Problems Afoot

I read the following article on Triathlete Europe’s website a couple weeks ago:

Try This Technique For Battling Plantar Fasciitis

“After function is restored, regular at-home use of rollers, therapy balls or even a golf ball to massage the plantar fascia can help support the health and mobility of the foot.”
Read more at http://triathlete-europe.competitor.com/2016/07/25/try-technique-battling-plantar-fasciitis

It got me thinking, so I had to write this:

A little over 10% of the population will experience plantar fasciitis, a severe heel pain, at some point in life. It is a miserable condition, and the risk increases with overuse, obesity, flat feet, and age. Yet more will deal with foot, ankle, and low leg pain that never seems to go away. During my time as a coach, I’ve heard the above recommendations and seen other ridiculous techniques for dealing with muscle pain, but unless the cause—a mismanagement of tension—is addressed, then the pain will continue. I have this conversation far too often, so I’m putting it down in writing.

First, let’s talk about overuse. It takes roughly 300-500 repetitions to create a movement pattern, but it takes 5000-7000 reps to correct a motor pattern. That’s all well and good I guess, but consider that walking one mile is around 2000 steps. You may want to re-consider running “just a few miles” with an injury. At 6-10,000 bad repetitions, you might never run the same again. Sure you can work to correct it by doing those 5000-7000 repetitions, right? Right, but they need to be perfect to reset your patterns. Do you pay attention to every step? And really, why is it so important to pay attention to all of this?

All of the numbers above are broad, loose estimates that serve to illustrate the importance of this point: The foot is designed to be an intermediary, a messenger between the ground and our more superior body parts. It is an intricate tensegrity network of different types of tissues, all of which are dependent on each other for efficient and painless function. Take some time to look at the tensegrity link and you will understand that a tensegrity structure can manage tension, but too much tension in any segment of the structure will affect the whole structure in some way. Any part of the foot that is affected through injury, inflammation, or immobility will affect the whole foot. Eventually the knees and hips will pay, giving rise to movement imbalances that can alter the connective tissues that run from the bottom of the foot to the low back to the neck and shoulders.

Plantar fasciitis is a global issue and shouldn’t be looked at as an acute inflammatory process that is only taking place on your foot. That’s true in part, locally, but again it is a mismanagement of tension, globally. It must be managed as such. If you squish the bottom of the foot, congratulations! Your legs, hips, shoulders, head, eyes, etc., can still be out of order and you’ll get no relief. I have clients that have TMJ pain that is only corrected by developing awareness in the feet. It is all connected.

Now is my time to say that I DO NOT RECOMMEND using a lacrosse ball, golf ball, foam roller, or orbital sander on any part of your body— especially the foot. The fascia responds best when its processes are respected, and it is easily torn or permanently damaged by using medieval tactics like these. Of course it feels better after doing it, adding a painful stimulus on top of existing pain just leads to pseudo-relief when the stimulus is removed.

Some of these techniques create lingering pain-patterns in the nerves. Most often, the painful “trigger points” found while rolling are the innervation points. Like the hairs on your arm, there are nerves in the body that poke through different layers of tissue. Those nerves are there for a number of reasons, but you can further sensitize these nerves by constantly subjecting them to trauma which creates a type of recurring pain, a feedback loop that pushes you to do more rolling, more grinding on your tissue. In this way it becomes an addiction, the more you do, the more you need to do (drugs? In a greater irony, you may need drugs if you continue to kill your nerves). The sensitive tensegrity (there’s that word again) structures of the foot are designed to feel. Mechanically induced pressure at such incredible forces just doesn’t make sense based on the rules of our physiology. Watch the video below for a better understanding of soft tissue. Rolling is not a good way to manage the tension.

Myofascial release is a fluidic process in the body, as the film “Strolling Under the Skin” beautifully demonstrates. The video is long, but worth it.

So what can be done for plantar fasciitis? How do we manage tension if using force is less than ideal?

You have to move fluid. If you watched the video above, you see how important water is to the body’s connective tissues. We know that takes pressure, but how much pressure? The answer is less than you think. Like rivers, the flow to certain tissues can be increased, decreased, or dammed. It can be easily re-directed with the smallest of inputs. Imagine a dam made of rocks, if you pull out the right one, the whole thing crumbles. The flow in the body works much in the same way. Remember, the fascia can and does remodel and heal itself via the inflammatory process; our job is to move the fluid to where it is needed, and then get out of the way to let the body do its work. You don’t need dynamite for the dam, just the right rock, so to speak.

Now you can “stretch.” Once the fluid is moving to the right areas, you can begin to normalize the tissue. Myofascial stretching, when done properly, is also considered myofascial strengthening because it works the fascial network as a complete system. It moves muscles through extreme ranges of motion, normalizes tone, develops awareness, and reorganizes the structure of the fascia. The organization of the tissue needs to be respected, though. While just starting with myofascial stretching of the hamstrings or calves can be helpful for plantar fasciitis, you still need to move fluid into the tissue before it can be effectively stretched. Stretch a dry rubber band and watch it pop, oil it and it stretches just fine. Get the fluid moving inside before you do anything else.

Strengthening comes next. Most usually it is necessary to strengthen the joint in all ranges of motion with segmental strengthening before integrating global movements like the squat. A mismanagement of tension places excessive pressures on specific areas, so you have to train some of the weaker supporting structures to take a higher percentage of load. This process not only serves to reinforce the unit but also gives you awareness within the joint, the foundation for improving motion.

It sounds like loads of work because, honestly, it is. With the right mindset and goals, though, you’ll realize that it is not only possible but also necessary to do if you want to stop oscillating between peak performance and those nagging injuries. In my opinion, the oscillation is a bigger load of work  because you’re wasting your energy doing the same thing year in and year out. If you change your mindset, your new routine will replace the old routine for a little while and, before you know it, you will be balanced.

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An example of what it can take to play through the pain with plantar fasciitis.

The process of breaking down the injury cycle is the same for everyone, but the exercise program is different for most of the population as compared to athletes. I’m not foolish enough to tell a competitive athlete to cancel the rest of the season. If your job is to win, you have to win. Your injury can be managed so that you can do your job. The affected area can be strapped or taped, then proprioception and analytical work can be done, and you can get on with your job. Your body will pay, but the off-season is there for a reason. You can get ahead of the curve when the time is right.

If you’re a weekend warrior that just wants to stay healthy, you should probably stop killing yourself. Take a break to heal. “No pain, no gain” “100% grind” “24/7/365” and all that crap makes for good memes, but beyond that it just leads you down a path towards exorbitant medical bills. The further you compound your imbalances, the more permanent they become. I get it if you’re one of the driven and you want to group yourself into the competitive athlete bunch. No pain no gain right? Right. I have clients that live by that mantra and that’s ok, but I’ll say it again, your body will pay.

For whatever reason, the current trend in fixing injuries like plantar fasciitis is to hold stretches with force and crush the hell out of your soft tissue, but that’s not how the body most optimally responds. In some cases it can work, but when it’s not working well enough, there are much more effective and permanent ways of healing. I would love to show them to you.

You can contact me at (281) 803-9930 or by email at jonathan@antidote.fm.

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