Plantar Fasciitis and Massage Therapy

9AM Appointments Mon-Thur are discounted using EARLYBIRD code at checkout.

YES our therapists are still masked.

Body Mechanics NYC Gears Icon

Plantar Fasciitis and Massage Therapy

Many years ago – in what seems like the Dark Ages, I was in school to become a registered massage therapist (RMT) in Ontario, Cananada and was taught a standard massage treatment for plantar fasciitis and runners. 

The massage therapy mostly focused on the foot. It involved stretching the plantar aspect of the client’s foot by cranking the toes into extension forcefully and pulling the bottom of the foot tight. Then while your client was face down and you had this position achieved, you were to take your thumbs or even an elbow and dig away at the tissue until you had eradicated all of the ‘granular’ scar tissue. 

I quite clearly remember my teacher saying that we needed to then ice the bottom of the foot immediately, as he slapped an ice pack on my friend who was a runner and triathlete. I remember her gingerly limping off post-treatment. I can’t remember how long it was before she ran again after that. Who knows?  No explaination was ever given for the method of treatment. They never explained that the purpose was to break down tissue and re-injure the site to facilitate healing. But it surely stank of that mode of treatment, and it did not make sense. 

Why do we need to hurt someone to make a massage work? 

Now let me ask you a question, a question that I will likely repeat in multiple blog posts: If you come to me, as a medical practitioner, and you complain of a black eye, and I punch you in the same eye and tell you it will facilitate healing, does that make sense? No! So why is it acceptable in massage? Certainly it applys to plantar fasciitis and massage. 

Massaging the leg for runners
Photo by Adam Ninyo

Years later, I now teach a very different method to address runner’s issues to the therapists at Body Mechanics. It is far more gentle, treats the entire lower leg as well as upper (depending on time constraints), engages the brain by moving the body, and involves a referral to PT or exercise depending on the level of experience the runner or athlete has. 

The Plantar Fasciitis Massage Treatment

When assessing, we are looking at a far wider spectrum of dysfunction than simply plantar fasciitis. Indicators that there might be an issue or impending problem include heel pain, pain in the bottom of the foot, and sometimes calf pain. Of course with any assessment, we screen to rule out red flags as well. The symptoms listed above can also correlate with a recent increase in mileage or speed work for runners, or a weight change, plyometrics or recent changes in health. If there is no connection to the assessment you’re probably going to want to refer out regardless to check for bone Spurs and tendon issues. 

For the purposes of this blog let’s focus on the lower leg. I generally combine in-prone, general massage with gentle pin and stretch. Having the patient flex and extend the ankle as well as pronate and supinate. I am looking to see a full articulation of the foot and ankle. Often you will see that those with foot pain also have poor articulation. Resistance in these areas can be added to help cue the body into moving better. Once we have warmed the area with massage and movement, adding resistance to those movements is helpful. While many massages focus on the muscles, at Body Mechanics Orthopedic Massage I like to include tendon work, like “bowing,” as well. We want soft supple moving parts so practicing flexibility is helpful. 

When treating the bottom of the foot, I no longer use that awful stripping technique that requires an ice pack. Instead, I use a hot towel to warm the foot and then use a deeper gliding technique across the sole, while I have the patient flex and extend the toes, or spread them and let them fall to neutral. Here, if things are still not moving well we would add in some mobilizations between the tarsals and resisted exercises for the toes. 

As for home care, if the problem persists, we will refer you to a physical therapist and if it does not, then we would advise you to a program of foot and calf strengthening as injury prevention. As a massage therapist, I am not rehabbing you.  My job is to get you more comfortable while your body does what it does and what it was designed to do. It is adaptive. It will adapt, with or without me.

Summing up…

A warm towel? Simple exercises? No digging thumbs or elbows into the client’s foot? This is a far cry from the painful techniques that I was taught! No one is limping painfully off our tables before a run. The clinical outcomes seem just as effective and I’d say are more beneficial. If you are looking for a therapist who will not hurt you to help you, ask questions before you book. Look for someone who listens well and has a wide variety of techniques at their disposal. It would be a shame to miss your next run due to foot pain… especially if it was caused by the person trying to help you.

Check out more on plantar issues

 

Strengthening and Conditioning for a Marathon

The right strengthening and stretching program is important when preparing for a marathon. Strength training has been shown to improve running economy, prevent injuries, and improve body composition and resting metabolic rates. Strength training is particularly important for older runners. Endurance exercise, like running, does less to protect against age related loss of lean muscle tissue than strength training.

When training for a race runners should perform one to two full-body strength sessions per week. Your workouts should be staggered around your key running workouts for the week. Avoid combining your strength workout with a hard speed session or long run on the same day. Research shows it could compromise your running workout and recovery[1]

Your strengthening routine should focus on two goals. First you must focus on correcting any imbalances in your movement patterns like over-pronation or over-supination. Read my last blog post on Plantar Fasciitis for the right exercises and stretches. Research has shown that a 1:1 strength ratio between your hamstrings and quadriceps is related to optimal running economy[2]. When performing leg exercises you can compare how much weight you can lift on the leg extension exercise versus leg curls. You need to strengthen the weaker of the two muscles. Most people have stronger quadriceps than hamstrings and will usually do only the leg curl, instead of both leg curl and leg extension exercises in a workout.

In addition to corrective exercises, your workout should aim at overall strengthening throughout the body to improve running economy and endurance muscle fibers. The following is a sample workout that incorporates both :

Lower Body

If you over-pronate during running do:
-Ankle Inversions with dorsiflexion using resistance tubing,
If you over-supinate, during running do
-Ankle Eversions with plantarflexion using resistance tubing

If your Quadriceps are stronger than your hamstrings do
-Leg Curls

If your Hamstrings are stronger than your Quadriceps do
-Leg Extensions
-Hip Adduction
-Hip Abduction
-Dumbbell Front Squat
-Barbell Deadlift

Upper Body

-Bench Press
-Dumbbell rows
-Dumbbell press
-Barbell Curls
– Planks(hold 30-60 seconds)
-Side Planks (hold 30-60 seconds)
-Do 2 sets of each exercise of 8-12 repetitions

For each upper and lower body exercise start with a weight heavy enough to allow you to reach 8 repetitions per set. Try to increase the reps every week. Once you can perform 12 repetitions with a certain weight, you can increase the load enough to allow you to do 8 repetitions again. Use the routine alongside your running training 1 to 2 days a week.

Provided by Ivan Garay LMT CPT
References

Eur J Sport Sci. 2014;14(2):107-15. doi: 10.1080/17461391.2012.726653. Epub 2012 Oct 3.
The acute effects intensity and volume of strength training on running performance.
Doma K1, Deakin GB.

Journal of Strength & Conditioning Research:
doi: 10.1519/JSC.0000000000000376,
Post Acceptance: January 28, 2014
Relationship Between Functional Hamstring: Quadriceps Ratios and Running Economy in Highly Trained and Recreational Female Runners.
Sundby, Øyvind Heiberg; Gorelick, Mark

[1] http://www.ncbi.nlm.nih.gov/pubmed/24533516
See references for specific citation information

[2] http://journals.lww.com/nsca-jscr/Abstract/publishahead/Relationship_Between_Functional_Hamstring_.97501.aspx
See References for specific citation information