Tom Myers

DIY Friday: Plantar Fasciitis

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*Do it yourself! Every Friday we do a roundup of great posts, videos, or other resources around a theme that help people to turn their bodies from cranky to happy.*

A recent chat with the Facebook tribe started to go down the plantar fasciitis rabbit hole, so here I am dedicating a DIY Friday to it! I also have an interview coming up next week with Jae Gruenke, founder of Balanced Runner, and since so many runners struggle with plantar fasciitis it seemed like a theme was emerging.

First, what the heck is plantar fasciitis? The short version is that the plantar fascia (fascial sheet on the bottom of your foot) begins to pull away from it's attachement on the calcaneus (heel bone) and you wind up with some pretty gnarly burning heel and foot pain. In the book Born to Run* author Christopher MacDougall describes it as the runner's version of a vampire bite, because, as runner legend has it, once you're "bitten" with plantar fasciitis many feel you are never the same again. Well breathe deep because I'm here to tell you that plantar fasciitis is one of those things that I actually have in the "easy" category in my brain simply because I see it resolve so often and so readily. Which isn't to say it doesn't take some doing, but here's how:

  • Erik Dalton is a brilliant manual therapist and teacher, and this video is the clearest description I have found of what is actually going on in plantar fasciitis. The article that precedes the video also does a fanstasic job of explaining how it's not just your foot. It's never just one thing. Never, ever. But it's always helpful to be educated on the more global view of any condition, which is what this article handily does! If you are a manual therapist, there is also great content here on how you can treat it in your clients. If you are not a manual therapist, please don't go grabbing your friend's leg and shoving and shaking stuff around! It actually takes a good bit of learning in order to effectively contact fascia and to know how to appropriately work joints like he does in the video, so just mashing on your buddies is likely to cause more harm than good. The article is here, and the video is at the end of it.

 

  • Speaking of taking a global view, as Dalton mentions in his article, "Plantar fasciitis often results from lack of individuality of motion in the calf muscles due to adhesions." That is very true, and taking it a bit further, it is an issue with the whole posterior chain of fascia. Otherwise known as the "superficial back line" as defined by Tom Myers Anatomy Trains work. Here is a great image of that line. So, if you want to resolve your plantar fasciitis, give due attention to everything here along the chain as well.

superficial_back_line_copy

  • Oh look! Here's recently interviewed Sue Hitzmann of the MELT Method preaching it like she teaches it, and is also talking about plantar fasciitis as a global issue:

  • Oh wait! What do we have here!? It's Katy Bowman of Restorative Exercise talking about plantar fasciitis as a global issue (in particular those persnickity hamstrings with some data that talks about why). Hmmm, maybe it's not just about the foot...

Ok, ok, taking all this good input about how it's not just your foot and moving forward with a healing plan for yourself here's what I actually like, a lot, for treating plantar fasciitis:

Smart fascial manual therapy from either a practitioner, or you can MELT at home.

Softness! Learning how to soften your foot is a game of coaxing it to let go, not of yanking it around. I like hamstring stretches that have a fully dorsiflexed ankle (bring toes toward shin) so that you're not missing tight bits in your calves. This would look like lying on your back with a strap around the ball of your foot, and flexing at your hip to bring the foot closer to the ceiling. Though stop when you hit your own end range with the flexed ankle (rather than pointing the toe to get farther). You can also stretch standing on a slant board like this one, again, I like a soft surface to a slant board, and it is also very helpful to think about really letting all the musculature of your foot soften into is as you stretch. Think of your plantar fascia as warm, gooey silly putty that is just oozing onto the slant board. Do not hyperextend at the knee or shove your pelvis forward ofyour ankles while standing on a slant board.

Alexander Technique. Speaking of letting the musculature go, I find so many people micro grip in their feet as a result of stress, or strain and pain patterns elsewhere in the body. I love Alexander Technique as a way to learn about your own micro grips and how to find a way to let them go. I recommend working with a teacher, rather than doing this alone at home, as you will need trained eyes to point out things you have become totally blind to in your own body. Most people are amazed at how much they are subconsciously clawing at the floor with their toes. No really.

* Footnote: If you haven't read Born to Run I highly recommend it. And if you are a runner, I practicaly require it (if I could do such a thing). It has a lot of  fascinating information, particulary when it comes to the evolution of highly engineered running sneakers paralleling the evolution of highly unpleasant runner injuries, and is also a beautifully written and engaging story.

The Fountain of Youth in Your Fascia

2791037745_74d1e51438_bWe've been on a bit of a roll here about how a healthy physical structure can have pretty significant anti-aging and even reverse aging benefits. In my recent post on the top 5 ways to age-proof your body, I talked about the large role that fascia plays in aging. To get into that a bit more I wanted to put up this video of Tom Myers, creator of Anatomy Trains and founder of Kinesis Myofascial Integration because it's a great and succinct bit of info on how we "dry out" as we age, and the profound aging benefits of keeping your fascia hydrated and healthy. Come meet the fountain of youth in your fascia: (The video was made by the good people over at Wellcast Academy.)

Photo by martineno

Your inner cobra (getting to know the deep core)

cobra1The upright human posture and plantigrade gait requires a delicate balance to keep the ventral cavity operating at its functional best. Solving problems in the abdominopelvic region has focused primarily on the horizontal belt surrounding it: the transversus abdominis and its fascial connections to the thoracolumbar fascia and neural connections to the levator ani of the pelvic floor. The concept of ‘core support’ has ramifications to proper sacroiliac stability, lumbar support, pelvic floor health and continence. and a good foundation for respiration – and even on up to shoulder balance and neck strain.

While support in this outer belt is important, and the exploration has produced positive results for patients, less emphasis has been placed on a primary myofascial relationship which is of equal importance to human function, which could be termed our inner ‘cobra’. The cobra lurks inside the belt, and is essential for easy lumbar support of the rib cage, and links the rhythm of breathing and walking.

Cobra 2Our inner cobra is made up of the psoas major muscle and the diaphragm considered together as a functional unit. While these are often depicted as separate in the anatomy books, in the dissection lab the fascial connections are very clear between the diaphragm and the psoas major.

The posterior diaphragm is rooted into three structures: 1) the crura, which blend from the aortic arch into the anterior longtudinal ligament along the front of the lumbar vertebrae, 2) the psoas major (and, if present, the minor) which reaches down from each diaphragmatic dome to the lesser trochanter of the femur, and 3) the quadratus lumborum rooted down to the iliac crest and iliolumbar ligament (and in fascial terms beyond into the iliacus and iliac fascia).

There are two cobras, one on either side of the spine. The tail of the cobra is the lower end of the psoas, curled around the neck of the femur parallel to the pubofemoral ligament. The cobra’s ‘body’ goes forward of the hip joint itself, and then retroperitoneally back behind the organs to lie of either side of the lumbar spine. The ‘hood’ of the cobra is the spreading dome on each side of the diaphragm. In the image, the cobra’s face would be at the front of these domes, approximately at the end of the 6th and 7th ribs.

Cobra 3Considered as a functional whole, the balance of these two muscles is essential for respiratory and spinal health. Get the balance and function of these two cobras correctly, and it will matter less whether your patient has ‘washboard’ abs or ‘washtub’ abs. With a strong and balanced cobra, tight abs are less necessary to upper body support.

When the cobra gets too short, the cobra lifts up and exposes its throat, so to speak – in postural terms, the lumbars get more lordosis and the rib cage tilts back, restricting breathing in the back of the diaphragm. When the cobra loses tone, the head of the cobra dips, the lumbars fall back and the rib cage falls, restricting breath in the anterior part of the diaphragmatic domes.

Learning to read and correct the position of the cobra offers a new aspect to core support that supports the upper body easily, dynamically, and with less residual tension than just slamming down those abs.

Endlessly tightening the TvA, though it does offer increased support, also restricts movement, especially respiration and the organ excursion from respiration essential to their health. Your organs are ‘massaged’ neatly 20,000 times per day by the breath – restriction of the ‘abdominal belt’ and the ‘abdominal balloon’ may create support at the cost of essential function.

Learning to see, assess, and treat the ‘cobra’ of the psoas-diaphragm complex renders core support truly at the core, linking pelvic neutral and lumbar neutral with an easily functioning diaphragm.

                                                                                               

*The original post Cobra  is re-posted here with permission from from Anatomy Trains and Tom Myers

About the Author

Thomas Myers studied directly with Drs. Ida Rolf, Moshe Feldenkrais, and Buckminster Fuller. He has also studied less extensively with movement teachers Judith Aston, Emilie Conrad, and in the martial arts. His work is influenced by cranial, visceral, and intrinsic movement studies he made with European schools of osteopathy.

An inveterate traveler, Tom has practiced integrative manual therapy for over 30 years in a variety of clinical and cultural settings, including 10 years in London, and traveling practices in Hamburg, Rome, Nairobi, and Sydney, as well as a dozen locales in the US. He is a member of the International Association of Structural Integrators (IASI).

Author of Anatomy Trains (Elsevier 2001) and a set of supporting videos, Tom has also penned over 60 articles for trade magazines and journals on anatomy, soft tissue manipulation, and the social scourge of somatic alienation and loss of reliance on kinesthetic intelligence.

A certified Touch-in-Parenting instructor, Tom retains a strong interest in peri-natal issues relating to movement.

Living on the coast of Maine, Tom directs Kinesis, which conducts professional certification and continuing education courses worldwide.

To read more about Tom Myer's work, please visit Anatomy Trains.