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To Stretch or Not to Stretch

Posted by Scott Reeves on 1/07/03 at 11:16 (105021)

I have vistied two Podiatrists for possible ESWT. One said stretching afterwards is a critical factor for success. Then I visit the other one and he said no stretching post-treatment for eight weeks.

Any thoughts on the two schools of thought here and why?

Thanks.

Re: To Stretch or Not to Stretch

dave r on 1/07/03 at 11:41 (105022)

I would like to throw my two cents in if you dont mind.....
I believe that there are people that are able to stretch and that there are people that are not able to stretch. For those that are in an early stage of pf or under two years, they still have the ability to stretch properly without the chance of suffering the consequences for the next few months. I believe that once pf is chronic your plantar fascia looses its abilty to flex or move properly. Either from scar tissue,adhesions and or atrophy. The plantar fascia cant stretch,most doctors will agree, so what happens? Most of us dont stretch properly, we only end up over stretching the achilles tendon. If there is continuous trama to the area i would bet that scar tissue keep forming. Resulting in less flexabilty. Eswt can and does create tiny holes in scar tissue. New blood vessels fill in these tiny holes and new fibroblast is formed. Resulting in a stronger plantar fascia. i would think that if your are able to stretch properly before having eswt then you will be able to after words. if you ar unable to before eswt then i personally wouldnt try it. For me it has only made things worse. You also need to remember that i belong to that group where nothing helps at all.

Re: To Stretch or Not to Stretch

Dr. A on 1/07/03 at 14:57 (105031)

If stretching never worked for you before then the chances of it working after ESWT is low. If stretching has helped, even a little, then continue to do it.

Re: To Stretch or Not to Stretch

Scott Reeves on 1/07/03 at 16:03 (105033)

I guess more of what I was looking for is why would one doctor say you HAVE to stretch and the other says NO stretching at all post treatment - regardless of previous history/success/no success with stretching prior to treatment.

They are contradicting each other - and while I am not looking for who is right or wrong, I just wanted to hear opinions as to the two schools of thought here.

Thanks for the replies.

Re: To Stretch or Not to Stretch

Mar on 1/07/03 at 17:07 (105042)

I understand your frustration. I see that also with heat vs cold. One doc recommends heat, another ice. I guess the bottom line is that everyone is different and you have to figure out your own body. I'm still trying to figure mine out!! Mar

Re: To Stretch or Not to Stretch

Ed Davis, DPM on 1/07/03 at 22:20 (105066)

Scott:
I am not aware of the existence of two schools of thought. ESWT is a treatment that affects tissue quality. It does not directly affect the other factors which maintain PF. As such, if gastrosoleus equinus is a contributory factor, that will not be changed by ESWT.
Ed

Re: To Stretch or Not to Stretch

Brian McC on 1/08/03 at 00:01 (105076)

On the subject of stretching generally. Having had pf for 18 months, I am constantly amazed to find friends who have recovered by doing nothing. These friends have all been non-athletic and perhaps a bit lazy but have got better. My theory is that people like myself who are into all kinds of sport, have overcome many previous types of sport injury by 'doing all the right things' are so keen to get better quickly that we do rigorous stretching which further injures the plantar fascia. I now realise that for one year I continually, every spare moment reinjured my pf by doing the traditional stretches. I have improved hugely since I stopped the weight bearing stretches, started 'Julies stretches' and use a foottrainer. Look up http://www.foottrainer.com to see the list of injurious pf stretches. They are probably the ones you have been recommended!!

Re: To Stretch or Not to Stretch

Dr. Z on 1/08/03 at 05:57 (105081)

When you have plantar fasciitis you are going to be limping whenever you sit for any length of time especially first thing in the morning. This is due to the shortening of the achilles tendon and other posterior calf tendons. Stretching does warm up these tendons and help to reduce the limping until the plantar fascia heals from ESWT treatment. I have patients move the foot up and down about ten times and do 10 second wall stretches. Patients state that the foot feels better and helps to reduce the limping if it is still present post ESWT treatment

Re: To Stretch or Not to Stretch

Mar on 1/08/03 at 12:53 (105101)

But I have PF and I don;t limp or have pain when I get up from sitting. I do stretch before I get out of bed in the morning, but not during the night if I get up or during the day anymore. I have pain when I walk or stand for awhile. I'm usually good for the first hour in the morning and it just gets worse as the day goes on. Mar

Re: To Stretch or Not to Stretch

David G. on 1/08/03 at 16:19 (105113)

i definitely injured myself stretching after the second treatment and have gone downhill from there. i had a tingling a burning sensation in my left heel. it was diagnosed at tensynovitis (sp?) from an mri. any time i bent over, i got the feeling. my feeling is that you should do as little as possible after the treatment.

Re: To Stretch or Not to Stretch

JudyS on 1/08/03 at 19:10 (105128)

I think too, Dr. Z, (after, as you know, several years of trying everything), that the warm-up stretching you mention may be under-emphasized. I feel strongly that my own devotion to it, before ESWT, post-ESWT and continuing to this day, has been of tremendous benefit. We might also stress the fact that this kind of stretching is for warm-up/loosening purposes - not necessarly for serious stretching because some of us here learned that too much of that just made matters worse. When I approached it as warming/loosening up, then I found that the stretching, over time, became a secondary benefit.

Re: To Stretch or Not to Stretch

dave r on 1/07/03 at 11:41 (105022)

I would like to throw my two cents in if you dont mind.....
I believe that there are people that are able to stretch and that there are people that are not able to stretch. For those that are in an early stage of pf or under two years, they still have the ability to stretch properly without the chance of suffering the consequences for the next few months. I believe that once pf is chronic your plantar fascia looses its abilty to flex or move properly. Either from scar tissue,adhesions and or atrophy. The plantar fascia cant stretch,most doctors will agree, so what happens? Most of us dont stretch properly, we only end up over stretching the achilles tendon. If there is continuous trama to the area i would bet that scar tissue keep forming. Resulting in less flexabilty. Eswt can and does create tiny holes in scar tissue. New blood vessels fill in these tiny holes and new fibroblast is formed. Resulting in a stronger plantar fascia. i would think that if your are able to stretch properly before having eswt then you will be able to after words. if you ar unable to before eswt then i personally wouldnt try it. For me it has only made things worse. You also need to remember that i belong to that group where nothing helps at all.

Re: To Stretch or Not to Stretch

Dr. A on 1/07/03 at 14:57 (105031)

If stretching never worked for you before then the chances of it working after ESWT is low. If stretching has helped, even a little, then continue to do it.

Re: To Stretch or Not to Stretch

Scott Reeves on 1/07/03 at 16:03 (105033)

I guess more of what I was looking for is why would one doctor say you HAVE to stretch and the other says NO stretching at all post treatment - regardless of previous history/success/no success with stretching prior to treatment.

They are contradicting each other - and while I am not looking for who is right or wrong, I just wanted to hear opinions as to the two schools of thought here.

Thanks for the replies.

Re: To Stretch or Not to Stretch

Mar on 1/07/03 at 17:07 (105042)

I understand your frustration. I see that also with heat vs cold. One doc recommends heat, another ice. I guess the bottom line is that everyone is different and you have to figure out your own body. I'm still trying to figure mine out!! Mar

Re: To Stretch or Not to Stretch

Ed Davis, DPM on 1/07/03 at 22:20 (105066)

Scott:
I am not aware of the existence of two schools of thought. ESWT is a treatment that affects tissue quality. It does not directly affect the other factors which maintain PF. As such, if gastrosoleus equinus is a contributory factor, that will not be changed by ESWT.
Ed

Re: To Stretch or Not to Stretch

Brian McC on 1/08/03 at 00:01 (105076)

On the subject of stretching generally. Having had pf for 18 months, I am constantly amazed to find friends who have recovered by doing nothing. These friends have all been non-athletic and perhaps a bit lazy but have got better. My theory is that people like myself who are into all kinds of sport, have overcome many previous types of sport injury by 'doing all the right things' are so keen to get better quickly that we do rigorous stretching which further injures the plantar fascia. I now realise that for one year I continually, every spare moment reinjured my pf by doing the traditional stretches. I have improved hugely since I stopped the weight bearing stretches, started 'Julies stretches' and use a foottrainer. Look up http://www.foottrainer.com to see the list of injurious pf stretches. They are probably the ones you have been recommended!!

Re: To Stretch or Not to Stretch

Dr. Z on 1/08/03 at 05:57 (105081)

When you have plantar fasciitis you are going to be limping whenever you sit for any length of time especially first thing in the morning. This is due to the shortening of the achilles tendon and other posterior calf tendons. Stretching does warm up these tendons and help to reduce the limping until the plantar fascia heals from ESWT treatment. I have patients move the foot up and down about ten times and do 10 second wall stretches. Patients state that the foot feels better and helps to reduce the limping if it is still present post ESWT treatment

Re: To Stretch or Not to Stretch

Mar on 1/08/03 at 12:53 (105101)

But I have PF and I don;t limp or have pain when I get up from sitting. I do stretch before I get out of bed in the morning, but not during the night if I get up or during the day anymore. I have pain when I walk or stand for awhile. I'm usually good for the first hour in the morning and it just gets worse as the day goes on. Mar

Re: To Stretch or Not to Stretch

David G. on 1/08/03 at 16:19 (105113)

i definitely injured myself stretching after the second treatment and have gone downhill from there. i had a tingling a burning sensation in my left heel. it was diagnosed at tensynovitis (sp?) from an mri. any time i bent over, i got the feeling. my feeling is that you should do as little as possible after the treatment.

Re: To Stretch or Not to Stretch

JudyS on 1/08/03 at 19:10 (105128)

I think too, Dr. Z, (after, as you know, several years of trying everything), that the warm-up stretching you mention may be under-emphasized. I feel strongly that my own devotion to it, before ESWT, post-ESWT and continuing to this day, has been of tremendous benefit. We might also stress the fact that this kind of stretching is for warm-up/loosening purposes - not necessarly for serious stretching because some of us here learned that too much of that just made matters worse. When I approached it as warming/loosening up, then I found that the stretching, over time, became a secondary benefit.