Plantar Fasciitis Physical Therapy. What Can We Do?

Plantar Fasciitis Physical Therapy. What Can We Do?

by | Sep 4, 2024 | Healthcare

Millions of people suffer from plantar fasciitis each year. About 1 in 10 people will be affected in their lifetime. It is one of the toughest injuries we treat as physical therapists. It tends to be extremely painful, become exacerbated quite easily, and last for many months. It also has a high recurrence rate, meaning after it’s gotten better, it’s more prone to coming back again. 

What is plantar fasciitis? It is an inflammation of the plantar fascia in the bottom of the foot. The plantar fascia is a thick band of connective tissue that attaches from the heel (calcaneus) to the midfoot (metatarsals). The significance of this hard connective tissue is that it has a strong role in shock absorption in the bottom of the foot, especially during running and jumping. It is also responsible for maintaining the arch in our foot during the loading phase of standing, walking or running. Because of its role in absorbing forces through the foot, athletes and runners can be susceptible to overuse or trauma that can irritate it.

But like many injuries, they can be more complicated than a simple inflammatory response that typically gets better with rest, ice and a deloading period. What else can cause foot pain? Some other potential foot related pain could be: bone spurs, loose body (floating piece of cartilage), neuropathy, sciatica (or other nerve related referred pain from the low back or leg), bone bruise, growth related issues (like Sever’s disease) and many others.

So what can we do about it? Do we have options for plantar fasciitis physical therapy? The answer is yes, we can treat it. But it’s important to note that there are many different possible sources of the pain and therefore treatment options may be ineffective or even worsen symptoms. Common treatment options include stretching of the ankle, foot, calf and big toe, lacrosse ball or golf ball rolling the bottom of the feet, icing, resting, and potentially orthotics. Combined, these can be very effective tools. The one I would advise NOT to do early on in a truly inflammatory condition is to beat it up with a lacrosse ball or golf ball. I’ve never understood the logic here and it rarely helps. When something is irritated, we shouldn’t be beating it up while also trying to rest it. It’s counterintuitive. But stretching, icing, and deloading are really good first steps.

In addition to some gentle stretching, icing, and deloading, I like to institute a heel lift into the shoe. This is temporary in order to help us unload stress to the bottom of the feet. What else can we do when these things don’t help? The next steps would involve increasing the load tolerance of the plantar fascia through a progressive loading program. Make the foot stronger over time with gradual introduction of more and more stress. Simultaneously, we should be looking up the chain for other possible sources of this pain. We can look at the low back, the pelvis, the hips, the lower leg etc for other possible causes of referred pain that often get missed or undiagnosed. Lastly, if continuing to struggle, we should seek out an orthopedist for imaging to rule out a more serious pathology.

Plantar Fasciitis is a very difficult injury to treat. Begin with conservative measures for a few weeks (rest, ice, heel lift, gentle stretching). If not getting better, begin a progressive strengthening program and also look for other potential sources of referred pain besides assuming the plantar fascia is the issue. Lastly, seek medical help to rule out more serious problems.

Check out our physical therapy services and let us help!

References:

Trojian, T., & Tucker, A. (n.d.). Plantar Fasciitis. AAFP. https://www.aafp.org/pubs/afp/issues/2019/0615/p744.html#:~:text=Plantar%20fasciitis%20is%20a%20common,the%20condition%20is%20not%20inflammatory.

What Is Physical Therapy?

What Is Physical Therapy?

by | Aug 19, 2024 | Healthcare

What is physical therapy is a common question we still get asked today, despite physical therapy’s increasing value in society. And I feel like my answer to this question might be surprising.

The classic understanding of who a PT is and what we do can be found here. Traditionally, we are seen as healers. Masters of recovery. Doctors with a wealth of knowledge capable of helping you to recover faster and get back on your feet sooner. Have an injury? Go see a PT or you may end up with long term issues or not heal correctly.

In actuality, much of this thinking just isn’t true. PT’s and other healthcare professionals may not like this, but we really don’t do much in the way of “fixing” anyone. For acute injuries, I’d say we do very little to help people heal except to keep them active and dosing their exercises appropriately when they might otherwise just be hoping that rest fixes their issues. But the actual tissue repair process is very unlikely to be helped by us directly. Indirectly, we can be a great resource for improving pain (more on that below) but as a whole, our value and role in true tissue mending is questionable. And that’s okay!

Instead of “healers”, we should really be seen as experts, guides, and coaches. We can still have a tremendous influence on the lives and pain of our patients throughout the rehab process even if we don’t actually help tissue repair. As much as I wish I was a healer, my greatest assets are in my ability to get people to buy into a certain methodology, my ability to problem solve, my ability to be fluid and dynamic and continue to constantly reassess problems week after week, my ability to motivate, and my ability to help people buy into a belief that they are going to succeed no matter what. These things are so important to successful return to activity and shouldn’t be taken lightly. But I often feel we are taught to act like healers when we are far better suited as a coach.

Physical Therapists have a wealth of knowledge, and in my opinion, have some of the best foundational and practical medical knowledge of any profession to help people in pain. We have doctorate level understanding in medicine, athletics, psychology, nutrition, anatomy, physiology, biomechanics and so many others. We are so well equipped to serve as a guide on the journey to being healthy. When you are hurt or having problems in your body that won’t go away, my (biased) opinion is that we should all seek help from a physical therapist first. We are better diagnosticians than orthopedists (save for trauma or extreme injuries/puzzling cases) and we can actually implement a noninvasive strategy to problem solve your issue which is most people’s preferred treatment course anyway.

But we are not healers. If we want to call ourselves evidence based practitioners, we have to come to grip with this fact. We do not accelerate any tissue healing by means of our hands or knowledge. What we ARE equipped to do better than almost any other practitioner is to coach you through right and wrong ways that you can help yourself to recover and succeed on the journey to a healthier and more pain free life. We can be there when you get stuck, we can encourage you through painful movements, we can tell you when to back off, when to change strategies, when to load it more or less, when to start returning to sport or activity…but we do not heal.

 The perception of physical therapy is that it is a place to get massaged (minimal efficacy toward healing), stretched (minimal efficacy toward healing), receive modalities like e-stim or ultrasound (little to no efficacy toward healing), and exercise (great efficacy toward healing). But we are so much more than that. We are experts in navigating pain and injury, but unfortunately most physical therapy clinics are still geared toward making you feel better (massage, stretching, modalities) and not actually getting you better. The physical therapy world is changing for the better, but it still has a long way to go, much like the rest of the healthcare world. If you find yourself dealing with an injury, seek out a physical therapist that can give you the time and attention that you deserve.

To gain a better understanding for what physical therapy is, visit us at Kinetix and find out why we believe in a better version of PT.

 

 

REFERENCES:

https://www.webmd.com/pain-management/what-is-physical-therapy

 

 

 

 

 

 

 

 

Is Core Training Really As Important As We Think?

Is Core Training Really As Important As We Think?

by | Jul 13, 2024 | Healthcare, Training

One of the first things I wanted to talk about are the ideas surrounding “Core”. What is it, what is it’s relationship to pain especially in the low back, and is it as important as we believe for reducing injury and enhancing performance?

So what is it? In it’s simplest form, core refers to a lot of the smaller muscles that attach to the spine and help to control movement and provide support. We have lots of other muscles that attach to the spine that are designed for power and large movements, like our “6 pack ab” muscles in the front or our Lats in the back.

Some of the biggest issues I find clinically that I want to try to touch on is that for one, conceptually, patients and practitioners really don’t have a good understanding for what it is. Providers like PT’s, Chiros, Trainers, Doctors can often recite some of the textbook definitions of what muscles are a part of the core, but do a poor job with the application -or training part, which is ultimately the most important part. It doesn’t matter how well you know what muscles make up the core if you can’t train them appropriately. And on the patient or athlete side, they typically think that it means you need strong abs. I’ll touch on that in a minute. The second part that I wanted to address is the core’s relationship to pain and injury. There are some really outdated philosophies that continue to be perpetuated in the clinic and in the mainstream media platforms that are really not true.

So first, how do we train “core muscles” and how can we maybe do a better job of training them effectively. One of the biggest problems with our current philosophy is that we train core muscles in isolation. Over and over again, I see clients being trained in spinal neutral. Exercises like dead bugs, bird dogs, planks…these are very good exercises for a lot of reasons that I will still use in my practice. They all have a purpose, especially for the novice movers that need introduction, the sedentary clients who don’t do a lot of moving, or the patients who are suffering from extreme and debilitating pain. But we are doing our clients a disservice if they are used to moving even a moderate amount. People who run, go to classes, or use the gym regularly need more. For the elite movers, athletes, and gym goers I’d argue that we really shouldn’t be using these much at all.

Core muscles are designed to work during movement, not in isolation. They also turn on and off when they are supposed to. We don’t have to bring that out of them by trying to train certain muscles to “turn on”. These muscles don’t just shut off when we are injured or weak. We would fall apart if that were true. We need to spend more time focusing on movement based core strengthening. I would argue that our perception of people like trainers with these ripped abs do not have the strongest core. Some of them maybe, depending on how they train, but I’d argue that the individuals who have really strong core muscles might be athletes you don’t typically think of because they don’t have a six pack. Powerlifters and olympic lifters, for example, tend to have some fat on them but they handle extreme amounts of load when pushing them, pulling them, lifting them from the floor or catching them overhead. Golfers or baseball players aren’t always shredded, but they can rotate extremely powerfully and accelerate and decelerate very quickly. Dancers or Gymnasts who can control their bodies through extremely large ranges of motion. Core is far more complex than our current basic understanding of “strong abs”.

The next part I wanted to address is the core’s relationship to pain. I still see providers in mine and related fields talking about a weak core and it’s correlation to low back pain. Lots of this stems from studies in the late 90s and early 2000’s that linked weak transverse abdominis muscles to individuals with low back pain. But so many more recent and quality studies disprove what we once believed to be true. Even one of the pioneers of this concept retracted his opinions of it’s relationship! A STRONG CORE WILL NOT FIX LOW BACK PAIN AND IS VERY RARELY THE CAUSE OF IT.

A strong core is important for many different reasons, but very little of it has to do with preventing or solving low back pain. Low back pain can come from so many different sources and reasons, physiological reasons, genetic reasons, even emotional or psychological reasons. So saying or assuming that all of these sources for low back pain can be fixed with stronger core muscles is a joke and needs to be thrown out. 

The average, every day person needs to understand that core is really not related to back pain and that it needs to be trained differently than how we often think it does. And PT’s, chiros, trainers and doctors, people in my field, need to stop perpetuating false concepts and links to low back pain and outdated methods for fixing them. Everybody is built differently, and a good practitioner understands that back pain, and pain in general, is incredibly complex and individualized. We are all unique. We need to stop being part of the problem and start being part of the solution. Don’t give lazy diagnoses and treatment plans centered around core. Hopefully, we all can continue to grow in our understanding of the core and how we can use it more effectively.   

  • Core is poorly understood, even by experts!
  • Core muscles are NOT your six pack ab muscles
  • Traditional Core exercises are great for novices or when in large amounts of pain, but often poor for regular exercisers and athletes
  • Core muscles REQUIRE MOVEMENT to be effective
  • Core is very poorly linked to low back pain and injury
  • A stronger core, by itself, is NOT very likely to fix back pain
  • Low back pain can come from physiological, environmental, genetic, emotional or psychological reasons (to name a few) – stop using a weak core to define something so complex!