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.
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.
Stay tuned in!
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