Recurring Plantar Fasciitis

A 40-year-old marathon runner and coach developed pain in his left foot while training. He was told he had a “torn plantar fascia.” and was given a walking boot (foot brace), which he wore for several months. In our initial assessment, it became apparent that the walking boot was not alleviating the pain and that, indeed, the patient did not suffer from plantar fasciitis as he had been told. We performed an ultrasound scan of his foot and no tear or inflammation was found.

A subsequent physical examination indicated that his foot pain was probably caused a problem in his lower back, even though his low back pain was sporadic. Image studies and an MRI revealed a lumbar disc bulge impinging on a nerve that affects the bottom of the foot. Treatment was prescribed that focused on the lower back with stretches, strengthening and neuromuscular stabilization. The patient’s foot pain showed a marked improvement in the first week and was completely resolved within four weeks — with no recurrence in the past two years.

Running Knee Pain

A 30-year-old female runner developed progressive pain in her right knee. She was told that she had “tendonitis of the knee” as a result of a “patella femoral syndrome,” and underwent a variety of treatments over the next few months, focused mostly on her knee. She was prescribed a variety of medications, given tips on several training techniques, and underwent soft tissue treatment and taping — all to no avail. In our evaluation we confirmed the same diagnosis. However, we found that the cause of her recurrent knee pain was the result of easily fatiguing hip muscles that were non-painful on the same side. This allowed “overloading” of the knee with excessive force during running, which resulted in the knee pain. During a physical examination, we found the feet, ankles, knees, hips and lower back to be healthy. The revised treatments focused on controlling the right knee pain, as well as strengthening the muscle endurance and control of the right hip girdle, which provided full body dynamic stability. The right knee pain and tendonitis resolved within four weeks. She jumped in to a revised and improved training regimen and in only three months had returned to top form. Since then, she has successfully completed several marathons and half marathons.

Pain after Surgery

A 65-year-old male, who successfully underwent lower back surgery in the past, ago, developed recurrence of lower back pain, prompting him to rely on strong pain medications. As a result of the intense pain and the medication, he found that he couldn’t continue playing golf — his passion — and furthermore, was experiencing an overall diminished quality of life that was affecting not only himself, but his family and friends.
When he arrived at FORMA, we performed a comprehensive evaluation that included a detailed history of his back problems, a complete physical examination and a thorough review of new weight-bearing lumbar X-rays. Following an in-depth discussion with his spine surgeon, strategic injections were recommended for diagnostic and possible treatment to control his back pain. The patient responded well to the injections, citing decreased pain and inflammation, which allowed him to progress with physical rehabilitation. He was able to decrease his need for pain medication, and as he became more pain-free, he began a personalized “cross training” type of conditioning exercise regimen set up by FORMA. As a result of this structured exercise, he was able to return to the golf course with his friends.

Shoulder and Neck Pain

A 53-year-old female with a history of diabetes developed tightness in her left shoulder. Instead of seeking professional help, she dabbled in several self-directed treatments including massage and exercise therapies. As a result, she discovered she was unable to raise her left arm, making it difficult to get dressed or fix her hair without intense shoulder pain.

During a subsequent evaluation, the woman was told that she had a partial tear in her rotator cuff. Physical rehabilitation was recommended in lieu of surgery. But during a comprehensive evaluation performed at FORMA, it was discovered that, in addition to the rotator cuff injury, there was another problem. An MRI confirmed a compromise of the nerve supply from her neck to the left shoulder. These new findings explained why exercise alone was not able to resolve her left shoulder pain. Once an effective rehabilitation program was implemented — including the neck, upper back and shoulders — the patient experienced significant pain relief and a return to shoulder function. Within 12 weeks she was able to return to her own self-directed exercise program. Since then, she has traveled the world without the physical limitations that plagued her before her visit to FORMA.

Chronic IT-Band Pain

A 35-year-old female marathon runner developed pain in the left hip every time she ran any further than five miles. She said burning pain radiated to the back of her hip and then down the side of her thigh. The patient confirmed that the pain dissipated when she rested or performed stretches to the hip and lower back, focusing on her IT band syndrome pain. But her efforts proved fruitless and the pain progressed to the point where she couldn’t run more than a mile. An initial evaluation at FORMA showed that she had a slightly longer left leg and a curvature on the left side of her lower back. She was also found to have developed weakness in her left hip and left foot, which compromised her running posture as the muscle weakened. Her physical rehabilitation plan incorporated unloaded cardiovascular conditioning training to avoid de-conditioning, followed by focused lower back decompression and stabilization. She progressed to core strengthening and running specific stabilization for her hip, knees and feet. Since she became asymptomatic, she has maintained her personalized training schedule and has completed several races for which she was well prepared.

Shin Splints versus Stress Fracture and Training

A 25-year-old female undergoing training for her first marathon developed pain in the front of her left shin. She found that her pain was worse with running and better with rest. She purchased several brands and styles of running shoes without experiencing any significant improvement. An initial medical evaluation with negative shin x-rays lead to a diagnosis of shin splints. She decreased her running and the pain did not go away. In her initial evaluation at FORMA, the possibility of a stress fracture was explored and an MRI confirmed the diagnosis, allowing for a more predictable prognosis. Her marathon training was radically modified to allow her stress fracture to properly heal She was instructed on how to condition her running neuromuscular supporting system. To prepare for her first-ever marathon, she was also told to continue her cardio respiratory training demands using non-impact modalities. After six weeks, she progressed to the point of running with reduced loading, and two weeks later she began incorporating and finally transition to ground running. She completed her first marathon in 4.5 hours — without shin pain.