PLANTAR FASCIITIS AND ACHILLES TENDONITIS - Why It Should Be Easy To Get Better
I’m assuming, if you’ve landed here, you have had one of these conditions and you know what it is. I won’t go too deep into either condition but I will show you our approach to getting them better. They are very different but I wanted to share with you why the iMove Team are successful at treating Plantar Fasciitis and Achilles Tendonitis.
Whilst the conditions can last for 6-12-18-24 months we feel at iMove Physio that too many people are suffering for too long. You should notice significant improvement on a weekly basis in the first 6-12 weeks. There really is no excuse to have either condition hampering you for >6-12 months.
I will outline our multimodal approach and how we attack these conditions from several angles as well as the common points in rehab AND where people go wrong;
MULTIMODAL APPROACH (AKA ATTACKING IT FROM ALL ANGLES)
The people that come and see us at iMove Physio for ongoing plantar fascia and achilles tendonitis have usually tried 1 or 2 things but haven’t ‘gone hard’ early to really settle the symptoms down. Trying several of the following at the same time is crucial;
I will start by asking you to reduce your load by 50% depending on how bad your symptoms are. Even if it’s mild I might still go 50%. It also doesn’t matter if you’re running 15km per week or 60km per week. We need to pull your load right back and see if we get a change in symptoms. If you miss this crucial first step, where we can settle your symptoms down to a 2-3/10 pain, then you have no base to work from.
In fact, the most common mistake we see people make, who have had issues for >3months, is a failure to aggressively reduce their load in the first 2 weeks. The beauty of being so strict in the first 2 weeks is to get a rapid change and for you to know that your symptoms are changeable. Now we are working with something.
MONITOR YOUR PLANTAR FASCIA AND ACHILLES PAIN;
This is crucial as too often it is hard to recall exactly what triggered your symptoms or on the flip side what made you feel better. A simple spreadsheet, diary or A4 paper on the fridge to give yourself a score out of 10 in the morning, during exercise and at night is ideal. We can’t change what we don’t measure and too often people with symptoms for > 3 months have never been measuring their symptoms. This makes it extremely difficult to know what is helping and what is hindering.
SHOES - FINDING THE RIGHT PAIR - USING MULTIPLE;
In your first 2 weeks it is a great idea to trial 2-3 different pairs of shoes and see which ones have you feeling better or worse. Again symptoms that are changing are a great sign and often, even a shoe that makes you worse is a good clue. Once you find the shoe that has you feeling 1-2 points better we might stick with this for a week.
There is also a good argument to rotate your shoes once your symptoms are settling. Every shoe will load your structures in a different way and it is this variability that can help settle your achilles or plantar fascia down.
If your struggling, the general advice I will give is to have a shoe with a higher heel toe drop. Ie a traditional asics running shoe usually has a 12mm heel. This can take the strain or stretch out of your achilles and plantar fascia and can really help in that opening 2 weeks.
Lastly, for people who are really struggling or are still hovering around the 6-8/10 pain the HOKA shoe with the rocker bottom can really help. The idea is that the should of the shoe does the work for you and propels you forward thus resting your irritated structures.
Taping the foot is an amazing short term strategy to reduce symptoms and often will have our patients walking out 30-50% better. Whilst we know that the taping doesn’t hold for very long it does seem to do enough to change the way we use our foot and again this variability is what really helps and irritated achilles or plantar fascia. I will often tape someone 2 days on and 1 day off to keep it nice and strong and avoid skin irritation.
You’ve all seen it, you’ve all done it. Get on the ball 3-5 times a day for 1 minute. It’s some great short term relief. It may change the way we load our foot which all helps. Do it more frequently. If your achilles is struggling roll both your foot and your calf.
See how to roll here;
The research has shown us that just holding a static muscle contraction (isometric) can have a great pain relieving effect on our tissues. This has been comparable to paracetamol for pain. Like the rolling, we need to do this more often. 2 sets of 40 seconds, 3-5 times a day, or whenever you’re feeling symptoms. As well as being pain relieving this gives us a great base to go towards our more traditional exercises that get the muscles and tendons of the foot stronger in the long term and therefore prevent plantar fascia and achilles issues coming back.
We often see people with ongoing PF and Achilles pain who have significant difference in their ankle mobility or stability. When we identify and work on these areas we increase the proprioception at the joint and again, this causes some movement variability which will help offload the irritated structures. Don’t forgot to check your ankle with a simple knee to wall test and it is common the side your symptoms are on is usually a bit stiffer.
How to assess and treat any ankle mobility issues here > https://imovephysio.com.au/ankle-mobility/
It is not uncommon that we will apply all of the above points in the first 2 weeks. This has most of our patients feeling 50-75% better in the first 2 weeks. You need to be diligent in setting up your rolling, your exercises and having a footwear strategy. You have no choice though, do this, or have issues for 6-12 months. Get on top of it. Attack it from all angles. At this point in time your symptoms should be down at 2-4/10 and your finding your exercising is leaving you with less symptoms. We now enter Phase II, which is all about finding the right load and staying in a decent symptom range. Not symptom free but a decent symptom range.
THE 10% RULE WITH PAIN SCORES;
So you’ve been hovering at around 50% of what you normally do, your symptoms are settling, although still there. This is where big mistake number 2 occurs. You increase your load too soon. We pulled you back to 3k runs and you went out and did a 5k. We pulled you back to non impact gym sessions and you went out and did skipping or box jumps.
In Phase II you should only increase your weekly load by 10%. Anymore and you will enter the downward symptom spiral of PF and achilles tendonitis.
To help you with this, use your pain/symptoms scores. You should only be at a 2-3/10 both when performing the activity, after the activity and the next morning. If either of those has elevated to a 5-6/10, then whatever you did the day before is too much. You need to review what you did, and do even less, for the next 1-2 weeks. That is your new base. If you find the right base, you win. If you keep pushing, you lose.
PHYSIO EXERCISES ARE LOAD;
Yes, our exercises can make you worse. This is all part of it. This is normal. We need to find a base that can get the muscles stronger AND keep you exercising. Sometimes we don’t give you enough. Sometimes we give you too much. Stick with the process and keep up constant communication. Email us if you have questions. Let us know as it’s happening. Adjusting on the fly is better than letting it go a week and giving up on the exercises.
Keep in mind the only evidenced based treatment to get both plantar fascia and achilles tendonitis issues better is graded exercises. However, when we introduce these you are actually adding more load, albeit controlled load. This may mean that the 3K run you were doing at a 2-3/10 now has you feeling slightly worse. This is OK. We adjust. This is often where patients will discharge because something we did together made symptoms worse. It is important to understand we will overload you on the journey and we will underload you on the journey but your overall trajectory is up!
Credit: Adam Meakins: The Sports Physio.
NOW WE’RE GETTING SOMEWHERE;
After the initial bumps in PHASE II you will start getting into a rhythm of doing your physio exercises and increasing your activity by 10% per week. You may still have a 1-3/10 pain but you are now able to walk in the morning and complete an exercise sessions. This phase can last anywhere between 2-12 weeks. The good news is you can see the light at the end of the tunnel. Your increasing your activity and you feel your finally getting somewhere.
Big Mistake 3. Returning to your normal load, pain free, and stopping your exercises. “WHAT!!??, I’ve got no pain, I’m back doing what I need to be doing, but I’m not done yet?” - Not even close. If you want to keep this away and progress your activity you need to get better than pre-injury status. This is our goal for everyone that comes through iMove Physio. “Better than pre-injury status”. It was your pre injury status that got you injured, right? So we need to be stronger than that.
STRENGTH TO KEEP IT AWAY;
You need to progress your exercises over the next 3-6 months. You should be doing single leg calf raises and single leg soleus raises with 10-15-20% of your body weight in a backpack. This is loading you beyond body weight, getting you stronger, allowing for spikes in load, allowing for fatigue and most of all helping you to prevent injury. We see too many people discharge themselves and they are only doing basic calf raises, pain free, but they go back to there normal loading pattern. This is a recipe for recurrence of injury.
- ‘Go hard’, settling symptoms in the first 2 weeks. Use tape, rolling, isometrics, footwear changes and reduce your load by 50%. Your symptoms should rapidly improve.
- The middle phase is all about slowly increasing your activity and your physio exercises, it will be up and down but use 2-3/10 as a guide to finding a base to work off.
- Load beyond your means. Once better you need to add weight and speed to your exercises. Continue them for 3-6 months.
If you are having persistence plantar fascia pain, plantar fasciitis or achilles tendonitis/tendinopathy then get in touch with 1 of 3 clinics or book online below;
iMove Physio Miranda: (https://imovephysio.com.au/miranda/)
iMove Physio Panania: (https://imovephysio.com.au/panania/)
iMove Physio Rozelle: (https://imovephysio.com.au/rozelle/)
iMove Physio Miranda Services These Suburbs:
- Gymea Bay
- Yowie Bay
- Taren Point
- Caringbah South
iMove Physio Panania Services These Suburbs:
- Revesby Heights
- East Hills
- Picnic Point
- Padstow Heights
- Condell Park
- Voyager Point
iMove Physio Rozelle Services These Suburbs:
- Balmain East