Night Time Leg Cramps: Perform These 3 Stretches Before Bed

Have you ever jumped out of bed with an intense cramp in your leg or foot?  Night time leg cramps occur suddenly and are extremely painful.  Pain can be sharp and last for a few seconds or several minutes.  They can lead to substantial sleep disturbances.  Night time cramps occur in almost 50% of older adults.  Medications are prescribed to treat people with severe leg cramps.  However, the effectiveness of these medications is mixed and many have serious side effects. Thankfully, there is a series of proven home stretching exercises you can perform to alleviate your night time leg cramps.

Causes and Treatment of Leg Cramps

Leg cramps are actually sustained, involuntary muscle contractions of the calf, hamstrings, or foot muscles.  We don’t fully understand what causes these painful leg cramps.  Experts believe abnormal activity of nerves is the most widely accepted cause.  Abnormal firing of nerves can be due to medications (diuretics and steroids to name a few), physical inactivity, and age-related changes in nerves, muscles, and tendons.  People with other health problems such as thyroid disorders, high blood pressure, and neurological diseases are more at risk.

Foot cramp

Medications and supplements are commonly used to decrease activity of the excited nerves in order to reduce leg cramping.  Quinine has been shown to be moderately effective in reducing the frequency and intensity of cramps.  However, its use comes with the potential for serious and sometimes life-threatening side effects, especially in women.  Other medications have been used to treat leg cramps such as magnesium, Vitamin B, calcium, and Vitamin E; however none of these appears to be effective.

Proven Stretches for Leg Cramps

The combination of physical inactivity and age-related changes in the nerves, muscles, and tendons predisposes you to cramping at night.  Regular daily physical activity, such as a walking program, will increase lower leg blood flow to the nerves, muscles, and tendons.  Stretching exercises at night calms your excitable nerves and lengthens your shortened muscles and tendons.  A 2012 study of 80 adults over the age of 55, showed significant improvements in the severity and frequency of night time cramps after performing nightly stretches before bed.  The following 3 videos show stretches which can easily be performed in 10 minutes or less prior to settling in for the night.

Standing Calf Stretch

Stand facing a wall with your elbows straight and both hands on the wall at chest level.  One leg is forward with your knee bent, and the other leg is back with your knee straight. Both feet are in full contact with the floor. Your back heel remains in contact with the floor as you lean towards the wall.  Hold the stretch for a minimum of 10 seconds and as long as 30 seconds.  Perform 2 to 3 stretches on each leg immediately prior to bed each night.

Standing Hamstring Stretch

Face a chair that is placed against a wall.  Place one heel on the chair with your knee fully straight.  Hold on to something for balance.  Bend at the waist so that your trunk tilts forward, keeping your back straight. The foot on the floor should maintain full contact and the other heel remains in contact with the chair.  Hold the stretch for a minimum of 10 seconds and as long as 30 seconds.  Perform 2 to 3 stretches on each leg immediately prior to bed each night.

Seated Hamstring Stretch

This stretch is similar to the standing version.  Not everyone will need to perform both.  To perform the sitting version sit on the side of your bed with one leg extended in front. The other foot maintains in contact with the floor.  Bend at the waist so that your trunk tilts forward, keeping your back straight.  Hold the stretch for a minimum of 10 seconds and as long as 30 seconds.  Perform 2 to 3 stretches on each leg immediately prior to bed each night.

Start Stretching Tonight

Night time leg cramps can be miserable.  They can severely disturb your sleep leaving you with little energy to do things during the day.  Regular night time stretching can alleviate much of the distress.  In order to achieve the best results, stretching must be done each night.  Infrequent or random stretching will do little good.  Give these 3 stretches a shot for at least 6 weeks and see how things are going.  If you want more help give us a call.  Our physical therapists can help you find the right stretches for you and supplement these with massage and other manual therapy treatments.   You don’t have to keep suffering with night time leg cramps.

Calf Muscle Injuries:  Exercises for Your Best Recovery

A calf strain is an injury to the muscles in the back of your leg, below the knee.  Two major muscles make up the calf.  The gastrocnemius muscle is the large outer muscle in the back of the lower leg.  The smaller soleus muscle lies deep underneath the gastrocnemius.  Both plantarflex the foot.  This occurs when the toes are pointed downward such as when stepping on the gas pedal of a car.  These muscles are also highly active when pushing off during walking, running, or jumping.   Calf muscle injuries occur as a result of normal daily activities such as walking or stepping down from a curb.  Calf muscle injuries are also very common in sports such as tennis, football, soccer, and basketball.

Common symptoms of calf muscle injuries include sharp pain in the lower leg when walking or attempting to push with the toes.   Older adults and athletes with a previous history of muscle strains are particularly susceptible to calf muscle injuries.  Larger individuals are also at an increased risk.  Calf muscle injuries can be very slow to heel with typical recovery taking 3 to 6 months.  They also tend to reoccur often, especially in athletes.  Thankfully, early rehabilitation can expedite recovery from these nagging injuries.

Proven Treatment for Calf Muscle Injuries

Traditionally, treatment for calf muscle injuries has included rest, ice, compression, and sometimes medications to control pain.  This approach may result in an initial decrease in pain.  However, a more aggressive approach is required to achieve the best long-term outcome.

A 2018 study from Denmark, investigated the effectiveness of early versus delayed physical therapy on recovery after muscle injuries.  Individuals receiving early physical therapy began treatment 2 days after their injury.  Compared to those who delayed treatment, the early physical therapy individuals made a pain-free recovery and return to sports 3 weeks sooner.  These findings suggest too much rest early after a muscle injury can result in a prolonged recovery.  The following exercises are components of this proven approach to recovery from calf muscle injuries.

Calf Stretch

It is important to maintain ankle range of motion and flexibility as the injured muscle heals.  Gentle stretching will help the injured muscle heal at its normal length.  Begin sitting with the knee straight and a towel or belt wrapped around the ball of the foot.  Gently pull the toes towards the shin and hold this stretch for 15 to 30 seconds.  Performing the exercise with the knee straight emphasizes the stretch to the gastrocnemius muscle.  Slightly bending the knee emphasizes the soleus muscle.   This stretch can be performed multiple times each day.

Calf Isometrics

It is important to begin muscle activation exercises early after injury.  This will help diminish pain and facilitate blood flow to the healing muscle.  Slight pain (<5/10) is acceptable during the exercise.  Sit with the knee extended and foot up against the wall or another immovable object.  Gently push the toes and foot down into the wall as if stepping on the gas pedal of a car.  You will feel the calf muscle contract slightly as you do this.  Hold the contraction for at least 10 seconds.  Performing the exercise with the knee straight emphasizes activation of the gastrocnemius muscle.  Slightly bending the knee emphasizes the soleus muscle.  These exercises can be performed multiple times daily.

Heel Raise Exercises

As pain diminishes, isometric exercises are progressed to heel raise exercises.  This involves rising up on to the toes from a standing position.  Performing the exercise with the toes turned out will emphasize the inside aspect of the calf muscles.  This is where most calf muscle injuries occur. Performing the exercise with toes turned in emphasizes the outer aspect of the calf muscles. Weights can be held in the hands or a bar can be placed over the shoulders to increase the load.  Typically, 10 to 20 repetitions are performed for multiple sets several days per week.

Final Thoughts on Calf Muscle Injuries

Other treatments, such as manual therapy, can expedite recovery from calf muscle injuries.  More challenging balance and sport-specific exercises are incorporated when pain decreases and strength improves.  Pain free function can take several months.  However, starting the right exercises early is a proven approach.  These 3 exercises are only a small sample of an effective physical therapy program.  Your physical therapist can perform an individual assessment and design an exercise program based on your unique problems and goals.  Contact us today if you have questions about which exercises are right for you.

Painful Achilles Tendon? Learn the Right Exercises

Painful Achilles tendon disorders are common in people who perform repetitive running and jumping activities.  It is also common in less active people.  Sedentary individuals with chronic disease such as high blood pressure, obesity, and diabetes are at an increased risk.  Even though it is commonly injured, the Achilles tendon is one of the largest and strongest tendons in the human body.  It spans from the calf muscle in the lower leg down to its attachment on the heel.  It is important to transfer forces during routine walking and explosive movements in sport.

Irritation of the tendon is commonly referred to as “Achilles tendinitis” which implies the presence of inflammation.  However, studies show there is an absence of inflammation in most people who are suffering from a painful Achilles tendon.  It is now widely believed the problem is related to degeneration and weakening of the tendon, not inflammation.  This explains why many treatments aimed at reducing inflammation, such as rest and anti-inflammatory medications, are ineffective.

The Role of Exercise in Managing a Painful Achilles Tendon

Research suggests 3 out of 4 athletes with a painful Achilles tendon will fully recover with conservative treatment including exercise.  The prognosis for sedentary individuals is less favorable.   Regardless of age or activity level, 4 to 6 months of conservative treatment is recommended.  Research suggests exercise is the most successful conservative treatment for painful Achilles tendon disorders.   The focus of the exercise program is to progressively load and strengthen the painful tendon.

Some pain, usually 5/10 or less is acceptable during exercise.  However, increased pain experienced during exercise should not persist into the next day.  If this occurs, you would be best served to see your physical therapist.   Traditionally recommended exercise includes eccentrics characterized by slow lowering of the heel from a tip-toe position.  More recently, other forms of strengthening exercise have been shown to be equally effective.  The 4 exercises described here have been supported by research.

2-Leg Heel Raise

This is the first exercise to be performed as part of a progression.  Stand with equal weight distributed between both legs.  Hold on to a wall or other object for support.  Slowly rise up on both tip-toes.  Pause 2 seconds then slowly lower to the starting position.  Typically 3 sets of 15 repetitions are performed daily.  As pain diminishes and strength improves over a few weeks, begin performing this exercise with the heels hanging from a step.  This will increase the range of motion of the exercise and provide a stretch stimulus to the tendon.   The exercise can be further progressed by adding a backpack with 10 pounds of weight.

1-Leg Heel Raise

This exercise should be performed during the first few weeks along with the 2-leg exercise.  If pain greater than 5/10 persists after the exercise and into the next day, the 1-leg version may need to be delayed.  Discuss this with your physical therapist.  Start by standing on the involved leg only.  Slowly rise up on to the tip-toe.  Pause 2 seconds then slowly lower to the starting position.  Typically 3 sets of 15 repetitions are performed daily.  As pain diminishes and strength improves over a few weeks, begin performing this exercise with the heels hanging from a step.  This will increase the range of motion of the exercise and provide a stretch stimulus to the tendon.   The exercise can be further progressed by adding a backpack with weight.

Eccentric Heel Drop

This exercise can also be performed during the first few weeks along with the 2-leg and 1-leg exercises.  If pain greater than 5/10 persists after the exercise and into the next day, it may need to be delayed.  Discuss this with your physical therapist.  Start by standing on the uninvolved leg only.  Slowly rise up on to the tip-toe of the uninvolved leg.  Then shift the weight onto the involved leg.  Slowly lower to the starting position using the involved leg only.  Repeat this sequence of “up with the good” and “down with the bad” leg.  Typically 3 sets of 10 to 15 repetitions are performed.  As pain diminishes and strength improves over a few weeks, begin performing this exercise with the heels hanging from a step.  The exercise can be further progressed by adding a backpack with weight.

Heavy Slow Resistance Heel Raise

For many people with a painful Achilles tendon, performing the previous 3 exercises regularly will achieve outstanding results within 3 months.  However, many athletes involved in running and jumping sports will require higher loads to strengthen the injured tendon.  Heavy slow resistance exercise is performed with progressively higher loads performed very slowly.  The exercises are initially performed with loads which allow 3 sets of 15 repetitions.  Every 2 to 3 weeks, the load is increased and the repetitions are decreased.  The goal is to slowly perform 3 to 4 sets of 6 to 8 repetitions with high loads to fully stimulate tendon remodeling.  These exercises can be performed with a barbell on the back or with exercise machines such as a leg press or calf raise machine.

Speed Recovery by Combing Exercise with Manual Therapy

Achilles tendon

Many people will fully recover within 12 weeks to 1 year of performing the Achilles tendon loading exercises.  This length of recovery may not be acceptable for some people.  Thankfully, research shows greater improvements can be made when exercise is combined with manual therapy performed by a physical therapist.  One recent study showed the addition of soft tissue techniques resulted in 100% of patients achieving a successful outcome at 12 weeks compared to 50% who performed only exercise.   During each session 15 minutes of soft tissue mobilization is applied to the lower leg, ankle, and foot musculature.  The purpose is to improve mobility and further stimulate tendon healing and remodeling.

Closing Thoughts

Painful Achilles tendon disorders can be debilitating.  Thankfully, exercise and other conservative treatments delivered by a physical therapist have been proven to be effective.  Recovery is usually not quick or easy.  Success is dependent on your commitment to perform the exercises regularly.  Expect some pain during the exercise but don’t progress things too quickly if pain persists into the next day.  Often a little guidance from your physical therapist can keep you on the right track.  Contact your physical therapist if you would like some help.

Plantar Fasciitis Stretches to “Heel” Your Pain

Plantar fasciitis is the most common cause of heel pain in both athletes and older adults.  It is characterized by degenerative changes in the plantar fascia of the foot.  The plantar fascia is a thick band of ligament which supports the arch of the foot.  The most common symptom of plantar fasciitis is heel pain during the first few steps of walking.  The disorder affects 10% of the population at some time in life.  Two million Americans are treated for plantar fasciitis every year.  Plantar fasciitis stretches are one effective form of conservative treatment.

Deficits in the lower leg and foot muscle strength contribute to the development of this condition.  However, research has found inconsistent results when treatment includes strengthening exercises only.  Plantar fascia stretches have been proven to be more useful for helping people with plantar fasciitis.   The remainder of this article discusses how people can alleviate pain from plantar fasciitis through regular stretching.

Plantar Fasciitis Stretches

A 2016 study performed in Brazil compared the effects of 3 different treatment approaches.  One group performed stretching exercises alone.  Another group performed stretching plus strengthening exercises for the foot.  The third group performed stretching plus strengthening for the foot and hips.   All 3 groups showed significant improvements in pain and function after 8 weeks of treatment.  However, there were no differences between groups.  This suggests adding strengthening exercises to a program of stretches confers no additional benefit.  The principle improvements occur due to regular stretching of the plantar fascia and calf muscle.

Seated Plantar Fascia Stretch

This exercise should be performed first thing in the morning before stepping out of bed.  Sit on the side of the bed with the leg to be stretched crossed over the other.  Grasp the heel with one hand.  Grasp the toes with the other hand.  Pull the toes back towards the top of the foot until a mild to moderate stretch is felt in the bottom of the foot.  Hold this stretch for 30 seconds and perform 3 repetitions.

Calf Muscle Stretch

The plantar fascia tissue is continuous with the Achilles tendon and calf muscle complex.  Therefore stretching should be directed towards both of these areas.   Stand with the affected foot back.  The heel remains in contact with the floor as you lean towards the wall or a counter.  The knee remains straight to stretch the larger gastrocnemius muscle.  Slightly bend the knee to stretch the deeper soleus muscle.  It is important to stretch both muscles.  Hold each stretch for 30 seconds and perform 3 repetitions.

High-Load Heel Raises

This exercise is a hybrid stretching and strengthening exercises.  It utilizes the higher-load of your body weight to stretch the plantar fascia and provide a stimulus for the tissue to become stronger. This exercise is more effective for people who have been experiencing heel pain for 3 months or longer.   Expect some pain initially when performing this exercise.

Stand with both feet on a step and the heels hanging off the edge.  Place a small towel roll under the toes to help provide a stretch to the plantar fascia.  Rise up onto both toes over a period of approximately 3 seconds.  Remove the unaffected foot from the step once at the top of the movement.  Hold this position for 2 seconds.  Slowly lower the affected heel over a period of approximately 3 seconds.  Place the unaffected foot back on the step and repeat the sequence.  Typically 3 sets of 12 repetitions are performed every other day.  The exercise is progressed by incorporating a back pain with weights.

Closing Thoughts

It is common for plantar fasciitis to last up to one year.  Thankfully, performing regular plantar fascia stretches can alleviate pain and speed up your recovery.  If you are experiencing heel pain, start with these 3 stretches.  Perform the first 2 daily, and the high-load heel raises every other day.   Your physical therapist can also design an individualized exercise program tailored to your unique goals.  Give us a call if you need some help.

References

  1. Kamonseki DH, Goncalves GA, Yi LC, Lombardi Junior I. Effect of stretching with and without muscle strengthening exercises for the foot and hip in patients with plantar fasciitis: A randomized controlled single-blind clinical trial. Man Ther. 2016;23:76-82.
  2. Rathleff MS, Fredberg U, Kaalund S, et al. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scand J Med Sci Sports. 2015;25(3):292-300.

Plantar Fasciitis: The Role of Physical Therapy

Plantar fasciitis is one of the most commonly treated types of foot pain in physical therapy.  Overuse or repetitive stress to the bottom aspect of the foot is the most common cause.  It typically affects younger females however males are also likely to have symptoms. Older individuals are at risk for developing plantar fasciitis as well as athletes.  Individuals with an elevated body mass index are prone to heel pain and other foot conditions. Typically symptoms of plantar fasciitis will include pain on the bottom of the foot upon standing after prolonged inactivity or after an increase in activity.  This is common when runners increase their distances.  Symptoms may include chronic heel pain leading up to plantar fasciitis or chronic calf tightness.

What is Plantar Fasciitis?

The plantar fascia is a thick band of connective tissue that spans the bottom of the foot. It runs from the calcaneus (heel bone) down towards the toes.  The plantar fascia assists in walking by providing stability to the ankle and foot. In cases of plantar fasciitis, the tissue is “overloaded”.  This may cause pain that is most pronounced when standing for prolonged periods of time or upon standing after prolonged sitting. Chronic calf tightness or flat feet may be risk factors for developing plantar fasciitis.  However, any activity that increases the force on this structure may cause symptoms.

What can a Physical Therapist do for you?

Techniques utilized by a physical therapist can significantly decrease plantar fasciitis related symptoms. Some of these techniques include manual therapy to increase the ankle range of motion.  Improving ankle/foot range of motion through patient-specific exercise is also important. Your physical therapist may recommend exercises that reduce the load on the foot to start, including bike riding or swimming. Various athletic taping techniques have been proven to help reduce the load on the foot and allow the plantar fascia time to “rest”. These taping techniques have been shown to be an effective form of care in treating plantar fasciitis. Your physical therapist may also be able to assist you in an orthotic recommendation. Orthotics may be especially effective for individuals who respond well to taping techniques.

manual therapy for plantar fasciitis

Balance exercises are incorporated as symptoms improve.  Exercises to target hip and knee strength and range of motion impairments may also assist in improving symptoms. Calf and heel cord stretching is another effective method to reduce symptoms. These techniques will help progress a patient back to their sport or daily function without pain and allow for pain-free activity and improve your overall quality of life.  Talk to your physical therapist to see if your plantar fasciitis symptoms can be alleviated by some of these treatment options.

plantar fasciitis exercise

Conclusion

Plantar fasciitis is a common form of foot pain that impacts many lives and limits function.  Plantar fasciitis symptoms may resolve on its own over time, sometimes up to one year.  However, treatment by a physical therapist may assist alleviating pain at a rapid pace. No one treatment works best for everyone.  A physical therapist can assist you in determining the treatment plan that is going to be the most effective for you to reach your goals. There are many other forms of foot pain that may mimic plantar fasciitis. Your physical therapist can help in screening for these other types of injuries. Come to talk to your physical therapist today!

Written by Dr. Steve Ferro, PT, DPT, OCS

References

1.Martin R, Davenport T, Reishl, S, et al. Heel Pain–Plantar Fasciitis: Revision 2014. Journal of Orthopaedic & Sports Physical Therapy. 2014;44(11):A1-A33. DOI: 10.2519/jospt.2014.0303.

2.Cole C, Seto C, Gazewood J. Plantar fasciitis: evidence-based review of diagnosis and therapy. American Family Physician. 2005;72:2237–2242.

3.Pollack Y, Sashua K, Kalichman L. Manual therapy for plantar heel pain. The Foot. 2018;34:11-16. DOI: 10.1016/j.foot.2017.08.001.

4.Stecco C, Corradin N, Macchi V, et al. Plantar fascia anatomy and its relationship with Achilles tendon and paratenon.  Journal of Anatomy. 2013;223(6):665-76. DOI: 10.1111/joa.12111.

Ankle Sprains: Diagnosis, Treatment and Return to Sport

What are Ankle Sprains?

Ankle sprains are one of the most common injuries that people experience.  These injuries account for one million physician visits each year.  Lateral ankle sprains, also known as inversion sprains, are the most common.  They are particularly common in sports.  Forty percent of all traumatic ankle sprains occur during sports.  However, only 50% seek medical attention. The lack of medical care results in an increased risk for developing chronic ankle stability.  There are 3 different grades of ankle sprains, which progressively worsen with each grade.  Healing times vary from a couple of days to up to 6 months depending on severity.

Grades of lateral ankle sprain

What are Lateral Ankle Sprains?

Lateral ankle sprains occur when the outside of the ankle is stressed .  This usually occurs when the ankle is forcefully turned inward. This can happen when stepping on an uneven surface or landing awkwardly after jumping. The lateral ankle sprain typically occurs with stress to 1 of the 3 ligaments that stabilize the outside of the ankle. Depending on whether the foot is up (dorsiflexed), neutral, or down (plantarflexed) different parts of lateral ankle ligaments can be injured.

Lateral ankle sprains

How does a Physical Therapist Diagnose a Lateral Ankle Sprain?

A physical therapist can use tests and measures to diagnose ankle sprains. Typically this will involve checking ROM (range of motion) and strength of the ankle and lower leg.   Additionally, special tests and joint mobilization testing  can bias the ligaments to determine which are involved.  Movement analysis such as the FMS (functional movement screen), hop testing, and running/agility tests can also be used to help determine some of the impairments that may have contributed to the ankle sprain.  If you are seeing a physical therapist with direct access (seeing a PT first without going to a physician) they will perform other tests and screening procedures to make sure physical therapy is appropriate.  If your physical therapist feels you need different services, he or she will direct you to the best healthcare provider.

How are Ankle Sprains Treated?

Depending where you are at in the recovery phase and your goals, a physical therapist will approach your care differently. Early in treatment crutches or a boot may be used and a physical therapist will focus more on pain, swelling and maintaining motion and strength.   As your recovery progresses, your treatment will progress to more active treatments.  This will include manual therapy to improve ankle motion,  proprioceptive training, training for return to activity and strengthening exercises targeting areas that the therapist has found to be weak.

How do you Know you are Ready to Return to Sports?

Physical therapists have a great deal of experience in determining if you are ready to return to sports, work, and other activities.   A few of the tests a physical therapist can use to determine if you are ready to go back to your sport are the FMS, Y-Balance test, hop testing, tuck jump assessment, and the Landing Error Scoring System.  A physical therapist can also give you recommendations on footwear and proper training tips to help avoid ankle sprains in the future.  Contact your physical therapist to learn more about managing ankles sprains.

References

  1. Vuurberg G, Hoorntje A, Wink L, van der Doelen B,van den Bekerom M, Dekker R, van Dijk C, Krips, R, Loogman, M, Ridderikhok M, Smithuis F, Stufkens S, Verhagen E, de Bie R, Kerkhoffs G. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline.British Journal of Sports Medicine 2018;52:956
  2. Doherty C, Delahunt E, Caulfield B, et al. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med 2014;44:123–40
  3. Verhagen EA,van Mechelen W,de Vente W. The effect of preventive measures on the incidence of ankle sprains. Clin J Sport Med 2000;10:291–6
  4. McGuine TA,Keene JS. The effect of a balance training program on the risk of ankle sprains in high school athletes. Am J Sports Med 2006;34:1103–11
  5. Kobayashi T,Tanaka M,Shida M. Intrinsic Risk Factors of Lateral Ankle Sprain: A Systematic Review and Meta-analysis. Sports Health 2016;8:190–3
  6. Ivins, D. Acute ankle Sprain: An update. American Family Physician. 2006:741714-1720
  7. Wolfe M, Uhl T, Mattacola C, McCluskey L. Management of Ankle Sprains. Management of Ankle Sprains. 2001,63:93-1004
  8. EIM 2018 Sports Physical Therapy Competencies 2018 Lab Manual