you and your body a heightened level of body awareness due to increased contact with the floor. This can be
advantageous in many ways especially in drills involving foot and ankle mobility
and stability. A great example would be the use of an ankle mobilisation. I would always conduct such exercises involving the foot and ankle in a barefoot state.

Stick Ankle Mobilization

I like conducting such drills like this as you can feel the movement better in this position and in addition, if I was teaching such a movement I can actual see and feel what is happening which might not be as apparent in a training shoe.

I also at times like athletes and clients to lift, i.e. squat and deadlift variations in barefeet. In addition to the reasons mentioned above, for some, being in a barefoot position enables the foot to generate more torque and have a greater influence on knee and hip position during lower limb movement.

For example, in a barefoot stance an athlete is more easily able to generate a
lateral directed force from the foot into the ground prior to a squat. This can be cued by asking the athlete to try turn the feet outwards without the feet actually moving. That torque created enables stiffness through the foot and ankle creating a stable platform to lift and in addition pull the foot out of a position of pronation. This cue has been particularly useful for those athletes that excessively pronate. Getting out of excessive pronation also benefits the knee and hip by preventing possible knee valgus and hip internal rotation stress respectively which are detrimental to knee and hip health and movement quality.

Tripod stance

Regardless of what lift or activity that is being produced, be it a squat, deadlift or running the aim is generally to gain a neutral foot position. Having equal amounts of weight distribution between to foot is key to being able to create a stable foot position or ‘tripod stance.’

A successful tripod stance position would involve equal distribution of weight
between the three points of;

  • Base 5th metatarsal
  • Calcaneus
  • Base 1st metatarsal

If weight can be distributed evenly between these three points then the foot is
likely to favour a neutral foot position and in addition will provide a stable
platform for movement.

Tripod Foot Position

Therefore in my opinion the reason for opting to go barefoot or not isn’t the
main issue. The question is with what footwear type or barefoot style
stance will enable you to get into a neutral foot position or tripod stance. This will differ between individuals.

Getting that tripod stance is the key. As a result it doesn’t really matter what’s on your feet if anything as long as we maximise and make use of a good solid foot and ankle position for movement.


The type of activity the person is partaking will be a major determinant of
what to use in addition to the ability to gain a stable foot and ankle position to carry out such an activity.

To use myself as an example of three different activities in with I will alter what I wear on my feet. The activities include:

1. Squatting in the gym</br>
2. General wear (at work, walking, and general daily activities)</br>
3. Road running


Regarding squatting in the gym I lift barefoot. The reason for doing this is that I feel that I can use the floor and my foot position to gain a strong stable base of support prior to lifting. I am able to feel the floor and use it to my advantage. By almost screwing my feet into external rotation, without actually moving my feet, I can generate torque through the floor, bringing my feet out of a position of relative pronation and thus at the same time preventing knee valgus and hip internal rotation. In addition, I feel I can sit through my hips better and in doing so I am in a stronger position and as a result can shift more weight.


Conversely, I tend to wear barefoot training shoes for general activites throughout the day. I have a pathological right ankle which needs regular rehab predominately through ankle mobility drills. I have found that wearing a barefoot training shoe has enabled me to maintain my ankle range of movement in comparison to before I started wearing barefoot style shoes. This is ultimately because I am using/maximising the range at my ankles even during everyday activites and thus complements my ankle mobility rehab.


Finally, for road running, I feel more comfortable in a neutral training/running shoe as opposed to a barefoot shoe. I feel as though the additional support and cushioning of the shoe provides a better and more comfortable run and therefore I use such a shoe to run. In theory a barefoot shoe might seem more advantageous given my ankle pathology however this has not proved to be in case in my example.


To bring it all together, using I as an example, it is clear that different
activities require different footwear types. As athletes, weekend warriors or
practitioners we should be aware of the fact that differing activities require
different provisions and going one way or the other, being anti-barefoot or pro-barefoot, is maybe not the way to do it. Maybe being aware that different
circumstances require different training equipment is the way to go and adapting
our approach in that way.

Hope this has been of interest. Any questions just post them in the discussion forum.

Thanks for reading


Andy is the current head physiotherapist for the Leeds Rhinos first team squad and has been involved with the club for the past six seasons.

He graduated in Physiotherapy from the University of Bradford with a first class honours degree which followed on from a previous Bachelor of Science degree from Leeds Metropolitan University in Sports Performance Coaching.

Andy currently works privately in addition to his sporting work and has also previous experience within National League basketball and professional golf.

Andy has a keen interest in injury prevention and the biomechanics of movement in which he is continuing his studies with the start of a MSc degree later this year in Sports and Exercise Biomechanics.

Andy is also the creator and author of rehabroom.co.uk. RehabRoom is a free    online rehab resource site aimed at but not exclusive to physiotherapists, strength and conditioning coaches and personal trainers. To visit the site please click the link:  http://www.rehabroom.co.uk

Band Walks and Hip Strengthening

Band walks (a.ka. Monster Walks) are a physical therapy staple for hip strengthening, and are often used with patients who have had knee injuries or are suffering from back and/or hip pain.

It has been shown in the research that weakness of the glute muscles of the hip can be a direct cause of poor alignment through the lower extremities creating problems such as patellofemoral pain (anterior knee pain) and also putting one at higher risk for ACL injury.

Weakness through the hips is also proposed to be a cause of lower back pain since one is using the hip inefficiently to stand up, squat, lift, etc then the tendency is to overuse the lower back muscles to perform these tasks.

So strengthening the hip muscles sounds like a great idea right?

It can be when done correctly.  In the video below I demonstrate the wrong way to perform these exercises along with some simple corrections (the corrections may look simple, but they make the exercise much more difficult – and effective).

Hopefully you noticed that I talked about the importance of the trunk remaining stable throughout the exercise.  Only through stabilizing the trunk can the hip truly generate efficient force.  This is the most common mistake made, and in my opinion, makes the exercise a complete waste of time.

Give it a shot and let me know if you have any questions.




Taping for Plantarfascitis/Foot Pain

In this blog post I wanted to discuss the benefits of taping, specifically a technique known as ‘low dye’ taping, for relieving foot and heel pain while allowing the soft tissues of the foot time to heal. This is a technique we commonly use here at Elite Physical Therapy.

Plantarfascitis is the common term for the pain in the arch of the foot or even in the heel.  It’s usually worse during walking or running – activities that really stretch that tissue on the bottom of the foot.

Our treatment model for plantarfascitis includes:

  • soft tissue work using Graston Technique to the plantarfascia, as well as to the muscles of the foot and calf to promote healing and greater extensibility of the tissues.
  • low dye taping to support the foot in weight bearing and to allow for tissue healing.
  • therapeutic exercise to increase mobility through the foot, ankle, and calf, as well as strengthening for the musculature of the lower leg.
  • corrective exercise to address movement dysfunction or lack of stability further up the chain including the hips and trunk.  The underlying reason for your foot pain is often found here!

Orthotics can be an important piece to the puzzle here as well, but they are quite expensive and not always a slam dunk to work.  A successful trial of low dye taping along with physical therapy is either going to eliminate the patient’s pain to the point that orthotics are not really necessary, or it’s going to relieve the symptoms enough that I feel more confident recommending orthotics as a more permanent solution.

Check out the video below to see how we do it here at Elite Physical Therapy.  If you have experienced these types of symptoms and they just won’t resolve, feel free to contact me to see if physical therapy would be an appropriate intervention.

I also shot a video demonstration of using Graston Technique to treat the foot a few weeks back.  You can find that video here:  http://www.elitepttc.com/blog/?p=415


Graston Technique and Plantarfasciosis

I can’t believe it’s taken me 3 years to think of this but I decided it would be helpful to shoot an educational video about Graston Technique and how we use it here at Elite Physical Therapy.  More and more doctors in this area are recommending Graston Technique specifically, but often the patient has no idea what it is.  Hopefully this video will help to explain.

I also show a quick demo of how I would treat plantarfasciosis (the chronic equivalent of the more popular term plantarfascitis).  I’ll be posting more examples of how we use Graston Technique, but for now this is one of the more common areas we treat.