Can you help me understand the concept of stretching??Posted by Annette F. on 12/12/03 at 23:31 (139892)
I've read so much about the importance of stretching to try to help alleviate PF but I'm having a hard time understanding how this helps. Is the point to stretch the plantar facia itself? How is this possible if it is such a tough,cordlike tissue? Obviously, the plantar facia isn't stretching even when you bear all your weight on it, thus the tearing at the insertion point. Won't attempts to stretch (even gently) just cause more tension in this area? This even would seem to be to be the case with any type of nightsplint that pulls your toes back. Wouldn't that just tension the plantar facia and pull the tissue away at the bone again? Also, are the types of stretching that you recommend different based on the cause of the PF. For instance, I have high arches so wouldn't the stretches I'd need be very different then for someone who has flat feet? I am reading so much COMPLETELY contradictory information on the web. For instance, there are dozens of sites that talk about strengthening your feet by picking up something like a towel with your toes but then other sites that say this is ABSOLUTELY the wrong thing to do and will only aggravate the problem. I apologize if I seem to be rambling on but this week has been a VERY painful PF week and after hours and hours more research I am just more frustrated at the conflicting information I read from one place to another.
Thanks in advance for any insight you can give me.
Re: Can you help me understand the concept of stretching??Julie on 12/13/03 at 03:02 (139896)
Your understanding is correct, and you are wise to be asking these questions. The plantar fascia is essentially a tendon-like structure - it doesn't stretch. However, it is the end of a continuum that consists of the calf muscles (gastrocnemius and soleus), the Achilles tendon and the fascia. One of the common causes of PF is tightness in the calf muscles (often a problem for women who have been used to wearing high heels) and one of the main aims of stretching exercises for PF is to lengthen these muscles.
However, any exercise that is chosen should not increase the strain on the injured fascia. This is where many people go wrong: they are told to stretch, so they embark on a regime of aggressive weightbearing exercise (often, alas, on the advice of their doctors). Weightbearing stretches, particularly the hanging-off-a-stair stretch, and the classic wall stretch, are much too strong for most people suffering from PF. (Do a search on 'wall stretch' for past posts (including quite a few by me - this is a definite hobby horse of mine - which discuss the reasons for this.)
Gentle, non-weightbearing exercises that target the problem are called for. I have posted a series of yoga foot exercises that can be practised sitting in a chair or lying down: they've helped people who have used them. Click on the word yoga and you'll be taken to them. They also address two other main aims of exercise for PF: (1) strengthening the foot musculature and (2) avoiding the inevitable weakening and atrophying of muscles that comes from pain-enforced inactivity.
You asked about the night splint. The night splint is not actually meant to 'stretch' the calf muscles, simply to keep them in a gently lengthened state so that they don't shorten and tighten overnight. When we sleep, our feet are normally in a plantarflexed position, the effect of which is to shorten the calf muscles. The night splint, which keeps the foot gently dorsiflexed, avoids this shortening.
I hope this explanation is helpful. I am not a doctor, by the way, but I teach yoga, and have dealt with my own PF largely with the exercises mentioned above. I teach them to everybody, not just people with PF, but they have helped several students who have had PF.
All the best,
Re: Can you help me understand the concept of stretching??Kathy L on 1/02/04 at 01:33 (141115)
I've been doing the ankle bending and rotation under the sheets at nighttime for years... I just called it wiggling my feet. Annoyed my husband. I did it because it felt good, and it seemed to help my circulation, as I always felt cold footed. I'll tell my husband now that I'm doing Yoga .
But I agree with you 100% that gentle is the only 'stretching' you should do. I had 3 doctors, one a neurologist, instruct me to do hard stretches against the wall and the floor... and it made it worse. I always believed that worse pain was your body's way of telling you something isn't right. I went back to wiggling my feet. What do some of these doctors learn in their 12 years of education?
Re: Wiggling - for Kathy L.Julie on 1/02/04 at 02:58 (141124)
Yes, do tell your husband you're doing yoga, Kathy! That should impress him. They're wonderful exercises: part of a sequence that works systematically through all the body's joints, to promote circulation and energy flow. I'm glad to hear that you discovered them for yourself. Do them with full attention and awareness: that is what makes them powerful.
You are right: pain is always a message from the body to stop doing whatever is causing the pain. Discomfort from complaining muscles unused to exercise needs to be tolerated; pain no, especially when injured tissues are involved. I don't know why doctors continue to counsel strong weight bearing exercise for PF: many if not most people who have posted here have found that it made them worse. Unfortunately, people will sometimes trust what a doctor has told them to do better than they trust their own bodies, and will persevere with unhelpful exercise to the point where they do themselves more harm.