Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

Safe exercise for PF

Posted by Julie on 2/28/05 at 06:26 (170114)

Tightness in the calf muscles is one of the contributory causes of plantar fasciitis, so stretching these muscles is almost always considered an important aspect of treatment. Many doctors still recommend weightbearing stretches, such as the 'wall stretch' and the exercise in which you stand on a stair and let the heels hang lower than the balls of the feet. But these exercises, while they have been helpful to some people, are too strong for many if not most people, and can worsen the condition.

Injured tissues, which is what PF sufferers are dealing with, are best served by non-weightbearing exercise. Obviously there are different views about this, but this has become the consensus on this board, with Dr Zuckerman and Dr Davis agreeing that non-weightbearing exercise is the preferred option. Dr Davis said, in response to a question, on 23 February 2005, 'We want to lengthen the fibres without causing tearing or pain. Pain activates a spinal reflex which in turn tightens the area'.

So, stretching is important. Even if your calf muscles weren't tight, and your PF has a different cause, the enforced inactivity of PF will make them (and all your other muscles) tight. So we need to stretch, but in ways that don't exacerbate the PF.

Another cause of PF and other foot ailments is weakness of the intrinsic foot muscles. Also, enforced inactivity leads to further muscle weakness, and to atrophy. So strengthening exercises are also important.

The simple yoga foot exercises that follow will help to keep your calf muscles and achilles tendons gently stretched, and will also help to strengthen the entire musculature of the feet. They come from the Satyananda Yoga tradition and are part of a series for all the joints of the body, called Pawanmuktasana. This means 'energy-releasing exercises', and they release energy by speeding the removal of impurities and toxins from the jonts. They work systematically and precisely on the joints and on their associated muscles, tendons, and ligaments.

These exercises are safe for most people, but everyone is different. As with all exercises that you are unfamiliar with, please go gently at first and be aware of how you feel while you are doing them and afterwards.

I've practised and taught these exercises for many years. I found a new and helpful dimension to them when I was dealing with PF; and my PF-suffering students have appreciated them. One attributed her recovery to these exercises alone. They have proved helpful to a number of people at heelspurs.com over the past few years.

They are effective and powerful, and helpful for people who are dealing with PF, because they are both non-weightbearing and specific. They're also energising. The increased circulation and energy flow they stimulate should help you to feel better mentally and emotionally, as well as physically. Needless to say, for these benefits to happen, you need to practise them regularly, a couple of times a day.

These exercises can be helpful in cases of plantar fasciitis in several ways:

1. They improve circulation generally throughout the body. In particular they increase blood flow to the areas being worked on, which promotes healing.

2. They gently stretch the calf muscles and achilles tendons, which in time reduces the tension on the plantar fascia.

3. They strengthen the entire musculature of the feet and ankles.

4. They maintain muscle tone and improve range of motion, and thus help to avoid losing both during the 'down time' of decreased activity.

The exercises are best done sitting in a chair, but can also be done lying down. (They can also be done sitting on the floor with the legs outstretched, but this is not an easy position to hold, especially for people with low back problems.)

The instructions that follow assume you are sitting in a chair - preferably a straight-backed kitchen chair without arms. Try not to sag: sit with an open chest and an upright, lengthened spine so that you can breathe well.

Toe bending and stretching

This exercise works the toe joints (all 28 of them!) and the entire musculature of the feet, while holding a gentle stretch through the Achilles tendons and the calf muscles.

Lift one foot off the floor and extend the heel forward, so that you feel a gentle but perceptible stretch through the Achilles tendon and calf muscles. Hold this stretch while you work on your toes.

Curl your toes forward, without bending at the ankle (don't do this so enthusiastically that you give yourself a cramp).

Then stretch and spread your toes as you bring them back toward your body. Try and make a space between each toe and its neighbours. (If your foot muscles are weak, as most people's are, this won't be easy or even possible at first, but perseverance will strengthen the muscles and you'll find the spaces appearing and then increasing.)

Do the exercise ten times, then repeat with the other foot, and then with both feet.

Breathing Out as you curl the toes, in as you stretch them.

Ankle Bending

This exercise, which works on the ankle joints, helps to lengthen the calf muscles and increase the angle of dorsiflexion, which reduces the tension on the plantar fascia. It is safe for most people, in contrast to weightbearing exercises such as the 'wall stretch' and the 'hanging off a stair stretch'. It can help to overcome tightness in this area without exacerbating PF or creating further problems.

Lift one foot off the floor and bend it forward at the ankle, pointing your toes away from you.

Then bend it back, bringing your toes towards you.

Do this ten times, then repeat with the other foot, then with both feet.

Breathing Out as you bend the ankles forward, in as you bend them back.

Ankle Rotations

Lift one foot off the floor and circle it, slowly and carefully, ten times in each direction.

Repeat with the other foot, then with both feet.

Breathing Breathe freely and naturally - don't hold your breath.


Other points

I've included instructions for breathing. If you co-ordinate your movements with your breathing it increases the effectiveness of the exercises because (a) it slows you down so that you get optimum movement in the joints you're working on and (b) it focuses your awareness on what you're doing. If you find it difficult at first to synchronise your movement with your breath, just breathe freely and do not hold your breath. Holding the breath creates tension, and tension worsens pain.

These exercises can be done as often as you like, whenever you think of it: the more the better. If you work in an office, you can do them under your desk without calling attention to yourself. Whenever you've been sitting for a while, it's helpful to do them before getting up

I would also suggest to anyone with PF that you do these exercises first thing in the morning before getting out of bed. This should help you to avoid the 'first step pain' so typical of PF. It also gets your circulation going, which makes a difference to how you feel when you do get out of bed.

(I have given the instructions for the foot exercises only, but for anyone interested, the whole series, for all the joints of the body, can be found at http://www.yahooyoga.com/yyh1202.htm)


Arch strengthening

Here is another exercise to help strengthen all the muscles of the plantar (sole of the foot) area.

Sir upright and comfortable in your chair with your bare feet flat on the floor.

Draw the ball of your foot along the floor towards you, without lifting or curling your toes. You're aiming to lift the arch and instep, not 'scrunch' the toes, which are not involved and should just follow the metatarsal along the floor. Hold the position for a few seconds, then release.

What you are doing is trying to isolate and work the muscles of your arch to lift your instep. But you aren't accustomed to using these muscles, and therefore your mind doesn't readily connect with them. In time it will send the right messages to the right muscles: meanwhile persevere and be patient.

Do the exercise a few times with each foot, then with both feet. Don't hold your breath (you might, as you are concentrating so hard, but be aware of the tendency to do so).

As with all exercise, go gently at first: you may feel a little discomfort, and that's ok, but avoid pain. It's a subtle movement, but it's quite strong. If you feel it isn't right for you - and you are the best judge of that - please stop.

You can do this exercise whenever you think of it. If you're at work, you can do it under your desk without anyone noticing.


The Plantar Fascia Stretch

Here is another exercise that you may find helpful. It has been described on the board by Dr Z, and has been found in a randomized trial to be an effective non-weightbearing exercise for plantar fasciitis. It should be done first thing in the morning, before taking the first step, in order to reduce first step pain. It should also be done two more times during the day.

I will describe the exercise for the right foot. If it's your left foot that is painful, just reverse the instructions.

Sit upright on the edge of your bed (but please see the Note below before starting).

Cross your right foot over your left leg, and rest the ankle on the left thigh just above the knee.

Using your right hand, place your fingers across the base of your toes, and gently pull them towards your shin until you feel a stretch through the arch. If you find this painful, do it more gently.

While holding the stretch, use the heel of your left hand to gently massage the sole of the foot from the middle of the arch towards the ball of the foot. This massaging action encourages the muscles to relax, and enhances the stretch. If you find it at all painful, do it more gently.

Note Sitting on the edge of the bed can be a strain on the lower back, especially if the bed is soft, or low in height, or both. It is really better to sit on a straight-backed chair. If your hips sink below the level of your knees when you sit on the bed, it will almost certainly be bad for your back - so sit on a chair. Place the chair close to your bed so that you can do the exercise before you take your first steps.


Finally, we suggest that you investigate Mike Wilmot's Personal Foot Trainer. This is a device that you can use effectively to strengthen the intrinsic foot muscles. See Mike's website - http://www.foottrainer.com - for details, and also for useful explanations of why most of the commonly recommended exercises for PF are not good exercises.