Is it time to stop rolling our painful feet out with icy cold-water bottles, as most of us have done when dealing with plantar fasciitis? Some of us have, or I mean... a FRIEND of mine has used tennis balls as well, to massage the foot out - to the point where the balls would break in half.
David Pope, an Australian-based sports physical therapist and founder of Clinical Edge, an online education program for rehabilitation clinicians, states that frozen water bottles, needling or rubbing the soles of our feet with massage balls, are "pointless therapies" for plantar fasciopathy. The main focus in treating this condition, he writes, should be to increase the load capacity of the fascia.
Mr. Pope is basically telling us to leave the tennis balls for the golden retrievers (or tennis players), and use the water for hydration rather than for numbing our feet.
If you haven't experienced plantar fasciitis - or don't know what it is - it's basically an annoying condition that can screw up your running routine.
Plantar fasciitis, or fasciopathy, or plantar heel pain (many names!) is a condition where there's pain to the sole of the foot, near the heel, that often spreads up the arch of the foot. The symptoms are usually felt with the first few steps in the mornings (or after other periods of inactivity), and with the first few minutes of running. The condition is quite common in runners and varies in severity (with some people experiencing enough pain to stop running, gasp!!). It is caused when there's been an increase in training load (or when there's a decrease in tissue capacity, but more on that in another post). Stretching and massaging the sole of the foot has been standard treatments for quite some time, though most physical therapists would probably prescribe some type of resistance training as well.
So how do I heal from this, how do I get better?
There are a few factors your physical therapist will look at when prescribing an efficient rehabilitation program. The first would be to look at your exercise-and overall wellness history - for example, taking into account your running style, running routine, habits, sleep, stress levels, diet, muscle imbalances, movement patterns etc etc etc. The second factor is figuring out which of these factors most likely contributed to you developing plantar fasciitis, and then address that aspect in your recovery program.
BUT, the quick and easy answer of how to get better, is to work on the plantar fascia itself as a tissue. And I'm sure that's probably what you're after here. So I'm changing the question to:
What do I do to get the plantar fascia better?
It's simple, but it requires commitment - The fascia needs heavy loading resistance training that targets this tissue directly, for several weeks.
Loading is basically what we do to our muscles, tendons, and other tissues when we lift weights. Or run, for that matter, or walk. The exercise prescription for loading the plantar fascia so that it can tolerate our running mileage depends on where you are in terms of your pain; but ultimately, you'd want to load up heavily, with a progressive increase in resistance every week, for at least 12 weeks.
You may be able to run during these 12 weeks, but you'll probably need to reduce either speed, or distance, and/or frequency. There are "back-to-running" tests that can be performed as well, to make your training as pain free and healthy as possible while recovering. The best way to get better from plantar fasciitis is to check in with your local physical therapist on what loading exercises would fit you the best. You can also gain clarity on how to progress the amount of this load (week-by-week) so that you're stressing the fascia appropriately.
But, going back to tennis-ball treatments: If stretching and rolling is not effective, should I not do it? Even if it feels good? If it feels good, and doesn't aggravate the pain after you've stopped massaging it, I'd say it's an ok method to keep - for pain management. But it won't speed up the recovery time, and it won't build up the fascia to be able to withstand any significant increases in your running mileage.
So there you have it:
Your plantar fascia (sole of the foot) needs to have the capacity to withstand the repetitive loading that happens during running. You can up the capacity of the fascia by including heavy resistance training that puts high tension on the fascia, in your training routine. The higher the capacity of the fascia, the less likely you are to develop plantar fasciitis when you're increasing your speed, duration or frequency of running.
And hey. Icing your feet after a challenging run is ok, too
Katarina K. Erlandsson, PT DPT
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