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Stretching

Posted by Julie F on 10/28/00 at 03:33 (031495)

Hello everyone

Overnight I've been contemplating what Alan said under the 'Heel Lifts' thread yesterday, and woke up this morning wanting to underline his comments about stretching and add some of my own.

1. Stretching exercises can be done well or poorly. It's important to realize this; and also to understand that an exercise that may be right for one person, even when executed correctly, isn't necessarily going to be right for another.

2. Any exercise, in order to be effective and not do more harm than good, must be done properly, i.e. with respect for body alignment and body structure: this can't be too strongly emphasized. This is always true, but it's doubly important when an exercise is being used to target and improve a pathological/painful condition such as PF, TTS or tendonitis.

3. Aspects such as muscle length and tone, individual flexibility or lack of it, should be taken into account. So should any pre-existing conditions that might be aggravated by poor body use, such as a lower back problem. A poorly positioned pelvis, for instance, throws the whole body out of alignment and in particular stresses the lower back. If that is someone's problem, any exercise, even the simple wall stretch we all know and love, will increase that stress. (Obviously that's bad news - especially if I'm right in my hunch that at least some of our foot problems are related to what's going on in our backs.)

4. Several days ago I posted a caution about this, in the context of a strong forward bending exercise that someone recommended. I was sorry to be a wet blanket, and hope I didn't hurt anyone's feelings, but it really is a safety issue, and now I want to repeat the warning I gave then. Please be careful and don't just rush off to do an exercise because someone who found it helpful told you about it. It may not be right for you, and even if it is you may not know how to do it properly.

I realize this sounds very 'doom and gloom', but I have seen many people injured, or their back and other problems made worse by incorrect exercising, and I've thought about these matters for half my life, especially in the 13 years since I started to teach and train teachers. Exercise is important, and I certainly don't want to give the impression that we should all give up exercising. But I think that if at all possible, the exercises we do for our foot problems should be taught to us by someone who knows us, knows about our condition, and knows how to teach the exercises they give us. Doctors do sometimes hurry over this bit - mine did. Have the courage to insist on proper demonstration, explanation and instruction. Ask questions.

When professional instruction isn't an option (here it comes again!)

LISTEN TO YOUR BODY.

Go carefully, have respect for yourself, your body, let your pain be your teacher, and if anything hurts, STOP.

I hope this is useful, and best of good wishes to you all.

Julie

Re: Stretching

alan k on 10/28/00 at 07:48 (031500)

Just an amen:

In my experience with a few doctors and a few podiatrists, none of which seemed to me to be very good or interested in what they were doing (unlike our doctors on heelspurs.com), stretching instructions were close to laughable. I didn't say anything to them but it was obvious that they didn't do the exercises themselves and weren't really aware of basics of stretching like warming up the muscles first, and that the position of other parts of the body matter very much when doing stretches targeted for another part, like, for instance the position of the hips (square to the wall) when doing a wall stretch, etc. Also, recommended stretches like the stair stretch not only are a dicey for someone with pf, but they can put a huge strain on the muscle in the back of the knee, and anyone that has hurt that part knows how nasty and persistant that can be. Most GP's, I think, have so many conditions to deal with that if they aren't personally involved in stretching disciplines (of course many doctors are athletes, etc.), they may not know a lot about it.

Just a note on the long muscles/ short muscles thing-- just to be clear there are two things going on in flexibility. One is just how long your muscles happen to naturally be, which varies over your body. The other thing is, starting from that given length, how far can the muscles stretch and expand further-- the elasticity. Given a certain length, is the muscle more like a rope, or more like a rubber band? This is determined by the proportion of elastic muscles fibers relative to inelastic fibers in the muscles, which is increased through stretching and toning.

Just because you have long muscles allowing great dorsiflexion, and seem to be flexible, doesn't mean your muscles there are in great shape. They still need to be stretched and toned and challenged at the degree of flexion that is effective for them. I am sure Julie has seen people come into yoga class and immediately are able to bend themselves into pretzels, but that doesn't mean their muscles are in great shape. Luckily for them, Yoga has an infinite arsenal of stretches so that it doesn't matter how long your muscles are, there is always another degree of pretzel pose that is challenging and stretches and tones the muscles.

Short muscles of course similarly need stretching. Because they are tighter they may have had more of a negative influence on the development of pf than longer muscles, and so the pf may respond to stretching faster. At the same time, because they are naturally tighter, perhaps problems with improper stretching are translated more easily into the pf, so stretching guidelines are most useful. Unfortunately, any given GP may not be the best person for this. I sorely hope that my experiences with doctors is not typical, but it is replicated from time to time, as we know from reading eachothers messages. In fact, we have seen much, much worse than my doctors in peoples' messages before. Probably the best of both worlds would be a doctor who also practices stretching herself.

alan

Re: Stretching

Julie F on 10/28/00 at 12:49 (031520)

And another Amen...

While we're talking about flexibility, let's remember that ligaments as well as muscles are involved. The function of ligaments is to allow joints to move within a certain, safe range. People with loose ligaments (i.e. hypermobile folk) can easily overstretch and do themselves damage, so it's important they don't. (Pregnant women need to be especially careful, because the increased secretion of progesterone which loosens the ligaments of the pelvic floor in preparation for birth loosens all the other ligaments too. If a woman thinks 'oh boy, I can stretch further now', and goes on stretching too far after the birth, she will end up with permanently over-stretched ligaments.) Yes, I've seen lots of people who can pretzel themselves, or flop forward into a 'hairpin' forward bend, face on shins. And yes, it doesn't necessarily indicate their muscles are in good shape. It also - usually - means (unless they are yoga adepts and have worked on strengthening as well as stretching) that they're hypermobile. These people need above all to strengthen, and - I believe - to take care with stretching.

Re: the wall stretch - yes, the hips have to be square to the wall. In fact the whole pelvis has to be correctly held, in the vertical as well as the horizontal plane, otherwise, if it tips forward, the exercise stresses the lumbar. This easily happens unless the tailbone is consciously tucked under while leaning forward into the stretch.

I tried the stair stretch (which I found on another heel pain website!) I only tried it once, and was surprised that anyone recommends it to PF sufferers. (This is what I mean when I counsel caution about exercises picked up from here and there - if you didn't understand what's wrong with this exercise, you could persevere with it for too long because 'someone', somewhere, said it was good.) It's difficult, nearly impossible, to control it, so it can make matters worse by irritating the fascia, and can add Achilles tendonitis to the PF woes. And as Alan says, it's bad for the knees - it can easily lead to hyperextension.

Yes, ideally the best teacher would be an exercise-wise doctor. But sadly, as you say, Alan, they are thin on the ground. Ultimately we're responsible for ourselves, which is why I say we need to be aware of what's going on so we can take that responsibility safely and effectively.

All the best, Julie

Re: Stretching

alan k on 10/28/00 at 07:48 (031500)

Just an amen:

In my experience with a few doctors and a few podiatrists, none of which seemed to me to be very good or interested in what they were doing (unlike our doctors on heelspurs.com), stretching instructions were close to laughable. I didn't say anything to them but it was obvious that they didn't do the exercises themselves and weren't really aware of basics of stretching like warming up the muscles first, and that the position of other parts of the body matter very much when doing stretches targeted for another part, like, for instance the position of the hips (square to the wall) when doing a wall stretch, etc. Also, recommended stretches like the stair stretch not only are a dicey for someone with pf, but they can put a huge strain on the muscle in the back of the knee, and anyone that has hurt that part knows how nasty and persistant that can be. Most GP's, I think, have so many conditions to deal with that if they aren't personally involved in stretching disciplines (of course many doctors are athletes, etc.), they may not know a lot about it.

Just a note on the long muscles/ short muscles thing-- just to be clear there are two things going on in flexibility. One is just how long your muscles happen to naturally be, which varies over your body. The other thing is, starting from that given length, how far can the muscles stretch and expand further-- the elasticity. Given a certain length, is the muscle more like a rope, or more like a rubber band? This is determined by the proportion of elastic muscles fibers relative to inelastic fibers in the muscles, which is increased through stretching and toning.

Just because you have long muscles allowing great dorsiflexion, and seem to be flexible, doesn't mean your muscles there are in great shape. They still need to be stretched and toned and challenged at the degree of flexion that is effective for them. I am sure Julie has seen people come into yoga class and immediately are able to bend themselves into pretzels, but that doesn't mean their muscles are in great shape. Luckily for them, Yoga has an infinite arsenal of stretches so that it doesn't matter how long your muscles are, there is always another degree of pretzel pose that is challenging and stretches and tones the muscles.

Short muscles of course similarly need stretching. Because they are tighter they may have had more of a negative influence on the development of pf than longer muscles, and so the pf may respond to stretching faster. At the same time, because they are naturally tighter, perhaps problems with improper stretching are translated more easily into the pf, so stretching guidelines are most useful. Unfortunately, any given GP may not be the best person for this. I sorely hope that my experiences with doctors is not typical, but it is replicated from time to time, as we know from reading eachothers messages. In fact, we have seen much, much worse than my doctors in peoples' messages before. Probably the best of both worlds would be a doctor who also practices stretching herself.

alan

Re: Stretching

Julie F on 10/28/00 at 12:49 (031520)

And another Amen...

While we're talking about flexibility, let's remember that ligaments as well as muscles are involved. The function of ligaments is to allow joints to move within a certain, safe range. People with loose ligaments (i.e. hypermobile folk) can easily overstretch and do themselves damage, so it's important they don't. (Pregnant women need to be especially careful, because the increased secretion of progesterone which loosens the ligaments of the pelvic floor in preparation for birth loosens all the other ligaments too. If a woman thinks 'oh boy, I can stretch further now', and goes on stretching too far after the birth, she will end up with permanently over-stretched ligaments.) Yes, I've seen lots of people who can pretzel themselves, or flop forward into a 'hairpin' forward bend, face on shins. And yes, it doesn't necessarily indicate their muscles are in good shape. It also - usually - means (unless they are yoga adepts and have worked on strengthening as well as stretching) that they're hypermobile. These people need above all to strengthen, and - I believe - to take care with stretching.

Re: the wall stretch - yes, the hips have to be square to the wall. In fact the whole pelvis has to be correctly held, in the vertical as well as the horizontal plane, otherwise, if it tips forward, the exercise stresses the lumbar. This easily happens unless the tailbone is consciously tucked under while leaning forward into the stretch.

I tried the stair stretch (which I found on another heel pain website!) I only tried it once, and was surprised that anyone recommends it to PF sufferers. (This is what I mean when I counsel caution about exercises picked up from here and there - if you didn't understand what's wrong with this exercise, you could persevere with it for too long because 'someone', somewhere, said it was good.) It's difficult, nearly impossible, to control it, so it can make matters worse by irritating the fascia, and can add Achilles tendonitis to the PF woes. And as Alan says, it's bad for the knees - it can easily lead to hyperextension.

Yes, ideally the best teacher would be an exercise-wise doctor. But sadly, as you say, Alan, they are thin on the ground. Ultimately we're responsible for ourselves, which is why I say we need to be aware of what's going on so we can take that responsibility safely and effectively.

All the best, Julie