Pilates for the alleviation of symptoms caused by Plantar Fasciitis

Transcription

1 Pilates for the alleviation of symptoms caused by Plantar Fasciitis Bobbie Garza September - December, 2017 Comprehensive Foundation and Graduate Costa Mesa, CA 2016

2 ABSTRACT Plantar Fasciitis is a very common condition that causes intense pain in the heel and bottom of the foot. The condition involves inflammation, irritation and/or degeneration of the plantar fascia, a flat band of dense connective tissue that connects the heel bone to the toes, and responsible for supporting structures in the bottom of the foot. Plantar fasciitis occurs when some type of stressor disrupts the attachment point of the plantar fascia at the heel bone. (5)(6) The hallmark of plantar fasciitis is pain caused upon waking and taking the first steps when getting out of bed. At night while you sleep, your foot relaxes with the ligaments in a shortened position, allowing the damaged soft tissue to begin to repair itself. When you awake and put weight on your foot, the arch lowers and increases the stretch in the plant fascia. With each step, re-tearing of the half-healed ligament occurs, causing pain. (5) Several factors can contribute to the damage that occurs in the plantar fascia, including improper footwear, high or low arches, walking on hard surfaces, tight muscles, injuries, aging (over 40), excess body weight and pregnancy. Every expert suggests a different and variable range of treatments from icing to massage to orthotics. There are, however, two points that these experts all agree on: 1) the problem must be addressed and treated in the acute phase, before a tear in the plantar fascia occurs or a heel spur develops; 2) ideal treatment includes stretching and strengthening the intrinsic muscles and ligaments of the foot, stretching the calf muscles and correct posture. Pilates addresses each of these needs and is an excellent modality to use for the treatment of the symptom and pain associated with plantar fasciitis. 2

3 TABLE OF CONTENTS ABSTRACT 2 ANATOMICAL DESCRIPTION.. 4 CASE STUDY 7 CONCLUSION BIBLIOGRAPHY..13 3

4 ANATOMICAL DESCRIPTION The foot, which serves double function bearing the weight of the body and performing dynamic movements necessary for walking, is comprised of 26 bones, 31 joints and 20 intrinsic muscles. Pain associated with Plantar Fasciitis is located in the plantar fascia, or plantar aponeurosis, a strong layer of white fibrous tissue located beneath the skin on the sole of the foot, connecting the calcaneus to the metatarsals. It stabilizes the arch of the foot and allows flexion of the first metatarsal (hallux), enabling the hallux to carry the majority of the body weight. It also provides shock absorption when the foot hits the ground. (1)(2) Laterally, the plantar apoeurosis is divided into three sections: the medial, the lateral, and the central. The central portion is the most important structurally and functionally, and is attached at its origin to the medial calcaneus. Towards the front of the foot, at the mid-metatarsal level, the central portion divides into five sections, each extending into a toe. 4

5 The medial portion overlies the muscles to the hallux (big toe), while the lateral portion overlies muscles to the fifth metatarsal (little toe). (2) In addition to the plantar aponderosis, three more ligaments comprise the major ligaments of the foot. These ligaments are located at the transvers tarsal joint and are essential in maintaining stability in the longitudinal arch. Two layers of plantar calcaneicuboid (short plantar) ligament extend from the calcaneus to the cuboid and the base of the metatarsals. The long plantar ligament is located superficial to the short plantar ligament, extending from the calcaneus to the ridge on the cuboid and on to the bases of metatarsals II-V. Lastly, the plantar calcaneonavicular ligament attaches the sustentaculun tali to the navicular bone. It is important to mention these additional ligaments, as the client experienced secondary pain in the area of the plantar calcaneonavicular ligament and deep into the short and long plantar ligaments. (1)(3) 5

6 Also important to address, are the muscles and tendons of the lower leg and ankle, specifically the calf muscles and Achilles tendon. Tightness in the calf muscles and Achilles tendon will pull the heel up and back, causing a reduction in dorsiflexion and placing tension on the plantar fascia. Reduction in dorsiflexion can be a mechanical determinant in plantar fasciitis. (4) The calf muscles are collectively known as the triceps surae; the strongest muscle group of the leg. It consists of three muscular heads, all of which terminate on the Achilles tendon, which inserts on the calcaneus. Soleus is the deepest of the head of triceps surae, and originates on the posterior surface of the tibia and fibular shaft. The soleus is covered by the two superficial heads of the gastrocnemius that shape the outlines of the posterior calf, originating from the posterior surface of the femoral condyles. (1) 6

7 CASE STUDY Jennifer is a 43-year old mother of two who began experiencing intense heel and foot pain, believed to be caused by plantar fasciitis. Her symptoms were consistent with those associated with the common foot problem extreme pain when taking the first several steps after getting out of bed in the morning, pain that felt like walking on a bed of nails but would subside after 15-minutes or so. Jennifer was also sensitive to pressure when applied to the bottom and inside of the heel. The symptoms were consistent in her right heel and foot, however the pain would only occasionally occur in the left heel and foot. This was not Jennifer s first experience with plantar fasciitis. Shortly after giving birth to her second child she began to experience the same pain. At that time, Jennifer wore high heels daily to her office, experienced weight gain with her two pregnancies and had just turned 40 years old. After discussing the symptoms and risk factors with her primary care physician, they concluded that it was in fact plantar fasciitis. Together they established a treatment process including massage/reflexology, acupuncture and frequent icing. After several weeks following the plan, the pain relief was subtle and would still come and go. With two small, very active children and a demanding career, she decided to receive a cortisone injection. The pain relief was immediate and all symptoms disappeared. Three years later the symptoms returned suddenly and the pain was even more intense. In the three years that had passed, many things had changed in Jennifer s life. Jennifer transitioned to a part-time job, working from home. One would assume that no longer having to wear high 7

8 heels would lessen the symptoms of heel pain. However, Jennifer rarely wears shoes while walking around on her hardwood floors at home, and when she leaves her home office she is often wearing flip-flops or other non-supportive shoes. Jennifer has been practicing Pilates for several years, but recently has only participated in an advanced-level class. Most exercises performed are very challenging and provide an excellent workout. However, Foot Work is often eliminated in this class with a more focus placed on strength building and little attention paid to stretching. During our initial meeting, my first observation was a slight deviation in her gait. She walked with a slightly increased pronation in her right foot, indicating inadequate ankle dorsiflexion. I also observed a deviation in per posture common with tight hamstrings and hip flexors. This was confirmed during my assessment of her posture and alignment in her initial roll-down. In developing a Pilates program for Jennifer, I chose to focus on four goals when selecting exercises: 1. Stretch and strengthen the intrinsic muscles and ligaments in the foot 2. Stretch the calf muscles 3. Stretch the hamstrings and hip flexors 4. Focus on pelvic stability to improve posture Consistent with most of my research on the treatment of plantar fasciitis, Jennifer was experiencing a slight increase of pain when her feet were in a position with weight bearing on 8

9 the ball and toes (ex. Up Stretch 1, 2 and 3). Therefore I decided to eliminate any exercises where the foot was placed in this position for our first session. We were able to add these types of exercises to all subsequent sessions, without limitation and without pain. FIRST SESSION - REFORMER ONLY Block Exercises Focus Warm Up Pelvic Curl Spine Twist Supine Chest Lift Chest Lift w/rotation Pelvic Curl - focus on finding and keeping a neutral pelvis, watching that knees track over ankles and feet remain flat Foot Work Entire Foot Work Series, excluding Prehensile A major emphasis was placed on the Foot Work Block! Each of the exercises strengthen and stretch the intrinsic muscles and ligaments within the entire foot. Calf raises and prances allow for ideal stretching of the calf muscles. Attention was also focused on maintaining a natural pelvis and watching the knees and feet remained parallel Abdominal Work Short Box Series All abdominal work will help to improve posture. I chose the Short Box Series for the additional lateral flexion and rotation Hip Work Spinal Articulation Frog Circles Up Circles Down Openings Short Spine Long Spine Hip Work is essential for working on pelvic stability and to strengthen hip flexor and extensors, and hence improving posture Both exercises are excellent for keeping the spine and hips healthy, therefore improving posture. 9

10 Stretches Standing Lunge All exercises from the Hamstring Stretch Group are ideal for stretching tight hips flexors and hamstrings. I chose the Standing Lunch to avoid putting too much pressure on the ball of the foot Full Body Integration-F/I Elephant Elephant provides an excellent stretch for the calf and hamstring muscles Arm Work Rowing Series Rowing Series for the additional spinal flexion and extension offered in the exercise Full Body Integration-A/M Eliminated Leg Work Side Split For that extra inner thigh stretch Lateral Flexion/Rotation Mermaid Again, for that little extra stretch and for keeping the spine healthy, improve posture Back Extension Breaststroke Strengthen the back extensors to help with posture In our next three sessions we incorporated several additional exercises that would lend themselves to the focus of our four primary goals: Block Exercises Focus Warm Up Cadillac Warm Up Series The Warm Up Series on the Cadillac is great for promoting pelvic stability (Roll-up w/rubar) Foot Work Abdominal Work Entire Foot Work Series on the Cadillac Standing Pike Pike Sitting Standing Pike Reverse Again, the Foot Work Series is critical in achieving each of our four goals. However the Cadillac provides even more opportunity for a greater stretch in all areas of our focus, along with great pelvic stability These three abdominal exercises on the Wunda Chair provide a great stretch in the hamstring and calf muscles 10

11 Hip Work Supine Single Leg Series This series on the Cadillac allows for extra attention to be placed on pelvic stability Spinal Articulation Stretches Full Body Integration-F/I Monkey Original Tower Prep Tower Gluteals Hamstrings Adductors Hip Flexors Sitting Forward Saw The calf and hamstring stretch is intense in these Cadillac exercises. The muscles and ligaments in the foot will also be stretched and strengthened The Ladder Barrel stretches are an excellent option for stretching almost every muscle in the leg and hip These two Cadillac exercises are great full body exercises that also allow for a stretch in the calf and hamstring Arm Work Arms Kneels Side Series This series provides an great stretch in the hip flexors while performing the Deltoid Reach Full Body Integration-A/M Tendon Stretch The name says it all! This advanced exercise not only challenges my advanced-level client, but also provides an excellent stretch in the calf muscle and Achilles tendon Leg Work Lying Side Single Leg Series Maximum pelvic stability is required for this Cadillac series. A slight hamstring stretch can also be achieved in the Circles Forward and Circles Back exercises Lateral Flexion/Rotation Side Lift with PTBar Oblique work is necessary for improving posture and pelvic stability Back Extension Hanging Back In the start position of this Cadillac exercise, you will feel a good stretch in the gluteals and hamstrings and it is a fun exercise to round out a Pilates session 11

12 CONCLUSION Prior to the start of our fourth session together, Jennifer reported that she awoke that morning and took her first steps pain-free! She still had slight pain when deep pressure was applied to the bottom and side of her heel (when pressing with her thumb). One week later ALL pain was gone. In addition to the Pilates treatment program I developed for Jennifer, I asked her to 1) use a spiky massage ball to roll the bottom of her foot and heel daily; 2) ice her foot daily by freezing water in a plastic water bottle and rolling it under her foot; 3) wear proper, more supportive footwear while working around the house. After just four Pilates sessions and following the program outlined, Jennifer was free from pain in her foot and heel. Pilates is the ideal exercise program for the treatment of plantar fasciitis, if used properly. The incorporation of the Foot Work Series is critical in the strengthening and stretching of the intrinsic muscles and ligaments within the foot. Additionally, focusing on exercises that stretch the calf muscles and Achilles tendon is important in the treatment program as well. As long as the symptoms are addressed while still in the acute phase, Pilates should absolutely be included in the treatment program and continued on to prevent future pain and suffering. 12

13 BIBLIOGRAPHY (1) Calais-Germain, Blandine. Anatomy of Movement (Revised Edition). Seattle: Eastland Press, Print (2) Healthline Medical Team. Plantar aponeurosis. Healthline.com. April 13, Web (3) Human Anatomy Atlas. Argosy Publishing, Inc., Version Visible Body. App (4) Bolivar, Y.A., P.V. Munuera, and J.P. Padillo. Relationship between, Tightness of the Posterior Muscles of the Lower Limb and Plantar Fasciitis. Foot & Ankle International, 34, no. 1 (2013): (5) Dombroski, Colin. The Plantar Fasciitis Plan: Free Your Feet From Morning Pain. Lioncrest Publishing, Print (6) Best, George. Plantar Fasciitis Exercises and Home Treatment. George F. Best, D.C., Print Images: Human Anatomy Atlas. Argosy Publishing, Inc., Version Visible Body. App 13