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Conflict: Doc says "don't stretch" PT says "stretch"

Posted by Beverly on 4/18/00 at 00:00 (018913)

Help! This is so confusing. My doctor says my relapse (terrible heel and arch pain, with a little pain in achilles tendon) is because I stretched too much. He says I need to stop stretching before I get achilles tendonistis and a worse case of PF than I already have! He disagrees almost violently with the program my physical therapist had me on that consisted of a series of stretches. (She has had PF herself.)
Yet, I believe my foot relapsed (I'm new to this condition), because I just did too much the first week I felt better. I believe the stretching helped and it's what got me better the first time. But doctor says that part of my problem was getting out doing too much too fast and part of the problem was stretching. He says, 'Don't stretch anything until you are free of pain.' Yet, how am I going to get free of pain if I don't stretch? Did I do it too often? I stretched on rising... at bedtime, before and after biking, and sometimes at midday. I guess I averaged 3-5 times a day. It was a series of about five stretches. (Mostly ones like flexing foot back for gentle pull 10x and then more for a greater pull 10x, pulling foot back more with big toe 10x, gently flexing foot sideways 10x, and one wall stretch with foot on wall 5x + gentle massage.)

To the PT's credit, she healed me of a neck/shoulder injury last year when nothing else helped, and it's stretching that fixed it. But doctor says my foot is not my neck...

So, what do I do? I'm very frustrated. The doctor especially dislikes the stretches on wedges, off steps, ect.. Is this typical?
Beverly


Re: Conflict: Doc says "don't stretch" PT says "stretch"

Nancy S. on 4/18/00 at 00:00 (018918)

Hi Beverly -- I'm no stretching expert, not by a long shot, so what I say is just my opinion based on my own experience. But the amount of stretching you've been doing is way more than I've ever dared try, and if I were in as much pain as you sound, I wouldn't be doing any at all -- I'd be resting a lot, making sure I wear the best supportive shoes when I'm walking around, and exercising my foot only in non-weight-bearing and gentle ways, like swimming. I had a nasty relapse back in January from trying a rather aggressive stretch. Now the only stretching I do consists of calf stretches in the air before getting out of bed (and a little bit of flexing my feet at the same time -- in the air, no extra pulling), and an against-the-wall stretch (but not holding the stretch, just 'touching' the point of stretch and backing off; I do this just 6 times in a row two or three times a day). And I have been getting better.
I realize this probably sounds like nothing to athletes and other avid stretchers. But having had relapses due to overeager stretching and too much time on my feet, I have to say that the progress I've made I attribute mostly to Birkenstocks and rest, as well as diet changes, and also swimming for foot and overall stretching and exercise. I think regarding stretching I may fall more into the atypical category that Robin feels she's in -- except that I don't do no stretching, I just do very minimal stretching. I tend to agree with your doc on this one. You don't have to not move your feet around at all, but when you're in pain be very wary of following an active stretching regimen. What your PT prescribes might be fine for someone else, but to me it doesn't sound good for you right now. --Nancy S. P.S. Personally I think that hanging off the stair stretch sounds like a nightmare. I don't know if it's genes or foot-activity history or what, but you couldn't pay me a million bucks to do that to my fascia.

Re: Conflict: Doc says "don't stretch" PT says "stretch"

ChrisO on 4/18/00 at 00:00 (018931)

Hi Beverly - I can't help but echo what the others have already said here - if you have to stretch - do it minimally and gently. I guess the theory is that if inflammed/torn tissue is being stretched, then it's only creating more inflammation/tearing. My understanding is that, again, if there is stretching, it should be non-weightbearing - like the sit-down one with a towel around the ball of the foot - and it should not be directed at the planter itself - rather the calf and perhaps the big-toe joint. We all wonder about the stretching thing! I've begun to think that it's not really the 'stretch' of the tendon(s) we're after, it's the loosening, because inflammation= stiffening.

Re: Conflict: Doc says "don't stretch" PT says "stretch"

Nancy S. on 4/18/00 at 00:00 (018918)

Hi Beverly -- I'm no stretching expert, not by a long shot, so what I say is just my opinion based on my own experience. But the amount of stretching you've been doing is way more than I've ever dared try, and if I were in as much pain as you sound, I wouldn't be doing any at all -- I'd be resting a lot, making sure I wear the best supportive shoes when I'm walking around, and exercising my foot only in non-weight-bearing and gentle ways, like swimming. I had a nasty relapse back in January from trying a rather aggressive stretch. Now the only stretching I do consists of calf stretches in the air before getting out of bed (and a little bit of flexing my feet at the same time -- in the air, no extra pulling), and an against-the-wall stretch (but not holding the stretch, just 'touching' the point of stretch and backing off; I do this just 6 times in a row two or three times a day). And I have been getting better.
I realize this probably sounds like nothing to athletes and other avid stretchers. But having had relapses due to overeager stretching and too much time on my feet, I have to say that the progress I've made I attribute mostly to Birkenstocks and rest, as well as diet changes, and also swimming for foot and overall stretching and exercise. I think regarding stretching I may fall more into the atypical category that Robin feels she's in -- except that I don't do no stretching, I just do very minimal stretching. I tend to agree with your doc on this one. You don't have to not move your feet around at all, but when you're in pain be very wary of following an active stretching regimen. What your PT prescribes might be fine for someone else, but to me it doesn't sound good for you right now. --Nancy S. P.S. Personally I think that hanging off the stair stretch sounds like a nightmare. I don't know if it's genes or foot-activity history or what, but you couldn't pay me a million bucks to do that to my fascia.

Re: Conflict: Doc says "don't stretch" PT says "stretch"

ChrisO on 4/18/00 at 00:00 (018931)

Hi Beverly - I can't help but echo what the others have already said here - if you have to stretch - do it minimally and gently. I guess the theory is that if inflammed/torn tissue is being stretched, then it's only creating more inflammation/tearing. My understanding is that, again, if there is stretching, it should be non-weightbearing - like the sit-down one with a towel around the ball of the foot - and it should not be directed at the planter itself - rather the calf and perhaps the big-toe joint. We all wonder about the stretching thing! I've begun to think that it's not really the 'stretch' of the tendon(s) we're after, it's the loosening, because inflammation= stiffening.