Nerd Out: Plantar Fasciitis

My latest assignment for my Master’s in Holistic Nutrition was to write a paper about a disorder of the musculo-skeletal system. I chose Plantar Fasciitis, as many of the active people I know experience it. If you’d like to nerd out with me, continue reading:

Plantar Fasciitis is a chronic foot condition, described by some experts as inflammation of the fascia or connective tissue supporting the arch of the foot (Wheeler, 2019), and by others as chronic degeneration and irritation at the insertion of the fascia to the calcaneus, or heel bone (Young, 2019). Affecting an estimated 2 million people a year in the United States (Searing, 2019) the cost of treatment of plantar fasciitis is estimated at between $192 and $376 million dollars annually (Young, 2019).  Pain ranges from mild to extreme, intermittent to constant, and may affect one or both feet. Risk factors include obesity, age, overuse of feet via running, jumping, or standing for long periods of time, tight calf muscles, menopause, flat feet or high arches, and wearing unsupportive footwear (Ingraham, 2019; Wheeler, 2019). Symptoms include sharp, stabbing, burning pain in the heel or arch of the foot, or both. Pain is often most intense with the first steps in the morning, with symptoms sometimes subsiding with increased blood flow to the calves, heel, arch, and fascia as the day progresses. However, it is common for symptoms to be severe, lasting months or even years, affecting work, recreation, and activity level for its sufferers. 

Etiology is multifactorial but overuse is most often to blame (Young, 2019). Because of its high incidence in runners and other athletes such as football, basketball, and baseball players, it is supposed that repeated microtraumas through jumping and running contribute to plantar fasciitis (Young, 2019). Heel spurs may encourage or magnify symptoms, and are thought to be a result of plantar fasciitis rather than the cause (Wheeler, 2019; Young, 2019). Plantar fasciitis often presents in conjunction with an uptake in activity or training: increased miles, increased duration, or the addition of higher-intensity drills are examples (Young 2019). This condition is not limited to athletes, however, as overweight may be a contributing factor (Young, 2019). Standing for long periods of time, wearing footwear with insufficient arch support, age, and gender play a role as well (Young, 2019). Women experience plantar fasciitis twice as often as men, with peak incidence occurring between the ages of 40-60 (Young, 2019), coincidentally during the time of perimenopause and menopause (Wheeler, 2019). Any hormonal connection is yet to be explained.

Structural risk factors include a low arch (pes planus) or high arch (pes cavus), as each is associated with increased stress on the connective fascia (Young, 2019). Other sources of fascia stress include leg-length discrepancy, overpronation, excessive lateral tibial torsion, and excessive femoral anteversion (Young, 2019). Tight muscles, specifically the hamstrings, gastrocnemius, and soleus, as well as tight Achilles tendon may play a role as well (Young, 2019).

Plantar fasciitis is diagnosed by ultrasound, MRI, or x-ray (Wheeler, 2019), by ruling out other causes of pain, such as heel bruising, fractures, achilles tendonitis, infection, arthritis, and other foot syndromes (Ingraham, 2019; Wheeler, 2019). 

Once a diagnosis is made, Allopathic approaches indicate rest, ice, stretching, massage, and non-steroidal anti-inflammatories (NSAIDs) for relief of symptoms (Wheeler, 2019). Despite these options, this chronic inflammatory condition may last many months. At the 12-month mark, 80% of cases will experience relief, with 5% of cases progressing to more invasive options (Young, 2019). Treatment for persistent or severe cases includes physical therapy, extracorporeal shock-wave therapy, shoe inserts or orthotics, corticosteroid injections to the affected area, and/or surgery for plantar fascia release (Buchbinder, 2004; Wheeler, 2019; Young, 2019). Because each case is unique,combinations of treatments are recommended for optimal healing (Buchbinder, 2004).

Integrative approaches to treatment of plantar fasciitis utilize the above-mentioned allopathic treatments in addition to other holistic measures. An integrative practitioner will take into consideration stress levels of patients as well as quality of sleep, hormone levels, and nutritional status. Complementary treatment practices include chiropractic, massage and body work, dry needling, acupuncture, cupping, etc., with the intention of decreasing inflammation and restoring blood flow (Al-Boloushi, Gómez-Trullén, Bellosta-López, López-Royo, Fernández, & Herrero, 2019).

Assessments utilized may include meal-tracking with subsequent data on nutrient excesses and deficiencies. A detailed health history including sleep tracking and stress-level questionnaires provide important background information related to inflammation and lifestyle patterns that may contribute to chronic pain. Lab tests, including insulin and glucose levels assess inflammatory markers, while a gut microbiome test or comprehensive stool analysis can assess gut integrity (Rakel, 2018, p.869). 

An anti-inflammatory diet may be recommended. Eating foods high in healthy fats including omega-3s (found in cold water fish, such as salmon, mackerel, anchovies, and herring), oleic acid (found in olive oil), a variety of nuts, and coconut oil, lead to the formulation of less-inflammatory or antiinflammatory prostaglandins and leukotrienes (Rakel, 2018, p.870-872). Organic vegetables and fruits provide protective phytochemicals (Rakel, 2018, p.873). Avoiding gluten may reduce inflammatory markers, while decreasing intake of  over-processed, packaged foods and focusing on whole-food, nutrient-dense sources of low-glycemic carbohydrates favor an optimal gut microbiome composition and balanced insulin response (Rakel, 2018, p. 872-873). Cultured or fermented vegetables such as kimchee or sauerkraut also optimize gut microflora while sea vegetables such as kombu, arame, dulse, wakame, and nori provide essential micronutrients and trace nutrients (Lipski, 2012, p.148). Finally, bone broth is touted for its collagen-enhancing properties (Kresser, 2019), while certain spices (turmeric, ginger, rosemary, oregano and cayenne), garlic, green tea, wild mushrooms, organic red wine, and cacao or dark chocolate all provide improvements in inflammatory markers (Rakel, 2018, p.874; The Anti-Inflammatory Diet & Food Pyramid: Andrew Weil, M.D., 2019; Turmeric, 2018). 

Integrative approaches may also call for supplementation. Common anti-inflammatory supplements include glucosamine chondroitin, s-adenosyl methionine (SAMe), EPA/DHA fish oils, Hawaiian astaxanthin, vitamins C and D, medium chain triglyceride oil (MCT oil), Co-enzyme Q-10 (CoQ10), N-acetyl-cysteine (NAC), methylsulfonylmethane (MSM), and trace mineral drops (Bode & Dong, 1970; Kohlstadt, 2012, p.684-689; Wilson, 2018). 

Lifestyle changes are encouraged in holistic practice to decrease stress and support healing. Positive sleep hygiene promotes deep, restful sleep, allowing the body to heal and restore (Seaward, 2014, p.13). Meditative practices, including breathwork and moving meditations like yoga and tai chi, provide opportunity to release emotional and physical stress (Krohn & Taylor, 2000, p.342-344). Hyperbaric oxygen therapy helps oxygenate tissue to promote healing (Krohn & Taylor, 2000, p. 348-349). Cold therapy, including cryotherapy, increases microcirculation and synthesis of collagen, while heat therapy, including epsom salts soaks, steam rooms, and saunas provide pain relief and help to improve circulation (Krohn & Taylor, 2000, p. 262-265). Magnets are thought to encourage healing (Krohn & Taylor, 2000, p. 437-438). Finally, body work, touch therapy, and energy work such as chiropractic adjustments, Swedish massage, shiatsu, Rolfing, sports massage, Thai massage, reflexology, acupuncture, therapeutic touch, Reiki, and qi gong provide relaxation and reduction in chronic pain  (Al-Boloushi et al, 2019; Krohn & Taylor, 2000, p. 258-261).

Both allopathic and integrative experts agree that plantar fasciitis is persistent and often challenging to treat. With multiple options and different approaches, the consensus is that a combination of treatments bring the most favorable results (Fink, 2012).

References

Al-Boloushi, Z., Gómez-Trullén, E. M., Bellosta-López, P., López-Royo, M. P., Fernández, D., & Herrero, P. (2019). Comparing two dry needling interventions for plantar heel pain: A protocol for a randomized controlled trial. Journal of Orthopaedic Surgery and Research, 14 doi:http://dx.doi.org/10.1186/s13018-019-1066-4

Anti-Inflammatory Food Pyramid:Andrew Weil, M.D.(2020, January 16). Retrieved January 18, 2020, from https://www.drweil.com/diet-nutrition/anti-inflammatory-diet-pyramid/dr-weils-anti-inflammatory-food-pyramid/

Bode, A. M., & Dong, Z. (1970, January 1). The Amazing and Mighty Ginger. Retrieved January 25, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK92775/

Buchbinder, Rachelle, MB,B.S., F.R.A.C.P. (2004). Plantar fasciitis. The New England Journal of Medicine, 350(21), 2159-66. Retrieved from https://search.proquest.com/docview/223938185?accountid=193085

Daniels, C. J., & Morrell, A. P. (2012, March 11). Chiropractic management of pediatric plantar fasciitis: a case report. Retrieved February 7, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3315855/#bb0070

Fink, B. R., M.D. (2012). Management of plantar fasciitis evolving. The Journal of Musculoskeletal Medicine, 29(1), 16-20. Retrieved from https://search.proquest.com/docview/922379503?accountid=193085

Ingraham, P. (2019, November 1). What Works for Plantar Fasciitis? What Doesn't? Why? Retrieved February 5, 2020, from https://www.painscience.com/tutorials/plantar-fasciitis.php

Kresser, C. (2019, September 24). Bone Broth Benefits: Everything You Need to Know. Retrieved February 7, 2020, from https://chriskresser.com/the-bountiful-benefits-of-bone-broth-a-comprehensive-guide/

Kohlstadt, I. (2012). Advancing medicine with food and nutrients. Boca Raton: CRC Press, Taylor & Francis Group.

Krohn, J., & Taylor, F. A. (2000). Natural detoxification. Point Roberts, WA: Hartley & Marks Publishers.

Levy, J. (2019, September 3). Is This Fatty Oil Actually Good for You? Retrieved January 25, 2020, from https://draxe.com/nutrition/mct-oil/

Lipski, E. (2012). Digestive wellness: strengthen the immune system and prevent disease through healthy digestion. New York: McGraw-Hill.

Rakel, D. (2018). Integrative medicine (4th ed.). Philadelphia, PA: Elsevier.

Searing, L. (2019, November 25). The Big Number: 2 million Americans get treated for heel pain caused by plantar fasciitis. Retrieved February 5, 2020, from https://www.washingtonpost.com/health/the-big-number-2-million-americans-get-treated-for-heel-pain-caused-by-plantar-fasciitis/2019/11/22/0dfe89e8-0c7a-11ea-97ac-a7ccc8dd1ebc_story.html

Seaward, B. L. (2014). Essentials of managing stress. Burlington, MA: Jones & Bartlett Learning.

The Anti-Inflammatory Diet & Food Pyramid: Andrew Weil, M.D. (2019, August 9). Retrieved January 18, 2020, from https://www.drweil.com/diet-nutrition/anti-inflammatory-diet-pyramid/what-is-dr-weils-anti-inflammatory-food-pyramid/

Turmeric. (2018, November 27). Retrieved January 25, 2020, from https://nccih.nih.gov/health/turmeric/ataglance.htm

Wheeler, T. (2019, October 7). Plantar Fasciitis: Symptoms, Causes, Diagnosis, Treatment. Retrieved February 5, 2020, from https://www.webmd.com/fitness-exercise/understanding-plantar-fasciitis-basics

Wilson, D. R. (2018, September 18). 7 Health Claims About Astaxanthin. Retrieved January 25, 2020, from https://www.healthline.com/health/health-claims-astaxanthin

Young, C. C. (2019, November 12). Plantar Fasciitis. Retrieved February 5, 2020, from https://emedicine.medscape.com/article/86143-overview#showall

I Challenge You to Drink More Water!

Did you know that many of us are chronically dehydrated during the winter months?

We drink less water when it's cold out, our thirst response is diminished, and we lose more fluids through respiratory water loss in the winter. This could lead to foggy brain, sleep issues, weight gain, and mood swings, among other things. You can read more about it HERE.

So... how about this idea for a New Year’s resolution— -- DRINK MORE WATER! 

The goal is to drink half your body weight in ounces of water every day. (For example, if you weigh 200 lbs you would consume 100 ounces every day.)

Start with drinking your quota for a week. Then see if you can make it two, three, then four weeks. The longer the challenge the more likely it will become a lifelong habit.

Here are some tips to make hydration easier:

*Pre-fill multiple water bottles the night before with the amount your body needs and finish all the water bottles by the end of the next day. Avoid using one bottle with the intention of refilling it during the course of the day-- it rarely works. 

*Use only stainless steel or glass containers as water bottles. Plastic (even BPA-free) contains estrogen-mimickers and other hormone disruptors. Best to keep those out of your body. 

*Add slices of lemon, lime, cucumber, or crushed mint, etc. to your water to subtly flavor it. Avoid processed flavorings and mixes-- your taste buds will adapt over time to the more natural flavorings.

*Drink a tall glass of water first thing in the morning, right when you wake up. Not only does this give you a head start on your daily intake, but it helps get things moving, if you know what I mean.

*Drink water at meals rather than soda, coffee, etc.

*Try sparkling water to mix things up if flat water gets boring. Just avoid preservatives (often found in canned waters) and artificial flavorings. 

*There are several great apps out there that help you track your progress. I use my Fitbit app, but HERE are some other highly rated apps for hydration.

*Coffee, diet soda, sports drinks, etc. don’t count. It’s all about H.2.O.

We can do this! Tag @fittbodies on your hydration posts and use the hashtag #hydrationchallenge to let me know your progress.

Always yours in Health,

More info: 
Most Plastics Leach Hormone-Like Chemicals

6 Benefits of Staying Hydrated

24 Doctors and Health Experts Share the Benefits of Proper Hydration

Over-Exercising. Yes, It's a Thing.

Most of the people I work with fall into two camps-- they either over-exercise and are not getting the results they want, or they're not exercising enough and are obviously not happy with the results.

Which one are you?

Over-exercising is something I'm seeing more of lately, so I'm going to focus on that today. As we age, our nutritional needs change, our digestion is affected, hormone levels deplete. We gain fat around the middle, in the thighs and butt, or on our upper arms that we didn't have before. We seem just a bit "fluffier" than we were, despite doing "everything right." So we exercise harder, longer, faster. And nothing seems to change.

MORE exercise does not equate to LEANER bodies. Nor does it equate with BETTER health. 

Those of us in our 20's and 30's can get away with pushing ourselves super hard all the time. But as we age, what worked before no longer does. Our bodies tire of compensating for the constant beating, battering, and pushing. It burns out.

My solutions for this may seem counter intuitive, but I've seen these methods work time and time again. With some relatively simple tweaks to your routine, you can shed that "fluffy" layer and feel more like yourself again.

*Move More: In my experience I've found that the fittest people find every excuse to move their body in any way possible. In other words, a workout doesn't need to always be extreme or even planned to be effective. Finding ways to move your body that challenges you differently than the day before is key.  

*Move Even More: Walking more often, taking the stairs, trying a new activity-- these things all count. Mixing up your routine works, too.

*Play Around With the Time and Length of Your Workout: Work out in the afternoon once in a while if you always work out in the morning. Or vice versa. Force your body out of its comfort zone, not always with intensity, but with length of your workouts as well. Do a short, quick workout once in a while. Take a long hike or bike ride. Mix things up.

*Do Something New: Try something you've always wanted to try-- many clubs/trainers/facilities offer free classes to whet your appetite.

*Did I Mention Move More?: Treat yourself to a walk during lunch or after dinner. (Check out my "Walking is Underrated" YouTube video). 

*Add Another Rest Day:  This might drive you crazy at first, but hear me out. We increase inflammation in our bodies with exercise. This is expected and wanted-- to a point. When we don't allow for proper rest and restoration, our bodies never get the relief from the inflammatory process. Puffiness, fatigue, extra fat padding, sweets cravings, overuse injuries, and poor sleep are all signs of over-exercise. Back off. The quality of your remaining workouts will improve and your whole body will thank you.

*Periodize: In other words, if you're training  hard over a period of time, incorporate some lower-intensity days/weeks/months in to the mix. Some people focus on an intense month alternating with a more moderate month. Others go hard certain days of the week and take it easier the others. I personally do two high-intensity workouts a week (Spinning), three moderately-intense workouts a week (hot yoga), and one low-intensity workout a week (rebounding). I rest two days a week. I walk every day that I can fit it in, take the stairs every time possible, and use a fitness tracker to keep my activity level consistent every day. And I'm as fit, maybe fitter, than I was when I was pushing myself every day to the extreme. 

*Hydration & Nutrition: This is a whole 'nother blog post. What I'll say here is that the older we get, the more watchful we must be with every single bite of food in order to maximize our health and stay the leanest we can. That doesn't mean becoming an orthorexic, or obsessing over our food. But it does mean that exercise alone ceases to work when we reach a certain age. 

So here's the deal-- if you were suffering from the signs and symptoms listed above and were exercising a ton with little or no response, I would counsel you to slow down. It's not sexy, not exciting, and certainly feels like slacking. But it might be just what you need to get back on track.

**As always, I welcome your thoughts on this. Follow me on Facebook, Instagram, Twitter, and YouTube for lots more. And THANK YOU for tuning in!

xoxo,

My Fittbodies fitness and nutrition products are on $ale! Check them out HERE.

Walking is Underrated

At work we've started the collective effort to walk more, with many of us participating in a program called "Walktober." It got me thinking about walking, and how it's such a wonderful way to move our bodies, but tends to get a bad rap, especially with the "fitter" crowd.

Walking tends to get overlooked as a way to get healthy and as a way to get or stay in shape for a variety of reasons. We think a higher intensity activity is the only way to go. We think it's boring, or time-consuming, or too simple. It's not social enough, or it's too social (if we walk with friends). It's something "old people" do. 

Health and fitness experts agree that walking is one of the BEST ways to move your body. 

It's free, it's easy, it's safe, and it's convenient.

So, how much of it do we have to do to gain benefits?

Most experts agree on 10,000 steps a day. More is better, when it comes to walking, so if you can beat that number you'll get even more benefits, which can include

*Better sleep

*Decreased anxiety

*Increased memory recall

*Decreased waist circumference

*Increased bone mass

*Reduced risk of cardiovascular disease and stroke

*Decreased stress

*Increased energy

*The list goes on...

A fitness tracker is a great tool to track your steps each day. Some models offer heart rate stats, sleep stats, calories burned, etc. Click HERE for a review of 2017's top models.

Find excuses to move your body more, whether it's taking the stairs, parking farther away from your destination, moving around the classroom more, or taking a walk during lunch. (See my prior blog post--Sitting is the New Smoking--for ideas to keep moving throughout the day).

Always yours in health,

Sources: 

http://time.com/4745061/how-many-steps-walking/

https://chriskresser.com/how-many-steps-should-you-get-in-a-day/

https://www.nbcnews.com/better/health/why-walking-most-underrated-form-exercise-ncna797271

https://www.prevention.com/fitness/benefits-walking-every-day

Sitting is the New Smoking

Maybe you've heard the saying, "Sitting is the new smoking." 

While there's nothing wrong with sitting and putting your feet up after a long day at work, what IS a challenge is to moderate all the sitting that happens while at work. 

Where we work and spend our day represents the whole spectrum: teachers are up and down throughout the day. Office folks tend to sit down to get their work done. Postal workers, retail workers, food service workers, and others might never get a chance to sit down during their work day. 

Wherever you fall in the grouping, it's important to be aware of the downsides of sitting too much.

*Our risk of obesity increases, with weight gain around the middle more prevalent.

*Cholesterol, blood sugar, and blood pressure tend to be higher.

*There's an increased risk of cardiovascular disease and cancer.

Experts say sitting too much can be as unhealthy as smoking...

Here are some ideas to manage all the sitting we do:

*Set a timer for 45 minutes and get up and stretch, get a drink, move around when the timer goes off. Set it again after a few minutes break and repeat throughout the day.

*Use a standing desk, or make your own. (I set up my laptop on top of the mini fridge on my desk.)

*Have standup meetings (or walking meetings) instead of sitting. 

*Take the stairs instead of the elevator. Easy to do here at some work sites or at home. Tougher to do at medical centers, taller office buildings, etc., but worth it.

*Walk a brisk lap around the building before or after lunch. (Map out an inside route for bad weather days). Wave hi to your co-workers as you pass their classrooms.

*Move while watching TV. Stretch, bounce on a mini trampoline, ride a stationary bike, or plank, squat, or do sit ups during commercials. 

*Park further away from your destination to compel you to walk more. That could be as simple as parking at the back of the Safeway parking lot or a bit more challenging like parking at JC Penney's and walking through the mall to your Nordstrom destination. (I must note it always fascinates me to see the people at my gym fight over a front row parking spot.)

*Invest in a fitness tracking device (FitBit, TomTom, Garmin, etc.) to track your movements. (I get reminders on my FitBit when I haven't reached 250 steps in an hour.)

*Enlist the support of a coworker. Whether they're at the cubicle next to you or in the kitchen or the office, having someone hold you accountable can get you moving. 

Regardless of your methods, it's important to MOVE!! Our bodies are designed for movement, so find excuses to get up and go!

Enjoy moving more everyone!

xoxo,

Sources: 

http://www.techrepublic.com/article/is-sitting-really-the-new-smoking-an-in-depth-discussion-with-the-experts/

http://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/sitting/faq-20058005

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4838429/

Ladies, I Need Your Help!

Do you identify with any of these statements?

*I consider myself healthy and fit.

*I try to eat healthy meals and snacks.

*I love to learn more about health and fitness.

*I exercise regularly.

**I'm experiencing the beginnings of perimenopause-- bloating, weight gain, digestive issues, brain fog, fatigue, mood swings, etc.

**I'm well into my journey through menopause.

**I've made it through to the other side of menopause and celebrate my transformation.

If you answered YES to any of the above statements, I need you!!

I am writing an ebook about the transformation of fit women through menopause, and I'd love to include your thoughts, experiences, & advice within the pages.

Most women begin "the change" in their late 40's into their mid-50's, but many women experience peri-menopausal symptoms in their 30's all the way to their 60's. And yet it's something we don't talk about much...

Wherever you fall in this spectrum, you have tips, tricks, hacks, suggestions, advice that we all could benefit from. Please consider sharing your knowledge with other fit, healthy women in the Fittbodies community.

Click on this LINK & FILL OUT THE FORM-- (If you're uncomfortable using your real name then please sign off as "anonymous.")

If you've got more than one tidbit to share, by all means fill out the form several times, and don't forget to share this email with any of your fit, wise, midlife friends so they can contribute too!

I can't wait to learn from you!!

Thank you in advance for your contribution!

xoxo,

Stephenie

Sleep and Weight Loss

NEED A NAP RIGHT NOW?

You're not alone! 

Studies show that nearly 1/3 of Americans suffer from sleep deprivation. This affects just about every aspect of life, from relationships, productivity, sexuality, mood, driving, health, and life span. 

Click HERE to see the National Sleep Foundation's "25 Random Facts About Sleep." It's fascinating and frightening at the same time.

Some of you know how much I LOVE podcasts. I just listened to a 2-part interview on The Chalene Show with Dr. Michael Breus, a sleep expert, and I'm so excited to share what I learned with you!

*We all fit into one of four sleep chronotypes.
*It's a myth that we all need 8 hours of sleep a night.
*Our weekends can undo great sleep during the week.
*Sleep-deprived people tend to eat more and have higher body fat than their well-rested counterparts.
*Our hormones go haywire when we don't get enough quality sleep.

Please take the time to listen:

How Sleep Loss Affects Weight Gain, Part 1

How To Radically Improve Your Life By Knowing Your Natural Sleep Type, Part 2

Happy Listening (and Sweet Dreams)!

xoxo,

Stephenie

PS-- I'm a BEAR. Just in case you were wondering what my sleep chronotype was...