Can you run with plantar fasciitis? Safe limits, hills and hiking

You're listening to the Restoring Human Movement podcast. Thanks for joining the movement, movement. I'm Sebastian Gonzales, show curator and head clinician at Performance Play Sports Care in Southern California. This show's for active people, those who refuse to let pain and injury get in the way of their life and how they want to live it. Trails and trips, fields and courts, whatever moves you. Each episode features rotating host, expert guest, and real clinical conversations that help you move better and trust your body again. Here we go. Today we're covering with a running expert about plantar fasciitis.

We're going to see these three questions you guys submitted. The first question is, can I run through plantar fasciitis? The second is, how do I know if I'm ready for hills? And the third is, does power hiking make it worse? Everyone, this is Mandy Riehl, and we are going to cover those three questions we just mentioned. The first one is, actually the whole thing is kind of about like, can you run despite having plantar fasciitis? Is it safe or risky? So in your experience, is it okay to run with it? And if so, what are some, maybe some concepts that people should be using? Yeah. I'll start by when you should not run through it.

If it's swollen or bruised, like obvious, I can see it type of swollen, you need to rest. If it is something that you are limping while walking for more than a few minutes, like it doesn't seem to warm up, you need to rest. Similarly, if you haven't gone to a medical professional and you're not absolutely sure it's plantar fasciitis or a similar type of condition, you need to go rule out a heel stress fracture. Past that, you can probably run through it. So I've run through my own plantar fasciitis. I almost never rest people who come in here with plantar fasciitis. Typically, it's a matter of if you are tolerating it.

But if you have a pain three or four out of 10 or below, with six being you wouldn't start a race, then it's usually fine. And then the rule of thumb is if it's getting worse throughout your run, find the inflection point. So where it starts actually getting a lot worse, that's the limit of how long your run should be. But I'm okay with people running through pain as long as it's not getting above that level or they're not limping through the run. So if you're running all funky, you're going to have other issues. So that's a hard limit too. Yeah. Is there something that, how would people know when that inflection point is happening?

For the pain. Yeah. It's usually fairly obvious of like, oh, I'm three miles in, I feel fine. And then the fourth mile, you're limping. I had a patient recently who she couldn't really notice it. She was one of the few that she's just high pain tolerance. So she wasn't really, you know, noting how her pain felt. But her friend running next to her, this was during a longer trail race, her pacer was like, what the heck is going on? She was kind of, yeah, doing this guy. So if you have a running friend, that's another way to tell too. Yeah. Actually, funny side story then with that, I was talking to a friend about, we were talking about the concept of red, yellow, green activity or exercise.

And it sounds like you're talking about green is you feel good, go ahead and run. Yellow is like, that's like a, what'd you say up to six is kind of a lot. Yeah. Six being, I don't start a race, something you train for. And then red is like definitely six and above. And so he's like, well, how do you know what is yellow and red? I said, you pay attention. Yeah. Like you have to be, don't micro focus on your pain, but like you have to pay attention and make a decision if it's too truly uncomfortable to continue or not. Yeah. I find a lot of people too, who have chronic issues, it's really hard to be in touch with that or they're hypersensitive to it.

So this is where it's especially important to have an objective point of view. So frankly, people like us to tell you like, yes, I think this is safe or no, I don't because trying to make all of those decisions on your own when you're the one experiencing it is really hard. Yeah. I always suggest people at least take like a little notebook, write some stuff down, but I don't really like the idea of like having a pain journal. Yeah. But it is nice to like note the things that are questionables and you can start checking them off if they are really fine to do. Yeah. I've commonly had people who use Strava.

There's a private notes section where you can write down. I've had them track their pain to a degree, but more in the sense of first five miles felt great. Last three felt horrible. And they can write that down and kind of go back in their activities to see how long their run should be. I know that you manage some people with plant pushitis in combination with their coach. Yeah. Right. And is there a how's the communication go with the athlete's nose versus like what you guys are doing on the back end? Yeah. Basically, we see what irritates it and what doesn't. So for some folks, it's like you can do a ton of speed work and it feels great.

But once you start going uphill, it feels horrible. So usually the coach and I will communicate on what the biomechanics patterns are of what irritates it. And then I give them the carte blanche to, you know, figure out how to train their athlete effectively within those limitations. Now for a quick pause before we keep going. Hey, everybody, it's Sebastian. If what we've been describing in the show so far sounds very familiar and you've been dealing with some ache, pain or stiffness that keeps coming back no matter what you do and no matter what you try. We're offering a free discovery call today where we brainstorm with you what has been working for you, what hasn't been working.

And we also try to unravel what is a critical part of the puzzle that you've actually been missing that's keeping you from full recovery and getting back to full activity. The link's in the description. It only takes a few minutes to fill out the form. Okay, back to the show. Nice. It sounds like a whole, like, it's like the recreational athlete has, like, a team of people. Yeah, it's fantastic. I love working like that. I'm a high school cross-country coach, but these coaches are working at the next level, you know, like elite and pro athletes. But having that communication gives them the peace of mind of, like, hey, I'm not going to train my athlete to where they're totally broken and can't run.

But also, I'm not having my medical professional tell me how to train my athlete. Yeah. So it works well. I think I've heard that a lot of athletes don't really want to go to the doctor because they'll just tell them to not do that activity. What is your experience, at least with people you've talked to? Yeah, I was one of those athletes. I ran on a stress fracture for a month because I didn't want to go into the doctor and tell them or have them tell me that my leg was broken. I didn't know it was broken, but I should have. But you didn't want to hear it, though? I didn't want to hear it, right?

I was in the NCAA. I was, you know, excited to be running Division I. I did not want them to sit me for a cross-country season. Spoiler, I was sat for a cross-country season. But part of the reason I got into the field is to find a better way in that sense of how do you keep someone running because that's what they like to do. Without sitting them, as long as it's safe. And so there's a ton of ways to do that. I think rest is overused. And after the first couple weeks, I'll say two to four weeks usually, if it's not helping, then there's a missing piece and you've got to do something other than rest.

So then with just things that are coming to mind that maybe like the beginners out there were like, well, I'm not going to, then maybe not rest after I've been cleared medically. Yeah. But I've heard this thing like running in water and then Alter-G treadmills. And like, is there, if I don't have the means for that, like what is there, is there other ways where people can usually get by to keep their activity up while they're still recovering? Yeah. So there's a ton of different ways to cross train. There is aqua jogging, which, oh my gosh, I did that for like a year. It sucked. But it does work where you just kind of run in the pool.

You can use an elliptical. That's the most common that I see. Or a stationary bike. You can go to, you know, the YMCA or a gym and they usually have those. Alter-G is very fancy. You can, they basically put you in some shorts and they lift your body up partway with a treadmill under you. So you're running at some percentage of your body weight. For my elite and pro athletes out there, that's probably something you have access to. Some NCAA teams too, which is cool. Apart from that, if you don't have access to that, walking and fast walking, power hiking can help. And then lifting, supervise towards that.

But your total strength capacity, if you are losing aerobic fitness because you can't run, your strength capacity will help you get back quicker once you feel good. Good. Yeah, I can, we can go on that forever. Let me go, let me go to the next question. So the, how would someone know that maybe they're ready for hills after having plantar fasciitis? Basically test it. Okay. There's a few variables there in the sense of what irritated it before when you were running hills. So if say super steep hills hurt, but previous to getting treatment or resting, super steep hills hurt, but really mild ones don't start with the mild ones.

If really rocky hills hurt, but like non-technical ones didn't start with the non-technical, but it's the same concept as building mileage. You're just building either steepness or technicality or both. So say I live in an area where there's not a lot of hill options, and so I have to drive out to this place that has hill options. Yeah. But really the only hill option is a hard one. Yeah. There's not a lot of opportunity to like say slant, like less steep or et cetera. Do you have any, do you have any ideas for people with those type of constraints? Yeah. And then it comes down to running intensity.

So if your only option is a super steep hill and you drive all the way out there and you don't want to go anywhere because it's an hour drive out there, if running up that hurts, try power hiking. If that doesn't help, some people have access to, you go on a ski lift and you only do downhill, or you have a ski lift and you only do uphill. That can work too. But it's, it's playing with variables. So you can kind of write out all the variables usually that's grade. So how steep technicality, how rocky or dancey it is. And then if you're going uphill or downhill, those are the three main variables that you can play with and experiment with which ones feel okay and which ones don't.

Okay. Well, you kind of leaned into the third question, which is the power hiking. Yeah. So the, is power hiking generally okay for people with this or is there, yeah. Yeah, I like power hiking. Also, it's a good way to get out there if you're itching to get out there and you can't run right now. Power hiking can work great. The only problem that I see with it sometimes is if people turn that into backpacking or rucking. That can be fine. But if you're adding a ton of load on, sometimes that overloads the foot. But past that, just power hiking, like with your vest on or without anything, yeah, totally fine usually.

Dumb question, but what is power hiking? It's what trail runners call racing. It's what I call trail runners. I mean, I remember in middle school, we did something called power walking. It was just faster walking. It's basically that. So it's hiking fast. Yeah, pretty much. For trail runners who don't usually use poles, you can kind of, that's where some will give in and use poles. So for some people, that's the difference of am I using poles or not. So poles means power hiking? For some people, I use it while I'm running too, but for some folks, yeah. Okay. Yeah, just curious. I didn't figure that everyone changes their terms around.

Yep, yep. All right. Well, if you guys want more information, we have a video in the corner which covers more plantar fasciitis. Mandy Riehl also wrote this great book. It's an e-book. It's free. It's on our website and there'll be a link in the description. So if you have means to read a little bit, I think that's a good start. And we also offer telehealth too in different states. Yeah.