PLANTAR FASCIITIS PROTOCOL

Congratulations on taking the first step toward solving your PLANTAR FASCIITIS! After working through our protocol, you should be able to:

Understand some of the reasons why this painful condition sometimes develops
Desensitize tissues and decrease symptoms during recovery
Create behaviors that optimize your tissues for speedy healing
Improve the mechanics of your extraordinary feet
Prevent this problem from reoccurring

INTRODUCTION

Before we dive in, we want to appropriately set your expectations. First, understand that your feet are extraordinary in design, are designed to be worked hard and last a hundred years. Second, not that long ago, your feet were crucial for your evolutionary success, which means they are not fragile!

After going through our process, you should have a solid hypothesis about how this painful condition began in the first place. Keep in mind that human beings are incredible healing machines and your ability to heal and improve the function of your body doesn’t have an expiration date.

We also want to make sure you understand that your foot pain didn’t spontaneously occur. While your body is pretty brilliant at being able to buffer shapes and movements that aren’t always the most efficient, (and in environments that can be downright hostile to our body’s tissues), movements that you’ve performed safely and without pain, sometimes for decades, can suddenly become very painful.

To see the best results with this protocol:

Expect to spend 15 mins per day DESENSITIZING with our morning routine, compression/elevation, and gua sha techniques
Expect to spend 10 mins per day (no more than 20min) RESTORING TISSUES with mobilization work
Expect to spend 30 mins per day WALKING (this can be split into smaller sessions, but the goal is to accumulate 30 mins per day)
Expect to work on controlling your SLEEP QUALITY and QUANTITY every day
Expect to work through this protocol in 6 Days, and then continue by revisiting 1-2 mobilization techniques per day that you found most helpful until your symptoms feel better

1. Introduction

2. A Systems Approach

TREATMENT MODEL

Our treatment model is organized around a few key concepts.

How can we influence the environment around the site of our pain? Are there methods with which we can DESENSITIZE the pain generators in the bottom of that foot in a way that doesn’t slow or limit tissue healing? Can we remove congestion and swelling in the feet that may be slowing healing time and contributing to pain when you walk?

Can we RESTORE the normal function to your feet? Rarely do we see mechanical based foot pain that isn’t also associated with some kind of tissue restriction in the mechanical system (in this case your foot and ankle). Improving global functional capacity of your feet may potentially unload an aspect of your sensitized foot.

Are there particular shapes and positions that support better functioning of your feet day-to-day that might unload your plantar fascia while it normalizes and heals? How can we PREVENT future injury by changing your movement patterns and environmental factors?

DESENSITIZE

3. A Closer Look at the Foot

Often, when we have a painful area of our bodies, a quick Google search leads us to technical descriptions of our ailments along with still images of the “offending structure.” The problem with this approach is that it fails to explain how the tissue in question relates to the parts of the body above and below it. The plantar fascia for example, is only one aspect of the foot’s intrinsic mechanical system. This video places the plantar fascia into the greater foot context. This information will create some of the rationale for some of our “upstream” and “downstream” treatments.

4. First Minutes of the Morning

While we do want to help you improve your understanding about this problem overall, our primary goal is to give you the tools to improve your daily pain and symptoms. We know, for example, that the first few steps out of bed in the morning are the worst. So, before we go any further, let’s make a plan to improve the way your foot feels when it touches the ground for the first time during the day. One of the ways we want to treat this problem is to get your nervous system to stop being so jumpy and sensitive by eliminating pain spikes. A little three minute preparation plan before you start moving is just the thing.

Rx: 1x every morning before getting out of bed while symptoms persist

5. Compression & Elevation

One of the pieces of the plantar fasciitis puzzle that is often missed is the reduction of congestion or swelling in the injured or sensitized area. This is critical as often the pain generator in a tissue like the plantar fascia is localized swelling. This next video will include some ideas about decongesting and desensitizing the foot. Keep in mind that we can often eliminate painful sensations in a challenged tissue well before that tissue has a chance to completely heal. This means you may be able to return to normal activity while simultaneously continuing to normalize the plantar fascia’s native function.

Rx: 3x per day while symptoms persist, 10 minutes total

6. NMES Therapy

The next level of decongestion might include the use of neuromuscular-electrical-stimulation or “NMES.” While this technology is advanced and may not be practical for everyone, it is a cutting edge technology that we would be remiss in not explaining.

7. Gua Shua

One of the oldest methods for desensitizing and improving blood flow to and around an injury site is a very old technique commonly called “Gua Sha.” People have been using various instruments like soup spoons, bones, and horns as tissue scraping devices for as long as there have been people. The modern equivalent is called Instrument Assisted Soft Tissue Mobilization or “IASTM.” As the name implies, the ultimate goal is to mobilize the affected tissue with whatever spoon, tool, butter knife, spatula, or scraping tool you might have lying around. Remember, the goal is to not irritate, but to desensitize and to improve tissue mechanics. This technique is very localized and often is an excellent way to improve blood flow at a specific site.

Rx: 1x per day while symptoms persist, no more than a few minutes

8. What About R.I.C.E.?

You may be asking, “Does the old Rest, Ice, Compression, Elevation—’R.I.C.E.’ still have a place in this protocol?” It turns out that rehabilitation science has come a long way since your mother started putting a bag of peas on that ankle sprain. We are much better these days at engaging with behaviors that support and facilitate the body’s healing. Your body is actually a pretty spectacular healing machine. The question we should be asking is, “Am I slowing down or facilitating my body’s natural and pretty complete healing response?” Often when we make choices about recovery, they are aimed at reducing pain, not creating a situation where the body can heal optimally. Watch the video, become better informed, and make the decisions that feel best for you.

9. The Role of Orthotics

How do we feel about some of the “plantar fasciitis” tools on the market like orthotics? Is there a place for them?

RESTORE

As we noted in the introduction, the next phase of our protocol is designed to restore and improve the soft tissue function of your feet and ankles. When we are mobilizing the tissues (muscles, connective tissue, joints) of our body for the first time, the experience may be a little foreign and even scary. But know you’ve got this!

We’ve organized these interventions into stand-alone sessions. It is critical that you accumulate many short sessions over the course of the week, rather than only a few longer sessions. We recommend that you work through these techniques in order, spending 10 minutes every day (and no more than 20 minutes per day). Once you have worked through each technique, continue working the techniques you found most helpful, 1-2 per day, until your symptoms feel better.

10. Roller Couplet

Tools: Roller
Time: 5 mins per side

11. Scrubbing

Tools: Lacrosse Ball, Roller
Time: 5 mins per side

12. BALL + ROLLER INTERVENTION

Tools: Lacrosse Ball, Roller
Time: 5 mins per side

13. POSTERIOR TIBIALIS INTERVENTION

Tools: Lacrosse Balls, Roller
Time: 5 mins per side

14. Shin Intervention

Tools: Roller
Time: 5 mins per side

15. Basic TV Template

Tools: None
Time: 5 mins per side

PREVENT

When we find our lives and activities suddenly limited by a painful condition, our gut instinct is to correctly solve that pain problem first. Unfortunately, the immediacy of our pain needs often override our long term planning and behavior modification needs. When our athletes and patients present with a problem, we always want to try and discover “why” and if there were contributing factors like stress, changes in volume, or new shoes for example.

Our feet are some pretty extraordinary engineering. When a problem pops up, we believe that you should know how to put out the flames, develop an understanding for potentially why those tissues became sensitized and painful in the first place, and an action plan to keep it from happening again.

In this section we will present you with some ways to think about helping your feet function more effectively during your day-to-day. We will also take you through what we call our “After Action Report.” This is an exercise we work through with our athletes and clients to help them discover potential behaviors that may have contributed to their dysfunction. And finally, we will briefly talk about how seemingly innocuous or unrelated issues like stress and lack of sleep can challenge the resilience of even the most solid tissues.

16. REFERENCE FOOT POSITION

17. AFTER ACTION REPORT

Thank you for working through our
TENNIS ELBOW PROTOCOL

We hope that you found it helpful and are on your way to recovery.
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