Heel pain is incredibly common and one of those injuries that can take months to years to heal. So the more that you can do to help it at home the better right? Recently there has been a shift in thinking in rehabilitation soft tissue injuries and this has brought with it a new plantar fasciitis exercises that significantly speeds up recovery.
Mechanotherapy has recently been brought back into the limelight and more focus has been put on this. Mechanotherapy is basically looking at how tissue reacts to the forces that are put through it. If you put the right progressive loading through a tissue, it will adapt and change according to that load – The body is an awesome thing and we can use this adaptation to loading to give injuries a push in the right direction to heal pain strong and fast.
A good explanation of mechanotherapy can be found here for more information.
In the past, the treatment for plantar fasciitis (which should really be called plantar fasciopathy) has been quite passive with footwear, stretching and injections being the go-to options. these definitely help, and I have written a post in the past with some great rehab exercises in it, but new research has added another dimension to the treatment of plantar fasciitis that we can add to this.
A recent new study, looking at 48 patients with plantar fasciitis, compared two treatment options which basically had one group stretching the plantar fascia and using shoe inserts and the other group doing plantar fascia specific high load strength training and shoe inserts. The results at the 3-month review mark showed a much better improvement for the patients that were doing the simple progressive exercise every second day.
New findings like this can’t be ignored as who wouldn’t want to be pain-free faster!
So what is this new progressive exercise regimen that you can add to your rehab exercises?
The exercise is a simple single leg heel raise with a towel rolled up and put under the toes to put the plantar fascia on stretch and load up the windlass mechanism.You then do a heel raise, taking 3 seconds to go up, a 2-second pause at the top and then a 3 second lowering down again.
Do 3 sets of 10 reps every second day.
As pain improves and it becomes comfortable to do for after two weeks, you can add weight to the exercise by putting some weight in a backpack (e.g. a few books or a brisk or two) to progress the exercise and progressively add more force.
Note: This exercise needs to be done slowly as described to decrease the risk of flaring up the injury
The main thing is with plantar fasciopathy is to persevere, keep at your treatment and rehab exercises as it does get better.
In today’s world of concrete pavements, cushioned shoes and sedentary lifestyles – Our feet get stiff, imbalanced, achy and neglected. This often leads to arch pain and plantar fasciitis (or fasciopathy) but luckily these is a way to help loosen off your arch!
It is time to take 2 minutes to wake up your feet and get them loose and mobile again with one simple exercise.
Our feet lay the base for our entire body to work off and they really are an amazing piece of machinery, they:
Propel us forward with spring-like mechanisms (see more here)
Have cat-like reflexes
Balance out and lay the foundations for our whole upright body
The amazing human foot: This BBC documentary on the human foot gives a great insight into all the structures that combine to give the foot the ability to take all of our weight, day in day out. At 18-19 minutes you can see the plantar fascia that runs along the bottom of your feet clearly and how it gets tensioned as you walk, acting like a spring – this is the spring that you are going oil up with this treatment today!
The feet really do have a lot to do, and have a lot of weight and forces going through them every single day. This combined with us tending to keep them cramped up in fabric coffins for the better part of the day, or even worse in flat shoes and flip-flops – leaves them needing a little R & R.
So how can you say “thank you feet” and give them some relaxation and mobility?
Take a ball, any ball will do (I prefer to use a lacrosse ball as they are grippy and firm) but the firmer, the better. Place it under you foot, apply some pressure and slowly roll it around the bottom of your foot.
Maintain a comfortable pressure, while rolling it into all the tight spots in the sole of your foot – namely the inner arch and outer arches of your feet between your heel and the ball of your feet.
Do this for two minutes on each foot and feel the difference. You do this while standing or sitting (under the desk at work even), so really there is no excuses 🙂
This is a great little exercise to really loosen up the Fascia (connective tissue), massage the muscles and mobilize the bones, and as a bonus, it increases your flexibility.
As a quick test to see if your tight feet are affecting your flexibility – before you start the myofascial release, slide both hands down your legs and see how far down you can get (toe touch), and remember how far down you get. Roll out both feet for two minutes each and then re-test – Most of you will be pleasantly surprised that you get significantly lower down
And YES if you have Plantar Fasciitis or Heel spurs – This will really help you.
So, if you have any foot arch pain, heel pain, calf pain or just generally want to look after your hard working feet – Take a few minutes out of your day and get this done and you will be much better off for it.
We all do it; sit down, slip our socks on (apart from the bare-foot runner among us) and proceed to firmly and decisively tighten and tie our laces.
Great! And away you go, but unfortunately this little ritual is often done wrong – with all the best intentions I know! But wrong none the less.
Tightening up the top few rings of our shoes as firmly as we can – ensuring stability, a firm fit and feel-good-factor right? When in reality you are strangling your foot’s blood vessels and nerves, causing paresthesia (Tingling and numbness) in your foot and more commonly, your toes.
The human foot is an incredibly complex piece of machinery with 26 bones, 33 joints, 20 muscles and many ligaments all combining to move you around all day, taking thousands of steps and acting like a natural spring.
But it too much compression is placed on the foot – The is a lot of places for your little nerves to get trapped, pinched and compressed.
Definitely not something we want on our runs!
So whats the easy fix?
A lot of seasoned runners will know this and do this already but believe me they are far out numbered by those that don’t.
Answer: Tighten your laces from the toe-up. Ensuring that the last two rungs are no more than 80% of the max tension.
This gives your feet breathing space, which makes for much happier feet and a much happier runner!
Give it a go, alter than ritual and be forever better off.
Note: In mostcases, foot and toe numbness and mild pain are due to improper equipment or technique, so relatively easy to fix when the offending problem is sorted out. BUT if it continues after the problems are fixed – it is time to consult a professional and check that there is no underlying pathology.
Thanks for reading and striving to improve yourself! Get out there and put it into practice 🙂
If you have any running related questions – head on over and ask the team at The Running Forum, a great community, that is always happy to help – and as always you can comment below.
Whenever I see a patient with a lower limb injury come into the practice wearing flip-flops I cringe inside. Really, these simple bits of plastic are causing a lot of pain and injury and are not something you should wear all day.
Flip-flops absolute lack of arch or heel support puts you at risk of unnecessary pain and injury. We are (I am generalizing here) so careful to wear the best footwear when exercising, keeping up to date with the latest running shoes, orthotics, braces etc but when it comes to relaxing and what we wear outside of work and sport – we aren’t so smart. A study found that in a large shopping center, 43% of all women were wearing flip-flops(1) – That is a huge amount of foot, calf, shin, knee and back pain! Yes this may keep Physio’s and podiatrists in business but it keeps a lot of the population out-of-pocket – And often there is a very simple thing you can do to ease your pain and injuries….
Throw your thongs away!!
Really flip-flops aren’t that bad if you just wear them to the beach, around the changing room or shower etc – It’s when you start wearing them out shopping, to lunch, all day, everyday that they can cause real problems. What problems can flip-flops cause you may ask? and why? Flip-flops can lead to:
They wouldn’t be so bad if our feet weren’t so weak and de-conditioned. Yes we evolved to roam the open plains and jungles barefoot but now that we live in this concrete world – we need a little more protection for our feet. Also because we so often wear cushioned supportive shoes the rest of the time, our feet are not able to handle the complete lack of control and support when wearing flip-flops – Like sleeping on a nice comfy bed one night and then on concrete the next – You will get sore right?
And because they change the way we walk, we use our muscles in a different way, while increasing the shock going through and feet and legs due to lack of shock absorption. Wear them for a long time and the repetitive strain leads to overuse injuries. For example:
Every time you step, you need to squeeze and scrunch your toes to hold the flip-flops in place! Meaning your feet and calf have to work very, very hard = tight, tight calves.
Due to the total lack of arch support the arch can repeatedly over-pronate, increasing the stretch on your plantar fascia. Repeat this over hundreds of steps and you get micro-tears, inflammation and pain. You can read more about this here.
Good things in moderation
So, you don’t need to go and throw your flip-flops out but PLEASE limit the amount you wear them as they can be a huge cause of pain and injuries. This is also such an easy thing to change that can drastically improve your function and decrease injury risk, so why not do it huh?
Addendum: As a proud Kiwi I feel I should give a quick history on the proud origin of flip-flops.. or should I say Jandals! The flip-flops was originally invented in Auckland, New Zealand in 1950. The idea came from the original Japanese sandals which allied soldiers saw while doing occupation duty in Japan during WWII. The original name Jandal (Japanese sandal) was trademarked so that lead to other countries having t come up with other names such as:
So wear this great invention in moderation and save yourself a lot of trouble. Please Share, like and comment away!
Plantar fasciitis is the most common cause of heel pain in adults and accounts for 10% of running injuries. I will show you the WHAT, WHY and HOW to treat it yourself!
How common is it really?
Accounts for 15% of all podiatry visits
Is bilateral (in both feet) in up to a 1/3 of cases!
10% of running injuries
That’s enough stats to show you just how common this is and how important it is that you can treat and rehabilitate this yourself. Unfortunately it is often looked at as a trivial injury and if not treated right can last for months to years, really stopping you doing what you love.
So what is it?
The plantar fascia is a strong band of connective tissue that starts at the bottom of your heel and runs along bottom of the foot, attaching into the toes. It is important for:
Maintaining your arch when walking and running – tracking from your heel to the toes it stops them spreading apart as your land on and push off your foot.
Stabilises your foot: as you push iff your toe the fascia is put on more stretch, raising up the arch into a more stable position so you can propel yourself forward!
Provides proprioception – feedback to your brain about how your foot is moving
Facilitates good foot motion/bio-mechanics – Check out this post for the plantar fascia’s role in running and walking.
Plantar fasciitis is degeneration and a small amount of localised inflammation of the proximal fascia (the part closest to the heel). The most common area of pain is near the origin of the fascia at the base of the heel. Fasciitis happens when the fascia is overloaded, whether this be from:
Tight calves or Achilles.
Sudden increase in activity or training.
Poor footwear e.g. worn or over-flexible running shoes.
Hard training surface.
Arch being too high or too low
Or increased weight.
This overload produces excessive stress on the fascia leading to a lot of tiny little tears in the fascia. This causes your body to go into protective mode, starting an inflammatory (healing) reaction, which makes the fascia thicker, less flexible, more sensitive AND painful. If this is not treated properly, it gets stuck in a chronic inflammatory phase and can be very frustrating.
Symptoms – to see if you do have it:
Pain upon waking and taking your first few steps –This “start up pain” is because your plantar fascia and calves have been in a contracted, shortened position all night.
Sharp stab or dull ache in your arch or at the heel.
Pain after long period sitting.
Pain that eases gradually in a walk or run as it warms up.
The big question, so how do you get rid of it?
It is important to address all aspects contributing to plantar fasciitis in order for it to heel strong, these include:
Inflammation and dysfunction of the fascia
Lower limb and hip muscle weakness
And this is how we you will do it:
Rehab exercises for Plantar fasciitis:
1. PF rolling: In order to re-align the fibers in the plantar fascia and lengthen it out, it really needs a good deep massage. This works best with a hard ball (I use a lacrosse ball). The other option is to freeze a small water bottle full of water and roll this under your arch (the ice gives great pain relief at the end of a day!)
Roll the bottom of each arch between the heel and toes (not under the heel) for 2 minutes.
This should be done at least 2 times daily.
2. Calf stretch: Drop your heel off the edge of a step and hold it for 1-2 minutes.
This needs to be done 3 times daily (the more the better).
3. Hip strengthening: Often the foot gets more force put through it due to poor hip strength and control. Do this Quick test to see if you have hip weakness, and if you do, then you should also seriously rehab you hips also.
4. Ice: For ten minutes at a time after a long day, exercise of when hurting.
Taping: Taping to support the arch is great for unloading the plantar fascia. Using rigid strapping tape strap from the outside of the foot to the inside, pulling it tight up the arch. See this video for an example.
Footwear: This video shows how the plantar fascia works during walking and running. You can see from this that if your toe was pushed up less when Walking (In case you didn’t watch it: As your heel comes off the ground the toe is pushed up – putting your fascia on more stretch) there would be less repetitive stress on the fascia. So wearing supportive running shoes with arch and heel support and ditching minimalist of over flexible shoes will really help this. Wearing flats all day also aggravates the fasciitis as this puts the calf on stretch which wraps under the heel and pulls on your fascia – so having some heel support is great (but not high heels!)
Orthotics: Orthotics do help this condition a hue amount if your problem is with poor foot bio-mechanics – Head along and see your local Physio or Podiatrist for a foot and gait assessment.
Training volume: it is important to decrease the load for a short time to decrease the overload on the fascia while you sort out the contributing factors (above). This may involve:
Walking or running halve your normal distance and then increasing this by 10% per week.
Decreasing training on hard surfaces and hills/steps.
Adding in time to stretch and warm up.
Remember the training rule that you should not increase your distance by more than 10% per week – this is often a big cause.
This needs to be followed to 6-12 weeks for best results and when, better you should keep looking after it so that it doesn’t happen again. Keep stretching your calf, keep your hips strong and don’t have sudden increases in activity – build up to it.
The windlass mechanism is an integral function of the foot that is critical to efficient walking and running. I am going to tell you all about how the windlass mechanism works to help you do what you love and how to test it yourself!
What is Windless Mechanism?
The windlass mechanism is simply put, the tightening of the fascia (rope may be the better term) on the bottom of your foot as you push-off. As it tightens it acts to stop your foot collapsing by supporting your arch and helps propel your forward, conserving precious momentum and energy!
Why do we need this mechanism?
It is so incredibly important that this mechanism works. If you want to keep walking or running pain-free – you need this mechanism functioning. If it doesn’t you could end up with one of a number of injuries, including:
Not to mention the undue pressure that gets put through your knees, hips and low back.
So how does the windlass mechanism work?
Your Plantar Fascia (or aponeurosis) is a very strong band of connective tissue that begins at the base of your heel and extends along the bottom of your feet to the toes.
As you walk and run a huge amount of force is put through your feet and so the plantar fascia has a very high tensile strength to hold the foot together and prevent it collapsing.
Because the fascia runs from the heel to the toes, as the foot is put down, the fascia is stretched which stops the toes spreading away from the heel – and so keeping the arch from collapsing.
Without this we would walk with no efficiency and our feet would be continually collapsing in (over-pronating) – Not ideal.
The really fantastic part of the mechanism is at the end of the gait cycle when our heel comes off the ground. As the heel comes up and the big toe stays on the ground getting pushed up, the plantar fascia is put on further stretch.
This winds the fascia around the balls of your feel like a pulley system which shortens the distance between the heel and the balls of your feet to raise and stabilise the arch of your foot.
This means there is no weak point in the foot – it is nice and stable to that you can really push-off and not lose any force.
Interestingly the Achilles tendon also helps tension the plantar fascia.
This is because collagen fibers from the Achilles tendon go around the heel to blend in with the outer layer of the plantar fascia.
This is a great example of how the body is connected and really works in synergy and not in isolation. This connection can also have a negative effect on the plantar fascia if the calves are too tight but we will address this in a future post.
Check out Windlass Mechanism in action at home – Test is yourself
Have a buddy standing up, fully weight-bearing and then you lift their big toe (they need to be putting their weight through the foot).
You will see the inside arch lift up as you lift the toe up. This is exactly what happens (or close to anyway) when you step through and push-off your big toe!
This is a really simple test but it can tell you so much. The windlass mechanism could be:
Not happening at all
Or needing a lot of force to initiate
And it is also a great test to see if your orthotics do in fact help: Do the test standing on the ground and then standing on your orthotic and see if:
It is easier to lift the big toe
The arch rises up easier or smoother
The arch lifts up quicker or earlier.
This is another pretty cool example of how our body is an amazing machine! A simple little mechanism and yet it makes us be able to run far, fast and smoothly while absorbing shock and preventing injury. And it’s an important aspect for any health professional to check for any lower limb or back injury.
A good example of an injury where the Windlass mechanism is often not working is Plantar Fasciitis, so if you have arch or heel pain when walking, running and getting up in the morning – check this page out for exercises to rehab it and for your own sake – Don’t wear flip-flops.
Can’t touch your toes and would like to? I am going to give you 5 easy exercises that will show you how to become more flexible, fast!
To be able to touch our toes (with your knees straight) you need to look at a few body areas – not just the hamstrings.
The main ones are:
Low back: Your Erector Spinae muscles run up the side of your spine from your pelvis to your neck and need to be flexible to bend down and touch your toes. The other muscle here that helps to loosen up is your quadratus lumborum (QL).
Hips (Namely your Gluts) – Your Gluts connect the chain between your hamstrings and erector spinae and need to be flexible to touch your toes and to be functional.
Hamstrings: Your hammies are important because they cross over both your knee joints and hip joint at the back to can limit your knees staying straight and your hips flexing forward.
Calves: The largest calf muscle, your gastroc (the larger of your calf muscles) crosses both the ankle and the knee joints so again is very important that this is flexible. Your calves are always working hard, so need regular attention to prevent tightness.
Plantar Fascia: Your plantar fascia travels from your heel to your toes and is also linked/connected to your calves. This is strong connective tissue and doesn’t so much need to be stretched as it does relaxed and released – But it does make a huge difference, you will see!
The reason you can’t get to your toes by just stretching your hamstrings: Your muscles is all connected together, it isn’t a lot of separate pieces working by themselves. I’m sure a lot of you would have heard of the kinetic chain before, well it’s a real thing. The body is connected together in a lot of places by your fascia. The fascia (derived from the latin word for band or bandage) is like a soft tissue skeleton which muscles attach to and which connects up your muscles (pretty cool huh!). Here is a good explanation for an example of the fascia of your back.
It used to be thought of as leftover, residule tissue that isn’t really important.. but that isn’t the case! This way of thinking has been changed recently and the fascia has been shown to be very important and not to be missed or ignored by any health professionals – Or by you out there reading this post!
Alright here we go!
Below are 5 exercises to improve your flexibility! Some of them have two options, so pick which one works best for you.
Hint: It is also helpful to re-test (see how close you can get to your toes) after each exercise so that you know which ones work best for you!
1. Low back myofascial release: It is tricky to get a good stretch through the low back as it is made up of a lot of little stabilising (short) muscles. The best way to loosen up your back is with a Massage Ball as shown below:
Step 1. Place a ball in your low back to the side of your spine (you may be able to feel tight muscle here).
Step 2. Then pull your knee up towards your chest so that it flattens the muscles into the ball and rock from side to side and up and down, really grinding the ball into the muscle. You can adjust the pressure you put into the ball with your knee.
Do this for 1-2 minutes each side.
2. Gluts: Get down and hold this stretch for at least 1 minute:
3. Hamstrings: For the hamstrings, you can use either a Foam Roller if you have one or a ball.
Option 1: Foam roller: As shown here place your free leg over the one on the roller, sit up as much as you can to put the hamstring on stretch and use your arms or free leg to move you. Spend 1-2 minutes on each leg.
Option 2: Hamstring myofascial release. Click over to one of my most popular posts for a demo and easy explanation of this exercise.
4. Calves: hanging your heel off a step is the best way to get a good stretch.
Hold it for 1-2 minutes
5. Plantar Fascia: Place the ball (a nice hard one, I prefer a lacrosse ball) under your arch, put some weight through it and roll it around the bottom. roll it through all the tissue in between your heel and ball of your feet.
Do this for 1-2 minutes.
Note: the last two exercises will also hugely help anyone with heel pain or plantar fasciitis!
Now do a final re-test of your toe touch to see how close (or far past) to your toes you can get! This is something you will need to stick at to get the improvement to last – You will really see good results if you do it every day for 6 weeks.
Let me know how you go learning how to become more flexible and please share and like!