Plantar Fasciitis can be frustrating. A painful heel can get in the way of work, and prevent you from enjoying things such as walking, running, playing golf, or exercising. To make matters worse, Plantar Fasciitis is often slow to respond to traditional types of care, often creating further disappointment and aggravation.
Now for the good news…..
A new treatment technique known as Active Release Techniques® (ART®) is proving to be a very effective method to treat many common foot problems, including Plantar Fasciitis. But before we talk about how ART works, let’s first talk about how Plantar Fasciitis develops.
How Does Foot Pain Occur?
All musculoskeletal injuries, including plantar Fasciitis, occur through one simple principle, the load (i.e. the physical stress or strain placed on an anatomical structure) exceeds that structures capacity to tolerate that load. This seems logical to most people when thinking about traumatic injuries such as sprained ankles or broken bones, but what most people don’t realize is that the damaging and excessive loads do not have to happen all at once. Instead, many injuries are categorized as overuse or repetitive strain injuries, meaning pain and tissue damage are not the result of strain or overload from a single event, but instead occur as the musculoskeletal system (in this case the foot) is exposed to a large number of sub-maximal forces over weeks or months. In these cases, tissue damage occurs slowly over time, eventually accumulating to a critical point in which symptoms are felt. This is why in most cases it is difficult to trace the pain or symptoms back to a specific incident or event.
To better understand the occurrence of overuse injuries it is important to realize that there is a significant amount of stress placed on the muscles, tendons, fascia, and ligaments of the foot on a regular basis. Even simple activities such as walking, prolonged standing, or climbing a flight of stairs requires the foot muscles muscles to work hard in a effort to move and stabilize the bones and arch of the foot. With sports such as running, soccer, or tennis, the demand on the foot is even greater.
How does damage accumulate in the muscles, tendons, fascia, and ligaments?
Over time the strain on the foot can develop into what is know as micro-trauma. Simply stated, micro-trauma is very small scale damage that occurs in the muscles, tendons, and ligaments in response to small levels of strain. Although only small, and initially is not painful, this damage still needs to be repaired, which the body does by forming new tissue in and around the injured area. This new tissue, often referred to as scar tissue or soft tissue adhesions, is very sticky and acts to ‘glue’ the damaged tissues back together.
Unfortunately, over time this scar tissue can build-up and accumulate in the muscles, tendons, and ligaments of the foot. As this happens it places more and more strain on the area as the muscles must now stretch and contract against these adhesions (normally muscles need to be able to move and slide against each other, but these adhesion act to ‘glue’ them together…. this is a big problem). This in turn places even further strain on the foot, which leads to even more micro-trauma. Essentially a repetitive strain injury cycle is set-up causing continued adhesion formation and further increased strain on the foot. At this point pain and tightness at the foot and surrounding area will start to become noticeable.
As this repetitive strain injury cycle continues the ability of the foot muscles to meet the demands placed on them diminishes. At this point it is not uncommon for the muscles to give way and a more severe and debilitating pain occurs. In fact, many patients come into our office explaining how they have plantar fasciitis pain but they did not really have any major type of injury occur. As you can see from the explanation of the repetitive injury cycle, these types of injuries build-up over time until it eventually develops into larger scale injury.
How Can These Foot Problems Be Fixed?
The Traditional Approach….
Some of the more common treatments for plantar fasciitis include include anti-inflammatory medications, rest, ice, ultrasound (US), muscle stimulation (E-Stim), laser therapy, wearing braces around the foot or ankle, and stretching or strengthening exercises. The main reason that these approaches are often ineffective is that they fail to address the underlying scar tissue adhesions that develop within the muscles and surrounding soft tissues. It is these adhesions that are binding the muscles together, restricting normal motion, and interfering with the normal flexibility and contraction of the muscles in the foot.
Passive approaches such as medications, rest, ice, and ultrasound, all focus on symptomatic relief and do nothing to address the muscle restrictions and dysfunction. More active approaches such as stretching and exercises are often needed for full rehabilitation of the condition and to restore full strength and function of the muscles, however, they themselves do not treat the underlying adhesions. In fact, without first addressing the scar tissue adhesions, stretches and exercises are often less effective and much slower to produce relief or recovery.
Our Approach: Active Release Technique® – A Better Solution
ART® is a new and highly successful hands-on treatment method to address problems in the soft tissues of the body, including the muscles, ligaments, fascia, and nerves. What makes ART® different from other treatments is that it is designed to identify and address scar tissue adhesions that are interfering with the normal strength and flexibility of the body, not simply stretch out the muscles.
If you are unfamiliar with Active Release Techniques® you can think of it as a type of active massage. The practitioner will first shorten the muscle, tendon, ligament, or joint capsule, and then apply a very specific tension with their hands as they actively stretch and lengthen the tissues. As the tissue lengthens the practitioner is able to assess the texture and tension of the tissue to determine if the tissue is healthy or contains scar tissue that needs further treatment. When scar tissue adhesions are felt the amount and direction of tension can be modified to treat the problematic area.
One of the best things about ART® is how fast it can get results. In our experience, the majority of plnatar fasciitis problems respond very well to ART® treatment. Although each case is unique and there are several factors that will determine the length of time it will require to fully resolve the condition we usually find a significant improvement can be gained in just 3-4 treatments.
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