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American Orthopaedic Foot and Ankle Study on nonweight bearing vs weight bearing stretches for PF

Posted by Mike W on 9/25/02 at 11:03 (096189)

Purpose of the study: 'We hypothesize that a structure specific plantar fascia stretch is the single most important treatment modality in the sucessful nonoperative treatment of patients with chronic, disabling plantar heal pain.

Conclusion: When analyzed by the pain subscale of the Foot Function Index and by subject relevant outcome measures, a statistically significant difference in regards to improvement in pain, overall function and satisfaction was noted in the plantar fascia stretch group as compared to the standard achilles tendon stretch group. A nonweight bearing plantar fascia specific stretch is superior to the standard weight bearing achilles tendon stretch in the treatment of patients with chronic, disabling plantar heel pain.'

For more info I have a link http://www.aofas.org/02summer/200207140724.asp .

For info on incorrect exercises go to my website http://www.foottrainer.com .

I am trying to get the formal study and will post more info when I receive it.

Regards,

Mike W

Re: American Orthopaedic Foot and Ankle Study on nonweight bearing vs weight bearing stretches for PF

dave r on 9/25/02 at 12:05 (096199)

Well, this out to start a debate. Thats for sure.
Every doctor i have ever seen has said that ' i must stretch '.
Using the wall stretch and the heel drop as a bible.
I personally have never been able to do the wall stretch or the heel drop without reinjuting the fascia. But at the same time havent been able to find the 'right way to stretch'

Re: American Orthopaedic Foot and Ankle Study on nonweight bearing vs weight bearing stretches for PF

Mike W on 9/25/02 at 13:01 (096204)

Hello Dave,

I have tested hundreds of PF sufferers and found that everyone of them has weak extensor (ones that extend your toes and feet up towards your body)foot and lower leg muscles and short tight flexor muscles.

If you strengthen the weak extensor muscles you will automatically relax the tight flexor muscles. This is known as reciprocal muscle inervation.

I have talked to many people who were performing the wall and heel drop exercises who got worse. They are physiologically incorrect because weight bearing muscles cannot be relaxed in a weight bearing poition.

I hope you heal soon.

Regards,

Mike W

Re: American Orthopaedic Foot and Ankle Study on nonweight bearing vs weight bearing stretches for PF

dave r on 9/25/02 at 13:05 (096205)

Mike, what excersizes do you recommend?

Re: American Orthopaedic Foot and Ankle Study on nonweight bearing vs weight bearing stretches for PF

nancy s. on 9/25/02 at 15:33 (096210)

dave, please listen to mike on this. countless people with pf on this site in my three years here have been injured doing the drop-stair stretch and the wall stretch (weight-bearing). i know the wall stretch seems harmless if you do it gently, but it isn't harmless. in fact, i believe i prolonged my pf agony by a couple of years -- and possibly caused or definitely contributed to achilles tendonitis, which added itself to my pf -- by doing that wall stretch.

i ended up using a nonweightbearing device to gently and gradually stretch and strengthen the various areas of my feet and legs that were ultimately affected, and it was one of the things that really got me onto the road of recovery. mike's is the foot trainer, and i'm sure he'll give you more help on this.

also, have you printed out 'julie's stretches'? all nonweightbearing and very helpful.

nancy

Re: American Orthopaedic Foot and Ankle Study on nonweight bearing vs weight bearing stretches for PF

Nancy N on 9/25/02 at 18:08 (096219)

I'd just like to second what Nancy has to say here. I, too, was told to do the wall and stair stretches--one doc wanted me to do the stair stretch for 10 minutes at a time, and I did it faithfully, even though I could feel pain in the PF area on my foot! I still believe that I finally started to heal when I stopped aggravating the area with the weight-bearing stretches and started using the same device that Nancy used, which I think is no longer available.

I don't think this new study will cause much controversy at all--at least not here on the board, where many of us have had the same negative experience with weight-bearing stretches.

Re: American Orthopaedic Foot and Ankle Study on nonweight bearing vs weight bearing stretches for PF

Mike W on 9/25/02 at 20:55 (096233)

Hello Dave,

If you go to my website you will see several examples. If you want I would be happy to send you a copy of my exercises if you email me your address.

Regards,

Mike W

Re: American Orthopaedic Foot and Ankle Study on nonweight bearing vs weight bearing stretches for PF

Andrue on 9/26/02 at 06:58 (096252)

I agree about the conventional stretches. Neither worked for me and I suspect that both caused damage.

Re: American Orthopaedic Foot and Ankle Study on nonweight bearing vs weight bearing stretches for PF

dave r on 9/26/02 at 07:10 (096253)

Actually , yes i have started doing Julies stretches. Its only been a few days. I have noticed from doing julies stretches that i have alot more blood flow in my feet. Thanks

Re: the "right" way to stretch

Ed Davis, DPM on 9/26/02 at 19:05 (096277)

The right way to stretch is to place adequate tension on the gastrosoleus-achilles complex such that no muscular contraction (by reflex action) is ellicited. Low intensity but long duration is the key. Night splints provide one of the most effective ways to achieve the proper stretch.
Ed

Re: Mike W

Pete on 9/27/02 at 06:36 (096302)

So what were the non weight bearing stretches then ? Have you examples of this for us all to try ?

I already do the stretches prescribed by Julie.

Re: Mike W

Mike W on 9/28/02 at 19:19 (096402)

Hello Pete,

Sorry for not replying sooner but I have been away for a few days.

I can't describe the exercises (not stretches)here but I would be happy to send you a copy of them.

Please go to my website http://www.foottrainer.com and you will find more info and my email address.

Regards,

Mike W

Re: the "right" way to stretch

Mike W on 9/28/02 at 19:23 (096403)

Hello Ed,

Have you ever heard of Reciprocal Muscle Inervation?

Regards,

Mike W

Re: the "right" way to stretch

Ed Davis, DPM on 9/29/02 at 13:35 (096434)

I have not heard of that term.
Ed

Re: the "right" way to stretch

Kim R. on 9/29/02 at 15:34 (096452)

Dr. Ed, I am curious what your thoughts on the 'Pro Stretch' device are. I use a splint at night but also rely on my 'Pro Stretch' several times a day to release those tight calf muscles. What do you think of this? Kim

Re: the "right" way to stretch

Mike W on 9/30/02 at 08:13 (096504)

Hello Ed,
Reciprocal Muscle Innervation:

Muscles usually work in pairs (Flexors and Extensors) and when say an extensor muscle is contracted the opposing flexor will automatically relax.

Therfore instead of trying to force a short tight flexor muscle to stretch for long periods a person can RELAX the the flexor by simply contracting the extensor.

Most people with PF have weak extensors, so they need to strengthen them before RMI will occur.

Regards,

Mike W

Re: the "right" way to stretch

Ed Davis, DPM on 9/30/02 at 17:02 (096540)

Mike:

You stated that 'most people with PF have weak extensors.' Do you have any research to that effect? I think that muscle imbalances in the lower extremity are common although I have not seen any definitive correlations of PF with weak extensors.

Circumstances will dictate if opposing muscles will relax. Opposing muscles often contact eccentrically, that is, contract while the muscle lengthens in order to dampen the effect of the agonist muscle and provide stability. For example, if I use a dumbell to perform a curl the biceps are concentrically contracting while the triceps are eccentrically contracting.

The purpose of stretching the gastosoleus-achilles complex is not necessarily to obtain relaxation but to obtain additional length. It is the relative shortness of that complex which limits ankle dorsiflexion and limited ankle dorsiflexion present as the foot goes into propulsion causes increased plantar fascial tension.
Ed

Re: the "right" way to stretch

BGCPed on 9/30/02 at 23:08 (096568)

I agree, the folks you see bending leg and putting the knee to the ground doing wall stretches or even the real bad ones that bounce a bit while doing it are not helping. It is like getting a hard massage where you tighten up in the back and shoulders when they put excess pressure on.

Re: the "right" way to stretch

Mike W on 10/01/02 at 00:04 (096570)

Hello Ed,

I have no research regarding weak extensors just every one I see with PF has them.

Why? I believe that 2 major contributing factors are that they (extensors) are neglected, combined with the natural aging process (known as Sarcopenia) whereby the average person loses 30% of their overall muscle mass between ages 30 and 50 and 10% every decade thereafter.

Have you ever noticed that most PF sufferers are over age 30?

In your example the the triceps I believe the triceps would be eccentrically relaxing not contracting. Also if the triceps are weak and them contracted the biceps will not relax to allow movement as well as if they were strong.

Regards,

Mike W

Re: the "right" way to stretch

john h on 10/02/02 at 08:36 (096690)

I have read that more women have PF than men which would seem to be the case on this board. That could point to shoe wear. I suspect that a very large number of men and women with PF can also be traced to some specific event or ongoing activity such as running up hill in my case over an extended periond of time. Many athletes who have world class muscle tone have developed PF from repetitive injury such as jumping (basketball) and down lineman (pushing off with tremendous force on your feet). There is little doubt in my mind that if I had recognized what was happening to my feet when PF first showed up with minor symptoms I would not be chronic. On two occasions it got so well I thought it was cured and went back to basketball and running only to finally be brought down for good with chronic PF. Muscle tone played no part in my problem as I exercised and stretched 7 days a week. I have walked a few miles each day for 4 of the last 5 days and rode a bike for 20-30 minutes. My feet are handling this but still have a low level of pain. Every day at the club I watch people bending in the runners stretch while bouncing up and down and only wish I could say something to them. I have said this many times and is especially directed to those with long time PF. You can get better. You may not be cured but you can get better. I am 8 or more years into this and am 70% or so better than 7-8 years ago. I have setbacks but they are mostly brought on by some poor choice of activity. I have no secrets other than I am willing to try almost anything and over time have narrowed down the things that appear to help

Re: American Orthopaedic Foot and Ankle Study on nonweight bearing vs weight bearing stretches for PF

dave r on 9/25/02 at 12:05 (096199)

Well, this out to start a debate. Thats for sure.
Every doctor i have ever seen has said that ' i must stretch '.
Using the wall stretch and the heel drop as a bible.
I personally have never been able to do the wall stretch or the heel drop without reinjuting the fascia. But at the same time havent been able to find the 'right way to stretch'

Re: American Orthopaedic Foot and Ankle Study on nonweight bearing vs weight bearing stretches for PF

Mike W on 9/25/02 at 13:01 (096204)

Hello Dave,

I have tested hundreds of PF sufferers and found that everyone of them has weak extensor (ones that extend your toes and feet up towards your body)foot and lower leg muscles and short tight flexor muscles.

If you strengthen the weak extensor muscles you will automatically relax the tight flexor muscles. This is known as reciprocal muscle inervation.

I have talked to many people who were performing the wall and heel drop exercises who got worse. They are physiologically incorrect because weight bearing muscles cannot be relaxed in a weight bearing poition.

I hope you heal soon.

Regards,

Mike W

Re: American Orthopaedic Foot and Ankle Study on nonweight bearing vs weight bearing stretches for PF

dave r on 9/25/02 at 13:05 (096205)

Mike, what excersizes do you recommend?

Re: American Orthopaedic Foot and Ankle Study on nonweight bearing vs weight bearing stretches for PF

nancy s. on 9/25/02 at 15:33 (096210)

dave, please listen to mike on this. countless people with pf on this site in my three years here have been injured doing the drop-stair stretch and the wall stretch (weight-bearing). i know the wall stretch seems harmless if you do it gently, but it isn't harmless. in fact, i believe i prolonged my pf agony by a couple of years -- and possibly caused or definitely contributed to achilles tendonitis, which added itself to my pf -- by doing that wall stretch.

i ended up using a nonweightbearing device to gently and gradually stretch and strengthen the various areas of my feet and legs that were ultimately affected, and it was one of the things that really got me onto the road of recovery. mike's is the foot trainer, and i'm sure he'll give you more help on this.

also, have you printed out 'julie's stretches'? all nonweightbearing and very helpful.

nancy

Re: American Orthopaedic Foot and Ankle Study on nonweight bearing vs weight bearing stretches for PF

Nancy N on 9/25/02 at 18:08 (096219)

I'd just like to second what Nancy has to say here. I, too, was told to do the wall and stair stretches--one doc wanted me to do the stair stretch for 10 minutes at a time, and I did it faithfully, even though I could feel pain in the PF area on my foot! I still believe that I finally started to heal when I stopped aggravating the area with the weight-bearing stretches and started using the same device that Nancy used, which I think is no longer available.

I don't think this new study will cause much controversy at all--at least not here on the board, where many of us have had the same negative experience with weight-bearing stretches.

Re: American Orthopaedic Foot and Ankle Study on nonweight bearing vs weight bearing stretches for PF

Mike W on 9/25/02 at 20:55 (096233)

Hello Dave,

If you go to my website you will see several examples. If you want I would be happy to send you a copy of my exercises if you email me your address.

Regards,

Mike W

Re: American Orthopaedic Foot and Ankle Study on nonweight bearing vs weight bearing stretches for PF

Andrue on 9/26/02 at 06:58 (096252)

I agree about the conventional stretches. Neither worked for me and I suspect that both caused damage.

Re: American Orthopaedic Foot and Ankle Study on nonweight bearing vs weight bearing stretches for PF

dave r on 9/26/02 at 07:10 (096253)

Actually , yes i have started doing Julies stretches. Its only been a few days. I have noticed from doing julies stretches that i have alot more blood flow in my feet. Thanks

Re: the "right" way to stretch

Ed Davis, DPM on 9/26/02 at 19:05 (096277)

The right way to stretch is to place adequate tension on the gastrosoleus-achilles complex such that no muscular contraction (by reflex action) is ellicited. Low intensity but long duration is the key. Night splints provide one of the most effective ways to achieve the proper stretch.
Ed

Re: Mike W

Pete on 9/27/02 at 06:36 (096302)

So what were the non weight bearing stretches then ? Have you examples of this for us all to try ?

I already do the stretches prescribed by Julie.

Re: Mike W

Mike W on 9/28/02 at 19:19 (096402)

Hello Pete,

Sorry for not replying sooner but I have been away for a few days.

I can't describe the exercises (not stretches)here but I would be happy to send you a copy of them.

Please go to my website http://www.foottrainer.com and you will find more info and my email address.

Regards,

Mike W

Re: the "right" way to stretch

Mike W on 9/28/02 at 19:23 (096403)

Hello Ed,

Have you ever heard of Reciprocal Muscle Inervation?

Regards,

Mike W

Re: the "right" way to stretch

Ed Davis, DPM on 9/29/02 at 13:35 (096434)

I have not heard of that term.
Ed

Re: the "right" way to stretch

Kim R. on 9/29/02 at 15:34 (096452)

Dr. Ed, I am curious what your thoughts on the 'Pro Stretch' device are. I use a splint at night but also rely on my 'Pro Stretch' several times a day to release those tight calf muscles. What do you think of this? Kim

Re: the "right" way to stretch

Mike W on 9/30/02 at 08:13 (096504)

Hello Ed,
Reciprocal Muscle Innervation:

Muscles usually work in pairs (Flexors and Extensors) and when say an extensor muscle is contracted the opposing flexor will automatically relax.

Therfore instead of trying to force a short tight flexor muscle to stretch for long periods a person can RELAX the the flexor by simply contracting the extensor.

Most people with PF have weak extensors, so they need to strengthen them before RMI will occur.

Regards,

Mike W

Re: the "right" way to stretch

Ed Davis, DPM on 9/30/02 at 17:02 (096540)

Mike:

You stated that 'most people with PF have weak extensors.' Do you have any research to that effect? I think that muscle imbalances in the lower extremity are common although I have not seen any definitive correlations of PF with weak extensors.

Circumstances will dictate if opposing muscles will relax. Opposing muscles often contact eccentrically, that is, contract while the muscle lengthens in order to dampen the effect of the agonist muscle and provide stability. For example, if I use a dumbell to perform a curl the biceps are concentrically contracting while the triceps are eccentrically contracting.

The purpose of stretching the gastosoleus-achilles complex is not necessarily to obtain relaxation but to obtain additional length. It is the relative shortness of that complex which limits ankle dorsiflexion and limited ankle dorsiflexion present as the foot goes into propulsion causes increased plantar fascial tension.
Ed

Re: the "right" way to stretch

BGCPed on 9/30/02 at 23:08 (096568)

I agree, the folks you see bending leg and putting the knee to the ground doing wall stretches or even the real bad ones that bounce a bit while doing it are not helping. It is like getting a hard massage where you tighten up in the back and shoulders when they put excess pressure on.

Re: the "right" way to stretch

Mike W on 10/01/02 at 00:04 (096570)

Hello Ed,

I have no research regarding weak extensors just every one I see with PF has them.

Why? I believe that 2 major contributing factors are that they (extensors) are neglected, combined with the natural aging process (known as Sarcopenia) whereby the average person loses 30% of their overall muscle mass between ages 30 and 50 and 10% every decade thereafter.

Have you ever noticed that most PF sufferers are over age 30?

In your example the the triceps I believe the triceps would be eccentrically relaxing not contracting. Also if the triceps are weak and them contracted the biceps will not relax to allow movement as well as if they were strong.

Regards,

Mike W

Re: the "right" way to stretch

john h on 10/02/02 at 08:36 (096690)

I have read that more women have PF than men which would seem to be the case on this board. That could point to shoe wear. I suspect that a very large number of men and women with PF can also be traced to some specific event or ongoing activity such as running up hill in my case over an extended periond of time. Many athletes who have world class muscle tone have developed PF from repetitive injury such as jumping (basketball) and down lineman (pushing off with tremendous force on your feet). There is little doubt in my mind that if I had recognized what was happening to my feet when PF first showed up with minor symptoms I would not be chronic. On two occasions it got so well I thought it was cured and went back to basketball and running only to finally be brought down for good with chronic PF. Muscle tone played no part in my problem as I exercised and stretched 7 days a week. I have walked a few miles each day for 4 of the last 5 days and rode a bike for 20-30 minutes. My feet are handling this but still have a low level of pain. Every day at the club I watch people bending in the runners stretch while bouncing up and down and only wish I could say something to them. I have said this many times and is especially directed to those with long time PF. You can get better. You may not be cured but you can get better. I am 8 or more years into this and am 70% or so better than 7-8 years ago. I have setbacks but they are mostly brought on by some poor choice of activity. I have no secrets other than I am willing to try almost anything and over time have narrowed down the things that appear to help