What can we learn from pain and the color red? It’s not so much about this specific color, as it is about context; and, how the context of a situation can change how we experience pain.
What do you think of when you imagine red?
Heat, danger, fire, etc.
What about when you imaging blue?
Cold, calm, water, etc.
When you go to turn on a faucet or the shower, blue means cold, red means hot… right? This is done deliberately because of the associations made with those colors, and the likelihood that people will turn the faucet in the correct direction pending their ability to see those colors.
An interesting experiment was conducted in which a very cold piece of metal was put in people’s hands. While people touched this piece of metal, they saw a blue light. They weren’t told anything about this light, but the timing was such that they saw blue at the same time that they touched this cold object. Afterwards, they were asked to rate the pain they felt out of 10.
This was repeated with the same people, and the same cold piece of metal; however, this time a red light was displayed vs. blue. Again, they were asked to rate pain out of 10. What do you think happened?
While some people reported no difference, many of the individuals reported a higher rating of pain when the red light shone despite the metal object being exactly the same. It was even as significant as some people reporting no pain with the blue light, and 8 out of 10 with the red light!
So, what? It doesn’t seem like your back or knee pain is related to the color of lights around you, right?
Maybe. BUT it is largely related to context and how we perceive that context. This experiment showed us that the only thing that needed to change in order to increase someone’s perceived pain was the color of the light – the context!
This is a hugely important factor when dealing with pain. Especially pain which has been around for a long time. The cool part? We can often change or have some amount of control over our context… we can definitely control a lot of the thoughts and beliefs we tell ourselves which is where a lot of this starts! (i.e., the belief that red = hot)
How might context be affecting your pain experience? Is some of this in control?
If you’re feeling lost about how to begin managing your pain or injury and getting back to what you love, head to the Talk with a PT page on our website!
Elle Carlson, PT, DPT
Do you every experience nagging hip pain? Maybe it feels achy along the outside of your hip and maybe even moves toward your tailbone, or into your low back? This can sometimes be related to pelvic floor muscles, believe it or not!
The pelvic floor is made of a sling of muscles that travels from the pubic bone to the tailbone. They work to help support pelvic organs, and play a role in things like continence, sexual function, and stability. Some of these deep pelvic floor muscles act on the hip to help rotate it in and out; think of the motion you might do when performing a fire hydrant exercise or kicking a hacky sack (do kids still play with those?).
Because of the relationship with the pelvic floor, hip pain that we believe to be related to the hip joint, may in fact be related to these pelvic floor muscles that double as hip rotators.
If you’ve been following along in this blog or on social media, you’ve heard me describe some of the tension or guarding that can be seen in the pelvic floor muscles. This can sometimes contribute to pain and dysfunction, and it may manifest as hip pain with or without the symptoms we typically relate to pelvic floor dysfunction.
So, how can we address this?
Just like any other muscle, the muscles of the pelvic floor need to be exercised through their available range and placed under the appropriate stress to meet the demands of life and activities. These hip rotators that we’re highlighting today are not always trained into this rotation movement, so may not have the opportunity to move through this range as often as we’d like. They play a huge role in singe leg stability, pelvic control, and low back support! Therefore, giving them a little TLC can help not only improve function of the pelvic floor, but in turn, support the hips, pelvis, and low back more effectively!
Here are some of my go-to movements for improving mobility here and progressing toward strength!
Give these a go, see how they treat you, and reach out with questions!
Elle Carlson, PT, DPT
P.S. This will be the last blog for a few weeks as we jet of to Croatia this weekend! See you soon!
When we feel tightness, stiffness, or pain in a certain area, we often think we need to just stretch it away! Stretching can feel great and can provide relief to pain; but it’s important to note that this is short lived.
At Mobility Innovated, we see strength training as the best long-term approach to this sensation of tightness. It may be that the tightness you’re experiencing is in fact telling you those muscles need some strength! Here are some common myths about stretching to discuss this week.
#1: Stretching should be part of a warm-up routine
Static stretching – which involves holding a stretch for a period – has been used as part of warmups for decades. Recent research has suggested that warmups may not be the best time to incorporate this static stretching. Of course, this depends on the type of workout you’re doing.
We believe that a warmup should support you as you head into a workout for both performance and safety. Current research points toward static stretching potentially doing more harm than good when it comes to strength and performance during the chosen activity.
Perhaps instead of static stretching as part of a warmup, the warmup should consist of a gradual progression of intensity that mimics the coming workout and elevates the body temperature. Static stretching does neither of these things as it does not mimic the workout movements, and typically does not increase body temperature due to the static nature.
Dynamic stretching can be a great alternative that increases the body temperature and increases blood flow to the muscles that you are about to use. Some of our favorites include squats, lunges, skips, inchworms, or anything that elevates the heart rate and targets the muscle groups about to be used.
#2: Stretching improves sport performance:
As we alluded to above, studies have shown that static stretching can decrease performance, especially when it comes to power, strength, and speed. It’s unclear what exactly contributes to this decreased production of power and strength.
This is not to say that stretching cannot be helpful at other times during the day, but it may be best to find time other than right before a workout or activity in which performance is important to you.
#3: Stretching makes muscles longer:
This is a tricky one to debunk because it seems to engrain in our brains – to get longer muscles we need to stretch more! As we learn more and more about the human body and how it functions, it appears that although there is an increase in range of motion with stretching, it is not due to an actual change in the muscle length! Rather, we see changes due to a neurological adaptation and improved tolerance to the tissues being placed on stretch. Simply put, our brain becomes more willing to move through a range of motion because it is less sensitive to that stretch; the muscle itself has not changed.
So, what to do instead of stretch?
At Mobility Innovated, we’re big fans of strength training! It’s a lot easier to create changes through tissues via resistance training than static stretches. Of course – just like anything of benefit – strength training requires time and consistency; however, the payoff is far greater than stretching, plus you get stronger while doing it! The effects of resistance training have been researched extensively, and its effectiveness proven. Stretching lacks this evidence to back it up.
An example of an exercise that works on both strength and length is the RDL, or Romanian Deadlift. If you’re unfamiliar, this exercise involves a hinge at the hips while keeping knees as straight as possible. This movement takes the hamstrings through their full range for a lot of folks, moving through an ‘eccentrically’ controlled range of motion. This movement simulates a passive stretch of the hamstrings as if you were touching your toes, while at the same time requiring the muscle fibers to adapt to the added load of strength training.
All this to say, it’s not BAD to stretch:
If stretching feels good to you, go for it! We’re all about making sure you feel great and enjoy what you’re doing when it comes to exercise and movement. With static stretching, you may see a slight increase in joint range of motion, but it’s important to recognize that this will be transient; and that perceived tightness of a muscle is likely just weakness of the muscle. “Most stiffness is a sensation, a symptom, a kind of mild pain with movement rather than an actual limitation of movement” (Ingraham 2020).
You know your body better than anyone else, so if stretching makes you feel like you can move better, or relieves some soreness, do it! Stretching and modalities like myofascial release, foam rolling, etc. can still have their place in warmups, cooldowns, and for recovery.
Elle Carlson, PT, DPT
Bracing is a strategy used in many aspects of life. Definitely by those who do heavy lifting in the gym whether it be CrossFit, power lifting, or traditional strength training; but also, in everyday life when lifting something from the floor, or moving a heavy object. When I say bracing, I mean the tension and pressure created through the abdomen upon lifting. This is generated by core musculature and influenced by bracing and breathing strategies. Do you hold your breath when you lift, breathe out with the greatest effort, or allow yourself to breathe however feels comfortable?
Unbeknownst to many, the strategy being used can largely impact the pelvic floor; and it may be important to evaluate this if you experience stress incontinence, have a prolapse or suspected prolapse, are currently pregnant, or are recovering from labor and delivery. Depending on the strategy, the pressure changes within the abdomen and therefore through the pelvic floor. So, what do these strategies look like?
Strategies that reduce pressure through the pelvic floor include breathing in and out throughout the movement or breathing out during the most difficult aspect of the movement. If relating this to a full balloon under pressure, releasing some of this pressure through the opening of the balloon can reduce pressure throughout the balloon, creating a better tolerance to load. If this breath is held, pressure may escape elsewhere – commonly through the path of least resistance. Sometimes this is the pelvic floor, which can lead to leakage or affect a current prolapse. This can also be a diastasis or separation through abdominal muscles.
Strategies that can increase pressure through the pelvic floor include Valsalva or wearing a weightlifting belt. We’ve talked about increasing pressure through the pelvic floor, and how this can sometimes have a negative impact; but is this always bad? This isn’t bad in and of itself. It’s a matter of whether the pelvic floor is strong enough! These strategies can be great for increasing effectiveness and strength through a lift and allowing for one to lift heavier! However, if one’s pelvic floor is not ready for this increased pressure, the previous strategies are likely a better place to start.
A Valsalva maneuver involves taking a deep breath in and then sealing escape routes including the nose and mouth; this is done by keeping the mouth closed as well as closing the glottis, so air doesn’t escape through the nose. Because the escape routes are closed, pressure increases throughout the abdomen and pelvic floor. You might imagine a balloon that does not allow air out through the top. However, when imaging this balloon as the abdomen, upon bracing and breath holding you want to draw your abdomen in vs. pushing it out. Pushing out can send the pressure down toward your pelvic floor and focus it here rather than distributing it more evenly through the abdomen and pelvic cavity.
Wearing a weightlifting belt creates the most pressure through the pelvic floor, but again, this is not inherently a bad thing! It’s important to remember that when wearing a belt, pushing out against the belt is going to create the most pressure distributed toward the pelvic floor. Instead, we want to think about drawing in away from the belt as if assisting it in keeping everything sinched in. This will reduce pressure through the pelvic floor and create better efficiency in bracing over all!
Who knew such a small thing like bracing can influence the pelvic floor so much?! It seems simple but can have a great impact; but because of that simplicity and impact, we can also make small changes that will make a large difference in pelvic floor symptoms when lifting or working out!
If you or someone you know has trouble with leakage, pressure, or pain when lifting; or they are working to get back into the gym and to those activities, we encourage you to work with someone who has experience in pelvic floor training!
Elle Carlson, PT, DPT
If you follow along on social media, I had a post last week discussing relative vs. absolute increase when it comes to running progression; and particularly when returning after baby. This can be a difficult concept to grasp, especially when navigating this for the first time, so we’ll dive in more this week!
Typically, when someone wants to increase their running distance or time; or they’re training for a race that is further than they typically run; or they are training for performance… the recommendation is to increase their distance/time running by no more than 10% from week to week. A number is placed on this to safely, effectively, and efficiently have them move through their training regimen and see the results they’re after. Too large of an increase too quickly may expose tissues throughout the body to an intensity they’re not yet prepared for; too little an increase, and we’re not going to overload the body enough to trigger adequate adaptation – it can be a tricky balance! When returning to running post-partum, the problem with this 10% increase is that it can be really small relative to where one is starting; and this can potentially take away from progress or effectiveness of training.
When someone is returning to running after baby, and when ready individually, a walk-run progression is commonly recommended; and this goes for returning from a variety of injuries as well! With this walk-run progression, one might start out running/jogging only 1-2min at a time, followed by walking for 60-90sec, repeated for a set duration. Of course, this can vary by individual as well. When considering a 10% increase from starting here this week, to next, that is only adding 6sec to 60sec of running! You can imagine that this strategy might make for a long road to recovery.
This is where the difference of relative increase vs. absolute increase comes into play. Relative increase is that 10% or associated number – the percent increase this week relative to last week. Absolute increase is how much distance or time was actually added from week to week. 60sec this week to 66sec next week is a 10% relative increase, and a 6sec absolute increase. In the situation where the time or distance spent running may be small (for now!), it can be helpful to have a large relative increase. Sometimes upwards of 50%. With this, we can increase by 50%, but add 30sec to next week’s running time. This allows for an appropriate progression to keep your body adapting, while still providing guidelines to assure a safe progression.
So, although the 10% increase is a good rule of thumb, once you have more miles and time consistently under those tennies, there is plenty of wiggle room in those early stages to keep you progressing, improving, and working toward those running goals!
Need some guidance on getting back to those miles? Hit the “Talk with a PT” button above to get started! We would love to meet you!
Elle Carlson, PT, DPT
The idea that strengthening muscles makes them more stiff or less flexible is one of the past; as is the thought that a long and flexible muscle is weaker. Both mobility and strength are necessary for performance and injury prevention, and it’s hard to improve one without the other.
Why not static stretching like we’ve done our whole lives? Although this can feel good, and can improve mobility in the short term, it doesn’t produce long-term change like we used to believe. Static stretching can dampen the nervous system response to a stretch so that it feels easier to move into this position for some time; however, this is short lived. Permanent changes in tissue length at the muscular and cellular level are not seen, so true length changes throughout the muscle don’t happen. We’ve learned in recent years that the best way to improve a muscle’s flexibility may be to load that muscle as it is stretched.
In the world of exercise this is called an eccentric activity. When thinking of how a muscle contracts there are three primary methods: isometric, concentric, and eccentric. Isometric occurs when there is no motion, i.e., arm wrestling against someone who’s an even match. Concentric involves shortening of the muscle as it moves against a load, i.e., the part of a bicep curl that brings the weight closer to your shoulder. Finally, eccentric involves lengthening the muscle while it lowers a load, i.e., the part of a bicep curl when you lower the weight to your side.
This eccentric load has been shown to create long term changes within the muscle that improve mobility around a joint and flexibility of that muscle, while simultaneously strengthening within that range. It does so by breaking down the tissue under a heavy load during the exercise. During recovery the muscle remodels to withstand this stretch better the next time it comes around. Just as you break down your hammies during a deadlift and can go heavier over time. This can be especially effective at the hamstrings or hip flexors, but really many muscle groups can benefit from this training as we use eccentric motions throughout our life! Bending over to pick something up, lowering our body weight off a step, lowering an object from a high shelf, etc.
What do these exercises look like? Think about the position you’re in when that muscle is in a big stretch. This is the motion you want to create through the exercise, simply adding a load. Some examples might include psoas lower, reverse Nordic curl, and a dropped heel raise.
Research and evidence are ever evolving. So much so that it seems hard to keep up! Our current body of evidence suggests this approach of eccentric loading may make more impact than static stretching, and that static stretching maybe doesn’t do what we once thought. Even so, it’s always best to analyze what your body needs, and what works well for YOU!
If you need guidance on where to start, or what approach suits your needs, head to our website to chat with a PT!
Elle Carlson, PT, DPT
What is diastasis recti? It’s a common diagnosis in the pelvic floor world but what does it mean to you? Is it a problem? What can be done about it? Can it be avoided? Who develops it? These are all common questions surrounding diastasis, and things I hope to shed some light on this week.
Diastasis recti is commonly seen in pregnant people as they reach full term, as well as after a baby is born; in fact, nearly 60-70% of pregnancies will see diastasis develop. Even so, we can see diastasis in anyone who has a rapid change in the size of their abdomen, pregnancies, weight gain, or even toddlers with their cute little bellies. It is more common in women just because of the pregnancy and childbirth factor, but men can develop diastasis because all you need is that rapid change in shape. Ultimately it is a stretch and thinning of the connective tissue that connects our left and right ‘6 pack abs’. These abs, more specifically named rectus abdominus, run vertically from our pelvis to ribs and help to curl our trunk toward our legs and legs toward trunk. Between the two vertical muscle bellies, there is connective tissue that also runs vertically in line with our belly button – this is called the linea alba. Its job is to transfer load between the muscle bellies when we need stability at the center. Like when we lift, jump, brace, or transfer load from our arms or legs.
When we have a sudden increase in size that surpasses the tissue’s ability to adapt, this connective tissue can become less elastic, and less effective at transferring that load. This often shows up as a gap between the muscle bellies that can either dent inward or protrude out with an increase in abdominal pressure. This process in and of itself is typically not painful, and doesn’t appear to create direct problems; however, with this decreased ability to effectively spread load throughout our core, it can become harder to manage pressure within the abdomen and pelvis with exertion. This can potentially lead to other pelvic floor symptoms including pelvic pain, hip/low back pain, as well as incontinence.
To identify a diastasis recti, a practitioner may press along the midline of the belly (on the linea alba), feeling for an indentation or gap between muscle bellies. This can be further examined by asking the person to engage through the abdominal muscles and assess for changes in that gap – does it widen even further, can I sink my fingers deeper between the bellies, or does it become taught, making it harder for my fingers to sink down? The latter is a normal response, and what we want to see; the former are responses we would expect with a diastasis.
Natural healing of this connective tissue occurs once the stretch placed on it is reduced, which in most instances is after delivery. We also see the extent of this natural healing complete within a few months. However, even with this natural healing, the tissue is never quite the same and one can continue to have difficulty with pressure management; especially for someone who enjoys higher level physical activity, or things that require lifting and bracing. Fortunately, there is so much to do to help despite the changes in tissue!
So what can you do about it? The large focus here is to re-train one’s ability to manage the pressure created throughout the abdomen by improving coordination and strength throughout additional core musculature, including transverse abdominus, obliques, and rectus. A focus is also placed on breathing and bracing strategies during functional activities to promote support to that connective tissue and improve the ability to transfer load throughout the core. As this strength and coordination is improved, as well as integration of appropriate strategies during activity, we see an improved ability to transfer load through the core which can reduce any current symptoms but can also prevent others from coming along down the road! The cool part is that the already changed tissue doesn’t have to change back for this to happen! So, even when someone is months or years out from pregnancy and feels like there’s nothing to be done – there definitely is!
These strategies are also put in place as someone progresses through pregnancy or is trying to avoid a significant diastasis from developing! Check out this table for helpful tips surrounding both prevention and treatment:
I want to prevent a significant diastasis!
Diaphragmatic breathing w/ abdominal squeeze on exhale
Plank / modified plank
Side plank / modified side plank
I want to help my current diastasis!
Diaphragmatic breathing w/ abdominal squeeze on exhale
Deep abdominal squeeze with curl up
Bent knee fall out
It’s important to note that the appropriateness of these exercises is largely dependent on the individual, and their circumstances; therefore, an individual assessment is so important! You can find videos by clicking on the bold print above.
As always, hit the "Talk with a PT" button above to dive into your specific case and see how we can best help!
This week we’re talking all about RED-S. Something many of you may have never heard of. If you’ve spent time in the world of sport and athletics, you may be familiar with the female athlete triad – a combination of disordered eating, lack of menstruation, and osteoporosis. This combination is typically developed through over training with inadequate intake (FOOD!) which results in poor calcium maintenance in bone and altered hormones affecting reproductive cycles. It’s important to clarify that inadequate food intake can be both intentional and non-intentional; both because of poor eating habits and too intense exercise. RED-S has come about more recently to capture all the bodily functions affected by over-training and under-fueling; and to address the fact that males can fall into these patterns just as commonly.
Really, any active person is at risk for developing RED-S – relative energy deficiency in sport. You don’t have to be involved in competitive athletics, training, or sport; however, competitive athletes may be at a greater risk due to more rigorous training schedules. Those who participate in endurance sports, or aesthetic sports like gymnastics or dance are also at a greater risk. RED-S captures both males and females and in its most simple form occurs when an athlete consumes too few calories for their activity level.
RED-S can be difficult to diagnose because it can present in a variety of ways. A large indicator for this in females is a cease in menstruation; especially if the cycle had been regular previously. Decreased caloric intake doesn’t allow for the energy required to maintain appropriate hormone levels and conduct these functions throughout the month. This can have a long-term effect on bone health as proper estrogen levels are essential for affective calcium storage. RED-S is often seen in younger females who are not typically concerned with something like osteoporosis; however, bone density peaks between ages 25-30 so this is a crucial period to assure strong bones are being developed! Bone loss can occur in just a few months of having an irregular or absent period. Other symptoms – for both males and females - can include repetitive stress injuries, decreased performance or difficulty training at a high level, dehydration, GI problems, cold intolerance, low heart rate and blood pressure, cramps, fatigue, and brain fog.
Behavioral indicators can also be spotted, including anxiety or depression, body dysmorphia, exercising beyond what’s required, difficulty concentrating, and avoidance of eating or certain eating situations.
RED-S can impair health and sport performance as an under-fueled human is slower and weaker, regardless of the activity being performed! As activity levels remain high despite inadequate fuel, we can see fatigue progress to a loss of strength and muscle size as the body uses this tissue to fuel essential functions. Inadequate fuel can also affect the brain, leading to difficulty concentrating or remaining on task. With these changes in strength, energy, concentration, and coordination, there can also be an increased risk of injury. Along with the potential implications of bone health, stress fractures – and repeated stress fractures – can be a sign of RED-S and inadequate bone density. With that, repeated stress fractures, or unexplained injuries should always be a red flag for further investigating one’s exercise and fueling routine!
So, what can be done to prevent RED-S; to make sure our young athletes and active adults are setting themselves up for success; or to allow you to recognize if you’re trending toward some of these patterns and how to move the dial in the appropriate direction?
As always, consult with a physician if you are concerned about anything discussed above.
In a world where we have people and things to compare ourselves to literally in our palm, it can be easy to constantly ask more of yourself or to continue to push despite signs that you need the opposite. It’s common to think that we’re not doing enough exercise, or the right exercise; or that we need to follow this diet, or that other one you heard about last week. In a lot of instances, we need to fuel ourselves MORE, and more appropriately for what we’re asking our bodies to do. Rest and recovery needs to be recognized and encouraged in order to have the most success… and far more importantly, to take care of our health for the long haul!
This week we’re bouncing back to the pelvic floor and diving more specifically into some of the topics within this realm. If this is a topic that interests you, or you feel you’re in need of some work here, we’d love to see you at one of our upcoming workshops! We unpack the pelvic floor, its function, and its potential dysfunction; as well as what we can do about it. As these evolve, we’ll dive deeper into specific aspects; so, if you’ve been to one already, keep your eyes peeled for something fresh!
At a pelvic floor workshop last week, we talked a lot about incontinence. Particularly stress incontinence (leakage with things like coughing, sneezing, lifting, jumping, etc.). Something that is SO relevant to many! This one can be a tricky thing to manage because we need to know exactly what is going on in YOUR body, not that of the person next to you. HOWEVER, there are some general concepts surrounding breathing and pressure management that can go a long way; so that’s what we’ll talk about today!
Incontinence, as well as many other symptoms of pelvic floor dysfunction, is impacted greatly by the pressure we create – and manage – through the abdomen and pelvic floor. Think of the area from your ribs to pelvis like a cylinder, or a pop can… do you say pop? Anyway, this cylinder is formed by the diaphragm on the top, pelvic floor muscles on bottom, and abdominal muscles/spinal muscles all around the outside. When we do things with exertion – sneeze, jump, run, cough, etc. – we create increased pressure through this cylinder. This in and of itself is not a bad thing – it helps us to move STRONGER and brace better. The problem comes when an aspect of that pop can can’t withstand the pressure created. This is often the pelvic floor, and this can result in leakage during activity.
Strength can be an issue here, but it seems to more commonly be increased tension or over-activity through the pelvic floor. One thing we can work on to address this is breathing. Through our breath, our pelvic floor is meant to stretch upon inhalation, and return from this stretch on exhalation. This is caused by a synchronistic movement with the diaphragm; when we breath in, the diaphragm and pelvic floor both lower, when we breathe out, they raise. If we don’t utilize the diaphragm as we should, this synchronistic lowering doesn’t happen, and the pelvic floor remains tense. This is fairly common because many of us breathe primarily through our chest for a variety of reasons. This can be because of anxiety or feeling stressed; but also, because we try to keep our abdomen tight and belly sucked in. Regardless of the reason, when we don’t get adequate belly movement during breathing, we have inadequate diaphragm and pelvic floor movement.
The first step in this is to work on breathing more into your belly and toward your pelvic floor. You can start by simply lying on your back when you’re hanging out in the evening or getting into bed. Place a hand on your belly, and as you breathe, send your breath toward your hand so that it raises as you breathe in, and lowers as you breath out. At the same time, you can think about sending that breath lower toward the pelvic floor, and feeling a gentle flare of your sit bones as you breathe in.
This is a super simple movement, but it can go a long way in the journey of addressing incontinence! It’s important to note that this alone will not likely have a large effect on leakage during activity – laying down on your back is much different than jumping rope after all! These breathing and bracing strategies need to be progressed to functional movements for ultimate success; and need to be part of a plan that tackles mobility, strength, and coordination! That being said, it is a great place to start, and to assess what your natural breathing pattern is.
Try it out, reach out with questions, and keep your eyes open for next week’s newsletter!
If you’re interested in learning more about the pelvic floor, or how to help yours, hit ''Talk with a PT' up top for to register for a free discovery call!
Dr. Elle Carlson, PT, DPT
This month we’re talking about the ever-so-annoying and common diagnosis of plantar fasciitis. That’s a fancy name, so let’s first break it down. Plantar describes the aspect of the foot. Plantar refers to bottom, dorsal to the top. You’ve probably heard of fascia in various areas of the body. Really, fascia encompasses everything. Among other roles, it allows our muscles to work closely together by connecting them to each other and connecting our muscles closely to our skin and bones. This specific fascia runs from our heel toward our toes and blends with the muscles that allow us to bend our toes and support the bottom of our feet. This fascia is important in supporting the arch of our foot, and in creating some ‘spring’ when we push off through our toes. That last part of the word ‘-itis’ means inflammation. Inflammation of the fascia on the bottom of your foot – plantar fasciitis.
This condition can be intense, and the pain is often described as tearing along the bottom of the foot, most commonly with those first few steps out of bed in the morning. Despite this intensity of pain, the condition in and of itself is benign, and typically does resolve on its own over time. Even so, there are things that can be done to move that along, and strategies to use moving forward to prevent it from returning!
Because this is an -itis, and inflammation is involved, the first course of action is typically to reduce inflammation and modify activities as needed to prevent large increases in inflammation with exercise. These modifications usually surround activities like running, jumping, walking, and explosive movements. Duration, frequency, terrain, and speed are all modifiable factors for these exercises that can improve symptoms and reduce inflammation. It can also be helpful to assess shoes worn during these activities and adjust as necessary to reduce irritation; or ask yourself if you recently changed shoes as sometimes that can be the culprit for a new case of plantar fasciitis. Over the counter orthotics are often helpful for improving symptoms in the short term, especially for those who spend a lot of time on their feet. Over the counter are typically just as good as the custom-made orthotics for plantar fasciitis, so don’t go running to a podiatrist for custom orthotics just yet!
After symptoms are improving and inflammation is controlled, it’s important to gradually load these tissues so they can build resiliency toward the exercises or activities that may typically aggravate the plantar fascia. These tissues need to be able to withstand both stretch and load, so we need to introduce these in a controlled manner. They become stretched when we go onto our tiptoes, or when we push off toes when walking or running. They also take on load in these positions due to the need to support the bottom of the foot as it stretches. Load is also felt when we move through standing on that foot when walking or running. This is because forces are attempting to flatten the arch of our foot, and this area needs to support that for reduced stress through joints as well as improved efficiency in our push-off in walking or running. We can mimic the activities that create stretch and increase intensity as tissues adapt through things like load and speed. For a good place to start, check these out!
There are also tiny little muscles on the bottom of the foot that help to take up this load and reduce the burden through the plantar fascia and surrounding muscles. These muscles can be addressed through specific exercises that you can find HERE, but they also get stronger by walking barefoot! People with plantar fasciitis are often told to never go barefoot out of fear of worsening symptoms or threatening the integrity of the arch. However, walking barefoot is a great way to strengthen the muscles of the feet and promote adequate mobility through the many joints of the foot! Now, if your foot is very sensitive, there may be benefits of wearing shoes more consistently in the short term, but as this sensitivity decreases, we encourage you to spend more time around the house without shoes!
Through a combination of controlling inflammation and decreasing sensitivity, strengthening throughout the foot and ankle, as well as promoting the natural strength and mobility of the foot when out of a shoe, we can reduce symptoms of plantar fasciitis and return to the activities that matter most!
If it seems daunting to tackle this on your own, or you’re in need of further guidance, we’d love to be the guide on your journey toward healthier feet!