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Monday, February 3, 2014

Dealing with plantar fasciitis

I haven't been injured much.  Probably the physical therapist in me keeps me in check a bit more than average and I've also always had pretty fair body awareness.

The past four or five months, though, I've been dealing with a very stubborn plantar fasciitis.  Normally a very consistent runner and cyclist -- I had been working out nearly every day doing one or the other or both for almost two decades.

But the last 18 months have been much less consistent for me.  New additions to the family and a growing small business have interfered, making workouts difficult.  And I think that my lack of consistency has led to this injury.

When you run every day, and have been for many weeks, months, or years, tendons and connective tissue are more resilient.  On again off again schedules lead the soft tissues to go through more of a roller coaster -- those same tendons are not getting the input and so they're thinner and exhibit less tensile strength.  Because of the weaker tissue, each workout creates a greater than average amount of tissue tears.  There is also the inevitable weight gain as you work out less, which means more force on the tissues as well.

It's ironic -- I've spent a career treating injured people and here I am somewhat foundering in the face of a recalcitrant injury.

I'm improving each day and each week, and it seems that the healing has gone in stages.

Stage 1:  I can still run, and have no soreness afterwards.  It's at night that I notice it and I wasn't paying enough attention to it so it worsened to the point that it did begin to hurt after runs (actually felt like someone had taken a hammer to the bottom of my foot after a run).  I  also now had soreness after a bike ride for the first time.  Night time was the worst as I hobbled to the bathroom every time I stood up on it.  At the end of this stage is when I began a hiatus from running to give my foot a chance at healing without continually causing inflammation.

Stage 2:  Aggressively stretching of the gastrocnemius muscle.  This is PT 101 for plantar fascia issues, and it does help.

If my foot was sore during the day if I did one long (45 seconds) calf stretch on the stairs, I would be pain free -- for a while.  I also invested in a Straussburg Sock, which is a comfortable night splint that holds your toes up to keep a consistent stretch on the plantar fascia.
This approach helped for a while.  It helped me get the symptoms under control -- no more pain on on the bike -- and while it got me close to running, I wasn't able to keep symptoms under control so the running hiatus persisted.

Stage 3:  Hip mobility.  I was getting more diligent with my stretching overall.  For most of my athletic career I was a dedicated stretcher, but as my life got busier, and there were more demands on my time, stretching was bumped down the priority list.  This injury motivated me to get back to my previous good habits.  I noticed one day stretching, that if I stretched my hip adductors and hip flexors (which are common areas hit with some of the Warrior poses in yoga) I could eliminate my foot pain entirely

Stage 4:  Neurological effect.  Another day stretching revealed something that would also completely rid me of acute symptoms.

Bring the leg up (as pictured but not quite as far) and then
across the body, keeping toes pulled up.
If I did a neural tension stretch on my leg, my heal pain would disappear.  A neural tension stretch is exactly what it sounds like -- the leg is put in a position that doesn't stretch the muscles and tendons as much as it puts the nerve in a fully lengthened or tensioned position.  When you do this stretch correctly you'll get some annoying, sharp, sometimes burning or buzzing sensations down your leg and into your foot.  These are typical nerve sensations, and you have to be careful not to over-do it, but it can be really effective.  Again I was amazed at how quick and effective this was at relieving acute symptoms.  Moreover I could feel the foot improving long tern with this -- I wasn't just temporarily relieving acute pains.  I began to run a little in this phase.  Never two days in a row -- actually only twice a week -- and only about 15-20 minutes at a time, but at least I was starting.

Stage 5:  Aggressive soft tissue massage.  How aggressive?  I use a golf ball and, sitting on a carpeted floor, use both hands to press my foot into the ball and roll the foot around to hit different sore spots.
When I find a really sore spot I stay on it and oscillate back and forth on it.  I generally try to cause as much pain as I can tolerate.  After about a minute or two of this torture, then I  bend the foot and toes up with ,y hands and hold a stretch for about 30 seconds.  Then repeat a couple times.  I might do this 2 or 3 times a day and especially before or after runs.  I still have pain but this work has really helped me manage symptoms after runs.  If I stay consistent with my golf ball I can run an hour or more and have little to no tightness or pain at night.

So this is where I'm at right now.  I think I'm on the way to full recovery, but I have to stay on top of things.  I've carried forward all the treatments from previous stages.  So while I don't do quite as many neural tension stretched or hip mobilizations, I still work them in every week.

That's it for now -- I've been sitting at this laptop long enough.  I'm off to stretch and golfball my foot....

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