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Stretching the plantar facsia AND theachilles tendon

Posted by Dr.Kosova on 1/22/01 at 01:41 (037057)

How many of your docs. have you stretch both the pf and achilles tendon??I am still amazed of how well patients do when they do this. It is when they stop that is the problems. This works well for mild to moderate pain along with orthotics etc.

With the pf I mean puling your toes back with your foot at a or past a right angle then holding it for a minute 15x 3x day. This is an isolated pf strectch. I also tell patients to bring up their ankle(dorsiflex) as much a possible at work or while in line at the supermarket etc. Do this BEFORE getting out of bed to avoid that sharp first step pain. I do this myself when my pf acts up and it seems to help. A patient of mine bought a product on this site to help in this for people that cant reach and to do it effectivley.

Dr. Kosova

Re: Stretching the plantar facsia AND theachilles tendon

Barbara TX on 1/22/01 at 02:47 (037063)

I think that the patient should be very carefully advised not to overstretch... stretching even as advised did me a great deal of damage, and when I attempt to do it, I get serious pain all around the rim of my heel and at the back (this is probably achilles damage?)that I never had before trying this therapy. My first DPM never checked my range of motion to learn if it was adequate, or if my ankle joint was moving properly. A really caring extremities chiropractor discovered a lack of range of motion in the ankle joint itself, and not because of the tightness of the pf. Seriously, I stretched myself into a real, persistent, year-long nightmare to no avail. Yes, and I stretched the 'right way.'

I have a question that never seems to get answered by the physical therapy gurus: is it the actually plantar fascia that gets stretched, or just the surrounding structures (like the gastrocs, hamstrings, heel cord, etc)? I have heard that the PF is impossible to stretch - that's why its so hard to cut through it... What is your opinion? So many patients here are advised to 'stretch through the pain.' I'm really curious about stretching... because if we can't use basic therapies properly - what kind of a chance do we have in handling the really technical stuff (like ESWT)? The perpetually confused B.

Re: Stretching the plantar facsia AND the achilles tendon

Nancy N on 1/22/01 at 09:57 (037070)

Barb/Dr. Kosova--

Barb knows I'm with her on this one. Actually, my POV is not that the stretching itself is bad, but that if it's done while weight-bearing, it can continue the aggravation rather than helping to heal it. I religiously did the wall and stair stretches for months through the pain, and all it did was continue the pain. I bought the Acu-Flex because it allows me to stretch while I'm seated, so there's no weight on the feet. Once I stopped the weight-bearing stretching, I started to improve.

My Pod never checked me for range of motion the first time I had PF, either. he sent me for PT the second time, when it moved into the other foot, but still never checked me himself--just assumed that the PT was doing the right things. Seems sort of odd to me.

I'm curious about this fascia stretching, too. I wonder if the dorsiflexion I can do with the Acu-Flex is similar? I can cross my leg (knee bent, much like I might do ordinarily when sitting) and the Acu-Flex, which has loops around each toe, wraps around me to pull the toes back. Does that sound like the same sort of thing? I do think that helps a lot, possibly even more than the other stretching/strengthening exercises I do with the Acu-Flex.

Re: Stretching the plantar facsia AND the achilles tendon

Dr. Kosova on 1/22/01 at 14:37 (037083)

Nancy and Barb. Hello. The accuflex looks great the first picture with the toes back. Yes this is a isolated pf strecth to the most degree that we can do it. HOLD THE STRETCH. Barb I dont strecth patients standing either. I didnt say to over stretch. Yes stretch the calves and thigh is recommened but to your personal tolerance and rom etc is part of any basic exam by any lower extremity specialits. Most pts that I have worked with dont do this strectch till I show them. Now they do. They do the wall stretch and backwards off a step with the forefoot or toes of the step then lower the heel down. I hate this one I think more people can potentially hurt themselves. I also dont like wall stretch most people seem to do this incorrectly anyway.

I hope this helps.

Dr. Kosova

Re: Stretching the plantar facsia AND theachilles tendon

Kay S on 1/22/01 at 19:37 (037106)

Hey Barb---just so you don't think you are crazy, I am going to a new PT for massage (friction massage, and it hurts like hell sometimes, but since I haven't done anything like this in a couple of years I thought I'd give it another shot),,,,,,,,,,anyway, I asked about the stretching exercises, and he said 'No way, Kay. You are already WAY too stretched.' Could it be that I was overzealous in my attempt to cure my pf, or is it just people like you and me who don't fit the norm?
This is why I like this site. You cannot have a condition/recipe which works for everyone. Good for y'all who can stretch and get better. But for BarbTX and me, it ain't happenin'!!!
Kay

Re: Stretching the plantar facsia AND the achilles tendon

alan k on 1/23/01 at 09:04 (037143)

Hi Nancy,

If I am understanding your description of your favorite stretch, that position would emphasize the soleus muscles and de-emphasize the gastrocs, as well as help lengthen out the achilles a bit more than with straight legs. (The gastrocs are 'programmed' to disengage when knee is bent).

yours, alan k

Re: Stretching the plantar facsia AND theachilles tendon

Julie on 1/24/01 at 07:10 (037190)

There is a real problem here, and at the root of it is that the same stretches are counselled for everybody and are seldom properly taught. Every website I have investigated on the subject of PF, and most pods, including mine, advise the standing wall stretches, which I am now convinced can do more harm than good. Weight-bearing stretches are not the right thing for many if not most PF sufferers and certainly not for those with Achilles and the other tendonitises. Non weight-bearing systems such as Acu-Flex (which come with clear instructions) are far more suitable for most people - not only are they more precise and therefore more effective, they are also more controllable and less likely to do damage.

Also, as Dr K points out, most people do the generally-prescribed stretches incorrectly. Doing them correctly means keeping not only the feet but the entire body in alignment - particularly the pelvis, so that the lower back isn't strained. Most people don't even know what this means.

And not everyone needs them: look at Kay's example! My calf muscles too are well stretched,and my pod admitted, when I told him I didn't think the stretches he'd recommended were helping me, that if the calf muscles aren't tight, the wall stretches can do more harm than good.

The board has resounded with the cries of people who have followed blanket stretching instructions in good faith and lived to regret it. My view is that anyone wanting to target their particular condition with exercise should be given exercise appropriate to that condition by someone who knows about the condition and that person's individual manifestation of it, and who also about exercise, and can teach it properly.

This is a counsel of perfection, I know, and unlikely to be achieved. So the responsibility devolved upon the individual. Learn to listen to your body and respect the messages it gives you. Pain is always a signal to stop doing whatever is causing the pain.

I hope those of you who have heard me say this several times before will forgive me for repeating myself!

Julie

Re: Stretching the plantar facsia AND theachilles tendon

Barbara TX on 1/22/01 at 02:47 (037063)

I think that the patient should be very carefully advised not to overstretch... stretching even as advised did me a great deal of damage, and when I attempt to do it, I get serious pain all around the rim of my heel and at the back (this is probably achilles damage?)that I never had before trying this therapy. My first DPM never checked my range of motion to learn if it was adequate, or if my ankle joint was moving properly. A really caring extremities chiropractor discovered a lack of range of motion in the ankle joint itself, and not because of the tightness of the pf. Seriously, I stretched myself into a real, persistent, year-long nightmare to no avail. Yes, and I stretched the 'right way.'

I have a question that never seems to get answered by the physical therapy gurus: is it the actually plantar fascia that gets stretched, or just the surrounding structures (like the gastrocs, hamstrings, heel cord, etc)? I have heard that the PF is impossible to stretch - that's why its so hard to cut through it... What is your opinion? So many patients here are advised to 'stretch through the pain.' I'm really curious about stretching... because if we can't use basic therapies properly - what kind of a chance do we have in handling the really technical stuff (like ESWT)? The perpetually confused B.

Re: Stretching the plantar facsia AND the achilles tendon

Nancy N on 1/22/01 at 09:57 (037070)

Barb/Dr. Kosova--

Barb knows I'm with her on this one. Actually, my POV is not that the stretching itself is bad, but that if it's done while weight-bearing, it can continue the aggravation rather than helping to heal it. I religiously did the wall and stair stretches for months through the pain, and all it did was continue the pain. I bought the Acu-Flex because it allows me to stretch while I'm seated, so there's no weight on the feet. Once I stopped the weight-bearing stretching, I started to improve.

My Pod never checked me for range of motion the first time I had PF, either. he sent me for PT the second time, when it moved into the other foot, but still never checked me himself--just assumed that the PT was doing the right things. Seems sort of odd to me.

I'm curious about this fascia stretching, too. I wonder if the dorsiflexion I can do with the Acu-Flex is similar? I can cross my leg (knee bent, much like I might do ordinarily when sitting) and the Acu-Flex, which has loops around each toe, wraps around me to pull the toes back. Does that sound like the same sort of thing? I do think that helps a lot, possibly even more than the other stretching/strengthening exercises I do with the Acu-Flex.

Re: Stretching the plantar facsia AND the achilles tendon

Dr. Kosova on 1/22/01 at 14:37 (037083)

Nancy and Barb. Hello. The accuflex looks great the first picture with the toes back. Yes this is a isolated pf strecth to the most degree that we can do it. HOLD THE STRETCH. Barb I dont strecth patients standing either. I didnt say to over stretch. Yes stretch the calves and thigh is recommened but to your personal tolerance and rom etc is part of any basic exam by any lower extremity specialits. Most pts that I have worked with dont do this strectch till I show them. Now they do. They do the wall stretch and backwards off a step with the forefoot or toes of the step then lower the heel down. I hate this one I think more people can potentially hurt themselves. I also dont like wall stretch most people seem to do this incorrectly anyway.

I hope this helps.

Dr. Kosova

Re: Stretching the plantar facsia AND theachilles tendon

Kay S on 1/22/01 at 19:37 (037106)

Hey Barb---just so you don't think you are crazy, I am going to a new PT for massage (friction massage, and it hurts like hell sometimes, but since I haven't done anything like this in a couple of years I thought I'd give it another shot),,,,,,,,,,anyway, I asked about the stretching exercises, and he said 'No way, Kay. You are already WAY too stretched.' Could it be that I was overzealous in my attempt to cure my pf, or is it just people like you and me who don't fit the norm?
This is why I like this site. You cannot have a condition/recipe which works for everyone. Good for y'all who can stretch and get better. But for BarbTX and me, it ain't happenin'!!!
Kay

Re: Stretching the plantar facsia AND the achilles tendon

alan k on 1/23/01 at 09:04 (037143)

Hi Nancy,

If I am understanding your description of your favorite stretch, that position would emphasize the soleus muscles and de-emphasize the gastrocs, as well as help lengthen out the achilles a bit more than with straight legs. (The gastrocs are 'programmed' to disengage when knee is bent).

yours, alan k

Re: Stretching the plantar facsia AND theachilles tendon

Julie on 1/24/01 at 07:10 (037190)

There is a real problem here, and at the root of it is that the same stretches are counselled for everybody and are seldom properly taught. Every website I have investigated on the subject of PF, and most pods, including mine, advise the standing wall stretches, which I am now convinced can do more harm than good. Weight-bearing stretches are not the right thing for many if not most PF sufferers and certainly not for those with Achilles and the other tendonitises. Non weight-bearing systems such as Acu-Flex (which come with clear instructions) are far more suitable for most people - not only are they more precise and therefore more effective, they are also more controllable and less likely to do damage.

Also, as Dr K points out, most people do the generally-prescribed stretches incorrectly. Doing them correctly means keeping not only the feet but the entire body in alignment - particularly the pelvis, so that the lower back isn't strained. Most people don't even know what this means.

And not everyone needs them: look at Kay's example! My calf muscles too are well stretched,and my pod admitted, when I told him I didn't think the stretches he'd recommended were helping me, that if the calf muscles aren't tight, the wall stretches can do more harm than good.

The board has resounded with the cries of people who have followed blanket stretching instructions in good faith and lived to regret it. My view is that anyone wanting to target their particular condition with exercise should be given exercise appropriate to that condition by someone who knows about the condition and that person's individual manifestation of it, and who also about exercise, and can teach it properly.

This is a counsel of perfection, I know, and unlikely to be achieved. So the responsibility devolved upon the individual. Learn to listen to your body and respect the messages it gives you. Pain is always a signal to stop doing whatever is causing the pain.

I hope those of you who have heard me say this several times before will forgive me for repeating myself!

Julie