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SET TALK
By Don McCann, MA, LMT, LMHC
MA3267 MH705 MM3717
(Massage Message March/April 2002)
PLANTAR FASCITIS
Recently, I have noticed an increase in the
number of clients who are seeking treatment for pain in their heels and arches.
They are often diagnosed with plantar fascitis, which seems to be the
diagnosis of the new millennium. Plantar fascitis is an inflammation of the
fascia (soft tissues) of the sole of the foot, often complicated by plantar
flexion. The following four examples will illustrate what appears to be
either an increase of the problem, or an increased awareness in diagnosis by
physicians of the problem.
Example 1: Jack, a ballroom dancer, had been
seeing me for shoulder, hip and low back problems. He also complained of severe
pain in the heel and the arch while dancing in long competitions. He noticed
this especially after dancing on the balls of his feet.
Example 2: Shelly was being treated for
injuries following an auto accident with a diagnosis of a cervical flexion /
extension injury, and low back lumbar/sacral sprain/strain. She had difficulty
standing up straight and walking due to the low back injury, and about a week
after the accident she started noticing severe pain in the heel of her right
foot.
Example 3: Jim ran a pressure washing business
and came to me complaining of severe pain in both arms and shoulders. He also
had shaded the backs of his legs and heels on the intake form indicating pain in
those areas. Upon talking to him further I found out that a lot of his work was
done while standing on ladders, and that the pain in his heels got worse when
the pain in his arms and shoulders increased.
Example 4: Sally, a full-figured data input
operator who was only five feet tall, always wore high heels. She initially came
to me for relief of tension and pain in her head, neck and shoulders. Then,
after spending one weekend at Sea World, she came limping in saying her feet,
especially her heels, were excruciatingly painful.
All of the above clients had plantar fascitis,
and in each case the plantar fascitis was brought on by a structural distortion
pattern that originated in the hips and low back and involved the feet.
Jack, the ballroom dancer, was experiencing
pain in his low back and hip, as well as his shoulder, due to a structural
distortion involving his low back. Dancing and spending long hours on his feet
while in this distortion was irritating his heel and the plantar fascia. This
was exacerbated further by his shoes, which had inadequate arch support and
inadequate padding for his heels. Also, the way his foot related to the ground
due to the structural distortion caused the muscles in the arch to be in a
weakened state and incapable of maintaining a proper and balanced support
relationship with the ground. Thus, the tissues of the arch, heel and plantar
fascia were constantly being strained while dancing.
Shelly, who was being treated for her injuries
from the auto accident, also had a low back injury which resulted in a
distortion of the low back and hips. This created an imbalance in her foot that
caused the tissues in her foot to be severely strained whenever she walked
resulting in inflammation of the plantar fascia and heel. Her physician kept
asking her where her foot had been during the accident trying to determine
whether it was injured in the accident. Shelly’s foot had not been directly
injured by the accident, but the distortion in her low back resulting from the
accident created an imbalance in her foot. This imbalance in her foot caused the
plantar fascia to become increasingly strained and inflamed as she went about
her normal daily activities.
Jim, who ran the pressure washing business,
had a structural distortion in his entire back that caused both shoulders and
arms to be internally rotated creating severe pain. This distortion also forced
the feet to compensate for the internal rotation of his shoulders, which put
undue strain on his arches and plantar fascia. In addition, standing on a ladder
for long periods of time caused extreme tightness in his gastrocnemius and
soleus which pull on the heel and the arch. Consequently, the heel and plantar
fascia became increasingly inflamed and painful.
Sally, who always wore high heels, came to me
for treatment of head, neck and shoulder pain. Her right shoulder was also
rotated internally, which caused her left foot to rotate laterally setting up a
strain pattern across her left arch and into her left heel. She aggravated this
strain by wearing inappropriate shoes with high heels, and walking extensively
beyond her conditioning during the weekend at Sea World. Consequently, the
lateral rotation of her left arch was strained by extensive walking, and
exacerbated by inappropriate support from the high heel shoes. In addition, the
high heels caused a shortening of the gastrocnemius, soleus, and hamstrings and
a pulling on the arch. The result – plantar fascitis.
The common thread that runs through all these
cases is that there was an existing structural imbalance before the symptoms of
plantar fascitis appeared for each client. I find this to be true in 90% of
clients that present for treatment with plantar fascitis. The activities of the
clients that actually directly affect the heel would very possibly not cause
inflammation and strain of the plantar fascia if the distortion of the
structural balance was not already affecting the client’s arches and heels.
Evidence to this effect is that prior to having plantar fascitis, each client
had years of using his/her feet in the same way without having the painful
symptoms.
Those of you who have been reading this column
will not be at all surprised when I tell you that to effectively treat plantar
fascitis you need to also treat the structural imbalance from the low back down
the leg to the foot that causes the relationship of the foot to the ground to be
changed.
Some of the most common structural distortions
that I find with people who have plantar fascitis symptoms are:
· foot
rotated laterally
· arches
inverted
· knees
hyperextended
· knee
medially rotated
· ilium
rotated anteriorly
· one or
both shoulders internally rotated
For treatment to be effective for plantar
fascitis I have found that I have to first correct the significant structural
distortion so that the foot is able to relate to the ground in balance. This
essentially takes away the initial cause for the strain and the inflammation. It
is then appropriate to work on the tissues that directly affect the plantar
fascia. These I consider to be any of the soft tissues from the knee to the
toes. I pay special attention to the gastrocnemius, soleus, tibialis anterior,
peroneus longus, peroneus brevis, extensor digitorum, popliteus, plantaris, and
all the muscles and soft tissue of the feet. Again, I find the three-step
approach to be most effective to: first, initially release fluids, toxins and
trigger points; second, release the myofascial holding patterns; and third, work
on the individual fibers that may be strained or formed into adhesions and even
holding mineral deposits. (You can refer to my article on "Being Successful
Using Deep Tissue Techniques" in the November/December, 2001 issue of the Massage
Message, and on our website.) Because of the severe pain of plantar
fascitis, this technique will allow you to be able to work within the client’s
pain threshold and still work deeply to accomplish the release of the adhesions
and strained soft tissue.
All of the above cases improved dramatically
within three to five treatments, and were able to maintain pain-free function as
long as they were able to maintain structural balance.
If the information in this article has left
you with questions, confused or feeling inadequate, there are courses and
workshops you may take for additional education on how to balance structural
distortions, and how to use and apply the three-step approach. One source for
courses and workshops that can increase your knowledge and effectiveness is our
website - www.structuralenergetictherapy.com.
I hope the information in this article will
increase your awareness of effective treatment for supporting your clients with
plantar fascitis. Keep up the good massage therapy until we communicate again in
the next installment of SET TALK.
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