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Diana Remaley, LMT
Diana@RemaleyMassage.com
(203)292-5362
19 Compo Road South
Westport, CT

A Plantar Foot Stretch

Dealing with stubborn heel pain? This movement can help!

Plantar fasciitis is rampant. In fact, I'm starting to think practitioners just diagnose this to describe any pain on the bottom of the foot. While true plantar fasciitis is complicated and a little more than we can cover in one blog post stretch, strengthening the lower legs with this movement can help affect heel pain.

A few years ago, I had a nasty case of plantar fasciitis myself. In future posts, I'll explore how I alleviated it, but for now, I'll show you one of the easiest stretches to help any non-specific heel pain. You'll need an exercise band; there's really no substitute for it here. I like doing it at the end of the day while laying in bed, but you could do it seated at your desk, or even as part of your daily workouts.

Anatomy Lesson:

The two major muscles in the calf group are the "soleus" and "gastrocnemius." These attach from about the knee to the heel bone ("calcaneus") and it's this heel attachment that's critical: If the calf muscles are chronically overused, they're going to pull on the calcaneus, essentially yanking the foot toward the heel. Over time, this will irritate the connective tissue ("fascia") that holds the foot together. "Fasciitis" is simply an inflammation of this connective tissue. Managing fasciitis is therefore about reducing physical inflammation AND reducing the factors that contributed to the inflammation in the first place. Calf group tension is usually first on that list.

This movement is useful to strengthen the calf muscle group, and it's that strength built over time that will eventually help stop the heel from pulling and irritating the fascia.

The Movement

(This is kind of a half-stretch-half-strengthening exercise, so I'm calling it a "movement" because it fits in to neither category neatly.)

Barefoot, either lying down or sitting, hook the band around the ball of your foot. It should fit nicely in to the crook of your arch. Hold the other end with your hands. (The band should be long enough that you don't feel like you're going to snap it with this length.)

Bend your arms up, gently pulling the band to make your toes move up to about a 45 degree angle to your lower leg. Lower, SLOWLY, but don't intentionally point your toes, just let your foot go back to it's natural position. Repeat 5 times, as slowly as you can handle, pointing the toes and puling them back. The slow movement is key here; it you move too quickly, you're just using momentum to move the muscles. Slowly moving forward as well as backward, means you're using the muscles both concentrically and eccentrically, which is just a fancy way to say you're using them more efficiently and effectively.

When my foot was at it's worst, I'd spend about 10 minutes at the end of each day with this movement. Try to distract yourself by watching TV while you're doing it! If you notice any pain or burning in the heel, back off a bit. That usually indicates that the fascia is still irritated, and there's little point in irritating it further. Try doing the movement only once or twice instead of for a few minutes. Remember that training our muscles takes time. If it took you months, years, or even a lifetime to develop the patterns involved in plantar fasciitis, so you're not going to fix them in a week!

Massage therapy is an incredibly effective adjunct to treatment for plantar fasciitis. I've helped myself and many others through it! I'll see you in my Westport office!

The Kettlebell Halo

Stretch and strengthen your entire upper body!

By now, you guys know that I'm pretty obsessed with strength training. Although I do have a weight bench and barbells, my favorite tools for resistance training are actually kettlebells. Since you're often standing and moving them in different positions, they challenge more muscle groups than machines or simple barbells do.

The "Halo"is one of my favorite upper body strengtheners, because it engages most of the muscles in the upper body. It challenges your coordination and core balance, and that unintentional gentle wobbling might even help you realize how your posture could be improved.

Anatomy Lesson:

Technically, the halo works both the bicep and tricep muscles, as you hold the weight in front of yourself and rotate it behind yourself. But it's actually not the best way to train these muscles. In my opinion, the best use of the halo is for scauplar (shoulderblade) mobility.

In our everyday lives, we tend to mostly keep our arms in front of ourselves. While this isn't inherently bad, it means that the backs of our arms rotate our shoulderblades forward. Because of this tendency, it's important to rotate them back; this not only creates strength in the muscles themselves, but improves posture over time. And it feels great!

The muscles impacted by this movement include the rhomboids, trapezius (traps), deltoids, pectoralis group, biceps and triceps. It's the use of the rhomboids and traps that really impress me; these muscles usually don't get moved in such a complete way. When I perform this exercise, I imagine my shoulderblades rotating completely in a circle, and I LOVE the way that feels!

The Kettlebell Halo:

Start holding your kettlebell (or you can substitute a dumbbell) out in front of yourself, at about the level of your collarbone. Hold it far enough away that you won't hit yourself with it. Maintain the same angle bend in your elbows as you rotate your arms to your left, bringing the weight around your head, as if you were drawing a "halo". The motion should be fluid but not extremely quick; you should feel like you're in control of the weight the entire time. Don't pause anywhere in the back, just imagine drawing a circle around your head with the weight. Start and stop in the same position in front of your collarbone. You should keep your elbows close to your ears the entire time - if you kick them out, you're not going to engage your upper back muscles as much, and the exercise just becomes about your biceps and triceps. Repeat the halo in the opposite direction, going back and forth, circling around your head.

I'll do 15 reps of the halo in each direction (30 total) with a 15 or 20 pound kettlebell. But you can start at any weight you prefer - remember that having correct form is always more important than the amount of weight lifted. You may even find that 5 pounds are difficult with this movement- there's no shame in just using a small water bottle at first.

You should start to feel some increased range of motion right away, and with enough practice, you'll likely feel your upper back and shoulderblade muscles strengthen. This is one of my favorite moves if I feel like I'm starting to hunch over too much - it really helps me stand up straighter!

Remember that any training routine is always best complimented with massage therapy. I can help you keep your muscles functioning optimally for your next sweat session or competitive event. I'll see you in my Westport office!

Lymphatic Drainage FAQs

This addresses some commonly asked questions about lymphatic drainage therapy

I've spoken with a number of clients recently about lymphatic drainage. There seems to be quite a bit of misinformation about this treatment, so I wanted to provide a few frequently asked questions and answers, backed with credible resources. I hope that this post will answer all your questions, but if you have any more, please feel free to leave a comment or email me directly.

Q: What is the lymphatic system and how does lymph work in the body?

A: "The blood and lymphatic systems are the two major circulatory systems in our body… The lymphatic system is a linear network of lymphatic vessels and secondary lymphoid organs… the lymphatic system is a blunt-ended linear system, in which tissue fluids, cells, and large extracellular molecules, collectively called lymph, are drained into the initial lymphatic capillary vessels that begin at the interstitial spaces of tissues and organs; are transported to thicker collecting lymphatics, which are embedded with multiple lymph nodes; and are eventually returned to the blood circulation through the thoracic or lymphatic ducts that join to the subclavian veins."*

"The principal physiological function of the lymphatic vasculature is to take up fluid, leaking out of blood capillaries into interstitial spaces in the tissue, and to return it to the blood circulation. Any failure to effectively do so results in lymphedema, a chronic, disabling and disfiguring condition."#

"In addition to the tissue fluid homeostasis, the lymphatic system serves as a conduit for trafficking of lymphocytes and antigen-presenting cells to regional lymph nodes, where the immune system encounters pathogens, microbes, and other immune elicitors.*

"When interstitial pressure increases, the anchoring filaments are operated to pull the cells and open up the overlapping junctions (or flaps), which allows the lymph fluids to drain into lymphatic capillaries for recirculation." * THIS IS LYMPHATIC DRAINAGE. That mechanical force on the lymph to "drain it." Due to the implicit weakness in the lymphatic system, manually draining it can be beneficial to a degree for general health, but especially so after surgery, when those vessels are physically severed.

Put simply, the above quotes tell us that lymph is a fluid that flows throughout the body, like blood. Unlike blood, though, which is limited to arteries, veins and capillaries, lymph flows through "interstitial" spaces - that is, spaces in the body where nothing else is present. Kind of the "empty spaces" our bodies are full of. The reason lymph flows freely this way is because it's function is to move any foreign matter from one area of the body where it may enter to lymph nodes, where potential dangers are mitigated. For example, if you cut your ankle and dirt gets in to the cut, lymph is there to pull any dangerous substances to the lymph nodes, where it's cleaned and then circulated back throughout your body.

Q: Does that mean that lymphatic drainage will help "detox" my body?

A: "Detox" has become a bit of a buzzword lately, but the fact is, if there are "toxins" present in your body, they're filtered by your lungs, liver and kidneys. That includes any chemicals, viruses or bacteria you may either ingest or inhale. While it is the job of the lymph nodes to filter, lymphatic drainage really can't affect the job of the lymph nodes, as long as they're not compromised in some way. "Lymph nodes are filtration and purification stations for the lymph. In the nodes, specific immune cells destroy foreign or unwanted substances which can then easily be handled by the liver, and flushed out of the organs of elimination: the urinary tract, digestive apparatus, skin and lungs." (Chikly, Silent Waves, 2nd Ed. 2011, p. 46)

There's a theory lately that we may feel crummy from a buildup of either food-related or environmental toxins in our bodies. If your liver, kidneys or lungs are compromised, that COULD be true, but for the vast majority of us, it's just not. So lymphatic drainage will not "move toxins out of the body" or "reduce inflammation." If you feel sluggish after eating certain foods, that's valid, but it's completely unrelated to the lymphatic system.

Q: Will lymphatic drainage reduce the look of inflammation, puffiness or cellulite in my body?

A: I WISH! If there was a type of massage therapy that could reduce fat or inflammation, I'd be a Size 2. Again, we may feel a little puffy after eating certain foods (alcohol and sugar are typical culprits, but gluten does this for some people too) but that has to do with the digestion process, and has nothing to do with "toxins" in the body or the lymphatic system moving them. Manual therapy of any kind cannot "move toxins" throughout the body.

Q: Will lymphatic drainage boost my energy levels?

A: Ideally, yes. Many people report sleeping very well after this treatment, and that, in turn, makes you feel more energetic. I also perform it on myself briefly almost every night, and I'm happy to report that I do feel it makes me sleep more soundly. I also feel like it can reduce the intensity of illness: I had a little sore throat last month after being around a lot of sick people, but I performed lymphatic drainage, ate well and got extra sleep, and it my sore throat never developed into a cold. Certainly it wasn't the ONLY reason I didn't get sick, but I do feel it helped.

Q: Does that mean lymphatic drainage help me get over a cold more quickly?

A: No. In fact, if you're sick, your lymphatic system is already working overtime. There is no need to add extra stress to it during sickness. However, if you receive regular lymphatic drainage, and perform it on yourself, you may notice that you get sick less frequently and less intensely, as was my experience above. Lymph moves in the body as the body moves; that is, if you lead an active lifestyle with plenty of exercise, your lymph should already be moving pretty well through your body. This treatment is certainly not a magic bullet to make up for otherwise unhealthy practices. You'll note, however, that the lymphatic drainage treatment is extremely relaxing. I've had many clients say they slept more soundly after this light treatment than deep tissue work!

Q: Should I have lymphatic drainage performed after surgery?

A: Yes. Especially if that surgery was performed anywhere in your abdomen. Of course, clear any work with your medical professional beforehand. "The association between manual lymphatic drainage and the therapeutic ultrasound reduced the swelling and the tissue fibrosis and made pain disappear in liposuction and lipoabdominoplasty."$ "MLD [manual lymph drainage] can be an alternative or a supplementary procedure for patients surgically treated."%

 Q: Should that lymphatic drainage after surgery physically push fluid out of my body?

A: NO. It's alarming that I've heard a number of people say they've had "lymphatic drainage" performed while standing with someone physically pushing fluid out of their incisions. Not only is this medically dangerous, but it's out of the scope of practice for massage therapy, and more than that, is NOT ACTUAL LYMPHATIC DRAINAGE. Please, vet your surgeon and post-operative clinics before having this work performed. Lymph and other fluids should only ever stay in the body, and if fluid does come out of incisions, it's not actually lymph anyway, it's likely just water or plasma.

If you have any other questions about this treatment, please feel free to leave a comment or email me.  And if you decide that lymphatic drainage is right for you, schedule an appointment and I'll see you in my Westport office!

 REFERENCES

* The New Era of the Lymphatic System: No Longer Secondary to the Blood Vascular System. Choi, et al., Department of Surgery, Department of Biochemistry and Molecular Biology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, April 2012. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312397/

# The Lymphatic System in Health and Disease. Cueni and Detmar, Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology, ETH Zurich, Zurich, Switzerland. February 14, 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572233/

 $ Manual lymphatic drainage and therapeutic ultrasound in liposuction and lipoabdominoplasty post-operative period. Masson, et al., Department of Physical Therapy, Universidade Paulista, São Paulo, Brazil., January 2014. https://www.ncbi.nlm.nih.gov/pubmed/24987208

%  Patients with venous disease benefit from manual lymphatic drainage. Moloski, et al., Department of Orthopaedic and Traumatology, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland., April 2009. https://www.ncbi.nlm.nih.gov/pubmed/19367246

 For further reading: Preventative measures for lymphedema: Separating fact from fiction. Cemal, et al., The Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, May 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3652571/

 Mechanical Forces and Lymphatic Transport, JW Breslin, Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA, November 2014. https://www.ncbi.nlm.nih.gov/pubmed/25107458

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Diana Remaley, LMT
Diana@RemaleyMassage.com
(203)292-5362
19 Compo Road South
Westport, CT