Plantar Fasciitis (Education | Myths | Stretching & Strengthening Exercises)

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Do you have pain on the bottom  of your foot when standing,   walking, or taking that first  step out of bed in the morning? In this video, I’m going to discuss plantar  fasciitis, dispel the most common myths associated   with the diagnosis, and teach you everything  you need to know about managing the condition. The plantar fascia is an expansive connective  tissue located on the bottom of the foot that   aids in stability and control of  the foot. Activities that involve   extension of the big toe, loading of the  Achilles tendon, and weightbearing in general,   such as standing, walking, and running, increase  the tension experienced by the plantar fascia. Plantar fasciitis refers to inflammation of  the plantar fascia. However, current research   suggests that local inflammation is likely  not the primary driver of the condition.   Therefore, Riel et al suggest calling it  plantar fasciopathy or plantar heel pain. This is important to know because most people  associate inflammation with the need to rest,   ice, and take anti-inflammatory medication,  which are not recommended treatments. It’s also not recommended to aggressively roll or  massage the bottom of your foot with the intention   of breaking up scar tissue or  adhesions because it’s actually   not possible to do either.  The plantar fascia is a dense,   fibrous connective tissue that cannot be  altered with our hands or other tools. You can roll your foot on a frozen water bottle  or lacrosse ball if it feels good for you   and doesn’t take away from the primary  goals of rehab, but neither are needed. You may have also heard that the cause of your  pain is a bone spur, but research by Hansen et al   “found that a heel spur had no  influence on either the development   or prognosis of symptoms and that many patients  had a heel spur without having symptoms.” To understand what is recommended, it’s  important to discuss who gets plantar heel pain. The condition generally  presents along a continuum.   On one end, there is the younger, more active  population, such as runners. On the other side,   there are the older, more sedentary  individuals with a higher body mass index. But why did you get plantar heel pain? A simplified framework is that it’s thought  to occur when the intensity, frequency,   and volume of plantar fascia loading, such as  when standing, walking, or running, exceeds your   capacity to recover and adapt appropriately. For the runners, it often comes down to doing   too much, too soon. For example,  perhaps you increased your pace or   total running mileage as you were training  for a race, which represents a spike in load. For the less active individuals, it might  be related to a gradual decline in general   physical activity and overall well-being,  which represents a decrease in capacity. Therefore, the goal of rehab for either population   is to balance out this equation, so that your  capacity is greater than or equal to the various   loads you’re experiencing on a day-to-day and  week-to-week basis. It’s also important to   point out that other lifestyle factors like sleep,  stress, and nutrition can influence this equation. Based on this information, my first  recommendation for rehab is to modify   aggravating activities to reduce  the load side of the equation. If you’re a runner who can’t tolerate your  current training program, you need to temporarily   scale back by manipulating the frequency,  mileage, or speed of your runs. Similarly,   if you can’t tolerate a certain  amount of walking or standing,   you might need to do less, if possible.  To maintain or increase your capacity,   it may be helpful to swim, cycle, or perform  the exercises demonstrated in this video. I also highly recommend tracking your daily steps  because it helps you understand your baseline   level of function and tolerance. You don’t need  to hit a certain step count; you just need to   determine how much is too much right now and very  gradually build that up over weeks and months. Another fundamental component  of rehab is understanding   and monitoring pain. Ask yourself 2 questions: 1. Is my pain tolerable during exercise?   There’s not a universally acceptable answer.  You get to decide what tolerable means. 2. Is my pain better, worse, or the same the  day after exercise? If you feel fine during   and immediately after exercise, but you have a  significant worsening of symptoms the next day,   that’s an indication that you’re doing  too much and need to back off a bit. You can assess your next-day symptoms with  your first step out of bed in the morning.   For example, you rate your pain on day 1 as  a 2/10 pain. You then perform your exercise   routine within tolerance, go about your  day, and go to bed without any major issues.   The next morning you wake up  and rate your pain as a 5/10.   This means that even though your symptoms were  tolerable during exercise, you might have done a   little too much. You didn’t do any harm, but  doing less next time would be recommended. Also, you can replace the word  exercise with physical activity,   work, or anything else that affects your symptoms. Shoes and foot orthoses can be considered for  attempting to reduce the load side of the equation   by modifying the amount of tension  experienced by the plantar fascia. For example, you can trial a cheap heel cup  or off-the-shelf orthotic that supports the   arch of the foot to determine if it provides  some short-term relief. If you’re working   with a podiatrist, you can  discuss custom foot orthoses. In terms of shoewear, I’d expect a minimalist shoe  to increase plantar fascia loading and a motion   control-type shoe to decrease plantar fascia  loading. Theoretically then, it may be helpful to   use a shoe that decreases the load on the plantar  fascia early on when you’re highly symptomatic. However, what you choose to wear  will also be based on your comfort,   preferences, beliefs, and other factors. For the exercises, I’m going to present two  categories with different purposes. The first   category is meant to provide short-term relief.  One exercise is recommended based on the research,   and the other two are optional add-ons. The second  category is meant to improve long-term function   and increase your tolerance to standing, walking,  and running by gradually loading the plantar   fascia. Once again, one exercise is recommended  and the other two are optional add-ons. Whether you decide to do 1,  2, or all 6 of the movements   depends on your symptoms, goals, time  availability, etc. Tailor the exercises,   and all of this information,  to suit your individual needs. The first recommended exercise is a plantar fascia  stretch, researched by DiGiovanni et al in 2003   and 2006. After periods of prolonged inactivity,  such as sleeping or sitting, you can perform this   stretch with the intention of decreasing the  pain you experience upon standing or walking. Place the affected foot on the opposite leg   and pull the toes up toward the shin. Hold the  stretch for 10 seconds and repeat 10 times. Two optional exercises that you can  perform after the plantar fascia stretch   are toe curls and toe yoga. Toe curls involve flexing and extending your  toes, with or without the use of a towel. Toe yoga involves tapping your big toe  and other toes in an alternating fashion. You can do one or both exercises  for up to a minute at a time. The recommended exercise for improving  long-term function is a heel raise because   it’s weightbearing, requires extension of the  big toe, and involves loading of the Achilles   tendon and calf complex. In the research by  Rathleff et al in 2015 and Riel et al in 2019,   a single leg heel raise was performed on a  step with a towel under the big toe. Here   is a progression you can do with or without  the use of a towel or object under your toes. Level 1 - Double Leg Heel Raises on Flat Ground.   Aim for 3 sets of 25 slow and controlled  repetitions. Use your hands for balance as needed. Level 2 - Single Leg Heel Raises on  Flat Ground. Aim for 3 sets of 15 reps. Level 3 - Single Leg Heel Raises on a Step.   Aim for 3-4 sets of 8-15 reps. Over  time, you can add weight as needed. An optional exercise for improving  the strength, range of motion,   and control of your feet and ankles  is a split squat progression. Level 1 - Bodyweight Squat.  Gently tap your butt to a chair   and stand back up. If it’s too challenging,   shorten the range of motion or use your hands  for assistance. Aim for 3 sets of 20 reps. Level 2 - Split Squat. Start in a stride stance  and lower yourself down so that your back knee   taps an egg that you don’t want to crack. If  it’s too difficult for your front or back leg,   shorten the range of motion or use your hands  for assistance. Aim for 3 sets of 15 reps. Level 3 - Front Foot Elevated  Split Squat. Elevate the front leg   using a 2-4” object. Drive your  knee as far forward as tolerable.   Aim for 3-4 sets of 8-15 slow and controlled  reps. Over time, you can add weight as needed. Another optional exercise for improving long-term  function is a single leg balance progression. Level 1 - Single Leg Balance. Work your way up  to standing on one leg for 3 sets of 60 seconds. Level 2 - Single Leg RDL. Stand on one leg  while keeping a slight bend in both knees,   hinge at your hips until your trunk  is almost parallel with the ground,   and then return to the starting position. Repeat  this movement without touching your foot to the   ground. If this is too challenging, use your hands  to help with balance, shorten the range of motion,   or tap your foot to the ground.  Aim for 3 sets of 12 reps. Level 3 - Single Leg RDL w/ Knee Drive.   You can progress the previous  movement by adding a knee drive.   Aim for 3-4 sets of 8-15 slow and controlled  reps. Over time, you can add weight as needed. If you like to stretch before exercising,  the inchworm is a great dynamic option.   Start in a plank position, slowly  walk your feet toward your hands,   and drive your heels into the ground  so you feel a stretch in your feet,   calves, and hamstrings. Reset your  position and repeat for a few reps. In summary, plantar heel pain is characterized  by symptoms on the bottom of the foot   with standing, walking, running, or  taking that first step in the morning.   It generally presents along a  continuum with runners on one end,   and older, more sedentary individuals with  a higher body mass index on the other end. Since local inflammation isn’t thought to be the  primary driving factor of the condition, ice,   anti-inflammatories, and complete rest are not  recommended. Contrary to popular belief, managing   plantar heel pain is also not about breaking up  scar tissue, removing heel spurs, or changing   the structure of the foot. You can roll your foot  on a frozen water bottle or lacrosse ball if it   feels good for you and doesn’t take away from the  primary goals of rehab, but neither are needed. My core approach involves modifying aggravating  activities, keeping track of daily steps   and monitoring symptoms, and maintaining or  progressing tolerable physical activity over time. To aid with short-term relief, plantar fascia  stretching can be performed for 10 reps   of 10 seconds after periods of prolonged  inactivity, such as sleeping or sitting.   Following this movement up for a minute or  two of toe curls and/or toe yoga is optional.   To improve long-term function of your feet  and ankles, consider performing heel raises   every other day. Incorporating the split  squat and single leg balance progressions   to further improve function are optional, as well  as the inchworm as part of a dynamic warm-up. Regardless of what you decide to do,  it’s important to tailor the plan   to your individual goals and needs. There is  no quick fix for plantar heel pain, so it’s   helpful to set realistic expectations and plan  for the process to take a minimum of 3 months. Thank you so much for watching. If you  enjoyed the video, hit that like button,   subscribe, turn on notifications, and leave  any questions or comments down below. Peace!
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Channel: E3 Rehab
Views: 4,033,611
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Length: 13min 24sec (804 seconds)
Published: Sun Jun 26 2022
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