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does standing stretching stand or is standing stretching a stretch?

Posted by elliott on 2/21/05 at 12:40 (169575)

There's been some debate on these boards about stretching, with some advocating only seated PF stretches for everyone, and others claiming the standing stretches can also be valuable. Maybe we need to take a closer look. Well, there's plenty of literature out there. Here's some I picked up (I strongly urge you to click on every link):

Evidence that non-weightbearing stretches alone are better than weightbearing stretches alone (at 8 weeks):

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12851352

Night splint beats out standing stretching:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12194511

Night splint makes no difference in stretching group:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10613168

Splint alone is better:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9462907

Stretching should be first before splint:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7653427

Claims stretching highly effective for PF, and includes standing stretches:

http://healthlink.mcw.edu/article/987116429.html

Great photos on stretching, apparently for when already healing:

http://www.nismat.org/ptcor/plantar/

Recommends stretches including standing:

http://familydoctor.org/140.xml

Advocates standing stretches among other treatments, citing references that have been quoted frequently above:

http://www.aafp.org/afp/20010201/467.html

Advocates standing stretching:

http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=144&topcategory=Foot

Here's what I make of this: First of all, it seems to be standard practice, among orthopedists at least, to include standing stretching. So if one has fault with it, take on the orthopedists. I am guessing some of the prominence given stretching may have a lot to do with the same few articles that keep getting quoted, which included prominent orthopedists such as Conti. I'd prefer there was a consensus. Also very clear from a few of those links, and something we all already know, is that some things work for some and not others, and it is not always clear why. Nor is it often clear, even with many studies, exactly what treatment, or even subtreatment, to try first.

So I see it as being there is no one answer or universal rule here. It should be clear that the pro-standing stretch crowd is not advocating stretching a cold muscle hard with reckless abandon and likely injuring it. They also are not avoiding the seated stretches either.

My own view is, if one is not better with whatever he or she is trying, try the other conservative measures. If standing stretches, use some common sense in how you do them, and if it seems things are getting worse, back off. As long as one avoids permanent damage, no harm done, and they might just reap the benefits.

One thing for is sure: that's a great post title, if I may say so myself.:-)

elliott

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Re: does standing stretching stand or is standing stretching a stretch?

Darlene on 2/21/05 at 13:04 (169577)

Elliott:

Definitely a catchy title!
The website with the pictures is especially helpful.
I had MN surgery almost 6 weeks ago. I have an unusual post op pain. When I stretch my calf muscle (say while sitting on the floor with my feet extended in front of me) I get a shooting pain up my arch which I think is where the cut end of the nerve is. It is very intense. In the meantime my calf muscle is getting very tight on the surgical leg. Did you experience anything like this after your MN surgery? Was your MN surgery as success?

Darlene

Re: does standing stretching stand or is standing stretching a stretch?

Dorothy on 2/21/05 at 14:01 (169580)

Elliott - Thank you for the links. I will take a look, but haven't yet. I have done a lot of this searching myself over time. What I say to this and to the seemingly knee-jerk recommendations - whether one way or another - is this (and I'm surprised you are not saying this): where is the research? where is the supporting evidence for doing one kind or another stretching? or one kind or another anything?
Any kind of recommended treatment should not be 'try this' or 'try that' and 'if it works, keep doing it; if it doesn't work, stop.'
What is sorely and painfully lacking (acknowledging pun), is evidence-based treatment, consistent recommendations, clear instruction. Both the treatments and the rehabbing seem too extemporaneous, and therefore too much of a gambling and a whimsical connotation. It seems absurd and therefore untrustworthy.

Re: does standing stretching stand or is standing stretching a stretch?

Mike W on 2/21/05 at 15:26 (169586)

Hello Elliot,

You should check out http://www.aofas.org/02summer/200207140724.asp .
The American Orthopaedic Foot and Ankle Study on nonweight bearing vs weight bearing stretches for PF.

The problem is that people are performing these weight bearing exercises and are hurting themselves.

Regards,

Mike W

Re: does standing stretching stand or is standing stretching a stretch?

elliott on 2/21/05 at 22:16 (169601)

Mike W, your link didn't work, but I tracked down this one from the same conference which I believe is the same:

http://www.aofas.org/displayindustryarticle.cfm?articlenbr=13446

The journal article the same authors wrote on this is in fact the first link in my thread-starting post (didn't anyone read all my links before commenting as I requested?). Read the link above. I presume you were just speculating when you say '[t]he problem is that people are performing these weight bearing exercises and are hurting themselves', because that is not what the authors themselves said. They simply said that PF stretches alone were more effective in achieving pain relief than achilles stretches alone.

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Re: does standing stretching stand or is standing stretching a stretch?

elliott on 2/21/05 at 22:25 (169602)

Dorothy, if you'd read all the links first as requested, maybe at least some of your questions would be answered. :-) For example, the very first link suggests PF stretches alone are better than achilles stretches alone. There definitely is some research--not that any definitive answers are to be had. One of the links actually stated the percentage of PF sufferers that felt this or that treatment was the most helpful, and the numbers are all over the place. Maybe we just have to accept PF for the beast it is.

Re: does standing stretching stand or is standing stretching a stretch?

elliott on 2/21/05 at 22:47 (169606)

Darlene:

I had my first neuroma surgery (MN) over a year ago, and my second on a different interspace (the second) three weeks ago as one small part of a major surgery. The neuromas came from too tight a cast from a previous surgery, although I don't think most of the docs I saw for opinions believed me. The first surgery was definitely a success, with tremendous pain relief. I did end up with a little sensory loss as a result (just as the journals say can happen), but this is far preferable to the initial pain, and you get more used to it in time. I'm a little reluctant to comment on the second so soon, especially before I even get my foot in a shoe (I'm currently in a removable cast and cannot begin to weightbear for another month), but so far it feels good.

After the first neuroma surgery, my doc told me that with neuroma surgery, there is a bump up in improvement at 8-10 months out. I forgot about it until I had a remarkable bump up in improvement 8-10 months out. What I'm saying is, you likely might still see further improvement and things settle down as time goes on. That said, I'm not sure what you're describing is normal. I'd ask. The cut end of a neuroma nerve shouldn't be in your arch, should it? I think it's buried in a muscle in the ball area.

elliott

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Re: does standing stretching stand or is standing stretching a stretch?

John H on 2/22/05 at 09:23 (169618)

I would suggest their is no one size fits all.

Re: does standing stretching stand or is standing stretching a stretch?

Julie on 2/22/05 at 10:11 (169622)

Elliott, thanks for searching out all these links. It has taken me a couple of days to read them all, but now that I have, I think that this sentence, from your post, sums it up rather nicely:

'Some things work for some and not others, and it is not always clear why.'

As you say, a lot of the stuff is rehashed from the same sources, and perhaps not all that helpful. But it has been interesting to read it all, particularly the three longer articles. The most interesting thing about these is that none of them, in their run-downs of treatment options for PF, even mentions ESWT. Which suggests that they are out of date - and that could apply to their stretching information and recommendations too.
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