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Surgery Recovery and Stretches

Posted by Leopold on 6/03/05 at 18:43 (176089)

I had plantar fasciitis surgery about 9 mos. ago and I'm finding that I have to do my stretches 3x a day to stay fairly comfortable. When will I be able to stop some of this stretching if ever? For the people that have had plantar fasciitis surgery when were you able to stop stretching? I would hope that one of these days I possibly would only have to stretch once a day or not at all. Any comments would be appreciated.

Tired of PF!!!!!!!!!!!!!!!,

Leopold

Re: Surgery Recovery and Stretches

Ron on 6/03/05 at 19:23 (176090)

Leo, I stretched for some 7 years with very little success. I followed the doctor's orders the best I could. I would spends hours in front of the TV stretching. But it never hit me that my stretching technique was wrong. Afterall, I followed the doctor's prescribed techniques and just about every advice of how to stretch for PF out there, including my PT.

I'm having success now with Active-Isolated Stretching techniques, I've given up the old static stretching. After one month I can touch my toes, squat with my ass almost touching the ground, and especially my feet are doing so much better.

Just like me you'll never be able to stop stretching. Never consider your feet normal again, lest you return to your former self.

Good luck!

Re: Surgery Recovery and Stretches

JanP on 6/03/05 at 20:39 (176098)

Ron, I've been on the web sites you've named for AIS, and am trying to do some of the stretches. Is the main difference between AIS and what you call static stretching the amount of time the stretch is held? Do you do the ones that stretch the front of the leg and contract the calf? That seems counter to what a pf sufferer needs.

I'd appreciate a bit more detail as to which stretches you think are important. Thanks.

Re: Surgery Recovery and Stretches

Leopold on 6/03/05 at 22:21 (176099)

Thanks for the info on AIS techniques. Where can I find info on these stretches?

Thanks,

Leopold

Re: Surgery Recovery and Stretches

JanP on 6/04/05 at 09:14 (176107)

These are the links Ron has posted before.

http://www.stretchingusa.com/
http://www.aistretch.com/exercises.htm
http://www.aistretch.com/
http://www.hartmann-international.com/001articles/stretching.htm
http://www.massageandbodywork.com/Articles/AugSept2000/stretching.html
http://www.ackerman-massage.com/ais.htm
http://www.mrtherapy.com/articles/article2.html

Re: Surgery Recovery and Stretches

Leopold on 6/04/05 at 13:43 (176120)

Thanks Jan for sharing the links that Ron had posted. I will check them out!!

Leopold

Re: Surgery Recovery and Stretches

Ron on 6/04/05 at 15:31 (176127)

There are several difference between AIS and static stretching. You really have to read up on what the differences are. I suggest reading Aaron Mattes book on it and the Wharton book, both can be found at Amazon, for expert advice. Certainly it isn't easy and without pictures you can about forget getting it down right.

AIS in a nutshell.

THE ACTIVE PART:
1) Only hold the stretch for 2 seconds, then relax for 2 seconds. Every time you try to stretch for longer than this, the body has a natural tendency to counteract your intention with it's own reflex (myotatic reflex). This will inhibit stretching.

THE ISOLATED PART:
2) Isolating the muscle is very important. This can lead to some weird looking stretches. In static stretching, many times you will use several muscle groups at once. Like in touching ones toes, you'll use your lower back, hamstring, all your calf muscles and achillies heel, as well as some glutes. AIS avoids this as much as possible.

THE MAIN STRETCHING PART:
3) The muscle to be stretched must be relaxed. A tight muscle will inhibit stretching. The best way to increase relaxation is to tighten the agonist muscle, so the antagonist muscle can relax.

Flex your bicept (agonist) and your tricept (antagonist) will relax. For every agonist there is an antagonist muscle. However, sometimes it's not easy to locate which one to flex

I still don't get this part for every muscle group. It's very difficult to flex the stomach muscles while stretching the glutes, or to flex the shins while stretching the calves. This means reading up on this from an expert source to solve this problem.

Re: Surgery Recovery and Stretches

Mike W on 6/06/05 at 16:02 (176202)

Hello Ron,

Thanks for your info on AIS. I read the Wharton book 5 years ago and it is very good. However they do not show you how to isolate the toe/foot extensor muscles.

You should be aware that the agonist muslcle must function normally in order to facilitate the relaxation of the antagonist muascle.

I have tested hundereds of people with PF and they all have weak extensor toe/foot and lower leg muscles. If you strengthen the weak extensors you will have more sucess.

If you go to my website http://www.foottrainer.com and then click PF and PF exercises you will see how to isolate some of these muscles.

Regards,

Mike W

Re: Surgery Recovery and Stretches

Ron on 6/06/05 at 18:32 (176207)

> I have tested hundereds of people with PF and they all have weak extensor
> toe/foot and lower leg muscles. If you strengthen the weak extensors you
> will have more sucess.

I've found this theory of week lower leg muscles to be somewhat lacking in logic. How can so many runners have weak lower leg muscles and weak toe/foot muscles?

My leg muscles are quite large for being inactive. I've always had strong leg muscles. My problem so far has been proven to be very tight muscles. That may be the same problem with many runners.

I'll keep an open mind and look into your theories and read your site.

Thanks.

Re: Surgery Recovery and Stretches

Mike W on 6/07/05 at 08:35 (176236)

Ron,

Several reasons:

Sarcopenia - As we age every muscle in the body naturally becomes weaker/ loses its muscle mass. This process generally starts at age 30 and by the time you reach age 50 you have lost 2o% and 10% every decade after. Have you ever wonmdered why PF and AT affect so many people over the age of 30.

Use it or lose it: - Look at the traditional PF exercises. They all focus on the flexor muscles and not the extensors. Combine this with the above and you have a contributing factor.If you had a torn/tight bicep muscle why would you perform bicep curls? No you would try to rest it initially.And if you contracted and strengthened your triceps you would relax the tight biceps. Do you see the logic in this? Running involves more of the flexor muscles so they are naturally stronger. I would bet that you have weak extensor muscles and it is the flexor muscles that are tight.

You should read my site before you rush to judgement.

Mike W

Re: Surgery Recovery and Stretches

John H on 6/07/05 at 09:59 (176241)

Mike: the PT I have been undergoing for several weeks involves a lot of balancing. Much of it on one foot and on a big ball,balance board,wobble board,etc. Most of it is done barefooted or even in flip flops. This requires you to use ever intrinsic muscle in your feet. After about 6 weeks I have almost doubled my time to remain balanced in various positions. There are actually time standards based on age as to how long you should be able to stay balanced in various positions on various objects.. Balance on a half large ball that is sort of soft on one foot requires your foot to constantly be in motion and your goal is to stay balanced for 30 seconds. My most difficult one is to stay balanced on one foot with my eyes closed. I think being a pilot made me more dependant on my eyes (insturments) than the average person. The PT is also big on strength of the extensors. She often refers to the Core Body Strength. Lately we have been very much into muscles such as the hip flexor and big muscles of the upper legs.

Re: Surgery Recovery and Stretches

Ron on 6/07/05 at 19:31 (176278)

> You should read my site before you rush to judgement.

I haven't rushed to judgement, and I've finally finished your site.

You claim the reason why a person has PF is because their extensor muscles are week in the toes and the flexor muscles are tight. The flexor muscle is somehow tightening our plantar fascia.

In this instance wouldn't the flexor pull down and relax our plantar fascia, while the extensors, if they become stronger, pull up on the toes and tighten our plantar fascia?

Isn't this why a PT would recommend toe crunches with a towel? To strengthen the flexor muscles? Why would so many PTs recommend such excercises if they were doing us such harm?

You may be on to something. I'd like to hear some more theory or evidence before I either tell others about your foot trainers or before I buy them. Your site hasn't convinced me of your system. You haven't even referenced one medical source to try to bolser your claims. Instead, your site is on the fringe of anti-establishement.

In a nutshell, your site is simply too devoid of information for me to discount other medical theories of the cause and treatment of PF.

Re: Surgery Recovery and Stretches

Mike W on 6/09/05 at 07:57 (176379)

John,

It sounds like you have a good PT. I think that you are on the right track with core muscles. A friend of mine invented what is known as the Fitter. You kind of slide back and forth on it and it is good for ankle and other leg injuries. I hope you continue to improve.

Re: Surgery Recovery and Stretches

Mike W on 6/09/05 at 08:25 (176382)

Ron,

On my website you should click anatomy of the feet.

What most people call the plantar Fascia is really known as the Plantar Aponeurosis. The PA is not connected to the toe flexor or toe extensor muscles.

If you look at Heelspurs.com home page you will see a picture of the point where most people have pain. This is the insertion point of the flexor digitorum brevis not which is under the PA.

RE studies check out the American Orthopaedic foot and ankle study on weightbearing VS non weight bearing stretches for PF.

You recommend AIS. Where are the studies for AIS or any of the PF traditional stretches?

I am sorry you think I am on the fringe of anti-establishment. I think that many of the traditional approaches are poor and are doing more harm than good.

Re: Surgery Recovery and Stretches

Ron on 6/09/05 at 11:44 (176393)

> I am sorry you think I am on the fringe of anti-establishment. I think
> that many of the traditional approaches are poor and are doing more harm
> than good.

Many of the traditional methods may be harmful. That's not necessarily the point here.

> You recommend AIS. Where are the studies for AIS or any of the PF
> traditional stretches?

The real object of any stretching routine is to gain flexibility. I've included any study on anything that increases flexibility. There are countless other studies as well if these don't satisfy you.

This site claims that studies have been conducted for stretching with successful outcomes, but don't cite the study.
http://healthlink.mcw.edu/article/987116429.html

http://heelspurs.com/_intro.html
[No reference to this article]
'A 2003 journal article indicated people with a lack of flexibility in the calf muscles are 23 times more likely to get plantar fasciitis. Another relatively recent article claims stretching the plantar fascia itself is important.'

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9462907&dopt=Citation
_Effective treatment of chronic plantar fasciitis with dorsiflexion night splints: a crossover prospective randomized outcome study._

'We believe dorsiflexion splints provide relief from the symptoms of recalcitrant plantar fasciitis in the majority of patients.'

http://bmj.bmjjournals.com/cgi/content/full/315/7101/172
This site has references to tightness the legs as a root cause of PF.

http://ajs.sagepub.com/cgi/content/full/27/2/173
Increasing Hamstring Flexibility Decreases Lower Extremity Overuse Injuries in Military Basic Trainees

http://scholar.google.com/url?sa=U&q=http://general-medicine.jwatch.org/cgi/content/full/2003/729/6%3Fck%3Dnck
Fascia-Stretching Exercises Help Plantar Fasciitis

Reference only:
DiGiovanni BF, Nawoczenski DA, Lintal ME, et al: Tissue-specific plantar fascia- stretching exercise enhances outcomes in patients with chronic heel pain: a prospective randomized study. J Bone Joint Surg Am 2003;85(7):1270-1277

Re: Surgery Recovery and Stretches

Mike W on 6/10/05 at 09:21 (176448)

Ron,

You should be aware that Fascia is non elastic and therfore does not stretch. Trying to stretch it is wrong.

You promote AIS yet where is the study that shows it works?

The AIS exercises for PF are incorrect because they do not ISOLATE the Extensor Hallicus and Digitorum Brevis and Longus Muscles.

Re: Surgery Recovery and Stretches

Ron on 6/10/05 at 17:56 (176485)

> You should be aware that Fascia is non elastic and therfore does not
> stretch. Trying to stretch it is wrong.

The modern scientific belief is that the plantar fascia can be stretched. There are countless scientific articles that suggest stretching of the plantar fascia. To say that the fascia can be stretched like a muscle is wrong, and it's equally wrong to believe that it can't be stretched at all.

Your claim can easily be proven wrong. When a person gains weight, does the fascia stay the same size? It can't, and therefore must expand with weight (this could explain why weight loss helps). It isn't a static structure like bone.

> You promote AIS yet where is the study that shows it works?

I couldn't find any articles on AIS stretching techniques. For sure there will be some when it becomes more popular. Many athletes now are are just getting wind of it.

You promote your foot trainers, so where are your studies? Actually, you don't even site one scientific article or one doctor who supports your claims.

The real issue isn't whether your foot trainers help, but whether stretngthening the toe extensors relaxes the plantar fascia and decreases pain. The foot trainers are only a route to get there. Someone could, theoretically, use something similar to get the same results.

> The AIS exercises for PF are incorrect because they do not ISOLATE the
> Extensor Hallicus and Digitorum Brevis and Longus Muscles.

If a muscle can be strengthened in an isolated fashion then it can be stretched in an isolated fashion. Isolation is only a relative term. Most muscles can't be isolated completely with any technique.

You are really nitpicking about AIS as if it's some kind of machine - it isn't. It's as versatile as you understand how it works. Right now it's working for me, and I don't necessarily care if it works for others. I only support it to the degree that I believe it can. I have no financial interst in this at all. It would be nice to know if others can succeed over the same failures I've had with stretching.

That's the long and short of it. :->

Re: Surgery Recovery and Stretches

Mike W on 6/11/05 at 16:30 (176554)

There is no such thing as a plantar fascia. What you are referring to is called the plantar aponeurosis. The PA is like a ligament and sorry but ligaments are not elastic so trying to stretch it is incorrect and it has nothing to do with a persons weight.

If you look up a couple of threads you will see that DR. Zukerman believes my exercises are a good thing.

I also have many caring physiotherapists and doctors who use my Foot Trainer Exercises with excellent results.

Most muscles can be isolated if you are in the proper position and use the correct tecnique.

I hope you get better very soon.

Re: Surgery Recovery and Stretches

Ron on 6/11/05 at 21:40 (176565)

> There is no such thing as a plantar fascia. What you are referring to is
> called the plantar aponeurosis.

They're synonyms, but I think you know that. You're surely being pedantic here, no?

>The PA is like a ligament and sorry but
> ligaments are not elastic so trying to stretch it is incorrect and it has
> nothing to do with a persons weight.

It is beyond my knowledge to truly debate this in any formal manner. However, I'm going by what so many doctor's recommend. I doubt that your knowledge is so far greater than the entire medical community to be able to contradict them on this matter.

You aren't just debating techniques here. You're debating basic body tissue with no qualifiers at all, while contradicting the entire modern medical community. This appearance of arrogance alone is beyond my ability to understand where you are coming from.

I'd hardly think that the fascia is so inelastic that it has no room to expand. If I gain 50lbs., are you saying that the fascia remains the same size in not only in my feet but my entire body? If it doesn't expand in some fashion then how does it work for so many of us? Conversely, why does the plantar fascia become problemic for some of us because of a weight gain?

> If you look up a couple of threads you will see that DR. Zukerman
> believes my exercises are a good thing.

I'm sorry, I forgot that I already saw his testimonial on your site and it's quite impressive. But now I'm wondering if he agrees that the plantar fascia isn't really the plantar fascia but the plantar aponeurosis, and there's no such thing as a 'plantar fascia.' I'm also wondering if he believes the fascia can't be stretched at all. After all, he was the one who wrote the article on the plantar fascia stretch.

Good luck, Mike. I wish you luck in your business of help. I don't know if I doubt your sincerity or not (some really enjoy your help), but some of the things you've said doesn't give me much confidence in what you're claiming.