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Docs...read this and would like opinion...why is this person saying the following...

Posted by Carmen on 4/28/02 at 18:27 (081498)

'Contrary to popular belief, stretching exercises are contraindicated, because the fascia cannot stretch and exercise creates more trauma to the area due to overuse.
There are some myths surrounding plantar fasciitis, especially the need for stretching exercises as a treatment. Furthermore, at times, treatments are initiated unnecessarily without an accurate diagnosis. However, with a careful history and examination, a proper diagnosis of plantar fasciitis can be made.'

?

Re: Docs...read this and would like opinion...why is this person saying the following...

DR Zuckerman on 4/28/02 at 19:41 (081513)

Yes it is true. You can't stretch the plantar fascia. Stretching of the achilles tendon is important. A diagnosis of pf should be made before a stretching program is started. Should this only be done by a doctor. Well I would lean toward this statement because all pain on the bottom of the foot isn't pf.

Re: Docs...read this and would like opinion...why is this person saying the following...

Dr. Cozzarelli on 4/28/02 at 20:25 (081521)

Carmen:

I don't agree with this at all. I have seen it time and time again. If the patient is using a night splint. This form of passive stretching definately helps. Patients 9 out of 10 times tell me after one week the first step in the moring feels better.

Dr. John Cozzarelli

Re: Docs...read this and would like opinion...why is this person saying the following...

Mike W on 4/28/02 at 20:59 (081528)

Hello Carmen,

I have read the same disturbing quote from the Ontario Podiatry Association.

I believe that any physiologically incorrect exercise (can do more harm than good)is a contraindication and that most traditional PF exercises fall into this category so the statement is sadly true.

I agree with Dr. Z about the fascia not stretching well.

I disagree with Dr. Z about stretching the achilles tendon. The achilles tendon like the fascia is very inelastic and does not stretch very well either. What you should try to do is relax the calf muscles which will help reduce the tension on the achilles tendon.

The traditional approach to stretching the achilles is the standing calf stretch. I believe this is incorrect because the calf muscles will be automatically contracted prior to the stretch which will cause excessive traction on the achilles tendon. This is exactly the oppposite of what the goal of this stretch is! Muscles should always be relaxed prior to performing any stretch.

Regards,

Mike W

Re: Docs...read this and would like opinion...why is this person saying the following...

DR Zuckerman on 4/28/02 at 21:08 (081529)

The best type of stretching for the achilles is the non-weight bearing stretch such as has been described via the personal foot trainer. Stretching the anterior leg muscles is just as important.

Re: Docs...read this and would like opinion...why is this person saying the following...

Julie on 4/29/02 at 02:28 (081547)

Carmen

The aim, as Dr Ed (and Glenn - where are you, Glenn?) have pointed out in the past, is to increase the angle of dorsiflexion in order to take tension off the fascia. Views clearly differ as to how this can best be done, the most common being 'stretch the calf muscles and the achilles tendon',

The important factors to be aware of are (1) that the fascia cannot stretch and (2) that due to the injury/inflammation there is a weakness at the insertion point. Therefore any aggressive attempt to stretch the gastrocnemius/soleus/achilles continuum (which includes pretty well all the commonly recommended exercises, the wall stretch, the stair stretch) is going to stress that vulnerable point and exacerbate the PF.

Non weight-bearing exercise is best.

Re: ALL

Carmen on 4/29/02 at 07:48 (081562)

Thanks ALL!! I think this was important to clear up b/c so many people get put on a stretching program and it's unclear about waht's being stretched....Those comments are great...interesting point too.

Carmen

Re: ALL

Lisa G on 4/29/02 at 17:22 (081617)

i have had PF for about 8 years...and have continued to do my stretches...i was originally told that the fascia do, doesn't stretch very well...but continued stretching of the calf is very important...my new dr today said that my stretching all the darn time is probably what has kept me going all this time...

lisa

Re: ALL

Dr. Cozzarelli on 4/29/02 at 17:31 (081619)

Lisa:

Why would you want to auffer with PF for 8 years. Have you considered ESWT? Perhaps it is time to consider this non-invassive treament.

Dr. John Cozzarelli

Re: ALL

Dr. David S. Wander on 4/29/02 at 20:44 (081676)

I agree that the actual plantar fascia can not really be stretched. However, stretching of the calf muscles does increase dorsiflexion and decreases the pull on the plantar fascia. Our physical therapist has the patients non weightbearing and pulling on the bottom of the foot gently with a towel (toward the body) which stretches the calf muscles. He also has the patient actively 'fire' the anterior muscle group (front of the leg) to help pull the foot up (dorsiflex) even more. We've found this to be very useful, without causing additional inflammation or discomfort.

Re: ALL

paula on 4/30/02 at 08:30 (081742)

i just fired anterior leg muscle, the one on top, right? foot went up without pain! where are you , where is this therapist, does he or she know a good foot therapist in atlanta?

Re: ALL

Carmen on 4/30/02 at 09:00 (081750)

Paula~

I see you have been looking for a therapist in Atlanta and I remember you looking in the past as well...have you not found one that works for you yet?

Re: ALL

paula on 4/30/02 at 09:10 (081752)

i actually have a great therapist but she is not a foot specialist. i think it would really help if i consulted with one of those as well.

Re: ALL

Carmen on 4/30/02 at 10:49 (081766)

I see. Too bad you're not in the Marietta area....
If I hear anything I'll let you know.

Re: Docs...read this and would like opinion...why is this person saying the following...

DR Zuckerman on 4/28/02 at 19:41 (081513)

Yes it is true. You can't stretch the plantar fascia. Stretching of the achilles tendon is important. A diagnosis of pf should be made before a stretching program is started. Should this only be done by a doctor. Well I would lean toward this statement because all pain on the bottom of the foot isn't pf.

Re: Docs...read this and would like opinion...why is this person saying the following...

Dr. Cozzarelli on 4/28/02 at 20:25 (081521)

Carmen:

I don't agree with this at all. I have seen it time and time again. If the patient is using a night splint. This form of passive stretching definately helps. Patients 9 out of 10 times tell me after one week the first step in the moring feels better.

Dr. John Cozzarelli

Re: Docs...read this and would like opinion...why is this person saying the following...

Mike W on 4/28/02 at 20:59 (081528)

Hello Carmen,

I have read the same disturbing quote from the Ontario Podiatry Association.

I believe that any physiologically incorrect exercise (can do more harm than good)is a contraindication and that most traditional PF exercises fall into this category so the statement is sadly true.

I agree with Dr. Z about the fascia not stretching well.

I disagree with Dr. Z about stretching the achilles tendon. The achilles tendon like the fascia is very inelastic and does not stretch very well either. What you should try to do is relax the calf muscles which will help reduce the tension on the achilles tendon.

The traditional approach to stretching the achilles is the standing calf stretch. I believe this is incorrect because the calf muscles will be automatically contracted prior to the stretch which will cause excessive traction on the achilles tendon. This is exactly the oppposite of what the goal of this stretch is! Muscles should always be relaxed prior to performing any stretch.

Regards,

Mike W

Re: Docs...read this and would like opinion...why is this person saying the following...

DR Zuckerman on 4/28/02 at 21:08 (081529)

The best type of stretching for the achilles is the non-weight bearing stretch such as has been described via the personal foot trainer. Stretching the anterior leg muscles is just as important.

Re: Docs...read this and would like opinion...why is this person saying the following...

Julie on 4/29/02 at 02:28 (081547)

Carmen

The aim, as Dr Ed (and Glenn - where are you, Glenn?) have pointed out in the past, is to increase the angle of dorsiflexion in order to take tension off the fascia. Views clearly differ as to how this can best be done, the most common being 'stretch the calf muscles and the achilles tendon',

The important factors to be aware of are (1) that the fascia cannot stretch and (2) that due to the injury/inflammation there is a weakness at the insertion point. Therefore any aggressive attempt to stretch the gastrocnemius/soleus/achilles continuum (which includes pretty well all the commonly recommended exercises, the wall stretch, the stair stretch) is going to stress that vulnerable point and exacerbate the PF.

Non weight-bearing exercise is best.

Re: ALL

Carmen on 4/29/02 at 07:48 (081562)

Thanks ALL!! I think this was important to clear up b/c so many people get put on a stretching program and it's unclear about waht's being stretched....Those comments are great...interesting point too.

Carmen

Re: ALL

Lisa G on 4/29/02 at 17:22 (081617)

i have had PF for about 8 years...and have continued to do my stretches...i was originally told that the fascia do, doesn't stretch very well...but continued stretching of the calf is very important...my new dr today said that my stretching all the darn time is probably what has kept me going all this time...

lisa

Re: ALL

Dr. Cozzarelli on 4/29/02 at 17:31 (081619)

Lisa:

Why would you want to auffer with PF for 8 years. Have you considered ESWT? Perhaps it is time to consider this non-invassive treament.

Dr. John Cozzarelli

Re: ALL

Dr. David S. Wander on 4/29/02 at 20:44 (081676)

I agree that the actual plantar fascia can not really be stretched. However, stretching of the calf muscles does increase dorsiflexion and decreases the pull on the plantar fascia. Our physical therapist has the patients non weightbearing and pulling on the bottom of the foot gently with a towel (toward the body) which stretches the calf muscles. He also has the patient actively 'fire' the anterior muscle group (front of the leg) to help pull the foot up (dorsiflex) even more. We've found this to be very useful, without causing additional inflammation or discomfort.

Re: ALL

paula on 4/30/02 at 08:30 (081742)

i just fired anterior leg muscle, the one on top, right? foot went up without pain! where are you , where is this therapist, does he or she know a good foot therapist in atlanta?

Re: ALL

Carmen on 4/30/02 at 09:00 (081750)

Paula~

I see you have been looking for a therapist in Atlanta and I remember you looking in the past as well...have you not found one that works for you yet?

Re: ALL

paula on 4/30/02 at 09:10 (081752)

i actually have a great therapist but she is not a foot specialist. i think it would really help if i consulted with one of those as well.

Re: ALL

Carmen on 4/30/02 at 10:49 (081766)

I see. Too bad you're not in the Marietta area....
If I hear anything I'll let you know.