Saturday, June 19, 2010

Plantar Fasciitis, Part 5

The Running Phase of Therapy
Change your mindset. Accept that you are no longer a “distance runner”. You will be again, some day, but not now. Now you need to work your way up to 5K, and you need to do it very carefully so that you don’t cause regression and permanent scar tissue. If you run too soon, too far, too fast, and with improper form, you will not heal – ever. Some people run and race with PF the rest of their lives. They do it because they love the social aspects of running and racing, they want to keep their weight under control, and they’re impatient, but their PF takes the enjoyment out of running, and they run slower, with pain, the rest of their lives. If you’re going to recover, you need to keep your eye on the prize – whatever will keep you on-track. Depending on how bad your PF is, it might take you up to four years to recover, but optimally, even with serious PF, you should only miss one year. Accept that. If you need to mentally/emotionally focus on a specific race, do that. If you need to mentally/emotionally let go of any racing ambitions, do that. But stay on track. Don’t run until it’s time, and only run as far or fast as beneficial.

Never add exercises without stretching first. Stretching cold tissues is hazardous, and can lead to further injury, so like you have been doing, stretch gently and hold a long time. In fact, if you start out correctly, you’ll be spending more time stretching than exercising.

Initially, you start with walks. Most people walk on their heels, even if they normally run on their toes, but you need to walk on your toes when healing with PF. This doesn’t feel natural for most people, and this causes them to tense. Concentrate on loosening and opening your hip motion while taking the same short steps you should take when running. The only difference between your walks and your runs is you won’t get airborne. Don’t over-stride and don’t follow-through too far back.
With each and every step, squeeze your arches, but don’t let your toes curl under. Try to keep your heel off the ground. It's most important to keep your plantar slack if you have falling arches, but even if your plantar is too tight, it is bad to yank an inflamed plantar. Stretching is good for a tight plantar, but trying to stretch it out with the quick yanks that happen during walking/running is the wrong way to recover from a tight/inflamed plantar. All stretching should last several seconds.
In fact, do this everywhere you go. PF therapy should be a constant effort. Once you have your theraputic walk memorized, do it at work, while shopping...everywhere.
Ice your plantar 2-4 times a day, even if it doesn’t hurt. Elevate and compress too, if ice alone isn’t enough. In fact, you’ll have to get used to this process. You may never be able to stop icing.

Taping may help to protect your plantar. This is done with three lengths of athletic tape. This won’t last for too long, but it should give you at least 15 minutes of protection, and maybe as long as an hour of benefit.

Strengthen your feet, shin muscles, and lateral stabilizing muscles. This is done while standing. Do toe-raises, heel raises, stand on one foot and rise onto your toes and hold it. Balancing exercises are important.

Eventually, you will add short runs to your walking; maybe only 10 steps, at first. These runs should concentrate on knee lifts – evenly on both sides. With proper running, follow-through doesn’t involve trailing ground contact, but instead involves snapping the foot off the ground and bringing the heel up towards your butt. Practice ballistic action with the full range of motion – as long as it doesn’t involve over-striding. Feel the free elastic energy. Bounce on your muscles and tendons, minimizing ground contact. Do this very carefully. Don’t try to bounce into orbit just yet. Jab the ground quickly, correctly, and float to the next contact. Try to float, but don’t worry about floating far. Concentrate on each and every step. If you can’t do it correctly, and you can’t do it without pain, return to walking.

If you can, try walking and running barefoot. This takes away the “crutch” of modern running shoes and forces you to use natural processes to produce spring and shock absorption.
Strongly suggested… buy Vibram Five Fingers and wear Injinji socks. These slippers will give you a small degree of skin protection and keep your skin away from the normal animal feces (from geese, rodents, traces from dogs, etc.) that are found everywhere. Five Fingers will force you to use the muscles you’ve neglected while wearing running shoes. Your first run in Five Fingers might be brutal to your calves. Suggested: wear them walking for a couple of weeks and then run a mile or less the first time. Try to run with your heel never touching the ground. When you can’t keep your heel off the ground, return to walking.

When you really are ready to start running, it may take you a week to recover from one mile. And your “one mile” might actually be an accumulation of short runs during three miles of walking.
When you start running again, be very careful because endorphins may mask regressive stresses. Go by numbers. Increase your mileage carefully and systematically. If you still aren’t recovered from the week before, don’t do as much as you had planned. Return to stretching, icing, and walking, if you have to. If you over-do it, you’ll be one of those who take four years to recover.

If you’re running, then it’s also time to start jump-roping. This is good for getting your knees up, and teaching you to bounce. Jump-roping is all about elastic energy. Remember that the plantar plays a very central role in ballistic action. Protect your healing plantar by flexing your arch muscles to the max. If every muscle in your feet ache from this effort, but your plantar is fine, then you did it correctly.

Even though you’re now exercising, never forget that stretching is more important than exercise. And keep icing regularly. ALWAYS ice after exercise, even if there’s no pain. Massage several times a day.

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