How and Why You are TREATING your Tight Muscles Incorrectly.

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I’ve presented this idea in lectures as:

4 Simple Reasons you are Treating Chronic Tight, Stiff and Sore Muscles Incorrectly.

Stretch is soooo 1990s…

You’re doing it like your Parents.

and in some form or fashion the doctors in my clinic and myself give this lesson, I’d say…a dozen times per day.

Here’s the gist…I’m just going to point clients to this article and save my breath from now on saving me 1000’s of hours in “groundhog day-esque” repeats.

To Cut to the chase, your muscles are TIGHT primarily because:

they are too short OR

they are too long OR

splinting in an effort to protect an injury OR

you have an electrolyte issue.

PAY ATTENTION NOW!

These each have a different treatment. If you don’t finish this article. Get that.

Back in the 1980’s and 90’s – The old way was – “stretch muscles if they are tight.”

Now look, the music was better then but that advice for treatment, was off. Despite stretching tight IT bands daily for years, runners still had tight IT bands every day. They’d think, “hmm, I must have to stretch more.”

Sciatic pain was typically called “piriformis syndrome” and the figure 4 stretch was touted as the next big thing. Much Like the IT band deal though, It didn’t work well and the pain just came back each morning and you’d go through the same routine over and over forever.

That advice is now OUTDATED and why YOU ARE DOING THE WRONG treatment.

Then 2010 Came around. A great Era to be in the sports rehab/performance world. Graston and FAKTR Tools, Tak Balls, Deep Tissue RELEASE techniques blew up as the sports worlds exploded. Millions of dollars poured into the professional sports worlds, Analytics and dollars per performance was defined and Crossfit went from a workout in your garage to a legit Sport claiming Prime Time Television slots on ESPN. It was truly a golden Era of Human Performance experimentation and the aftermath we’re in now is a cornucopia of sports related careers that are exciting and cutting edge. There are 100’s of techniques to try and thousands of products from Vibration Guns to Cryochambers. We have stuff now that look like they came off the set in Star Wars. It’s a blast!

The 2010 era philosophy of the guys like me became:

“Stretch didn’t work fast enough or at all. Now we just BEAT the muscles into submission. RELEASE, COMPRESS, CRUSH, DEEP, MORE, HARDER. we went from tennis balls, to Lacrosse balls to Shot puts. from foam rollers to Squat bars – push more, beat harder, kill the muscle!

SUBMIT tightness, TAP OUT soreness, KNOCKOUT Roundhouse kick stiff shoulders into a Chuck Norris meme, CUP the low back until the 3 inch hickies are still showing a week later. (What?! Michael Phelps won golds galore with those hickies…it MUST work!!!) And If not, I’ll throw some pink tape at it.

A decade later…ala’ “Now” we look at our place in the sports practitioner world and can proudly state, “well, that’s not working too great either.”

It’s like stretching, It seems to work, it feels good, or in this case “bad, in a good way.” Except that the athlete/client returns a week later feeling the same way. Then we reply the same way as a our parents generation, “hmmm, maybe we just need to do more.”

Gives you perspective doesn’t it. We’re in the same trap.

Please allow me to offer a modern alternative. Something we can evolve here and take forward with us into the future.

Although I’m often introduced at lectures as, “Ladies and gentlemen, give it up for Dr. Chad Peters. He’s a sports based chiropractor from S. Texas and he HATES stretching.”, that’s just not true. I don’t hate stretching. I don’t hate foam rolling, balls, tools rehab, exercises, release and these treatments either. I also don’t magically “adjust” away the subluxation my amigos on YouTube push. I use these things. All of them on nearly every single client that comes in every single visit. But I don’t use them more. Or harder, Or deeper.

Please Browse around this website and the SportsDocDC YouTube channel. I’ll show you a better way. I don’t use or teach the tools the old way.

Nope, I opt for the modern version. A thinking mans game. I arrogantly like to think of it as chess to checkers. This revolutionary idea sounds more like this…

“First thing’s First – Find out WHY you are tight. There can be multiple reasons why and each reason has a different approach and unique fix.”

Seems better doesn’t it? Not a one treatment fixes all approach?

Stay tuned to this page because one of my next articles will be even more basic.

“Different body parts react to “threats” differently.” Meaning,..

Just by stopping for a second to acknowledge, “This is the back, this is the foot, this is the shoulder.” you can gain great insight into how the body reacts and therefore have a more clear direction on what treatments get you fixed, FASTER!

Hopefully none of this comes at you prompting this reaction: “OH NO! That’s just too much thinking. I’ll never be able to figure out what I should do!” but more so, “ahhh, I get it now! (lightbulb cartoon above the head) Now I can make better decisions for my own health.

Let’s get some more info out there, maybe this time you can make a better decision.

4 Reasons why you experience muscle tightness AND how treatment differ

  1. A basic muscle contraction.   (short muscle tightness)

So this is the basic, what everyone thinks they have. You could have a muscle that is just a little too tight and needs a stretch. Think of a bicep flexed.

The muscle is shortened, the joints come a bit closer together and you just need to relax this baby. This is typical a day or two after the gym, after a long run or when starting up exercise again. Muscles can and do get “tight” and some of the basic stuff from our high school track days still apply. Throw a little heat in there like a hot shower or manual work like a massage and man, “that feels gooooood”

Stretch is definitely a treatment option for this type of tightness and moderately “OK” for warm up, as in, it wont hurt you. But here is better warmup ideas than stretch –it’s the future after all

But, I’d bet this is NOT what you have.

If you’re to the point you’re seeking advice and medical healp, keep reading.

Here’s the rub (the 1st of multiple)  – this is almost NEVER what happens with an injury.

It is also almost NEVER what happens with long term pain and tightness.

version 2 is the exact opposite…

  1. An elongation of a muscle (long muscle tightness)

This might seem counter intuitive so try to keep your head from exploding while I drop the science like the Beastie Boys in ’94.

Most muscle injuries and in my opinion, nearly ALL OF THEM on your posterior side, such as 1) hamstrings,

2) Low back,

3) Upper back and neck “I hold all my tension here” &

4) Butt (think sciatic stuff here) are almost always muscles that are too long.

“WHAT?? Tight muscles that are too long? ..puh! impossible!”

I’ll explain. Keeping with our earlier analogy of the flexed bicep.

Go ahead, flex that baby – nice…feel your bicep flexed. “Tight”

Now, straighten your arm. All the way, as if you were going to hyper extend your elbow. Funny how the bicep still seems “tight” isn’t it?

That’s right, despite being too long, that elastic muscle is still way too tight and hence, the mistake that most of us make when self treating. It may be a different VERSION OF TIGHT.

If we just touch aka “palpation” we get “tight” as our feedback. Remember when I mentioned that I’m introduced as the guy that hated stretching? i don’t hate stretch, I hate the word “tight.”

Tight describes what I feel but not what is going on. I’d prefer short/long or contracted/ elongated. Its a better description and would improve treatments in the clinic . More importantly , Understanding of this would REVOLUTIONIZE home treatment!

An elongation of a muscle shouldn’t stretch at all, it should shorten into a more proper and pain free position.

How does this apply to you? I’ll tell you first how it applies to me. I see people in my clinic that have had the same IT band issue or “sciatic tightness” and have diligently stretched the area for weeks with no change.

They are treating it all wrong.. 90’s style. How it applies to you is that often, YOU are the fool doing it all wrong. So stop it!

“But it feels so good..” please… (see) Therapy vs Therapeutic…And why you’re screwed.

True, extra blood to the area does feel good but you are creating a poor therapy loop and not improving your condition and you are seriously hijacking your recovery. I don’t care what feels good, you want to improve yes?

The problem is with flexibility. A term that is thrown around way too much and should have basically died in the 1990’s. In the modern era we want to look at “mobility” or simply, how the body works in movement. I don’t care so much about your hamstring flexibility when tested by a sit and reach test but more about how your hamstring works in a real world application such as the back, hip, knee and ankle all bending together as you lift something off the ground…MOBILITY!

Remember in the 90’s when an Olympian or NFL player went down with a hammy? The trainer would run out and immediately start stretching that baby. You ever see that nowadays? NO WAY! –maybe for a cramp (keep reading, this one is down below)  Electrolytes – Dude, You need some but not a pulled muscle. The hammy almost always is injured in a “fast stretch” elongation injury. DON’T stretch it. Despite what your coach and PE teacher back in the day taught you. That era is dead, there’s a better version now!

Moral of the story here? Don’t stretch it unless you know for sure. Could you be OVERSTRETCHING? Yeah..not could you , you are. My advice… assume elongation – I think it’s about 90% of the cases. I can test most areas to see, you may or may not be able to do so. I don’t know your education or body awareness. I don’t have the book out yet to explain this all, but I’ll try my best on this website!.

I will offer you this though. Try whatever you want but if you don’t feel serious improvement, say 85% better sensation AND movement in about 4 treatments try something different than what you’re doing. In other words, If you’ve tried something 4 times and it hasn’t helped, try something else, possibly the opposite.

A year of, “it’s just not stretching, think I need to stretch more?” is crazy talk. Try something different. How do you think I figured all this out anyway?

 3. Protection along the spine

This is the big papa of them all. You will almost always get moderate to severe muscle spasm with any issue around the spine. Simple but painful conditions like a rib out of place or a disc strain cause a HUGE spasm, and because of that spasm – a HUGE amount of MIS – TREATMENT.

I can explain this as well.

This time let’s imagine a sprained ankle – immobile, black and blue, and swollen up like a thanksgiving turkey. OUCH – Now you all know not to heat and stretch this injury correct?  The acronym RICE (Rest, Ice, Compression, Elevation) has made it common recovery and first aid even my grade-schoolers understand.

“So what Chad? It’s not my ankle that hurts right now, My freaking back is all locked up and killing me!”

Well, most issues along the spine are like this, they are sprains and stress to connective tissues…the new sports med term – “threats” to the area..

Most likely a disc strain in the lower back or a rib in the middle and upper back. (Disc strain hurts to cough or sneeze and especially hurt while changing position with getting out of bed and the car the worst…Ribs feel like you’re being stabbed when you breath deep)  I have YouTube videos on this – learn here…

https://www.sportsdocdc.com/discInjuries (more on a disc strain)

And as promised, Rub #2 –Despite the injury being physiologically similar to the sprained ankle, the spine reacts differently than the sprained ankle. It really can’t allow for swelling like the ankle because there is all kinds of important stuff in that area.  Lots of nerves, important blood vessels and oh yeah, the spine. That’s important. So the body being the miracle of God that it is finds another way to immobilize the area and make it tough to move around so you don’t make it worse by being stupid. It locks up all the muscles in the area. Like I say in the clinic, “The brain doesn’t want you bowling tonight.”

The lock down is a protection mechanism to slow you down and not allow you to bend and twist quickly. (I hear “I couldn’t turn my neck to back out of the driveway today.”)

That’s smart! Your body is thinking for you…

The trouble is, it’s a muscle that’s all spasmed and tightened and easy to feel because it’s TIGHT.

So all of us- you, the doctors, chiros, massage therapists, PT’s, foam roller masters, trainers or well wishing friends and family can feel this.

“Darn Mel, that’s one tight back, you want me to sit on you and stretch that out for ya?”

But see, the muscle isn’t the issue. The issue is the disc or the rib and although usually a very simple and small issue, it hurts like crazy because there are millions of nerves RIGHT THERE so you want to DO SOMETHING. Remember, the issue is NOT the muscle – most likely its inflammation at the strain.  Inflammation doesn’t respond well to heat at all. Nor stretch, Nor Therapy Balls, Nor massage, Nor metal Tools, doorknobs, desk Corners or your spouse’s best intentions and rub downs.

In fact all your best intentions to relax the muscle, bring some heat to the area and stretch it out have an immediate feedback loop to your sore body. The injured area feels this and relays the info to your brain, similar to this…(use airline terminal voice) ”Say brain, I’m getting some strange responses here. Too much movement, inflammation is getting worse and this just isn’t safe, why don’t you just ratchet up this muscle a little tighter for a while until were out of the storm.”

An ever continuing spiral of despair and pain and this can go on for weeks! Basically starting over day 1 every. single. morning. The same loop the tweaked hamstring goes through.

Treat the inflammation. Treat the actual problem. Ice that thing. Inflammatory control treatment all the way, or at a minimum, at least don’t heat it and stretch it and do the wrong thing!

You’ve heard the poor advice…48 hours of ice, followed by 48 hours of heat and then contrasting ice and then 48 hours of heat sounded good from your coach in high school and all of us have heard this great-sounding-but-based-on-nothing-other-than-sounding-good-and-easy-to-remember-seminar-type-advice.

That advice is wrong – 1990’s advice and outdated. If it’s inflamed treat is as such, treat the problem, not the spasm!”

Some athletes are inflamed for weeks because of their sport, some people have immune-problems (rheumatoid issues, arthritis) or dietary reactions (IBS, colitis) that keeps them inflamed for weeks, some people have to go to work or have kids or live a real life and keep it inflamed day after day.

Here’s another way I can maybe help out. I ask all my clients 2 questions for any back issue.

Q1) Does your injury respond to anti-inflammatory (think Advil or Aleve) medication?

Does this make it feel better, even takes off the edge?

If yes, guess what? You’re inflamed. There’s no pain reliever in most anti-inflammatories, just anti-inflammatory…so if that works, adding stretch and or heat, which brings more blood is a “pro-inflammatory”.

You are basically doing the opposite of the medicine.

Despite that  “slap your forehead and say ‘a-ha’ – cartoon light bulb floating above your cranium” moment I still hear the standard low back protocol at the ER is 800 mg Ibuprofen and hot shower or massage..    BUZZ , wrong.. they are the opposites, a chemistry equation that does not equal – This terrible advice is great for my day to day employment as a chiropractor but we can all be better. We’re all smart and can figure this stuff out.

Q2) Does a hot shower make it feel great….for like ten minutes and then you can’t put on your socks because the pain returns so quickly.

Right. C’mon man. I don’t need to explain this all again.

I’m including this brief Follow up because people naturally just want to hear what they already believe and a couple of these ideas may have just shaken your belief system.  I’ve been doing this for 15 years so I’m going to give you a little bonus Q and A.

(the Q is the patient, the A is me..)

Q: “but really?, it feels so good”

A: “sorry. I know, ice doesn’t feel as therapeutic as heat – but often what feels good does not equal healing you for some conditions.”

Q: “something that small, like a little strain, can’t hurt like this right? This is a 9/10 here doc”

A: “ever had a paper cut? A piece of dust in your eye?”

Right, pain is such a liar. Pain is simply the signal. The “ENGINE MAINTENENCE” light.  Most often it’s all dependent on the amount of nerves in the area that dictate the pain not the severity of the injury. There are tons of nerves in the fingers, eyeballs, reproductive organs and along the ribs and discs, they hurt.

#4 Common Reason for “tight ELECTROLYTE ISSUES

CRAMPS, SPASMs or charlie horse. Easy fix -as it’s usually nutritional – you most likely need electrolytes in your system…

This article has become much longer than I expected and Electrolytes is such a huge issue I’ll not go into detail about it today. I have more on this website and podcast however so learn about it. Electrolytes are typically thought of as a dehydration issues and that’s true they are. But they are also a critical part of the neurotransmitter system. Bascially, how the brain controls the muscles.

If you get cramps at all, usually in the feet and calves the house bet is on you needing electrolytes. Get some.

Electrolytes

you can also have more than 1 of these 4 problems. Say, a disc strain in the lower back and depleted electrolytes. Your fix is to start taking the electrolytes and start inflammation protocol. All the stretch in the world and time off, rest and recovery isn’t going to get you better. Slow outdated ideas offering little benefit.

Q: “screw you Mr. know-it-all think your so smart doctor guy. I’m just going to do what I believe is right despite all the long term fails.”

A: OK, I made that one up, only a handful of people really tell me that.

But they think that..We all seek advice we already believe is true.

Just remember the 4 application theory I mentioned earlier. Try whatever the heck you want to try. 4 times. If you aren’t significantly better however, try something new, perhaps the above advice and see if it doesn’t help you make better informed decisions on your health and on your own body.

I know this article was a little longer and I preach all through this website, “simple explanation.”

In order to be simple it often needs explanation.

Explanation takes time the first time through and I hate advice without knowing the “why.” Now it should be simple to understand.

Like Biggie said, “And if you don’t know, now you know!

Could My Bursitis Be Hereditary?

me: “No, It’s not!”

OK- it’s a Friday afternoon and we’re one doctor short for the 2nd week in a row. The office has been slammed busy and for reasons that can only be explained by the BLACK SUPERMOON we have had the strangest, toughest cases we’ve had for the entire year.

This article will help you with the bursa thing, but listen this isn’t the advice article. That one is here>>> (link)

This one is about understanding at a deeper level. It’s to help you figure out that you are most likely just not doing things correctly. Here. Allow me to explain..

But now Friday has come and gone. We’re done. It’s sit around the office time. Time to discuss our week and go over cases as we wind down and get ready for the weekend.

And we’ve got gripes. That’s right, complaints y’all!

There is a tremendous amount of misinformation, denial and just straight up fallacy that is hindering our ability, as doctors, to make you guys, as patients, better.   

In an effort to let you understand the inner workings of a doctor’s office, I feel like I need to let you in on something.  

If you say certain things,as a patient, it just puts you in a different category as far as our expected outcomes. That’s correct…what you say can affect how fast you get better OR even if you CAN get better.

To state it simply – you may inadvertently say something that flips a switch in our minds and labels you, “cannot possibly ever recover.”

This is especially true for things that we find funny. Not funny that you’re feeling pain or hurt or discomfort, we’re not jerks. Funny, in that 

you are oblivious to the obvious.   

Things like this, 

“So what is it?” – and then we explain it and then you nod and ask again, “So what do you think I have…is it bad???”

And then we explain it again with a handout sheet, greatly explaining this condition to the macro-molecular level.  And then you ask, with a one eye squint and slight sideways look…“sooooo. What do you think it is?”

Yeah…that. Easy cure: pay attention. You’re never going to get better because you aren’t hearing it.  For whatever reason. (You have a choice

And this classic, “How did I do this?”

What? If you don’t know how you did it – how on Earth should I know?

And really by the time you get to my clinic, often -how you did it doesn’t matter – lets just fix it already.

And then there was this week…

Dozens of patients with musculoskeletal conditions telling us it is their hereditary condition.   As if a strained rotator cuff or blown knee is a genetic trait. You’re crediting the wrong cause for your injuries.

So let me set the record straight. There are genetic conditions. There are blood factors that are real.  Rheumatoid factors, chromosomal conditions, antibody antigen anti-things. I’m not denying the existence of these.

But.    

Shoulder pain.

Sprained ankles

Low back pain

Cricks in the necks 

Hot Discs

Sprains/Strains 

Rib issues

These are just things that happen.They suck, They Hurt, they make you come to the chiropractor, doctor, PT therapist etc but…

They. Are. Not. Because your grandma had it. This has to stop.

Why has nobody ever brought this up before?!

Wait wait wait, before you try to stop me and go off, I get it – your grandma, your mom and probably your aunt and sister all sprained their ankles at some point in their life. And I understand that you have now as well. But it’s not a genetic weakness, it’s not hereditary and it’s not your crutch to bear for the remainder of your life because of millennia of passed down weak ankle genetics. It’s just not.

Everybody sprains their ankle. It’s 100%

It’s neither causative not correlated it’s just a fact of freaking life. So yes, I’ll work on it and get you better but seriously, You have to understand this now. Injuries happen and people get hurt.

If you want to keep from spraining your ankle there is actually a ton you can do for it that is significantly better than NOT doing something to help your odds out. Blaming it on the “O’Malley Genes” that great uncle Ebenerzer brought across the pond during the Revolutionary War isn’t helping anything. (That’s him in the painting walking behind General Washington…see the limp?)

OK, but how about that bad back…Strained a disc? Yeah I know. It’s also called a herniated disc, others call it a disc bulge, and even is often called annular fiber tears.It may have been described as a stenosis because it was posterior and came into the canal a bit. I’m here to tell you, NAY>>>To preach to you. It’s all the same thing and it will get better and you’ll be normal. Soon.

Relating musculoskeletal INJURIES to genetics and family hereditary lines is like saying you have toe fungus because your granddaddy got trench foot off the coast of Normandy during the BIG ONE! 

Mark Twain said it, “the problem isn’t because we don’t know enough, it’s that we know so many things that just ain’t so.”

Dr.Tower related a story he saw at a nautical museum in Australia when he was vacationing. A placard described a famous shipwreck and listed the deaths and survivors. One of the guys died at 95.  “Due to complications from the shipwreck.” WTF? He was 19 when they ran aground. He lived to be 95! He outlived damn near everyone he ever met and probably every one of his doctors. Seriously!! Using that logic, I’d say the shipwreck was the best thing that ever happened to him. Gave him an extra 25 years from the standard of living of the time.

so…

You don’t need to tell me 17 years later that you have a disc herniation. Or that your 8th grade nurse once diagnosed you with scoliosis or that your sore shoulder that came last week mowing the lawn is most likely not from the car accident of ‘86. Or my friends’ classic, “because I played ball…”

OK, as your treating doctor, it probably is good that I know this info, it helps BUT..as the guy trying to help your life on DRCHADPETERS….I can’t have you carrying around this symptom and named issue as a DISEASE. Carried around like a 50 pound backpack for the rest of your life.

This is why I stated earlier that when you tell us this stuff it WILL affect your recovery and outcomes. Not because it is severe or unique but because you will NEVER get over something you can’t let go of.

This article is built so you can Unburden yourself.  95% of planet Earth has had the same thing you have at some time.   

The 5% that have never had an issue, that’s not normal: it’s lucky, or optimal. Normal is what 95% have had and we’ve all had it.

I know I’m fired up but listen please! – I’m not mad.  I’m trying to help you and free you and allow you to just go on with your life, don’t overthink pain nor musculoskeletal issues. Please, for your own sake. When it’s gone it’s gone.

Look, I do this daily.  DAY-LY.   

I see the 300 lb man that hasn’t worked out in a generation and smokes and drinks, is depressed and feels like absolute crap every day, This guy tells me he’s got his grandpa’s back. 

NO dude! – you’ve done nothing to help yourself – you’ve got chronic “decondition.” That’s your freaking diagnosis.

You want to fix the worlds medical problems. Fix chronic decondition and you’ve cleaned up 90% and saved trillions!

But it goes both ways.

I also see the super fit, super hot, lean muscular supermodel looking girl from the cross fit gym that practically wants to give up on life, eating right, workouts and relationships because she tweaked her shoulder 3 times over the course of a year.    

Please, fit chick..It’s not your weak genetics and it’s not that your gym and the instructors suck, you’re just a bit burned out and overworked. Change stuff up for a while, try a new approach.

It’s time for a reality check on health. I keep seeing the same things every day and I want to help you!  You’ve got to get this right in your head or you can’t be helped. AND we, as doctors, know this. You’ll never get active at treating these things because you can’t get over the idea that it IS IN YOUR CONTROL IN THE FIRST PLACE!

This article is simply my plea to take an honest look. Muscle skeletal issues are our wheelhouse and our strong point at this clinic. Our professions see them repeatedly all day long all year long. All ages, sexes, nationalities and morphologies. These issues happen to everyone and anyone and they are all treatable and fixable and when finished and gone – you are done with them – 

Your shoulder doesn’t hurt because you PLAYED football. Your shoulder hurts because you hurt it in football back in the day and proceeded to do nothing for 3 decades to help it recover. It’s shredded and sore and doesn’t move right. You’ve got a long road ahead and today is a new day 1, let’s take a small step forward. OR not.   

It’s not because your granddaddy hurt his shoulder shoveling coal on the Ole’ Santa Fe either.

And look, I’ve gone on enough. You get it.     

This isn’t about treatment and outcomes. It’s just me verbalizing my Friday Gripes –  just a wake up call on causes of pain so we can all just get past it and make better decisions to your healthcare. It’s about having hope.

Or you don’t get it and will always have your excuse and disease and have no hope for the future.  

It’s not up to me to decide. It’s your body – but being true to what you are dealing with dramatically affects your outcome and responses. I just want you to feel great and get back out there making our world better. It’s all about amping up the positive and down playing the negative.

Plantar Fasciitis

You need to understand that there are 20 different versions of PF - most likely you are doing something wrong!

I have been seeing a ton of Plantar Fascia, foot and ankle issues in the clinic lately.  It’s true – the Universe runs in waves and we’re on a big wave of these issues.

First thing’s first, these issue are treatable and if you are willing to put your time into some basic at home rehab and exercises you can speed the healing of this issue up considerably.   

If you’re willing to just take a couple minutes to learn a little I can all but assure you will respond EVEN quicker.  

This is a condition we see in the office a lot and have had good success with it.  It is not usually a “quick fix” issue however.  Typically one treatment doesn’t make a huge difference and I think that’s why there is so much jumping from clinic to clinic and so much MISTAKE and disappointment with treatment and expectations.

You need to understand the issue and the foot…and the body, if you want to fix it and you really need to understand the rules of treatment so you understand what you are trying to accomplish.   There is an order to the treatment.  If the first step isn’t taken care of before the second step you’re just spinning.

This issue as much as any other condition we see is OVERLOADED with mis-information. 

https://kajabi-storefronts-production.global.ssl.fastly.net/kajabi-storefronts-production/blogs/18335/images/sUfAOQRNSadJJdO0ftgK_foot.png

At the heart of the problem with treatment of PF is the name itself – collectively, Fasciitis (as well as any –itis) has multiple, different issues that are collectively called Plantar Fasciitis – see the picture and how large of a tendon, fascia and muscle we’re dealing with? Technically, almost any issue to this area with cause inflammation of some sore (itis) and now you’ve got a diagnosis.

This problem with this is that I could come up with 20 different issues are of which are typically called Plantar fasciitis.    20 different injuries need different treatments if they are going to be successful.   

You’ve got to dive a little deeper than, “this is what FB told me to do.”    You have to know what is happening that is screwing up the function of the foot… IE: “what is causing the –itis?” The twist is, it could be a few things.

It’s not that your friends, magazines, therapists OR hear-say is wrong – it’s just not specific – its giving you general information and you may not have the exact same condition.   

So if you’re looking for, “Doc, what exactly do I have to do to fix this?” I can’t help you on a blog or podcast – it’s going to take a little trial treatment and a lot of homework to get you to the right protocol.

There is good news though!   Despite 20 different versions, many times, just doing treatments in the right order and restoring proper foot, ankle and then hip function will take  care of the problem.   With this article, I will give you some basic ideas that seem to really help out the healing time and speed up recovery – general stuff that is a part of my “Rehab to Go” stuff for you to use at home.

OK, so let’s dive in. In almost all cases of PF it’s not so much the pain, but the lack of proper function of the foot and hip that is a major obstacle in the recovery of the issue.  Add to that – the lack of function is coming from some poor mechanics and form.   Now we’re getting down the rabbit hole!  This is why an injection or one or two treatments don’t fix this.

That’s why you won’t hear me push orthotics, braces and long term rest as part of your treatment protocol. I don’t like them for 99% of cases.

I’m not saying there isn’t a place for these but my protocol really pushes function and mobility as the key component to recovery. Let’s face it; Function and mobility need to be present before proper stability and healing can occur. Let me repeat that, Function and mobility need to be present before proper stability and healing can occur. Read it again and memorize it…that’s what this rehab focuses on.

My rules of at-home treatment

The most important rule being the one that is most often neglected!

The order of application makes a tremendous difference.

If you start rehab prior to getting the inflammation away I have seen next to zero recovery from this issue.  This is such an important factor that I cannot emphasize it enough. It is why I think the majority of rehab treatments for plantar fasciitis tend to fail.

Step 1!   You need to get the inflammation out prior to any start of rehab.

The stretches, the balls, the tools, the manipulation and mobilization needs to happen as the inflammation is under control and done. Why do you think cortisone is the recommended injection from the podiatrist? It is an anti-inflammatory.   

Often times when the inflammation is under control the pain also decreases or disappears- now is the time to start doing rehab. It blows my mind how often I hear in my clinic, “ I had this issue a few years ago on an injection made it go away.”   No – the injection stopped the inflammation – the problem still remained.    Cortisone doesn’t stop your crappy running form Karen.

This time around, plantar fascia version 2020-let’s do it better,  more thoroughly, finish the problem and then start to dive into how feet should function and move.

Ice – I prefer a frozen water bottle so you can strip out the fascia at the same time. This needs to be done DAILY. And keep working it until numb, usually 8-10 minutes. Work the fascia out with the ridges and contours of the bottle. (as seen on this bottle)
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You will get to the stage you might not need to do this, but you can’t go wrong here – if the foot is inflamed you need help putting the fire out!

step 2) shoe wear.   

Don’t use flip flops while there is pain.  Look, flip flops aren’t great. They make your big toe move incorrectly and then the foot is screwed up. I get it though, they are easy and practical and a common part of our days- people just won’t give them up.

Flip flops and dare I say it?  Shoes in general,  just jack up your motion man. They also force the foot to bend as one piece at the push off phase and this limits motion and rotation. This keeps the function of the foot less than optimal. Keep the flip flops if you have to, but save them for when your foot is fixed.

Limit your orthotics – (cough.. throw them in the trash)

This is where I get the most resistance in my office – these things are expensive, most likely ordered from a pro and you like them – I get it. But, the built up arch supports limit full ROM.  This really helps with pain initially but keeps perfect and proper motion which is vital while trying to fix the issue. Its vital to human movement.

Same reason I’m not a huge fan of the slings and braces – I want motion!  There are a few main arches in the foot and we want them mobile and functional, not limited! If you guys are in love with these things, keep them with you but try hours on and off and see what works better. Remember these are general rules of rehab, not laws and absolutes, everyone is different, but this seems to work in our clinic much faster than staying in them 24/7.

As I dove into the foot function more I found a group out of Canada made up of some fantastic physio’s that just have a knack for telling it like it is.  The group TFC (The Foot Collective is definitive worth your time if you want to really dive into it.)   They are very like minded, as our nearly all of the modern era progressive foot people.  To paraphrase TFC, “So you have super stiff and immobile feet huh?  It’s killing you to walk? Why in the world would you treat stiff and immobile with more stiffening and more immobility?   Get moving things moving again!  That’s your treatment.”  TFC, as well as myself recommends going barefoot as often as possible.

3) spell the ABC’s with your foot – Especially first thing in the morning –first two steps hurt like crazy and the fascia is restricted and stiff.   Get back into bed and put your foot through a full alphabet of movement. This isn’t a fix but at least you put the foot through all kinds of great ROM and it helps move the tendons, bones and fascia. This usually at least gives notable relief on the first agonizing steps out of bed.

4) Force Foot, Toe and ankle motion –    This is where again I would check out TFC.   https://www.thefootcollective.com/  You need this.   They are the best in the game.  Wiggle your toes, make a “foot fist”, rotate through the ankle not around it…etc. 

TAC balls  – (link to chadknows video)  use motion in all planes – look again at the picture of the foot and the different arches. Think of the inside of the foot, navicular bone specifically and the outside of the foot, the 5th metacarpal and cuboid bones.

Follow these steps: (with ball) Barefoot is best as these specific balls (TAC BALLS) have some grip and work the fascia better than a Lacrosse ball or tennis ball.

  1. Roll the ball from the front to the back – the length of the foot (not back to front however)
  2. Heel down, toes up – pivot shift side to side on transverse arch
  3. Inside of arch (navicular) – Smash and Shimmy then extend foot and toes
  4. Outside Mid Foot  – Smash and Shimmy then extend foot and toes
  5. Ball of Foot – Clamp Down and squeeze ball
  6. Separate Four toes and Big toes – separate squeezing
  7. Heels Down, Toes up- pivot and shift on ball of foot
  8. Using your hands – work the toes, foot  – knead and separate

This is a 2-3 minute process – work it, love it, get to know your feet – Get your feet back!

Usually there are other issues such as low back, hip rotation issues (every time), calf and anterior tibia strength ratio issues and others.   Then get to the cause – what are you doing to cause this.  I’ll fix this in 30 minutes in my clinic and you’ll undo this for the next 10 hours daily.  It’s a net loss and a comlete loss over time.  You need to fix this.    TFC recommends 2 minutes, 2x/day of self work for a minimum of two weeks as the MED.    I’m stealing this as our clinical protocol as well.   Easy to remember and apply.   

I’m guessing this isnt where you are at right now.  Experience tells me most of us are trying “mash the hell out of for a day and limp around the next two or three days and then say, “it’s not working”    

version 2020 – have a better plan!

Its a monster of an issue but that doesn’t mean you cant fix it.  I hate to tell you brother, but you’re going to have to handle most of the work yourself on this one.

Just like everywhere in the body, one thing leads to the next. There is a systematic and bigger approach to fixing this condition than just attacking where it hurts. We say in the office all the time, “The victims scream, but the Culprits hide!”

Remember that 20 different issues are all called the same thing they are all PF and these 20 different injuries need different treatments if they are going to be successful.