Identify, Eliminate Prevent Plantar Heel Pain
Here in the clinic, we see Plantar Fasciitis quite regular often with Runners, Walkers and Footballers.
Plantar fasciitis is a painful condition affecting the foot, most notably it includes “severe pain” for the first few steps of the day when getting out of bed, and the pain is usually on the sole of the foot – closer to the heel.
The question we often get is “Should I stretch Plantar Fasciitis, and does it work?”
The answer is yes. Research has shown Plantar Fasciitis does respond to stretching as part of a treatment program – mainly because gastrocnemius (calf muscle) tightness has been shown to have strong statistical correlation with severity of heel pain in plantar fasciitis.
That said, this is just the tip of the iceberg; the story doesn’t end there!
Running relies on more than just the calf muscles. Reduced flexibility of the hamstring has been shown to have an impact on foot injuries as well as hamstring strains. Your ability to meet physical demand depends on the flexibility of the whole lower leg.
There is ample scientific evidence that more injuries and re-injuries are noted in those with a reduced flexibility post-injury.
So – yes, of course you need to consider stretching in your training regime, however this is one of many aspects of the treatment and rehabilitation process for PF. In addition, we need to assess foot mechanics for instability or restrictions, along with factors further up the chain including knees, hips and spinal function.
With PF we need to ask…. Why are the muscles tight?
It’s one thing to find tight muscles, but the solution and recovery will be based on knowing why. Understanding Structure and function will go a long way to resolving and preventing a recurrence of the injury and the associated pain.
What should you focus on?
Self-help can be difficult as most remedies you find on the internet are aimed at symptom relief, without considering compromised foot joints or muscle tension in the legs or functional strength, all of which need to be addressed to optimise recovery and rehabilitation.
Your training is the first thing to address.
It’s best to have a more rounded exercise routine. For example, if you’re short on time – don’t just go out and run as fast as you can. Instead, it’s best to plan different sessions with a variety of objectives that meet your needs, and here is where a personal trainer can really benefit you.
A good exercise routine should have:
- A good warm up routine, as it’s important to prepare the body for exercise.
- A balanced and varied set of exercises, remember to consider the demands placed on the body not just in your sports or activity but your lifestyle, we know walking and running are great exercises but they don’t train you to pick up kids or pets.
- A cool down help bring the body into a relaxed state.
- Stretching using whichever method you prefer, can help the body recover whilst allowing you to identify restrictions and imbalances that may need addressing.
Sometimes self-help is not enough, and we need a little expert help to get us back on track. That’s where we come in, we can help with our clinical 5 step integrated approach:
- Injury Assessment
- Full Body Assessment
- A Dynamic Gait Analysis
- A tailored treatment plan
- Rehabilitation/Exercise prescription
Here’s what this approach looks like in clinical practice:
Recently a runner approached me to treat his PF so that he could return to his beloved sport. He had already seen other therapists and was a seasoned athlete who was very body aware and he had done all the right things to treat his PF, including resting, stretching, and gradual return to running. Sadly, his PF persisted, despite everyone’s best efforts.
As part of the injury assessment – I used an RS Dynamic Gait Analysis Unit to analyse how the foot moves through the normal gait cycle while the athlete was running and walking,. The results showed me things I could never have hoped to see with the naked eye during fast running – namely specific changes in ground contact due to restrictions in the function of the talocrural joint (ankle joint) as well as foot mechanics. Note most of this information and the identification of the restrictions and dysfunctions cannot be accurately assessed by watching a video of you run/walk and cannot be seen during standing or squatting. I used the results along with clinical assessment to apply specific mobilisation and manipulation techniques to the foot – on retesting the gait cycle RS Dynamic Gait Analysis Unit showed a smoother gait cycle after the intervention.
A full bio-mechanical assessment was also performed, which found restrictions in hip motion and knee mechanics. Stretching was part of the recovery plan (to ease muscular tension) along with mobilisation exercises for the hips and core stability.
With our runner treating PF involved exercises that seemingly had nothing to do with the foot. Up to this point he had only ever run and to get better simply ran more. Now he was examining and adding where needed flexibility, core stability and strength training, including movement for the whole body not just his legs.
We collated all of our findings and put together a bespoke, tailored treatment and rehabilitation plan for this athlete,
Our runner remarked that he’d never been given an exercise plan like this for PF before and never really considered things such as functional strength.
And the results speak volumes….
With a successful completion of the Lakeland fifty (a 50-mile run through the Lake District) the plan was successful in achieving optimal recovery, rehabilitation, and improved performance for our runner.
The takeaway is:
Identify the injured tissue
Correct any muscle imbalance.
Implement a plan to correct functional movement pattern alterations, Joint restriction, and adaptations.
Examine the gait alteration/compensation.
For our runner we addressed each issue along with the prescription of 3D Printed Phits bespoke custom orthotics (insoles) to optimise ground contact and foot function.
And – Yes, stretching was a contributing factor in the process.
Cover the basics and you are halfway there, If you are struggling we are here on hand to help.
Keep Well, Keep Active
Pearce CJ, Seow D, Lau BP. Correlation Between Gastrocnemius Tightness and Heel Pain Severity in Plantar Fasciitis. Foot Ankle Int. 2021 Jan;42(1):76-82. doi: 10.1177/1071100720955144. Epub 2020 Sep 13. PMID: 32924578.
Venus. K. Pagare, Pooja. M. Ganacharya, Aarti Sareen and Tushar. J. Palekar. Effect Of Neurodynamic Sliding Technique Versus Static Stretching On Hamstring Flexibility In Football Players With Short Hamstring Syndrome
Muscle Flexibility as a Risk Factor for Developing Muscle Injuries in Male Professional Soccer Players: A Prospective Study. The American Journal of Sports Medicine. 2003;31:41–46.
O’Sullivan K, Murray E, Sainsbury D. The effect of warm-up, static stretching and dynamic stretching on hamstring flexibility in previously injured subjects. BMC Musculoskelet Disord. 2009 Apr 16;10:37. doi: 10.1186/1471-2474-10-37. PMID: 19371432; PMCID: PMC2679703.