Sport Participation for People with Fibromyalgia

Press Release:

Fibromyalgia and resistance exercise have often been considered an impossible combination. But with proper support and individually adjusted exercises, female patients achieved considerable health improvements, according to research carried out at Sahlgrenska Academy.

“If the goal for these women is to improve their strength, then they shouldn’t be afraid to exercise, but they need to exercise the right way. It has long been said that they will only experience more pain as a result of resistance exercise, that it doesn’t work. But in fact, it does,” says Anette Larsson, whose dissertation was in physical therapy and who is an active physical therapist at Närhälsan in Herrljunga.

As part of her dissertation, she studied 130 women aged between 20–65 years with fibromyalgia, a disease in which nine of ten cases are women. It is characterized by widespread muscle pain and increased pain sensitivity, often combined with fatigue, reduced physical capacity and limitation of activities in daily life.

About half of the women in the study (67) were selected at random to undergo a program of person-centered, progressive resistance exercise led by a physical therapist. The other 63 women comprised the control group and underwent a more traditional therapy program with relaxation exercises. The training and exercises lasted for fifteen weeks and were held twice a week.
Substantial improvements

“The women who did resistance exercise began at very light weights, which were determined individually for each participant because they have highly varying levels of strength. We began at 40 percent of the max and then remained that level for three to four weeks before increasing to 60 percent,” explains Anette Larsson.

More than six of ten women were able to reach a level of exercise at 80 percent of their maximum strength. One of the ten was at 60 percent; the others were below that figure. Five individuals chose to stop the training due to increased pain. The group as a whole had 71 percent attendance at the exercise sessions.

“On a group level, the improvements in the fibromyalgia group were significant for essentially everything we measured. The women felt better, gained muscle strength, had less pain, better pain tolerance, better health-related quality of life and less limitation of activities. Some of the women did not manage the exercise and became worse, which is also an important part of the findings,” says Anette Larsson.


Focus on individuals with fibromyalgia:
In the control group, the improvements were not as significant, but even there, hand and arm strength improved. The relaxation exercises probably led to reduced muscle tension in the arms and shoulders, which in turn allowed the participants to develop more strength.

The findings for the women in the resistance exercise group are affected by several factors, including the degree of pain and fear of movement before and during the exercise period. Progress for the group as a whole can largely be attributed to the person-centered approach, with individually adjusted exercises and loads and support of a physical therapist, according to Anette Larsson.

“An interview study we conducted shows clearly that the women need support to be able to choose the right exercises and the right loads; they also need help when pain increases. This requires, quite simply, support from someone who knows their disease, preferably a physical therapist.”

The Enigma of Shin Splints in Athletes

Shin splints is a bad term for a problem that is common in athletes, especially runners. The term just means ‘sore leg’ so it could be due to any one of many different problems, so as a term it should no longer be used. When the term is used, it is probably most often referring to the condition of medial tibial stress syndrome.

This problem is one of a stress reaction along the edge of the shin bone or tibia in the leg. Running is the most common cause of medial tibial stress syndrome. The symptoms can usually be palpated along the edge of the bone. Initially its typically not painful when running, but eventually it progresses to the stage that it i painful when running.

Typically the problem is one of the running technique and the runner can often benefit from a gait analysis and a running retraining program to change the way they run. Typically this will involve running with a wider base of gait.

Clinical Trial on New Treatment for Plantar Fasciitis

Plantar fasciitis is a common clinical problem of the heel in athlete. This press release is about a new treatment that is undergoing testing:

MiMedx Concludes Enrollment for Phase 3 Plantar Fasciitis Trial

MARIETTA, Ga., Sept. 17, 2020 (GLOBE NEWSWIRE) — MiMedx Group, Inc. (OTC PINK: MDXG) (“MiMedx” or “the Company”), an industry leader in advanced wound care and an emerging therapeutic biologics company, today announced the conclusion of enrollment for a Phase 3 study of plantar fasciitis, an inflammation of the fibrous tissue along the bottom of the foot that results in intense pain. This key clinical trial explores how placental science may address and treat musculoskeletal pain and function disorders. The study has met its timelines.

Plantar fasciitis is an all-too-common, debilitating and painful foot condition that challenges both patients and clinicians. Several months to years of treatment may be required with conservative therapies before symptoms subside, and I believe plantar fasciitis represents a significant unmet patient need,” said Stuart Miller, M.D., Principal Investigator, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, and Assistant Professor, Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. “This is a landmark study that will help us advance the science and elevate the standard of care for millions of patients; I look forward to analyzing and publishing the data regarding treatment efficacy for this musculoskeletal condition. Our progress to date is all the more gratifying given the dampening effect of the pandemic on patient enrollment. This study is designed to provide statistically significant evidence of efficacy for this biologic treatment to reduce pain and improve function.”

More than two million people are treated for plantar fasciitis inflammation in the United States annually. In 10% of patients treated with traditional measures, the condition progresses to chronic plantar fasciitis-related pain – recovery from which is lengthy and recurrence of which is very common, with an estimated $284 million annual national economic burden. The current treatment algorithm aims to maintain arch shape, modify foot loading and/or improve shock absorbency of the heel through night splints and orthotics. While they may assist in reducing pain associated with plantar fasciitis, these treatments do not address the root cause of the condition, which is thought to be both degenerative and inflammatory.

Timothy R. Wright, MiMedx Chief Executive Officer, commented, “Given the variability of efficacy, cost, and potential side effects of available plantar fasciitis treatment options, additional evidence-based alternatives are needed urgently. As a pioneer in the development of placental tissue technology, following through on clinical research is part of our mission to improve patient outcomes. Using our placental science platform to address the unmet need posed by plantar fasciitis is just one of the critical ways that we are exploring its application to improve people’s lives. We look forward to sharing the results of this trial in 2021.”

About the MiMedx Plantar Fasciitis Trial
This study is a Phase 3, prospective, double-blinded, randomized controlled trial of the micronized dehydrated Human Amnion Chorion Membrane (dHACM) injection as compared to saline placebo injection in the treatment of plantar fasciitis. The trial enrolled 276 patients between the ages of 21 and 79 years, with an investigator-confirmed diagnosis of plantar fasciitis for ≥ 1 month (30 days) and ≤ 18 months. Patients were required to have a Visual Analog Scale (VAS) Pain scale of ≥ 45 mm at randomization and be receiving conservative treatment for ≥ 1 month (30 days), including any of the following modalities: Rest, Ice, Compression, Elevation (RICE); stretching exercises; NSAIDs or orthotics. The primary endpoints are change in VAS for Pain at 90 Days and incidence of related adverse events at 180 days, serious adverse events and unanticipated events during the first 12 months post-injection. Secondary endpoints include self-reported responses to the Foot Function Index – Revised (FFI-R) at 90 days.

Corns and Callus of the Feet in Athletes

Corns and calluses are due to too much pressure on an area of the foot. They are common in the general population and can be more common in those who play sports as the pressures on the feet are higher. If the pressure is more diffuse, then that typically causes a callus. If the pressure is more focused on a smaller area, then that typically causes a corn.

The too much pressure might come from the shoes if there is a foot deformity present. That deformity may be a bunion, hallux valgus or a hammer toe. If the pressure is higher under the ball of the foot, then that may be due to a prominent metatarsal head and result in a callus.

The only way to get rid of a corn or callus permanently is to remove the causes. A good podiatrist can easily remove the thickened skin of the corn and callus and this will give pain relief. However, they will come back unless the cause is removed.

There is a popular my that corns have roots that they grow back from if that root is not properly removed. They do not have roots. If a corn is removed properly by a podiatrist it will come back becasue the cause of the corn (the high pressure) is still there, not becasue there was a root that was left there by the podiatrist.

It may be that surgery, for example to fix something like a hammer toe, may be needed to remove the cause. A callus under the foot could be treated with a insole that remove pressure of the areas of higher pressure.

If you have a problem with a corn or callus, then see a podiatrist as to the best options to remove the cause so that it is no longer a problem.

What running shoes can I use if I have bunions?

There is an abundance of good information on bunions online, so there is no point going over all that information again.

The running shoes that are best if you have bunions are those that are wider in the forefoot to accommodate the bunion. The most typical running shoes that are made on a wider last is often not wide enough. You could try on the wider last models of each of the brands to see how they feel on you in the store. There is really only one brand that is any good here and they are the Altra running shoes. They are very wide in the forefoot compared to other brands and they have the width to accommodate the enlarged joint that is associated with the bunion. If you have a bunion, then try a pair in a running shoe store to see if they are for you.

The Altra Footshape Toe box can accommodate bunions

What else could you do if you have bunions?

The only way to get rid of bunion is with surgery, however, there are other options to help with the symptoms. What is important is to keep the joint supple and flexible with exercises as it does have a tendency to become stiffer or more rigid. A bunion corrector can also be used to help with that somewhat. If you can not get the shoes right, then there are pads chapped like donuts that can be worn to keep the pressure off the joint.