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Stretches and a website

Posted by Dorothy on 12/10/03 at 01:33 (139701)

While searching the internet for some more info. on 'wall stretch' to get more descriptions of it, I came across this website and information which will follow below. This website is from a D.P.M. and the podiatrist's name is Dr. Stephen Pribut in Washington, D.C. I thought his website was good so you might want to take a look, especially all of you runners here. He comments on PF, Achilles, stretches and such a bit as follows, excerpted from a broader discussion. These are Dr. Pribut's materials:

http://www.drpribut.com/
Dr. Pribut's Most Hated Stretches
My pet peeve stretches are those that excessively stretch the Achilles tendon. The two stretches that I disapprove of the most are standing on a step with your heel hanging off and then dropping down to stretch the calf muscle and the one using a towel to pull your foot up to stretch this same area. Both of these stretches may overstretch the calf and achilles. Physiologically the stair stretch breaks the current suggestions of slow and easy stretching. The muscle is being stretched past the point it will ever have to move, the muscle fibers are attempting to contract in this state, both because of the length that they have reached and also to maintain balance. The simple leaning against the wall stretch with one leg bent and forward and one back is just fine. This allows the muscle to be in a relaxed state when stretching. ..

The calf (achilles) should be gently stretched and so should the hamstrings. The best stretch for the calf muscles is the 'wall stretch'. I recommend stretching one set of leg muscles at a time. One leg is back, knee straight, the other leg is forward with the knee bent. The leg that is back is being stretched. Ten repetitions holding for 10 seconds each is ideal. There are several different stretches to choose from for the hamstrings: Forward bends with the knees slightly bent, knee to chest or leaning forward with the leg out straight in front of you all work. It is important to not aggravate your back while performing hamstring stretches

Under a whole section on Plantar Fasciitis, he writes:

You should also be doing gentle calf stretching exercises. This will reduce stress on the plantar fascia in two ways. The first manner in which a relaxation of the tension in the calf muscles can help heel pain is that it will reduce the direct pull backwards on the heel bone (calcaneus). The second reason is a little bit more complicated, but essentially it is that a tight achilles tendon and calf muscles causes the rearfoot to move in a manner that causes over pronation as your leg and body move forward over your foot. So go ahead and gently stretch the calf muscle by doing the runner's wall leaning stretch. To strengthen the muscles in your arch toe curls or 'doming' can be done. Toe curls may be done by placing a towel on a kitchen floor and then curling your toes to pull the towel towards you. This exercise may also be done without the towel against the resistance of the floor.

So, for what it's worth to you, here is some info. I am neither recommending nor dis-recommending. I am not a doctor, although I play one in my imagination... :-)

Re: Stretches and a website

Julie on 12/10/03 at 03:37 (139703)

He is absolutely right about the diabolical hanging-off-a-stair stretch and gives a good explanation of why it's not helpful. As for the wall stretch, yes, most podiatrists still counsel it, but I am not happy to see people with PF use it. It is not a gentle stretch, it is a strong stretch: an excellent stretch for healthy tissues, but too strong - like all weight bearing exercise - for inflamed, injured tissue.

It CAN be done gently, but seldom is, because most people,given human nature, will 'try' too hard. It is also a difficult stretch to do properly - i.e. without irritating the lower back. Like most exercises, it needs to be properly taught, which includes correct demonstration (here speaks the teacher). When my podiatrist recommended that I do it, he gave me about two seconds' worth of instruction (including a decidedly dodgy demonstration). Fortunately I knew how to do it, and also fortunately I realised very quickly that it was not a good stretch for me to do: it was exacerbating my PF, and I stopped. At around the same time I found heelspurs.com, and met a host of people who had persevered with the wall stretch on the advice of their doctors, until they too had realised it was making them worse.

It is not easy to do this stretch correctly: as well as keeping your feet and legs in the right position, you need to keep your pelvis aligned both vertically and horizontally, with your tailbone tucked under so that you don't put pressure on your lumbar discs and irritate the nerves there.

The calf muscles, Achilles tendon and plantar fascia form a continuum and when you stretch the calf muscles in any weight-bearing position, the stretch will pull on the tendon and the fascia. Some people have said (Nancy S is one, if I recall correctly) that doing this stretch for their PF actually gave them Achilles tendonitis. It also needs to be understood that while tight calf muscles contribute to many cases of PF, this is not true for everyone. If the calf muscles aren't tight and don't need to be stretched, the wall stretch will still pull on the Achilles tendon and on the fascia itself, and make things worse.

Mike Wilmot's Foot Trainer website explains why he too thinks the wall stretch is an incorrect exercise for PF: see his website http://www.foottrainer.com and click on Plantar Fasciitis and then Incorrect Exercises. And Dr Wander mentioned in a post in September 2002 that recent research has shown that weight bearing stretching exercise is not the best choice for plantar fasciitis.

It's good that this has come up again, because I suspect that most people are still being counselled to do this exercise, and although there have been reports from people who feel it has helped them, there have been many more from people who are sure it has made their problems worse. As I suggested yesterday, do a search on 'Wall Stretch'. In fact, here is the link: bbt.cgi?n=95916. You'll find three years' worth of posts on the subject of exercises for PF.

.

Re: Stretches and a website

Dorothy on 12/10/03 at 03:50 (139705)

OK, I'm convinced! No more wall stretch for me. Instead, I'm going to do some toe dancing, en pointe! Just kidding.
Seriously, thanks Julie.

Re: Stretches and a website

Mike W on 12/10/03 at 08:51 (139724)

Hello Dorothy,

Foot Trainer exercises #8 and #9 are both very good lower leg stretches.

If you email me I would be happy to send you Foot Trainer Achilles exercises.

Regards,

Mike W

Re: Stretches and a website

Ron B on 12/10/03 at 17:38 (139764)

wouldn't ya know it!! I do the towel stretches alot. I haven't done the wall stretch in a while but I guess I'll stop both. how is the stretch where you put one leg over the other ( over the knee) and reach down and pull your toes towards your knee? somebody recommanded that stretch on here, I thought it was Dr Z.?? when laying in bed I point my toes to my chest before I get up. is this ok??? Boy I didn't know having PF could be so mind boggling. I think it wears me out as much mentally as well as physically

Re: Stretches and a website

Jen L on 12/11/03 at 15:19 (139810)

You are absolutely right! It is one of the things particular about having P.F. To me it's like a constant guessing game, and I try to figure out daily what I did yesterday caused the discomfort today or things I did but did not bring any harm so that I could continue.
Someone suggested keeping a diary, and I think if you could do it diligently, it might help.

Re: Stretches and a website

Sher A on 12/12/03 at 19:24 (139887)

Dorothy, thanks for the info on the website. I too, just looked at it and was impressed by the content. Since he is in my neck of the woods, I may have go make an appt. He _sounds_ like he won't rush you out of there, and it also sounds like he could be sensitive to the pain issue. He also sounds like he'll stay with you if the condition doesn't go away after the first visit.

Re: Stretches and a website

Kathy L on 12/31/03 at 10:26 (141000)

My two cents on stretching is that it can do more harm than good. I had two doctors 'show' me how to stretch to help PF, and it generally just continued or worsened the pain. I decided pushing against anything was too much, and eventually only did 'natural', gentle stretching. When lying down, I would bend/rotate my foot, not touching anything. Kind of like a gentle warm up.

Re: Stretches and a website

Dorothy on 1/01/04 at 03:17 (141047)

Kathy, once again I find myself in agreement with you. I have been seriously questioning the wisdom of all this stretching. I have even been doing some reading of NEW research from sports medicine/rehab med. that seems to be also questioning the value of stretching. I wonder if it is possible that we are all reinjuring ourselves with the stretching, however subtle. I don't know....