Plantar Fasciitis

The What⁣

Your plantar fascia is the band of tissue that runs along the bottom of your heels to your toes. Plantar Fasciitis is a diagnosis for dull, achy pain and tenderness at the heel [which may be due to PF thickening or degeneration] thats usually worse first thing in the morning and following prolonged standing and running.⁣

⁣The Who⁣

Plantar fasciitis makes up about 8% of running-related injuries.⁣

⁣The Why⁣

Factors that may contribute include sudden increases in running mileage or intensity, anatomical structure, improper footwear, muscle imbalances and faulty running biomechanics.⁣

⁣The How⁣

How do we treat plantar fasciitis?⁣

Exercises to perform tailored for runners!

⁣Before running:⁣

Golf ball roll outs⁣, Ankle dorsiflexion mobilization⁣, Short foot⁣

⁣After running:⁣

Plantar Fascia stretching⁣ [You can also perform this after inactivity or when you first wake up in the morning!]⁣ ️Gastrocnemius & Soleus stretching⁣, Foam rolling the calves⁣ [You can perform this before & after!]⁣ ️Ice massage with water bottle⁣ [Place a water bottle in the freezer overnight!]⁣

⁣3/4x per week during your off-time: ⁣

Plantar flexion and inversion with band⁣, Heel lifts off-step with wedge under toes⁣ [Up in 3 seconds, down in 3 seconds. For more difficulty, wear a backpack with books or weights!]⁣ Standing clamshells⁣

⁣Prevention Tips

▪️Use several running shoes in rotation!⁣

▪️Increase your running mileage and intensity slowly!⁣

▪️Try the best you can to walk around barefoot throughout your house or whenever you can. Get those shoes off, wiggle and move those toes and feet!

Many runners and athletes complain of ankle instability and experience chronic ankle sprains. Some factors that may contribute to these conditions include limitations in dorsiflexion range of motion, impairments in balance, and decreased ankle and hip strength. 

 To Improve: MOBILITY 

Dorsiflexion Mobilization

Come into a half kneel position with the affected leg out in front. Increase the bend in your front knee and bring your leg forward without raising your heel off the ground. 

Dorsiflexion Mobilization with Band

Place the band just below the joint line of where your shin and ankle meet, on the talus, a bone below the shin. Then place the other end of the band underneath your opposite knee. This glides the talus posteriorly, stretching the joint capsule to help improve your mobility.

To Improve: STABILITY 

Star Drill with Cones

Place 5-8 cones at a reasonable distance away in several spots on the ground around your body. As you stand on your affected limb, use the other foot to tap the tops of the cones. The further out they are, the more difficult the exercise becomes. 

Single Leg Windmills

Stand on the affected leg and lift the other leg out straight behind you, ideally up to hip height. Bring your arms out in front of your body to test your balance. Then bring your arms out to each side and rotate your trunk.

  The Gatrocnemius and Soleus are the two muscles that make up your “calf” muscle. These two muscles join together to become the Achilles’ tendon, the strongest and thickest tendon in your body. 

 As a runner, we place high demand on our calf muscles and Achilles’ tendon. Keeping our muscles and tendons strong and flexible is an important way to improve performance and decrease risk for injury. 

Gastrocnemius Strengthening

Keeping both knees straight while performing heel raises off of a step.

Soleus Strengthening 

Keeping both knees bent while performing heel raises off of a step.

These exercises concentrically and eccentrically train our calf muscles and load our Achilles’ tendon. 

3 x 10-15 reps 

Challenge yourself: Single Leg Heel Raises

Gastrocnemius Stretching

Place your hands on a support surface in front of you and lean forward, step one heel back and anchor it into the ground, keeping your back leg straight while bending your front knee.

Soleus Stretching

Place your hands on a support surface in front of you and lean forward, step one heel back and anchor it into the ground, keeping your back leg bent while also bending your front knee. 

These static stretches help to lengthen the muscle and increase mobility. 

Hold 3 x 30 seconds

The What

“Shin splints” is another term to describe Medial Tibial Stress Syndrome (MTSS). MTSS is an exercise-induced stress reaction of the shin bone (tibia) and surrounding muscle and fascia. Symptoms include diffuse (spread out) pain throughout the inside (medial) portion of the shin during exercise.

The Who

MTSS primarily effects endurance athletes and makes up approximately 16% of all running related injuries.

The Why

Training Errors: Too much, too soon! A sudden increase in distance, intensity or frequency. Repetitive hill training or abrupt changes in surfaces.

Biomechanics: Foot strike and foot position, over-striding and inadequate strength of your hips, abdominals, posterior tibialis, soleus and intrinsic foot muscles.

Bone Density and Inadequate Calcium Intake

The When

Average recovery time is approximately 70 days depending on the severity of injury.

The How

How can we treat it?

ACUTE PHASE

Ice: 10-15 minutes several times daily

Stretch: Anterior tibialis [30 seconds x 3]

Soft Tissue Release: Massage or foam roller

Rest for several weeks!

SUBACUTE PHASE

Cross-Training: Biking & swimming

Strengthening: Posterior Tibialis, Soleus, Hips & Abs

Modified Training Routine: Decreasing distance, intensity & frequency by 50%

Differential Diagnosis

Stress Fracture: Small cracks within the bone. Symptoms include localized tenderness and increased swelling and pain with activity.

Exertional Compartment Syndrome: Blood or inflammation impedes compartment areas, which houses groups of muscles surrounded by fascia. Symptoms include numbness, swelling and tightness.

If you have concerns, consult with your MD or local PT!

Prevention Tips

Change your running sneakers every 250-500 miles

Maintain a strengthening routine throughout your run program

Avoid consistent hills and excessive road cambers

Follow the 10% rule when ramping up your distance, intensity or frequency each week

Have your running biomechanics evaluated by a PT!

“Runner’s Knee” is an umbrella term used to describe anterior knee pain in runners. The surrounding bones, musculotendinous structures and ligaments all play a major role in the biomechanics of the the knee. Overuse injuries at the knee are due in part by muscular imbalances, faulty mechanics or when improper load management occur.

Patellofemoral Pain Syndrome (PFPS) is one of the most common knee injuries seen in runners. Your knee cap (patella) travels within a groove on your thigh bone (femur). When your mechanics are off or there’s muscular weaknesses and then load is placed through the body, it can change how your pelvis, femur, patella, tibia (shin bone), ankle and muscles work with each other. Other common knee injuries that may occur include patellar tendinopathy and Ilitobial band syndrome.

Improper Body Mechanics

In the part of the video that demonstrates a step down, you can see a drop in my pelvis on the left side and internal rotation and adduction movement of the right side. This is a common pattern seen in runners with complaint of anterior knee pain who may have PFPS.

The most recent research demonstrates the correlation between PFPS and weakness of the hips, so let's strengthen those hips!

Clamshells, Bridges, Unilateral Bridges, Hip Abduction with Band, Side Plank with Hip Abduction, Hip Abduction + External Rotation + Extension, Hip Hikes

The quads are the muscle group located in the anterior aspect of your thighs and are made up of the Rectus Femoris, Vastus Lateralis, Vastus Medialis and Vastus Intermedius. The Rectus Femoris works to flex the hip and works with the other three quad muscles to extend your knee.

Runners place great demand on this muscle group! Keeping these muscles strong and flexible can help to improve performance and reduce the risk of injury.

Quadriceps Strengthening

These exercises concentrically and eccentrically train our quad muscles. You can challenge yourself by holding onto weights or using a higher step.

Goblet Squats, Step Ups, Split Squats, Terminal Knee Extensions with Cone Taps

3 sets x 10-15 reps

Quadriceps Stretching 

Static stretching helps to increase range of motion and muscular elongation. Best to perform immediately following exercise when the muscles are warm.

Standing Stretch, Sidelying Stretch, Half-Kneel Stretch, Kneeling Stretch

Hold 3 x 30 seconds 

The hamstrings are the muscle group located in the posterior aspect of your thighs and are made up of the semimembranosus, semitendinosus and biceps femoris. They work to control knee flexion and hip extension.

Hamstring strains are common injuries that can occur in runners and athletes. Rehabilitation for a hamstring strain focuses on loading & lengthening, eccentric control and trunk & pelvic stability.

Extenders

[Lengthening]

Hold your affected leg in 90 degrees of hip flexion. Bend and unbend your knee and stop when a moderate stretch is felt and BEFORE discomfort occurs. 

Bridges

[Loading and Trunk & Pelvic Stability]

Lie on your back with your knees bent and your feet flat on the surface, then lift your hips up towards the ceiling. 

Planks

[Trunk & Pelvic Stability]

Place your elbows under your shoulders, curl your back toes under and keep your hips in line with your shoulders

Supine Hamstring Curls with Ball

[Loading and Eccentric Control]

Place the physioball under your heels, lift your hips into a bridge position and bend your knees, bringing the ball towards your glutes and back out.

Nordics

[Eccentric Control]

Kneel on the floor and bend your knees into 90 degrees with your lower legs behind you. Anchor your shins and feet down with weights or have someone hold your feet throughout the exercise. Move your body towards the ground slowly. 

Divers

[Loading, Lengthening & Eccentric Control]

Keep the affected leg on the floor with a 10-20 degree bend in the knee. Lift the opposite leg up while reaching the arms out forward.

Gliders

[Loading, Lengthening & Eccentric Control]

Place the unaffected leg on a slider (or a towel underneath your foot with a wood surface.) Keep your body weight over your affected leg, with your knee kept at 10-20 degrees of flexion, and your foot dorsiflexed. Slide your unaffected leg back behind you and stop when you feel a moderate stretch and BEFORE discomfort is felt. Then use the bar and your upper body to pull your leg back up to the starting position. 

 The thoracic region is the area of the spine that connects the base of the neck to the low back. The thoracic spine contains twelve vertebrae, is the location of rib attachment, and is the connection of many muscular, neurological and tendinous structures.

It’s imperative that runners and triathletes have thoracic mobility and stability. Mobility allows you to rotate your body with each stride while running and rotate your body with your arm while swimming. Stability keeps your spine protected while running and swimming and helps you maintain cycling position while on the bike.

MOBILITY 

Cat/Camel, Puppy Stretch with Thread the Needle, Open Books, Extension over a Foam Roller, Extension with a Chair, Seated Rotation

Each of these can be held for 10 seconds for 10 times. You want to come into end range position for each. This means you want to feel a moderate stretch but no pain should be felt.

STABILITY 

Bird Dogs, Plank, Seals, Wall Angels, Y’s at the Wall, W’s on the Physioball

These exercises can be held for 5 seconds for 20 times. As you progress, you can either increase the amount of time each exercise is held for or increase the amount of repetitions. With the exception of plank, in which you could start with 30 second holds and build up to several minutes!