Saturday, June 19, 2010

Plantar Fasciitis, Part 4

Specific Therapies…
The Non-running Phase
There isn’t much you can do to heal PF, unfortunately. Mostly, you need to stop the advancement of the condition, avoid regression, and help the body to heal itself.
Reduce swelling with ice, compression, and/or elevation. Swelling reduces circulation, and can cause stagnation, which leads to scar tissue. Large amounts of scar tissue, left untreated, lead to heel-spurs, which may require surgery.
Use massage to avoid the development of scar tissue, or break up scar tissue. This increases circulation. Squeeze out stagnated fluids so that fresh fluids can flow back in. This is the single best thing you can do to improve new building-blocks entering the damaged area for healing.
If you try to massage an area which is already swollen, it will be difficult to force any benefit. If swelling is that bad, ice, elevate, and/or compress before massage.
Icing reduces swelling, but it also reduces circulation. Just as with swelling, trying to massage cold tissues will provide minimal value. If you massage cold tissues, though, it will not cause harm, it will just provide minimal return.
Massaging warm, swollen tissues may cause even more swelling. If you massage warm, swollen tissues, you need to use ice/compression/elevation immediately afterward to avoid causing more damage than therapy.
Some therapists say to massage with a golf ball or a hard roller, but many other therapists warn never to massage with hard objects. Instead, use a tennis ball, a hard foam roller, your thumb, or spiky-ball designed for plantar fasciitis.

Stretching must be done carefully. For the most severe cases of PF, it will be destructive to stretch at all, at first, but stretching is one of the most important therapies for PF. So even if you can’t “stretch”, you should at least take all slack away to avoid tightening-up during the period of total rest. When beginning actual stretching, the emphasis should be on minimal degrees of stretching, but maximum amounts of time spent at stretched angles… gentle for a long time.
One of the most effective long-gentle stretches is achieved with an orthotic boot designed specifically for PF, or by using the Strassberg Sock.

However, use caution with PF boots and socks! Not widely communicated, you have to use these devices correctly according to your specific cause of PF. If your plantar is too tight, and you have a high arch, then you need to stretch everything from the back of the knee to the tips of your toes (the plantar and calf.) But if you have a falling arch, stretching a failed plantar will make your injury worse, not better. In this case, you need to work on your calf, which is pulling on your heel and elongating your failed plantar. In either case of PF, the calf must be stretched, and a PF boot or sock will do the job. But if the arch is failing, always use arch supports inside the device, or you will see marginal benefits.
As things improve, don’t stop long-gentle stretching, but do add other stretching. Still, longer stretches are better than shorter ones.
Stretching should be whole-body, but most importantly from the hips down – don’t neglect the IT bands or lower back muscles. The back should be evenly strengthened and stretched to make sure there are no imbalances. Even proper arm dynamics can affect your plantar.
If you have falling (low) arches, when you stretch your calf standing up, and this coincidentally stretches your arch, squeeze your arch muscles to avoid pulling on the plantar with much force. If your plantar is too tight, then you want to stretch the plantar. Just don’t stretch too hard or you’ll continue to aggravate and swell your PF.
Gurus of normal athletic stretching preach that in order for any stretch to do any good, you must hold it for at least 20 seconds. For PF therapy, though, you need to take this further. Stretches should be held for a minimum of 60 seconds. It’s even better to stretch in phases, spending 60 seconds with virtually no stretch, then move a bit further and hold another 60 seconds, move further…
Some therapists say that when you stretch, you get a good feeling in the stretched tissues. They say with PF recovery, this is actually a bad sign – you’ve stretched too far. You need to avoid going quite that far until you’re back running again on a regular basis.

Two calf stretches help. One stretches the upper calf and the other the lower calf. One calf stretch requires keeping the heel down while keeping the knee straight and leaning forward (increasing the angle of the ankle). The lower calf stretch starts in basically the same stance but requires that you keep your heel down while bending the knee forward. Doing the calf stretch wrong, and stretching too vigorously, can actually lead to PF. Your plantar isn’t supposed to stretch much – it’s supposed to stabilize your arch. If you do calf-stretches with a relaxed arch, and you pull too hard, it can damage the plantar, especially if you’re already in an over-trained state. Whether your plantar is too tight or too loose (failing), pulling on an aggravated and swelled plantar can be counter-productive, depending on the stage of recovery and type of PF being suffered. One type of stretching/recovery program isn’t correct for every type of PF. However, ice is the one universal and absolutely critical therapy for all types of PF.

Clinical treatments may include ultrasound, phonophoresis, neuroprobe, contrast baths, or cortosteroidal injections.
Phonophoresis is the use of ultrasound to push topical ointments into the skin. This sounds like gibberish. For one thing, your plantar is almost solid, with no blood vessels flowing through it. Most medical doctors will tell you it’s impossible to get topical ointments down below the dermis, no matter how hard you rub, poke, or even use ultrasound. But if it gives you psycho-emotional comfort, and it’s not a substitute for remedies that “work”, then go for it.
Acupuncture has been proven to increase circulation in certain areas. Even if you could get $20 acupuncture (not likely), PF takes so long to heal that you’d have to spend thousands of dollars over very many months to see even a small improvement, at best.
Acupuncture has also proven to reduce pain. If this works for you, you could try it.
Some acupuncturists use electric probes on their needles. This is an implementation of neuroprobe. Acupuncture works – make no mistake – but it works varying degrees on different people/injury-types. It’s up to you if the amount of money and time you sink into it has a worthy return-on-investment. I’ve never known acupuncture to hurt an injury – that’s the good news.
A “contrast bath” is when you ice your foot for 20 minutes, then warm it back up again, usually in hot water, and then you ice it again. Icing shuts down the swelling, but icing also causes such severe contractions that it squeezes out old fluid, like wringing out a sponge. Heating it back up again causes fresh, nutrient-rich fluid to flow back in. Icing it again wrings it out again. And finally it will warm up again on its own, again letting fresh fluid and nutrients in. The plantar itself is solid enough that the fluid will not have much benefit, but the reduction in swelling is good, the increased health of the surrounding tissues is good, and ice baths are free.
There is a lot of witch-doctory out there, old-wives-tales, snake-oils, and dim-witted or misled advice for PF. Beware.

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