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Stretching, treatments, and exercise.

Posted by Bill E. on 1/23/01 at 14:05 (037155)

I know, that is a lot for one subject! I have been mostly lurking around here for a while and now have some questions. It seems that there are folks who have tried just about everything.

Background: I am male, 55, have been running since my 20's, not overweight (5'9', 160#). I think I got my PF last summer runnng barefoot on the beach. It got worse after a fairly hard run on a dirt trail. I haven't run in about 4 months or more. The original diagnosis was PF but naproxen didn't seem to help much. I got a single cortisone shot and a bone scan. The cortisone helped for a couple of weeks but from all I've read, I don't want to do that again. The bone scan showed some activity in both heels but no stress fracture. There is no physical bone spur on x-ray. I am almost embarassed to admit that the pain isn't really too bad. (So many people here have problems that are so much more serious than mine!!) I don't have the 'classic' early morning pain. But a day on my feet will result in worse pain for a couple of days. Orthotics (OTC: Superfeet and Spenco) have helped. It seems that some stretching helps.

My goal is to get completely healed so that I can run again. This is important to me physically but more; psychologically. But I won't rush things because I really want as complete of a repair as is possible.

My main question (for starters): Today I started physical therapy which is ultrasound with cortisone cream. It includes some massage and stretching. Does anyone have experience with this treatment? I am a bit concerned with the use of cortisone. I know that reducing all swelling for a while should give the faschia a chance to heal, but... Does cortisone, topically, have any of the side effects of cortisone injections?

Any great suggestions for stretches or exercise that will help me maintain aerobic condition and not incidentally, weight? I will follow up in another post on my stretching and exercise, I'm not 100% sure that it is optimal!

Thanks for any input!
Bill

Re: Stretching, treatments, and exercise.

Bob G. on 1/23/01 at 23:29 (037179)

Hey, Bill! I can relate, only I did not go into shots and all that stuff. I am back to jogging without pain. What did it for me was REST. About a year or so, but worth it.

A lot of rest which meant a new way of thinking and coping, and adjusting to the nightsplint, which turned the corner for me.

I could write a book, but better yet, do a search under my name for my story. (Don't pay any attention to the jokes.) BG

Re: Stretching, treatments, and exercise.

Julie on 1/24/01 at 02:40 (037186)

Hi Bill

I've had quite a bit of ultrasound treatment (and have also used my own intra-sound device, similar to ultrasound but at a lower frequency) and I think it helped, though of course when one is following several treatment paths it's difficult to be sure exactly what is helping. Perhaps one of the doctors will be able to answer your question on cortisone cream - I wouldn't have thought the small amount used for ultrasound would have any deleterious effects, certainly not to the extent that injected cortisone might; and especially as ultrasound treatment is not usually continued indefinitely.

Don't be embarrassed to say that your pain isn't too bad! It's wonderful (and attests to your good sense) that it isn't. You've stopped running and are giving the fascia a chance to heal, and most of us around here would agree that rest, whatever other treatments are undertaken, is the most important factor in healing. A good general rule is that if something hurts, to stop doing it, because increased pain means that the fascia is being re-injured. Bob is our shining example of a runner recovering through rest!

Have you read the PF Book? Do: it will give you a great deal of information and advice.

I've found taping very helpful: it doesn't just provide pain relief, it gives the arch the support that it has lost due to the tearing of the fascia, so that if you have to be on your feet more than perhaps you should it extends the time you can do so without damage. Scott's simple two-strip method, the first one illustrated, has worked well for me. Others have preferred the more complex systems - you need to experiment a bit.

Swimming is probably the best non-weight-bearing aerobic exercise (and you'll find some info on under-water running in the PF book). There are yoga exercises with an aerobic component. If you already practise yoga, you should consider omitting the standing postures.

Stretching is a complex issue. The classic 'wall stretches' which seem to be generally advised work well for some, but several people on this board, including me, have found that they and other weight-bearing exercises make matters worse. It depends on the individual: all cases seem to be different. I would suggest that you proceed with caution, listen to your body and follow the 'if it hurts, stop' rule.

I hope this is helpful. Keep posting your questions - there are lots of people here who have been through it, and will help.

All the best

Julie

Re: Stretching, treatments, and exercise.

Rich S on 1/24/01 at 06:05 (037188)

Sounds like we have almost the exact same experience albeit I'm in my late 30's. I'm a basketball player and a runner. I think PF is more related to age for our profile rather than a specific injury. Many of my peers (same age) in the military have PF as well.

I had ultrasound with the cortisone cream for 6 months and feel it was a complete waste of time. Resting for 6 months did absolutely no good for me either. I was in great pain after a day at the office.

My frustration of having little progress coupled with a long plane ride that aggravated my PF considerably drove me to alternative medicine. See my post below.

-Rich

Re: Stretching, treatments, and exercise.

Bill E on 1/25/01 at 09:23 (037319)

Bob,
Thanks for the encouragement. I have searched your name...it is a good source but kind of like drinking from a firehose. You have posted a lot on here.

The nightsplint worked? Do you have a good idea of why? Which one did you use? I suppose that the latter is in one of your posts but I didn't find it quickly and I guess I'm a bit too impatient to read through everything!

I am having some success, see above, and am looking forward to starting on a treadmill in a few months. But I'll be sure that it isn't too soon. I really want to get a full recovery. Right now I am dreaming of a half marathon!!! I hope that goal isn't unreachable.

Bill

Re: An Update - Positive results

Bill E. on 1/25/01 at 09:29 (037320)

I am reluctant to post this in fear that it will jinx the treatment but...

I've been to two PT sessions of ultrasound with cortisone cream and mild massage. It is working! I almost feel like I could go out and run this morning. No! No! I'm not going to do it. I suspect that the best that I can shoot for is several months in the future.

I am wondering if this isn't just a reduction of swelling and that two weeks after quitting the treatment I will be back to where I started. Right now I am scheduled for a total of six treatments with a potential follow on of another six if it is working.

Any comments, positive or negative, from others who have had experience with this treatment?

Bill

Re: Stretching, treatments, and exercise.

Bob G. on 1/23/01 at 23:29 (037179)

Hey, Bill! I can relate, only I did not go into shots and all that stuff. I am back to jogging without pain. What did it for me was REST. About a year or so, but worth it.

A lot of rest which meant a new way of thinking and coping, and adjusting to the nightsplint, which turned the corner for me.

I could write a book, but better yet, do a search under my name for my story. (Don't pay any attention to the jokes.) BG

Re: Stretching, treatments, and exercise.

Julie on 1/24/01 at 02:40 (037186)

Hi Bill

I've had quite a bit of ultrasound treatment (and have also used my own intra-sound device, similar to ultrasound but at a lower frequency) and I think it helped, though of course when one is following several treatment paths it's difficult to be sure exactly what is helping. Perhaps one of the doctors will be able to answer your question on cortisone cream - I wouldn't have thought the small amount used for ultrasound would have any deleterious effects, certainly not to the extent that injected cortisone might; and especially as ultrasound treatment is not usually continued indefinitely.

Don't be embarrassed to say that your pain isn't too bad! It's wonderful (and attests to your good sense) that it isn't. You've stopped running and are giving the fascia a chance to heal, and most of us around here would agree that rest, whatever other treatments are undertaken, is the most important factor in healing. A good general rule is that if something hurts, to stop doing it, because increased pain means that the fascia is being re-injured. Bob is our shining example of a runner recovering through rest!

Have you read the PF Book? Do: it will give you a great deal of information and advice.

I've found taping very helpful: it doesn't just provide pain relief, it gives the arch the support that it has lost due to the tearing of the fascia, so that if you have to be on your feet more than perhaps you should it extends the time you can do so without damage. Scott's simple two-strip method, the first one illustrated, has worked well for me. Others have preferred the more complex systems - you need to experiment a bit.

Swimming is probably the best non-weight-bearing aerobic exercise (and you'll find some info on under-water running in the PF book). There are yoga exercises with an aerobic component. If you already practise yoga, you should consider omitting the standing postures.

Stretching is a complex issue. The classic 'wall stretches' which seem to be generally advised work well for some, but several people on this board, including me, have found that they and other weight-bearing exercises make matters worse. It depends on the individual: all cases seem to be different. I would suggest that you proceed with caution, listen to your body and follow the 'if it hurts, stop' rule.

I hope this is helpful. Keep posting your questions - there are lots of people here who have been through it, and will help.

All the best

Julie

Re: Stretching, treatments, and exercise.

Rich S on 1/24/01 at 06:05 (037188)

Sounds like we have almost the exact same experience albeit I'm in my late 30's. I'm a basketball player and a runner. I think PF is more related to age for our profile rather than a specific injury. Many of my peers (same age) in the military have PF as well.

I had ultrasound with the cortisone cream for 6 months and feel it was a complete waste of time. Resting for 6 months did absolutely no good for me either. I was in great pain after a day at the office.

My frustration of having little progress coupled with a long plane ride that aggravated my PF considerably drove me to alternative medicine. See my post below.

-Rich

Re: Stretching, treatments, and exercise.

Bill E on 1/25/01 at 09:23 (037319)

Bob,
Thanks for the encouragement. I have searched your name...it is a good source but kind of like drinking from a firehose. You have posted a lot on here.

The nightsplint worked? Do you have a good idea of why? Which one did you use? I suppose that the latter is in one of your posts but I didn't find it quickly and I guess I'm a bit too impatient to read through everything!

I am having some success, see above, and am looking forward to starting on a treadmill in a few months. But I'll be sure that it isn't too soon. I really want to get a full recovery. Right now I am dreaming of a half marathon!!! I hope that goal isn't unreachable.

Bill

Re: An Update - Positive results

Bill E. on 1/25/01 at 09:29 (037320)

I am reluctant to post this in fear that it will jinx the treatment but...

I've been to two PT sessions of ultrasound with cortisone cream and mild massage. It is working! I almost feel like I could go out and run this morning. No! No! I'm not going to do it. I suspect that the best that I can shoot for is several months in the future.

I am wondering if this isn't just a reduction of swelling and that two weeks after quitting the treatment I will be back to where I started. Right now I am scheduled for a total of six treatments with a potential follow on of another six if it is working.

Any comments, positive or negative, from others who have had experience with this treatment?

Bill