Stretching for Plantar Fasciitis.

Whilst I talk about the various therapies and stretches for Plantar Fasciitis here, its worth tuning into the “length of stretch” debate.

If you look at Porter D, Barrill E, Oneacre K, May BD. The effects of duration and frequency of Achilles tendon stretching on dorsiflexion and outcome in painful heel syndrome: a randomized, blinded, control study. Foot Ankle Int 2002;23(7):619-624.

You’ll find two protocols coming neck and neck:

3 minute of stretching 3 x a day, or five sets, 20 seconds each, two times daily.

Either way, the take home message that a quick reluctant 10 second stretch when you can be bothered, isn’t enough. The study also determined that both sustained and intermittent Achilles tendon stretching exercises increase Achilles tendon flexibility. This increase in flexibility correlated with a decrease in pain!

This is an idea that features heavily in my fix your plantar fasciitis course. Its only £9.97 and has the most effective science backed drills.Never waste money on physical therapy agai

Plantar Fasciitis: cures and curses

A big welcome to your Plantar Fascia. An unknown part of your foot, that, so it seems, you don’t have to worry about.

It will do whatever the hell it does for years, then one morning, in some unlucky people,  it creates almost crippling heel pain.

First thing in the morning, upon getting out of bed,  you’ll be in so much pain that even hopping across your bedroom floor is something you’ll dread. Even contemplating  allowing your heel to touch the floor makes many want to throw up in their own mouths.

It’s not all bad. Just give it 5 or 10 minutes of hobbling around and you can begin to limp with a bit of dignity.  Welcome to the party you now have plantar fasciitis. It often self cures, in anything from 6 weeks to TWO YEARS.

There are  two positive sides to the condition:

1) You’ll meet lots of people online searching for a cure. So it’s like an agony based Tinder.

2) you’ll meet lots of dodgy therapists trying to part you from your money for quack cures. If you spot them, it’s fun to watch. If you cannot see a quack coming, its a bit expensive.

So some back ground, according to the BMJ plantar Fasciitis copy has the reputation of being “a trivial  condition”. Clinically “benign and self limiting”. So, if you are limping around your bedroom, screaming with pain,  wondering how you can get to the loo, don’t worry, its “benign and self limiting”.

Pull yourself together. Its not cancer

So who gets it?

  • Middle aged and older people. In some research I undertook, the age spread was thus
  • Athletes and active people

In my research, these were the activities being undertaken prior to Plantar fasciitis developing

  • Those with a reduced range of ankle dorsiflexion. I’ll publish my results soon, so do join the mailing list

According to the BMJ, the treatment options are

  1. Bio-mechanical treatments (orthotics, footwear modifications, taping)
  2. Stretching techniques including night splints
  3. “extracorporeal shock wave therapy
  4. cortisone
  5. surgery

From my research, pictured in the above graph, I found a wide variety of cures being attempted.

So, for the stretches check out

Heel To Heal: New Stretch Relieves Pain From Plantar Fasciitis

“sit with one leg crossed over the other, and stretch the arch of the foot by taking one hand and pulling the toes back toward the shin for a count of 10. The exercise must be repeated 10 times, and performed at least three times a day, including before taking the first step in the morning and before standing after a prolonged period of sitting”. Thanks to Benedict DiGiovanni and Nawoczenski,

IMG_3693

Most foot issues (not only plantar fasciitis, but the nasty achilles tendonitis)  benefit from a better range of ankle flexion and  pliable calf muscles. This daily stretch is also a must.IMG_3689

You’ll notice Im using a yoga block. It’s not ideal but gets you a start ( you could just use a step or a book, or a brick). If you have wealth beyond avarice, or £40, check out the
Navaris Wooden Slant Board – Calf Stretch Adjustable Incline Board Portable Anti-Slip for Pain Relief from Plantar Fasciitis Tendinitis and More

Most modern stretch commentators suggests you need to do this daily for 2 minutes.

Ice helps reduces pain, so freeze a bottle of water and roll  your foot on the iced bottle. One of my clients uses a cold bottle of beer!

Massage balls. If you can stand the discomfort, start rolling the base of your foot on one of those massage balls! Start gently.

Get a night splint, and wear it at night IF YOU CAN. This drove me mad so I clawed it off within a minute

IMG_3692

Lots of people can sleep with it , so as its about £11-£20 well worth experimenting with.
Night Splint Dorsal Soft Light for treatment of Plantar Fasciitis – (Black inner, 9 – up), Large

However, Crawford F, Thomson C. Interventions for treating plantar heel pain. Cochrane Database Syst Rev 2003; (3) found limited evidence to support the use of night splints to treat plantar fasciitis sufferers who had experienced pain for greater than 6 months. They found that patients treated with custom made splints improved but those with premade or ‘off the shelf’ splints did not.

INSOLES: In my humble opinion,  buying and wearing flatter shoes often causes Plantar fasciitis . This is often combined with the whole “go barefoot” rebellion.  It’s based on the “well, its more natural, innit” concept and totally, totally fails to take into account the fact that you have worn heeled, and supported shoes for the last 20-30 years!

Buy these Superfeet insoles.

IMG_3688

Superfeet  are worth every penny!!   These really helped me. Ive put a link that will make me £££££’s in commission if you use it. Superfeet Green Insoles, E (UK 8-9.5/ Mens 9.5-11/ Womens 10.5-12).

To actually fix your plantar fasciitis you need my SSES system ( stretch it, smash it, educate it, strengthen it). If you simply stretch it, the trigger points get you, and a lack of strength drags you back into pain. Strength on its own, without educating your muscles and restoring an effective range of motion,  is also a low return strategy.

In this course, I’ll teach you these skills with a  mixture of video, photos, and written teaching resources to help you learn. For the first 100 people you’ll get my email address so any issues I’ll be there to help you. However, I’ll soon set up a free but private Facebook group to support you that way.

If you need help or training, do drop me an email Andrew@andrewstemler.com

Alfredson and eccentric drops.

I refer to this  “genius” so often, that I thought I should post up this reference here.

Alfredson H Pietila T Jonsson P Lorentzon R. Heavy‐load eccentric calf muscle training for the treatment of chronic achilles tendinosisAm J Sports Med. 1998;26(3):360‐366. [PubMed[Google Scholar]

This is a report that has changed the lives of so many people, it’s ridiculous. It’s basically stretching a tendon through its eccentric phase, under load.

Here is a much younger me trying it out, back in the days when I was sufferer!

For those who want to dig further into this issue, check out this useful review.

Elbow Pain and Tendonitis

If you suffer from elbow pain, you’ll find this video very useful!

As always, if you want to book a Pt with me in Bethnal Green or Blackfriars, do drop me an email Andrew@andrewstemler.com

To keep up to date with fitness, physical therapy and mindfulness tips join my mailing list here:

Crossfit injury rates

At any time, somewhere in the world, an inadequate sport scientist or deluded therapist is about to initiate another defective study on injury and injury rates in CrossFit.

Let’s face it; if they didn’t tag their post as “CrossFit Injuries ” no one would care, no one would look at it. It would go as un-noticed as it actually deserved.

As CrossFitters, we are fascinated by injury rates but appalled by poor and shoddy sports science and therapy babble. The major problem is this: in CrossFit, as in life, unless there is a fall or an accident, most injuries are simply  “the straw that broke the camel’s back”.

Normally, clients tweak their back because they misuse their back all the time.  To push this proposition into the light, and to be a  bit silly,  if a client leaves a sports session, goes to hospital and is diagnosed with cancer, no one seriously suggests that the sport session gave them cancer.

Often, injury reviews make no attempt to correctly trace the aetiology of injury. Often, bad form is a result of constant poor posture, not of failure under fatigue. According to McGill, injury is often the result of a long term misuse and reduction in capacity. The actual activity that brings on a bad back is something as innocuous as brushing your teeth.

But there are lots of issues in studying CrossFit and injuries: what does CrossFit mean?  Often, in what passes as the literature, the implication is that injury is a result of high rep induced fatigue.  However at CrossFit London, for example, we have gymnastics, periodised strength sessions and Olympic weightlifting sessions, many of which are carried out at ” normal ” speeds.

If I tweak a knee in a back flick landing, at CrossFit London, is that a CrossFit injury?

Let’s explore an injury. One of my recent ones!

I’ve tweaked my right wrist and it hurts. It started the day after I missed a snatch. Is CrossFit to blame?  I was training on my own, at a very lazy pace. Was that injury caused by the poor snatch or the fact that my right upper limb always tries to compensate for my left side?  Why? Because I’m deaf in my right ear, meaning that I sleep with my left ear on the pillow, which means that for 55 years I’ve slept on my left arm, every night, which has weakened it.

So, was it those factors or the fact that I decided to solidly practice handstand walking for 9 days in a row?  Can any of this be laid at CrossFit’s door, apart from the fact that it was CrossFit which inspired me to improve myself?

Hak et al (2013) found that 73.5% of  CrossFitters had sustained an injury that prevented them from training (based on an injury rate of 3.1 per 1000 hours trained, just like gymnastics and weightlifting). Weisenthal et al (2014) reported that shoulder, low back and knee injuries were most common. Low backs were commonly injured during power- lifting movements.

Frankly, I’d ask if these people sat at desks or hunched. I see more seating injuriesthan I do deadlift ones.

But, lets follow the line of thought. CrossFitters, allegedly,  injure themselves during fatiguing workouts. Doing a lot of work with an eye on the clock is, therefore, wrong.

CrossFitters, at their core, view their workout movements as work. The aim of all work is to relate the work done, with time. How long did it take?

This  holds true in academic exams, running, rugby and life. Winning performances consist of doing good work, in a faster time

I’m not so sure about sex.

As we have discovered from life, activity can fatigue. The more emails you write, the more chance of a poor phrase slipping in. Morgan et al, 2009 (not really a report, more an article) Nachemson (1965) and Dreischarf et al. (2016) all observe the possible consequences of lifting with a flexed lumbar spine. I’m surprised sitting hunched at work hadn’t given them a clue. However, GOOD NEWS . There IS money in stating the bleeding obvious.

Overhead arm movements are problematic. Impingement of the rotator cuff muscles can occur if the space between the coracoacromial arch and the humeral head is reduced (Morgan et al 2010). Defective scapular positioning could be to blame (Kibler 1998). The scapulae should retract and tilt posteriorly in order to maintain the subacromial space during an overhead arm movement.

That scapula retraction is affected by the mobility of the thoracic spine and rib cage is once again stating the bleeding obvious, but well done Strunce et al (2009) for writing it up. Years of hunching, texting, peering at computer screens mean that our overhead positions need work.

Therefore, it can be suggested that without good mobility of the thoracic spine no one should risk putting their hands over their head.

No one should stock the upper shelves of your kitchen, no curtain hanging, no singing along to rock groups or holding up your lighter at a Prog Rock gig.

There is a line of thought that demands perfection in movement, without for one second conceding that the pathway to learning good movement is poor movement.

I get to watch, weekly, people swim, play football, walk and sit. 98% do so appallingly. The better athlete starts with poor movement and develops. The poor athlete is happy with more poor movement.

I don’t mind sport science hysteria, but the dangerous sports are contact ones; Rugby, boxing, jumping of cliffs with bits of cloth tied around some sticks. See this BBC Article.  I should say that I boxed and loved it: I personally don’t like sports that make me focus on a ball then encourage someone to pull my legs away or high tackle me.

Maybe I’m a coward.

I suspect if we really analysed injury, it would correlate with long term poor form. What identifies it is the health drive of the sub group. Casual pub footballers, probably won’t spend the money to see a  therapist. The average CrossFitter, passionate about their sport, will see a therapist to get back to fitness asap.

So what is the applicable morality here? If someone moves badly, should we ban them? If you walk poorly, taking 10,000 steps surely has a higher risk factor than lifting a bar 45 times. Sitting for 8 to 12 hours is, surely, more dangerous that a kipping pull up. Running to get a ball and crashing into a team member, or falling off skis, has a real risk of death. Maybe you can tweak a shoulder if you miss a muscle up.

According to my good friend Dale Saran: “You have to accept a risk of injury as a reality of playing a sport, or just living a life. A 100-percent safe exercise has a zero percent chance of getting you fit. It’s you sitting on the couch with a helmet and kneepads on.” I sort of agree, but I’d say “sitting on the couch with a helmet and kneepads on” is the most dangerous thing you can do. Sitting is  basically suicide for those who like to do things slowly (and watch TV in the process).

I suspect that  mental attitude has a role in all this. Frequently, aggressive people injure themselves. This is from a blog post: “Determined to perform well, he doubled down on his training, working out twice a day, upping his max dead lift to 375 pounds and doing 53 pull-ups at a time. The tough regimen took its toll – tennis elbow, golfer’s elbow, shoulder woes, knee pain, a persistent trick in his neck”

I think aggressive people have always injured themselves.

~So what are we to do? As Crossfit London, the UK’s 1st ever Crossfit affiliate we have a duty to lead the way in this research as,f rankly, those sport scientists that have  looked at injury rate in crossfit  are not up to the task. Im sure there are great  sports scientists out there btw. We intend to carefully record all of our injuries over the next year and  review the back ground and nail the aetiology. We will, where possible interview the  injured client, the coach and any witnesses.

So if you injure yourself, don’t be surprised if you get a very inquisitive email from me or one  the Crossfit London sports injury team.

Just sayin

 

References

“Consortium for Health and Military Performance and American College of Sports Medicine Consensus Paper on Extreme Conditioning Programs in Military Personnel”   Bergeron et al.

http://library.crossfit.com/free/pdf/CFJ_111200_Bergeron_Champ.pdf

Injury Rates and Profiles of Elite Competitive Weightlifters
Gregg Calhoon J Athl Train. 1999 Jul-Sep; 34(3): 232–238

Dreischarf M, Aboulfazl SA, Arjmand N, Rohlmann A, Schmidt H. Estimation of loads on human lumbar spine: a review of in vivo and computational model studies. J Biomech. 2016;49(6):833-45.

Gross ML, Brenner SL, Esformes I, Sonzogni JJ. Anterior shoulder instability in weight lifters. Am J Sports Med.1993;21(4):599-603.

Hak P, Hodzovic E, Hickey B. The nature and prevalence of injury during crossfit training. J Strength Cond Res. 2013; DOI:10.1519/JSC.0000000000000318. [Published ahead of print]

Kibler BW. The role of the scapula in athletic shoulder function. Am J Sports Med.1998;26(2):325-337.

Morgan WE, Feil C. Cross-Fitness injury prevention: Protecting the lumbar disc in squatting motions [online]. California; Dynamic Chiropractic; 2009 [last updated Oct 2009; cited 2016 March 23]. URL: http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54148

Morgan WE, Feil C. The Importance of the Thoracic Spine in Shoulder Mechanics [online]. California; Dynamic Chiropractic; 2010 [last updated May 2010; cited 2016 March 23]. URL: http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54622

Nachemson AL. In vivo discometry in lumbar discs with irregular nucleograms. Acta Orthop Scand. 1965;36(4):426

Neviaser TJ. Weight lifting: risks and injuries to the shoulder. Clinical Sports Medicine.1991;10:615-621.

Strunce JB, Walker MJ, Boyles RE, Young BA. The immediate effects of thoracic spine and rib manipulation on subjects with primary complaints of shoulder pain. J Man Manip Ther. 2009;17(4):230- 236.

Weisenthal BM, Beck CA, Maloney MD, DeHaven KE, Giordano BD. Injury rate and patterns among crossfit athletes. Orthop J Sports Med. 2014;2(4): 2325967114531177

http://ojs.sagepub.com/content/2/4/2325967114531177.full