Foot Pain & The Calf Muscles


A client I had came to me with disabling pain in the arches of her feet. She found that resting helped but the pain would start as soon as she started walking again. Even a short distance would cause the pain to come back.

Although she wore heels for work a lot of the time and many people were telling her that they were causing the issue, when she did change to smaller heels they actually made things worse!

She felt so upset as she was wanting to get back in to her running (which she had stopped 6 months previously as she thought that could be the cause).

When we assessed her lower legs we found that there was an extreme limitation in her range of motion.

And so her homework was to apply Soft Tissue Releases (self-massage or trigger point therapy) twice a day as well as stretches throughout the day in order to help with her foot pain.

We discussed how the limitations in her calves can cause foot pain and that often where the pain is, the cause is not.

After a few days, pain stopped being a problem and she was actually able to wear smaller heels with no issues (which are better for her body).

So if you’re having issues with foot pain give these a try and see if they help*

Self Massage:


*If it doesn’t or the it keeps returning then there may be something else going on such as a leg length discrepancy, pelvic issues or even a shoulder problem that will be worth getting checked out.

QL Trigger Points


According to The Concise Book of Trigger Points, issues with the Quadratus Lumborum (a deep ‘core’ muscle responsible for side bending) can lead to symptoms such as:

  • Renal tubular acidosis (accumulation of acid in the body)
  • Scoliosis
  • Mechanical low back pain.
  • Hip and buttock pain
  • Greater trochanteric pain (side of your hip)
  • Pain when turning in bed
  • Pain when standing upright
  • Persistent deep lower backache at rest
  • Pain on coughing and sneezing
  • Pain on sexual intercourse

Holy moly? Seriously?

Actually I can agree with a number of these especially as it’s an area I can have trouble with (if I sit too much or neglect my body/ movement).

Using Tennis balls is a great way to help with Trigger points. Just ask my clients who have a love/ hate relationship with them 😉

Check out this video to find out how to release the QL:

Factors That Influence Pain

IMG_0136The majority of people that come to me with pain will involve some kind of neuromuscular problem. This means that there is an issue with the muscles, the nerves and connective tissue as well as the adjacent areas. And so it is essential for me to have a good understanding of these issues as well as how best to treat them.

However, in addition to uncovering and treating whatever neuromuscular impairments are driving a client’s symptoms, I believe that it is also vital for me to work with my clients so that can we figure out what OTHER systems might be influencing their pain.

This might include looking into nutrition, sleep, stress, lifestyle, behaviours, thoughts and feelings, hormonal health and so on.

Sure, it’s a big time commitment (which is why my initial appointment can sometimes take up to 2 hours or more). Yes it would be easier to just treat the painful area and send them out the door.

But what I’ve observed in my practice is that if you want to successfully treat a person for the LONG TERM, then at the end of the day, it’s what works. I’m not looking for a quick fix.

I don’t want to have to see my clients on a regular basis*. I want to educate them on how THEY can look after their own body. It’s not about fighting fires. It’s about ensuring that they are aware when the match is lit and what they can do about it.

*Yes there are some clients that need regular attention. But these are exceptions and not the rule!

Explain Pain: 10 Key Concepts


Here are the 10 key concepts from Explain Pain Supercharged extracted by Lorimer Moseley and David Butler. Explain pain is a life changing book for those of us helping people in pain and I highly recommend it.

1. Pain is normal, personal and always real:

All pain experiences are normal and are an excellent, though unpleasant response to what your brain judges to be a threatening situation. All pain is real.

2. There are danger sensors, not pain sensors:

The danger alarm system is just that there are no pain sensors, pain pathways or pain endings.

3. Pain and tissue damage rarely relate:

Pain is an unreliable indicator of the presence or extent of tissue damage – either can exist without the other.

4. Pain depends on the balance of danger and safety:

You will have pain when your brain concludes that there is more credible evidence of danger than safety related to your body and thus infers the need to protect.

5. Pain involves distributed brain activity:

There is no single ‘pain centre’ in the brain. Pain is a conscious experience that necessarily involves many brain areas across time.

6. Pain relies on context:

Pain can be influenced by the things you see, hear, smell, taste and touch, things you say, things you think and believe, things you do, places you go, people in your life and things happening in your body.

7. Pain is one of many protective outputs:

When threatened the body is capable of activating multiple protective systems including immune, endocrine, motor, autonomic, respiratory, cognitive, emotional and pain. Any or all of these systems can become overprotective.

8. We are bioplastic:

While all protective systems can become turned up and edgy, the notion of bioplasticity suggests that they can change back, through the lifespan. It is biologically implausible to suggest that pain can’t change.

9. Learning about pain can help the individual and society:

Learning about pain is therapy. When you understand why you hurt, you hurt less. If you have a pain problem, you are not alone – millions of others do too. But there are many researchers and clinicians working to find ways to help

10. Active treatment strategies promote recovery:

Once you understand pain, you can begin to make plans, explore different ways to move, improve your fitness, eat better, sleep better, demolish DIMs, find SIMs and gradually do more.

Rotator Cuff Tears

Screen-Shot-2017-02-23-at-15.13.21-800x500_cSo many people have heard about Rotator Cuff tears. And so many people fear them. But actually, tears in the rotator cuff have been found to be more common than we realise. And not only that, but they can happen without us even knowing about it especially as we age.

In the research below, people who did not have any shoulder pain or dysfunction were given a scan. What they realised was that rotator cuff tears, must to a certain extent be regarded as a “normal” degenerative change. Just because someone has a rotator cuff tear does not necessarily mean that it is the main cause of pain or functional impairment.

The reason for this conclusion?

They found evidence of a rotator cuff tear in:
13% of those aged 50 to 59 years
20% of those aged 60 to 69 years
31% in those aged 70 to 79 years
51% in those aged 80 years or more

This is an astonishingly high rate of rotator cuff tears in people with asymptomatic shoulders and also demonstrating that these changes increase as we age.

Of course there is much more research needed as it is still unclear what actually changes an asymptomatic rotator cuff tear into a symptomatic tear. But as always we need to treat each individual case separately.

Source: []

MRI & SLAP Lesions

IMG_0127Following on from the last few posts about MRI and shoulder abnormalities (here and here), SLAP lesions or tears have been found to be another normal age-related change.

In the study below, 72% of the study group (aged 45-60 years old) were found to have SLAP tears. And just as in the previous studies, these were people who were asymptomatic and therefore not experiencing pain or any other dysfunction.

The reason this needs highlighting so much is that we need to realise that so many of the so called abnormalities that are found during scans, are often normal age-related changes. MRI cannot and should not be used alone to explain why someone has pain or dysfunction in their shoulder. After all, these people in the study had SLAP lesions but did not even know about it.

It also means that when someone identifies as having a SLAP lesion then this again does not mean that surgery is necessary. Everyone is different.

Sometimes the finding we see on scans can be likened to wrinkles…but on the inside. They are normal and happen to pretty much everyone.

1. SLAP is an acronym for Superior Labral tear from Anterior to Posteior
2. The labrum is the cup-shaped rim of cartilage that lines and reinforces the ball and socket joint of the shoulder.
3. Asymptomatic means that there are no symptoms including pain or dysfunction

Image: Complete Anatomy 19


Bursa Thickening: A Normal Adaptive Process

Shoulder joint structureHere is another piece of research to suggest that changes within the body such as bursal thickening are (often) painless adaptive processes. Which is why, seeing these on scans should not assume that they are the cause of someone’s pain.

After all, in the study below, bursal thickening was shown to increase as the amount of swimming increased, with no correlation between bursal thickening and shoulder pain.

And this makes sense. A bursa is a fluid filled sac which is there to help reduce the effects of friction. More training means more friction. More friction means the body will adapt and so increase the thickening of the bursa.

This is normal!

The body is super amazing at adapting to whatever we put it through. But these changes are nothing to be afraid of.

However it is important to note the difference between bursa thickening caused by an acute episode (which usually is painful) and the thickening caused by an adaptive training programme (which is usually painless).

As always, every client is different. Which is why an MRI is only one part of the puzzle.