Ask Well, answer Well

A client of mine passed along a link to a regular column on exercise in the New York Times.  It’s a Q&A page and the author of the blog, Gretchen Reynolds, gives, from what I’ve read so far, balanced and knowledgeable answers.  She does a good job of condensing the research into practical and meaningful advice to her readers.  So, I thought I’d point you to her column and then I would tackle one of the questions she addressed and offer anything else I feel could be of help.  So, let’s take a look at a condition one of Gretchen’s readers asked about–plantar fasciitis and what self treatment could be done to help heal it.  To read the full question and answer, see the following:  How can I facilitate healing my plantar fasciitis?  According to the doctor she interviewed for the article, self-care involved doing a calf stretch at the wall 20 times per leg and holding each stretch 10 seconds.

I would like to add to that a course of treatment advocated by a physiotherapist and author of “The 5-Minute Plantar Fasciitis Solution”, Jim Johnson.  He cites a number of studies into various types of stretching, sometimes in conjunction with other modalities such as anti-inflammatory drugs like Ibuprophen.  The treatment he prescribes is a specific type of stretching involving pulling back on the toes of the affected foot while that foot is crossed over your other thigh.  The stretch is held for 10 seconds and repeated 10 times.  The whole sequence is performed at least 3 times a day (10X10X3 = 300 seconds or 5 minutes).  Personally, I can vouch for the effectiveness of this stretch!  But please see his book for the full details.

Calf stretches were shown to be more effective in keeping plantar fasciitis from returning rather than treating it specifically, according to the studies he cites.  This classic stretch involves placing one foot forward on the floor, toes touching the wall, and the other leg well back and kept straight.  With the hands on the wall, lean in to the ball by bending the front knee.  Hold for 20 seconds per leg and do at least 3 times per day.  Repeat 3 days/week on alternate days.

The one pattern I noticed for all of the stretches suggested in the studies I’ve looked at were that the most effective stretches were held for several seconds (15-20 or performed multiple times if held for less time) and they were repeated several times a day and several days a week.  Clearly the body likes to “bounce back” to it’s familiar state and so not giving it too much time in between treatments to do so is what is required.  Unfortunately that familiar state is not always the most comfortable!

As with any health and fitness advice column, I recommend that you see a doctor or other qualified health care provider to get a proper diagnosis first before beginning self-treatment.  Depending on the condition, that treatment may be quite different.  What we often call an “-itis” may really be an “-osis” or the other way around.  Is the condition acute (a sudden traumatic event or injury and the first few days following), chronic (long-term with or without a known specfic cause or trauma), or sub-acute (a condition that resulted from a traumatic event lasting from several days to a few weeks)?  Other times we assume something is a tear when it really is “wear and tear”.  Sometimes we try to diagnose ourselves because we know someone else who had the same condition.  But was it really the same condition or did our friend’s perception of his/her symptoms just sound the same as ours.  Those are two very different questions.

So, my advice is to get the information you need to make an informed decision.  You may be afraid to see a physician, physiotherapist, or other health-care provider because you’re afraid that you may have to take medication or go for therapy, and that may consume too much of your time, money, or your quality of life.  But having a firm diagnosis does not necessarily mean that you need costly treatment or medication.  Many ailments like plantar fasciitis can be treated for free because you’re the one doing the work.  You may have somewhat better outcomes with an expensive therapeutic device such as laser or shock wave therapy but often these modalities provide the same outcome as self-care, although they may hasten or enhance the healing process.  How they will help and if they will help your condition depends on what your condition is.   Sometimes, you just need to take more time and be more patient with self-care.  But if you are limited by time or money or both and do not want to take medications, self-care such as a program of specific stretching tailored to your condition is often all you need, although heat or ice where and when appropriate may also be required.  Again, none of these treatments cost anything, although they do require some of your spare time.  However, sitting home doing a few minutes of stretching is not exactly wasting time compared to time lost travelling for professional treatment.

Conditions such as plantar fasciitis often recur because of imbalances or weaknesses in the underlying structures (the bones and joints themselves) or by improper movement patterns, which, unfortunately are exacerbated by the aging process.  And so it is imperative that you have a self-care treatment plan in your tool kit.  The type of stretching you choose, whether you use ice, heat, or both, or neither, lifestyle changes you may make, and other things you can do for yourself will depend on the specific condition you have.  Get a proper diagnosis and once you do have one, remember that you have options!

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