Anyone who has had that real burning feeling in their heel or underneath their foot knows all about Plantar Fasciitis. It can be a very annoying and painful chronic injury that can affect daily life and limit you from playing sports and simply just walking around. Most solutions are to use stretches and massage to relieve the pain. And while this may be effective at taking your pain away, they are merely just treating your symptoms it will not actually deal with why you got this problem in the first place. In this article I will show you some of the simple steps we have proven to work with not just plantar fasciitis, but also with other leg injuries and feet stability problems and even be able to help many people with severe walking impairments from spinal cord injury or disease. You will see videos and pictures of real life clients in our rehabilitation program from over 11 years as Personal Trainers in Melbourne. We know these methods work for we use them successfully everyday, and we want to help you learn these secrets in order to have an effective long term solution for your injury.
What Is Plantar Fasciitis?
Wikipedia defines this as: Plantar fasciitis (also known as plantar fasciopathy or jogger's heel) is a common painful disorder affecting the heel and underside of the foot. It is a disorder of the insertion site of ligament on the bone and is characterized by scarring, inflammation, or structural breakdown of the foot's plantar fascia. It is often caused by overuse injury of the plantar fascia, increases in exercise, weight, or age.
We find this injury is very common to people of ages, but in particular runners and hikers will present with this pain the most as they are speeding up the dysfunction due to their activity. To fully treat this problem you need to get a good understanding of where it came from, what was the cause? In 99% of cases it is traced back to muscle imbalance, poor posture and poor movement patterns. Factors such as excessive weight, incorrect shoes and excessive weight all exacerbate the problem but rarely are they the original cause of your injury. This is very important to understand if you want a permanent solution, or if you just want to treat symptoms as most therapists, surgeons, doctors do with their treatment of injuries these days. (read our article on Chronic Pain for more detail on this). Many running and hiking experts offer remedies that are just band-aid solutions to get you back running and hiking as quickly as possible, being ignorant to how to address the cause. Some try to give advice on taping and bandaging, which can help manage the pain, but again does not solve the problem.
You must look at the body as a system of systems all stacked on top of each other, analyze where the problems or leaks in the pipe are, and then try to solve the puzzle using a multi facet approach. This is not a quick fix approach by any means, and I won't lie to you and tell you it will be easy, but if you are patient and follow the steps outlined below, you will find the lifelong solution to your problem and get rid of it for good.
The danger of not addressing the cause is that this injury is just a warning of much bigger pain to come if you do nothing to correct the problem. Much more painful conditions such as knee Injuries like ACL Tears or full rupture, patella femoral tracking & ITB friction syndrome, and even many of the severe Back Injuries and chronic hip injuries like Piriformis Syndrome! Why? Because these all share the same common problems. If you have any of the above mentioned injuries, I would highly recommend getting a copy of our more intensive and step by step detailed programs by referencing our advanced online programs featured at the bottom of the page or by going straight to the Online Shop.
What Is The Cause Of Plantar Fasciitis?
As I briefly stated, the cause of plantar fasciitis might not even be with the feet! The feet might just be effect of weakness or tightness somewhere else in the body. It is your mission to find where this might be. Take a look at the picture below to see what I mean.
I have featured this picture many times on other articles on our website for it relates to injuries and pain from all over the body. Each joint needs the exact opposite force in order to maintain optimal alignment and movement. If a joint becomes stiff when it should be mobile then the next joint is forced to find the lost mobility putting it at risk of injury! See below for a summary of the main joints.
- Feet - The feet have a tendency to being lazy, and easily losing strength and motor control. From poor footwear, to sitting too much, and even the lack of barefoot walking, the feet need exercises to make them stronger and more stable.
- Ankle - The ankle tends to develop stiffness very easily and needs more focus on mobility and flexibility.
- Knee - The knee like the feet becomes weak and sloppy easily, (VMO for instance completely shuts down with as little as 10ml of fluid present). This in turn creates severe knee injuries and if left untreated eventually chronic stiffness in an attempt to stabilize it. Stability and strength work is needed for this joint.
- Hip - This joint is often the cause of many problems. The hips have a tendency towards stiffness and as a result benefit from flexibility and mobility work.
- Lumbar Spine - The lumbar spine needs stability to prevent unwanted flexion or extension.
With regards to plantar fasciitis you will find in all cases weak feet flexors and glutes, along with tight ankles and hips. Which one started the ball rolling is hard to say, but regardless of what started the process you now have to go about correcting the problem. The deeper you get into your assessment the clearer the picture will become as to what is having the biggest influence over your pain.
Where do you start with your assessment and corrective program?
Assess Your Posture
This must be your first step as your posture will give us many clues as to where to start. Where your weaknesses are. My recommendation would be to see a skilled CHEK Practitioner or a Chiropractor for a thorough postural assessment but if you want to do it yourself there are many really great apps you can use these days. We use one called Posture Screen Pro
Watch the video below to see how this works.
This provides us with a great starting point on where we might look for flexibility and strength deficits. Your goal is to improve your body's resting position to as close to Ideal Posture as possible. Ideal postural alignment (viewed from the side) is defined as a straight line (line of gravity) that passes through the ear lobe, the bodies of the cervical vertebrae, the tip of the shoulder, midway through the thorax, through the bodies of the lumbar vertebrae, slightly posterior to the hip joint, slightly anterior. Remember you are a human body made up as a integrated working entity, if one piece is not working correctly then there will be compensation and many pieces will not work correctly. Just because the pain is in your foot does not mean that is where the problem is.
Read our article Why Posture Is Everything For Chronic Pain for more information on this topic
Assess Your Breathing
Yes you read that right and might be thinking what has that got to do with tight ankles. It has everything to do with it. Breathing will affect every muscle in your body and alter your posture quicker than you click your fingers. It is the most important thing you need to do, get enough air to breathe. Without air you will die. Simple as that. Meaning, that it will sacrifice changes within the body to improve the ability to find a better breath, at the expense of pain and suffering in muscles. This is often something missed by most doctors and health practitioners. But understand that a person with forward head posture due to breathing dysfunction tends to lean forward on an angle in order to get more air. This is very typical of Mouth Breathers, anxiety disorders, asthma sufferers and people who are overly stressed and don't even know they have a breathing problem. If you have a tight neck all the time you can suspect you have a breathing problem. Click here to watch a video of where I show you correct breathing technique.
This forward lean created by finding a need to get more air, results in massive tension on the achilles tendon as it is now in a position of holding onto you to stop you falling forwards! Learning how to use nose breathing and improving your posture is paramount if you want to get rid or your ankle problems forever. If you suspect you have a breathing problem or you know you have a forward head posture I would encourage you to buy the book "Nose Breathing" By Patrick McKewon as it will give you some excellent tools and resources to correct this very quickly. I have used some of his tools with some of our current clients very successfully in the past year.
Incorporating exercises like the Prone cobra (pictured below) and the Swissball neck flexion are great ways to improve your postural strength which in turn improves your ability to breathe. Make sure you read our article on Breathing by clicking here.
Assess Your Ankle Mobility
Ankles are complicated structures and ankle injuries tend to be trickier than we assume. Even the simple sprains can leave strange after affects that will follow you around for a long time affecting your balance, even create new pain in other places, sometimes years later. And too often, what we assume to be simple sprains turn into more complicated injuries that need highly specialized care. But like so many chronic injuries tight ankles don't even need a sprain to become tight! As mentioned earlier it could be the weak feet or weak glutes and lack of stability that is the problem that is forcing the ankle to tighten up and lose what is known as dorsiflexion. Dorsiflexion is something we all tend to take for granted in daily life and in sport. Lunging, ascending and descending stairs, squatting and getting into and out of a car all require it. In sports with multi-directional movement patterns like tennis and basketball, the sportsperson must dorsiflex effectively into many angles, so as to transfer load and direction.
A tight ankle not only restricts this but forces the body to compensate and find a new way to do what you want to do. It is this compensation that creates plantar fasciitis and other new injuries and of course...... more pain!
Watch the video below of our best ankle mobility drills to use to help you here and a simple test you can use to see if you have adequate dorsiflexion is up next.
How To Do The Wall Test
Resting most of your body weight on the test leg, the person moves their foot back as far as possible, while still being able to dorsiflex with the heel on the ground so the knee touches the wall in front. The foot should point directly ahead and the knee should move directly over this. The distance from the end of the big toe to wall is measured. You should be able to achieve 8cm for normal flexibility.
If you are lacking range of motion you will need to do calf stretches and also use some of the self massage techniques to loosen the muscles surrounding the ankle but again I would find the ankle mobility drills work better than stretching here. If however you do not have any restriction your problem is going to be more stability and strength based.
Assess The Single Leg Squat:
The single leg squat is an excellent test to use as it to identify movement dysfunction and can pinpoint stability problems that may have started at the hip and created the ankle problem. Without a doubt the single biggest obstacle in getting on top of this problem and is also relevant to all of the other injuries we mentioned at the beginning. If you learn nothing else from this article other than the fact you need to single leg squat correctly I have done my job.
Make sure you read our full article Single Leg Squats Are The Best Leg Exercise on how to do this right and I give you the assessment checklist to help you. I also have provided you with 2 videos below to help you. One is an excellent video of a client of mine recovering from an ACL operation, performing what we call the Toe Touch drill which is a single leg squat performed in 360 degrees. An excellent test for assessing Gait. You will see in this video excessive pronation in her feet which can also increase the pressure through the various forefoot and toe joints. In this case and also with people who suffer recurring ankle ligament injury tend to show strength deficits in hip abductors and extensors. This client's tight ankle had on average a 3-degree deficit in dorsiflexion on her bad side. This results in the knee tending to turn inwards on the tibia, producing an exaggerated quadriceps angle (Q angle).
This then leads us to the next phase of rehabilitation - gluteal activation
Improve Feet Stability & Core Activation
It is only now we are looking at the feet! Amazing isn't it because most therapists would look here first. Make sure you read our article on how to improve feet stability to get more detail on this.
Our feet and ankles are meant to withstand incredibly high forces and should provide more in terms of shock absorption than perhaps any other body part. Unfortunately, we begin to gradually lose this ability once we start wearing shoes. Over time, the feet, ankles, and toes become inhibited. And as we expose our feet to some trendy shoes with all types of padding and support, this only make matters worse and exacerbates the lazy and weak feet muscles. Besides minimizing the ability to withstand intense ground reactive forces, the body gradually begins sending fewer and fewer signals to the feet, leading to distortions in pro-prioception and loss of innervation all the way up the kinetic chain.
If you have flat feet, you failed the wall test and your single leg squat failed you can safely say your feet flexor muscles are now weak and inhibited. Even if they were not the original problem, they now play a big part in keeping it active. The feet don't need orthotics, they need to be strengthened. The best way to strengthen your feet is to train with Single Leg exercises on the Sensa Mat. I will cover this shortly.
Now it is impossible for me to include every exercise here in this article, as every case is a lot different and must be treated this way. So what I will do is provide you with some of our most common exercises to use as a starting point. Below is 2 videos I encourage you to watch as they look very closely at the role of the feet in the stance and walking phase.
Single Leg Balance: This is a very simple exercise where all you need to do is balance on one leg as long as you can with your EYES SHUT! Great for building pro-prioception and reflex movements by the nervous system to provide stability for the ankle, hip and trunk. Try to count seconds in your head and see if you can get to 60 seconds.
All joints in the body are under the influence of segmental stabilizers ( muscles crossing that joint only ) and gross stabilizers ( muscles crossing multiple joints ). Assisting with joint stabilization is ligaments, joint capsules and fascial structures. When a muscle imbalance is present a faulty recruitment of stabilizer muscles will begin, resulting in reduced stability of joint or joints. This instability will now result in a strain on the capsule or ligament structures of the affected joints and send faulty information back to the brain via the nervous system. This faulty information develops compensatory movements which now can result in potential injury to other areas of the body. Not to address the weakness of the abdominal muscles would be foolish and prevent any long term success to your problem. To improve Core Activation in order to prevent this faulty stabilization I find this exercise is very effective in 99% of all clients I see.
Lower Abdominal Co-Ordination Test:
1. Lying on your back with a blood pressure cuff or your hand place underneath your low back at belly button level.
2. Bend your knees to 45° raise both legs in the air keeping the knees bent. Pump the cuff up to 40mm/hg draw your belly button inwards and slightly rotate your pelvis backwards which will flatten your low back into the cuff rotate your pelvis to the point where the pressure in the cuff raises to 70mm/hg. If you do not have a cuff rotate your pelvis until you feel a light pressure on your hand.
3. Lower both legs back to the floor maintaining the pressure on the cuff. The pressure on the cuff should not vary greater than +/- 5mm/hg throughout the exercises.
Strengthen The Glutes
This is quite a lengthy topic in it's own right and you must understand that your choices of exercises will need to start with being very simple but progress to exercises in a standing position. Again this is one area of rehab that fails with many therapists and trainers as the focus to intently on activating the muscle using exercises in a lying position. A person may have good gluteal strength when performing an exercise such as the bridge or leg press, yet at the same time be unable to use their gluteal muscles to stabilize the hip effectively in an standing position with pelvis held in neutral. This variation in gluteal strength depending on position is common to people with Plantar Fasciitis, and is an example of how the gluteals need to be able to act as either a prime mover or a stabilizer, depending on the task. When walking or running, it is crucial to be strong in the inner range, because the gluteals support the upright position of the trunk, and help maintain the pelvis and lumbar spine in neutral.
Watch the videos below to see how to assess your strength and use some simple exercises to build you up to a point where you can do lunges, deadlifts and single leg squats.
You will also find a great deal of information about how to progress from easiest to hardest in these articles here
Effectively Integrate Into A Standing Position
We must apply what we know about the slings of the body as this is how we are designed to move and where the inner unit and outer unit integrate to create efficient movement. The secret to our success here is to trick or encourage the lazy weak muscles to fire in the integrated movement. Once the movement is perfected it needs to be completed several thousand times perfectly for it to be written in as a NEW automatic movement pattern. This is the goal of our program to ensure the pain is removed forever! The best exercises to teach this are single leg squats, lunges and deadlifts. The videos below is possibly the best two integrated exercises for getting rid of Plantar Fasciitis but also paradoxically the same exercise that can aggravate your symptoms if the previous steps are not addressed first. So make sure you have completed all of the previous steps before trying this. This is also where I introduce the sensa mat for strengthening of the lazy weak feet flexor muscles.
Make sure you get a Sensa Mat, it will be the best piece of equipment you ever invest in.
You will also need to develop a fully rounded out program that addresses your stability and function across all movement patterns. Again this is too big a topic to discuss in this article and I suggest downloading our Free Report on Functional Training to get more information on how to do this.
Running Technique
Before we jump right into running make sure you walk correctly first. Read our article 6 Ways To Improve Your Walking Technique for more detail on how to do this and you can also check out the 2 videos below.
If you are a runner and have this injury it is extremely important you are wearing the correct shoes fitted by a qualified podiatrist. Also you will need to address your running technique as this could be the cause of your problems. I have been a competitive runner myself for over 10 years and have run several sub 40 minute 10km races and sub 90 minute half marathons and understand how important the correct running stride is. Not only for improved performance but also for injury prevention, which is why I adopted the POSE Running method many years ago. As a result I have never suffered from any repetitive injuries since adopting this technique. It is not easy to learn, and you must be patient when trying to change your stride, but if you stick with it the benefits are well worth it.
How To Do The Pose Method
Firstly watch this video POSE RUNNING VIDEO This will give you a good idea as to what it is all about. The distinguishing characteristic of pose running is that the runner lands on the mid foot, with the supporting joints flexed at impact, and then uses the hamstring muscles to withdraw the foot from the ground, relying on gravity to propel the runner forward. This style is in clear contrast to the heel strike method that most runners deploy and which is advocated by some health care professionals The concept is simple enough, but the practice is extremely hard to master. It is only with expert teaching, lots of patience and dedicated training that the runner can perfect the technique. Running with this technique at first is physically demanding, so runners must undertake strengthening drills before starting the program. Which is why we recommend starting with a stability and strength training first. Running should be easy, effortless, smooth and flowing. We have all seen and heard the heavy runner who pounds away on a gym treadmill. A good runner should have a very high cadence – not a long, extended stride length. In pose running, the key is to maximize your effort in removing your support foot from the ground; good training is essential to ensure that you don’t over-stride or create excessive vertical oscillation. The runner should fall forwards, changing support from one leg to the other by pulling the foot from the ground, allowing minimum effort and producing minimum braking to this body movement. The idea is to maximize the use of gravity to pull the runner for-ward. The pose method is centered on the idea that a runner maintains a single pose or position, moving continually forwards in this position. The center of gravity, which is around the hip position, should move in a horizontal line, without vertical up and down displacement and the rear leg maintains an ‘S-like’ form, and never straightens. This notion comes from animals such as the cheetah which do not land on their heels but run on the mid foot and deploy a pulling through action using their hamstrings rather than pushing the foot into the ground. Without a doubt the best running method for injury prevention I have seen in all my years as a trainer and keen runner.
Conclusion
In order to find effective long term solutions to injuries like Plantar Fasciitis and ankle restriction we must move beyond just looking at the area in pain. By looking at factors like Posture, breathing, abdominal control, tight ankles or hips, movement patterns and glute strength you will be able to find the missing answers to your problems that do not require invasive and often dangerous surgeries or medical drugs. Also do not discount the value of good nutrition and getting to bed on time. Without enough rest and poor vitamins and minerals coming into the system your body will never a chance to heal the inflammation. Again another area often neglected but plays a massive role in getting results.
If you have knee pain, hip pain or back pain which is common to people with plantar fasciitis you will find great programs for these below.
If you would like to know more about our programs or would like a Free Consultation where we provide a Postural and Movement analysis fill in the form below and I will get back to you within 24 hours.
