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stretchhing the fascia

Posted by R C on 10/28/03 at 21:51 (135907)

I remember reading that the plantar fascia cannot be stretched. But then in my most recent visit to my orthopedic doctor, he recommended stretching my fascia by flexing at the ankle, pulling back the toes, and using my thumb to forcefully massage the arch area. What do you think of this?

As background, my PF was largely resolved after about 3.5 years, but I seem to have reached a plateau around 90 to 95 percent. The doctor says that the injury has in fact healed, but that there is some residual inflammation. He talked my into a cortisone shot (which I am usually skeptical about), and advised me to use crutches to keep my foot off the ground for 4 weeks (the cast turned out to be unnecessaary).

Re: stretchhing the fascia

nancy s. on 10/28/03 at 22:13 (135910)

R C: i've read here for years, from some people, that the fascia cannot be stretched. at the same time, i've always wondered why, then, with acute pf does walking without proper support cause micro-tears in the plantar fascia? there must be SOME kind of pliability there. if 'stretch' is not a properly scientific term for this phenomenon, what is? i'd be happy to use whatever is the appropriate term.

i've been at about 75% recovered for two years now (and happy about it, believe me). recently i went back to my doc for a pf & tendonitis checkup. my doc is a sports med specialist with a family practice also, AND he has had pf. he recommended that i continue to 'stretch' the fascia regularly by gently pulling the toes back. i already do a form of this using julie yoga stretches.

but this was new to me: he had me hold my fingers on his fascia as he pulled back on his toes and feel how it stretches out and tightens, in order to understand what pressure or (gentle) stress does to it. and it DID tighten and become firm as though stretched out.

considering this experience and my doc's recommendation, your ortho's recommendation to do the same thing and massage the arch area makes sense to me. i seem not to have much residual inflammation, and six months of physical therapy two years ago dealt with much of the scar tissue. if you have residual inflammation, i would think the 'stretching' and massage would be beneficial.

i'd still like to know what the story is behind the stretching-or-nonstretching fascia, though. i mean, i felt the thing tighten and loosen myself.

anyone?

nancy
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Re: stretchhing the fascia

Carole C in NOLA on 10/28/03 at 23:25 (135913)

Here's my take on it. The plantar fascia are connected to other tissues in the foot and leg, and when you stretch, tissues such as muscles in the calf are pulled on, too. You can feel them being pulled on through the Achilles tendon, even when you gently pull your toes back. The objective in stretching is to create less tension on the PF, and if other, connected muscles relax and stretch, the tension on the PF will lessen. That would happen even if the PF is relatively inflexible, which it probably is.

As far as the micro-tears go, I think that would probably occur more when you haven't stretched and your PF are really tight. If you pull hard on something that doesn't stretch, it tears. Try pulling hard on a thin paper bag - - - it tears. But if you pull hard on a rubber vacuum cleaner belt, it doesn't tear (unless you are stronger than I am).

Carole C

Re: stretchhing the fascia

Rick R on 10/29/03 at 06:59 (135920)

Ok here I go off to make a fool of myself. Since I earned a D in high school biology I figure I'm an expert. I do believe the plantar fascia can be stretched. It either becomes more elastic so that the strain on the attachment to bone becomes less for a given angle of foot deflection, or it becomes longer accomplishing the same end. Now, let's say that's a load of hooey. What we do to 'stretch' has a positive effect regardless of the reason, I'm willing to accept and trust the body of empirical evidence we represent on the board.

RC:

Given my sterling track record in biology I'm now going to ask you to take what your doctor told you with a great deal of caution. I'm not going to tell you not to follow his/her recommendation, but I believe a period of less activity can place you at risk. I got to a plateau of less than 50% after many years. In a true mode of self destruction and desperation I started to run again. I improved and reached a 75% level, or there about. After surgery, the period of rest allowed me to screw up my 'good' foot. I didn't have an appreciation for the potential to become more vulnerable after limited activity. Be extra careful after and during this 4 weeks of rest.

Rick

Re: stretchhing the fascia

Julie on 10/29/03 at 08:31 (135925)

I have a little something to add to this discussion. It depends what you mean by 'stretching'. The fascia is a tendon-like structure, and the received opinion is that tendon tissue is inelastic and therefore cannot be stretched. However, tendons as well as muscles can become contracted and shortened through inactivity, poor body use, and in the case of the various ailments that plague the feet, poor shoes.

Contracted, shortened tissue can - even tendons, I believe - be restored to its optimum length through appropriate stretching. So we're not thinking of the fascia as being of a given length, and of making it longer by stretching it. It's probably true that it won't get any longer than it's possible for it to get, given the nature of the tissue. But if it has shortened, that shortening can probably - in some cases if not in every case - be overcome.

It's really more helpful to think of the entire complex of gastrocnemius and soleus muscles, achilles tendon and plantar fascia, as a continuous structure, and as Carole says, stretching the calf muscles will reduce the strain on the fascia. Whatever view one takes on 'stretching the fascia', what is not in doubt is that the calf muscles need to be stretched in order to resolve PF, and they need to be go on being stretched forever and ever because muscles that aren't regularly stretched will contract and shorten.

Then comes the question of HOW to stretch and what stretching is appropriate for PF, but that's another discussion.

Re: stretchhing the fascia

R C on 10/29/03 at 08:45 (135927)

Thanks for your comments. I see a somewhat of a consensus emerging.

I am taking precautions to protect my good foot while I am on crutches. I tape it securely every morning, so that it will better withstand the beating it will take all day. I am also wearing a knee brace on that knee, and an elbow brace on both arms. If that isn't enough, I might get a motorized wheelchair for the office.

After four weeks of this, my plan is to ease back into normal activity. This includes using crutches part way (say, bearing half weight) for a couple weeks instead of trying to walk all at once. I have those elastic bands and weights for doing the little exercises I've learned over the years from physical therapists.

Also using -- heat, ice, massage, glucosamine/chondroitin, multi-vitamins, and prayer. Anything that might help.

Re: stretchhing the fascia

Rick R on 10/29/03 at 09:55 (135936)

Julie,

Good points. I believe the tendency for the tendon to shorten from inactivity is what leads to the potential downside to rest.

While I'm at it I'll throw a minority opinion out there. I don't believe calf tightness has a direct bearing on the PF. I believe that is an impression we have because the stretch we do to stretch out the PF is the same as we do the stretch the calf. If the calf inhibits motion to the extent that we don't have an effective PF stretch, then it has a secondary but not causal factor. This can be eliminated by bending the knee during the stretch. Try the classic wall stretch first with a locked knee, then let it bend. You will find a far more aggressive PF stretch with the bent knee. Not a move for those not ready for an aggressive approach I might add.

Rick

Re: stretchhing the fascia

nancy s. on 10/29/03 at 12:35 (135944)

makes sense to me, julie. i should add that i don't think my doc used the word 'stretch' while talking about the fascia -- he was just showing me what happens to it when it's pulled versus contracted. and he knows i do your yoga exercises, too!

nancy
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Re: stretchhing the fascia

JudyS on 10/29/03 at 17:56 (135972)

Perhaps too the question is not so much can the Plantar be stretched as can it be more flexible - or loosened. I've always been under the impression that the actual stretching applies to the soleus and calf and that regular 'stretching/loosening' is needed to keep the Plantar loose.
Am I clear as mud? Again?

Re: stretchhing the fascia

Dr. Z on 10/29/03 at 23:53 (135987)

You are strething what is called the intrinic muscles of the foot when you do the pf stretch. It is these muscles/tendons that will stretch. The plantar fascia really can't stretched. In fact if you do try to pull on the area it even hurt. The pf stretch provides stretching but the pf . I recommend the so called pf stretch. It help in the treatment for pf

Re: stretchhing the fascia

Julie on 10/30/03 at 01:22 (135990)

Rick, I don't think the stretch is necessarily more 'aggressive' when the knee is bent, it's just different. With the knee locked, the stretch is felt mainly through the gastrocnemius (and higher up, at the back of the knee where the hamstrings insert). When it's bent you (I) feel it lower down: still partly in gastrocnemius, but more in soleus and achilles. It's just a different target. Neither is to be recommended to most PF sufferers.

However one stretches - and I am convinced that non-weight-bearing exercises are more appropriate for PF sufferers - the lengthening of the structures above the plantar fascia alleviates the tension on the fascia itself. So I believe that tight calf muscles and achilles tendons are in fact a primary factor in PF.

It's misleading to talk about 'stretching' the PF. Thinking it can be done, and trying to do it with aggressive exercise, can and very often does lead to further damage. Maybe it would be more helpful to think about 'loosening' (thanks, Judy) or 'relaxing' the PF - either word would help to encourage a less gung ho approach.

Re: stretchhing the fascia

nancy s. on 10/30/03 at 12:30 (136005)

ok, good: 'loosening' it is. i'm happy to have a word for it at last!

nancy
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