Discussion: Plantar fascia study

I just emailed this to Zan and thought that the rest of the AP (is it coincidentak that US Winter O' Training is in APtos CA?) might be interested as well.

A new pf article appeared recently in our local newspaper, based on research by Dr. DiGiovanni of U of Rochester. In a study reported in Journal of Bone & Joint Surgery, he compared his new exercise (below) with an "Achilles tendon stretch" and got favorable results.

Sit upright in chair, barefoot. Place the ankle of the affected foot on the opposite knee.
Using the same hand as the affected foot, reach across and grab the toes.
Flex the ankle forward and pull the toes toward shin.
Th test the stretch, place the thumb of your other hand on the bottom of the foot. You should be able to feel the cordlike plantar fascia running the length of the foot.
Hold the stretch for a count of 10, then relax. Repeat 10 times. Perform the sequence at least three times a day.

He recommends doing this immediately after getting out of bed and after other periods of inactivity.

Worth a try?

Hi Rick, somebody from Rochester (Dale Levine maybe?) posted that same article quite a while ago. I had to chuckle because the stretch he is describing is really nothing new to the physio world, it's been used for years. Sometimes we give it in standing, sometimes in sitting, depending how flexible the Achille's is. Fascia takes about 90-120 seconds to release, as opposed to muscles that release very quickly - hence the 10x 10 second stretch. I myself find I get better results with just a long 2 minute stretch instead of the 10x suggested in the article, but worth the trial if you are not too patient!!!

He recommends doing this immediately after getting out of bed

My understanding is that you want to do any stretching before getting out of bed, not after. At least that is what my sources tell me. You want to work the ligament a bit before that first step.

I've tried this stretch, I'm not sure if it helps or not. I do so many different things, from the outlandish such as eating grapes with seeds (supposedly that helps with collagen repair, can't hurt I suppose) to the more traditional, so it is hard to tell what works or not.

I spoke to a podiatrist who said in 20 years, he's not sure if streching helps or not; of course, he is in business to sell orthotics, but he's a good man, and I trust him.

I'm pretty sure you can stretch too hard; I know I started to hurt more after certain stretches that involve the ligament, and have read that collagen isn't really a stretchy substance, so you want to aim for a fine line where it is strectched, but not overdone so that the strectch itself causes damage. (I wish I had a link to this article for reference; its author claimed to be a podiatrist, FWIW). I like to think in terms of straightening, rather than stretching; in so doing I no longer think I am getting pain from over-stretching.

Good luck with this stretch and any other treatments. I think the advice to straighten out the ligament a bit after long periods of rest is a good one, FWIW. (I also sleep and couch potato with a strassburg sock (www.thesock.com), which keeps the thing straight all night, and I definately think this helps).

Here's a link to the article.

I saw essentially the same article in the Philadelphia Inquirer.

I asked my podiatrist about it. He said the results of the study were not statistically significant and there is no evidence that this stretch is any more effective than the achilles stretch commonly recommended for plantar fasciitis.

Just the fact that they were claiming they had invented a "new stretch" made me immediately skeptical.

Having said that, I'm doing the stretch anyway. Can't say I've noticed any difference so far though.

It is true that this stretch is nothing new in the physio world. As a therapist, I definately use it and it has some value. However, this can not be expected to fix the problem entirely. Physical therapy and specific exercise can often help, but does not eliminate a persons predisposition to injury. Plantar fasciitis usually caused by a mechanical problem related to poor alignment and biomechanics of the foot, ankle and lower leg. Most often, the best treatment for fasciitis is to control the offending compensatory movements of the foot. An custom foot orthosis in conjuction with therapy works best.

Well said edmundson!