Safety / Injuries
How to Deal with your Client's Plantar Fasciitis
A client of yours has been having chronic troubles with plantar fasciitis and Achilles tendonitis for years. Whenever these issues get too bad, she stops running and stops working out. Then she gains weight and is unhappy. After a few months, her foot starts feeling better and she get’s back to working out.
Great! Until….guess what, IT STRIKES AGAIN!!!!
Which is what’s been happening for this particular client for 5 years now.
Don’t let your client (or yourself) fall into this cycle.
Before you treat your client, remember this!
You’re Not A Medical Professional So Don’t ‘Treat’ Injuries!
It’s important to understand where your professional expertise is, and where it’s not.
It’s actually a very clear line. Pain. It something hurts. Don’t do it.
Now that doesn’t mean that client can’t work out with you, you just need to modify the activity. Change the exercise. As well, it really helps to understand a little bit about the injury. While it’s not your job to ‘treat’ the injury. You can still take actions to help resolve the issue and not lose your client to “I need to stop working out so I can heal from this injury”. That’s what I will provide you with today.
Understand The Injury - The Three Shock Absorbers of the Feet
Mechanically, something is going awry with the foot and the posterior chain of the hips, hamstring, calves, heel and the bottom of the foot. Whenever you take a single step with your foot, there are three main joints that act as ‘shock absorbers’. They are:
- Toe Extension
- Metatarsal-Philangeal (Mid Foot) Extension
- Ankle Dorsiflexion
These joints are very commonly restricted due to improper footwear, old ankle injuries and fallen arches. So now, the plantar fascia cannot lengthen the way it’s supposed to and the tissues start getting beaten up and starts becoming hard and tense. Eventually, if it gets bad enough, it could even start to get a bone spur growing out of the bottom of the heal. We don’t want that. So if you’re dealing with a client with such an injury, this is what you can do:
Exercises To Avoid
- Jumping Rope
- Box Jumps or Vertical Jumping
Exercises to Include
These will be used at the beginning of the workout as a ‘warm up of sorts’. One set of 10 repetitions should be sufficient for most of these.
1. Eccentric Calf Raises - Be sure not to perform the ‘concentric’ aspect of the calf raise.
2. Ankle Dorsiflexion Mobilizations
3. “Heel” and ‘Tippy Toe’ Walking - Have your client walk around with their shoes off and walking with the heels raised up for 1 minute. Be sure to not allow the ankles to ‘roll out’ or invert during the movement. You might have to allow them to hold onto a support and just walk in place. Repeat with the toes elevated and walking on the heels.
4. Toe Flexibility Work
5. Calf and Hamstring Stretching - Pick your favorite, I’m sure you know plenty of these.
Ways to modify other exercises in light of Plantar Fasciitis
1. Make the Exercises Less Weight Bearing -Perform seated and kneeling based exercises to reduce stress on the plantar fascia. The more you can get your client off their feet, the better off they’ll be. Suggest something like swimming or biking for cross training.
2. Lift the Heel - Now I’m not a huge fan of making this a recurring habit, but used sparingly, I don’t see a problem with it. If you really want to prescribe an exercise and your client says it hurts, try a small heel lift (like a small pad or a flat plate) which will change the length of the plantar fascia and hopefully provide relief. Remember, if there
is active pain during an exercise, don’t do it.
3. Stepping Down During Box Jumps or Plyometrics - The rapid lengthening of the plantar fascia will irritate the tissue, so don’t do it. Opt for stepping down instead. This is assuming your client can handle jumping up with no pain
Further actions and Education for you on this topic
1. Learn the Short Foot Exercise - Originally described by Vladimir Janda, this is an exercise that helps you to awaken the intrinsic muscles of your foot that have probably gone to sleep from years of padded footwear. In this exercise, we attempt to shorten the length of our foot, without pressing the toes downwards on the ground. Try it. It’s not easy.
2. Consider Recommending A Medical Professional - Having a few medical professionals that you have a rapport with is a huge advantage as a fitness professional. It will take time to develop your network (chiropractor, physical therapist, podiatrist, orthopedic, neurologist) but it’s a huge plus to be able to send your ‘injured’ clients to a medical professional that will offer something more than ‘rest your foot for 2-4 weeks and stop working out’ (which no one wants, especially you). Try your best to find a medical professional that are fitness or exercise inclined. They’ll understand you and your client a whole lot more. A really good one and you can be sure to coordinate your efforts with the client (which looks really great for you).
3. Consider the ‘Cock Up’ Brace - These braces can be picked up at your local drugstore. The keep the plantar fascia lengthened while your client sleeps which could decrease their morning stiffness. It’s not a complete treatment plan for the injury, but it can provide some relief especially in the morning.
4. Lacrosse Balling Rolling - While seated on a chair, place a lacrosse ball and roll the bottom of your foot over the ball. It should help to decrease some of the tension within the plantar fascia.
What I recommend you do with this article is to take action. Look up a medical professional and ask to have a cup of coffee with him. Get good at the ‘short foot exercise’. Read up on the ‘Posterior Chain’. See what it feels like to roll your foot on a lacrosse ball. If you’re going to recommend your client take an action, you’d better have some personal experience performing the same thing. Good luck and please leave a comment to let me know how it goes.
Dr. Scott Hoar
May 9, 2017
Moon, Dong-chul, Kyoung Kim, and Su-kyoung Lee. "Immediate
Effect of Short-foot Exercise on Dynamic Balance of Subjects with Excessively Pronated Feet." Journal of Physical Therapy Science. The Society of Physical Therapy Science, Jan. 2014. Web. 20 Sept. 2016.
Garrett, Troy R., and Peter Neibert J. "The Effectiveness
of a Gastrocnemius–Soleus Stretching Program as a Therapeutic Treatment of Plantar Fasciitis." Journal of Sport Rehabilitation 22.4 (2013): 308-12. Web.