Why stretching isn't fixing your plantar fasciitis

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 going to cover some of the questions about plantar fasciitis that you guys have been asking about.

This is our trail running expert, Mandy Riehl. The questions we're going to cover here in order are, why isn't stretching working for my plantar fasciitis? Do I need orthotics and should I use them forever? And can I still run through plantar fasciitis? Okay. So that first question, what do you think about stretching? If it's, say it's not working for me, what should we be maybe thinking about? Yeah, stretching is really useful for mobility, flexibility really, but gaining mobility. But that's not always the problem. That may not be what's triggering it. I've seen a lot of people with plantar fasciitis specifically, and this is interesting to me, they really want to stretch their foot because it feels stiff.

So like normal human reaction, let's stretch it. Like just this part of the foot or like the toes too? They'll like go like this, right? Which if that is not helping, sometimes it does, then you're just stretching an overstretch injury. A strain is essentially an overstretch injury. So if you are stretching an overstretch injury, that can cause problems or just keep it painful. If you're stretching other areas, that may help in some way if it's a mobility problem. But more commonly, it's a strength capacity problem. So you're not actually doing anything for the strength. You're just getting looser, which again can be good, but it's not addressing the driver of the injury cycle.

Yeah. So the stretching, I think there is, if you guys have looked around a bit about flexibility, mobility, and things of that nature. So there is supposedly a difference between the terms flexibility and mobility. Do you know the, like, can you give us an idea of maybe how those things would come into the picture here with the foot, with their stretching? Yeah, yeah. So flexibility, just to, if you guys haven't gone into this, flexibility is passive stretchability. So like for my, let's say for my hands, so flexibility is I would need the overpressure to stretch it all the way. Mobility is what you can do actively.

So mobility here. So flexibility, this, I can go way further. Mobility is just here. In the foot, you can usually get more flexibility than mobility, but I rarely see relevance in the foot mobility-wise apart from big toe that is relevant for plantar fasciitis. More commonly, it's hip, sometimes knee if you have past knee injuries, but it's a mobility thing, not necessarily a flexibility. The mobility is more of the problem than flexibility? Yeah. The caveat is you need the flexibility to access the mobility. Right. So if you don't have the passive stretch ability, if I can't bend my hand this far, there's no way I'm going to be active, actively able to do that.

You'll always get further on flexibility, but you need to raise that ceiling in order to also raise your mobility ceiling. But in the hip, for plantar fasciitis, really common in the, like I said, sorry, in the hip here. So hip extension and then internal rotation, which is kind of, it's almost like the knock knee rotation because when you stride backwards, if you don't have that extension, we've talked about this, but you got to dump somewhere else. So stressing the foot or stressing the back. So you want extension and internal rotation as a runner. Yeah. So stretching that will help give you the ability to train mobility, but you have to load it.

Okay. You can't just, you know, move your leg around. So then just two things on that. We'll start with, since you're at the hip, we'll talk about that then. What is a good way to get mobility of the hip in extension, internal rotation that you're, that you tell to get a kickback? Yeah. With the back of your stride. The back of the stride. So how do, how does a runner access that with mobility? Yeah. Versus just doing flexibility? Yeah. So again, build up the flexibility a little bit, but load, load is, load is king. So when you say load, basically weights, heavy things. So the most common one that I've seen that works well is hip thrusts.

So barbell hip thrusts are really great. With those, having them on a, with your back on a bench can get you max extension in the hips. That is more extension based rather than internal rotation. Internal rotation, you don't necessarily need a lot of mobility in that because you're not like knock-kneed while you're running. For most people, women sometimes are and that's fine, but you need the internal rotation flexibility to access the extension hip mobility. Like they go together? Yeah, it's called a couple motion. So for internal rotation, if you're trying to improve that, that's more stretchy stuff, but for hip extension, you need to load it.

So hip thrusts are really the go-to. Okay. And if you were to get, so when we're talking about mobility of the big toe or flexibility of the big toe as well, I keep thinking about this bunion people. Yeah. And so they have the bony overgrowth. They can't get the flexibility, right? It's not going to come back. Yeah. And so they won't get more mobility either. So they're training at a deficit probably, right? Yeah. This is similar for people who have any true limitations. So like I've had people who have ankle fusions, so they're never going to get the mobility back. There's a plate in there, right?

So trying to work that is not going to, it's not going to feel good and it's not going to give you any benefit. So if you have a limitation somewhere, a true limitation, you have to almost overdo the mobility in other parts to make up for it. So you do have to find a compensation pattern. So in that case, our compensation pattern is favorable to get you to be able to do the activity of running because you're never going to get, nor do you really need to, get the toe motion back or in say in the hip as well. You just have to find other ways around it. Yeah, you have to, yeah, figure out a way to do the motion or handle the load that works around the limitation.

So for people with bunions, plantar flexion, so like that, pointing your toe is usually the go-to because if you're not able to extend through your big toe, you have to be able to extend through your ankle as much as you can with that toe-off phase. So getting that and then dorsiflexion as well. So pointing your toes to your nose. You really got a fun little toenail right here, huh? Yeah, you know, trails, rocks. I'm never not going to have a funky little toenail. This is that one. Yeah. So probably a good tangent then is now to the orthotic question. 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. Because I would imagine that if you're using orthotics because it's what you've been told you don't have an arch, I'm sure there's other reasons too, I'm not sure what they'd all be, but do you have any thoughts on orthotics regarding plantar fasciitis? Yeah, the one big thought I have is I see people in orthotics who have high arches, which is counterintuitive, but I have seen it quite a bit. High arches, it's more bridge-like, but that also means your foot is stiffer than normal. For people with flat arches, it means the midfoot bones move more than normal. For high arches, they're stiffer than normal.

So adding stiffness with orthotics doesn't make a ton of sense. You don't have a stiffness deficit. For people with flat feet, depends. Is it a functional flat foot where you actually can get an arch, like you can use your muscles to pull yourself into an arch, or is it a true drop navicular where your bone has shifted and your foot is just physiologically flat. For those cases, we've worked together with podiatrists for that, but in general, if you know that it is not an absolutely necessary thing, like you're going to harm your foot irreparably if you're not in orthotics, and again, if you have orthotics, you're probably working with podiatrists, so ask them, but if you know that it's not 100% necessary, getting out of them can help because it's kind of a crutch.

It takes load off, which can be useful for a while, but then you're not strengthening it. I remember this one guy that I saw, he had an orthotic on, he didn't come in for a foot issue actually, but I saw, he had some shoes, and then I saw this big old thing popping out of here, it was like trying to loosen it, and I'm like, what is that thing? Oh, it's my orthotic, and I said he came in for knee pain, and so they had knee pain with squatting, and so I said, do you ever not wear that? They said no, and so we took it out, and then I had him squat, and his knee pain went away. So the trade-off was knee stuff, apparently, so I don't know if he still needed it for his foot, but it was interesting that it was this, all you had to do was remove the crutch, and things got better with that one.

Yeah, I mean, it's my theory on this is it's similar to a physiologic limitation like a bunion. You're creating stiffness that is not overcomable by your body. Yeah, it's stiff. It's not going anywhere. Right, right. So if you have plaster on the bottom of your foot, you're not going to bend that with your toe muscles. Similarly, if you have bony growth in the big toe joint, you're not going to overcome that. So finding compensation elsewhere can help in a sense, but if you're not needing the compensation, don't use it. Yeah, I had this, I don't think I told you about this person years ago. When I met them, they had a normal arch.

They eventually sustained, they felt a pop, and we think it was a tibialis posterior tear, and then so within a month, the arch dissipated. And so probably in that case, like, probably going to want one. Yeah, it is a stiffness deficit that you can't overcome. Yeah. So, yep. If you don't need it, try not using it, see how it goes. You can try some foot strengthening stuff. We have a ton of videos on that. I think our big plantar fasciitis video goes on that, too. But I would experiment with it and go gradually. So if you've been in orthotics for 20 years, don't just, you know, throw them away and then hope for the best.

Gradually. Kind of like building up mileage. Yeah, I think co-managing it with your, if you're too in contact with your podiatrist, probably a good idea to talk to them about it. Yeah. Some people we met actually, like, they have things implemented and they've never had them removed. So, like, I know you made a video recently where someone, you covered the knee-over-toe thing and, like, how it's a strategy implemented by people like us, but it's intended to be temporary. Yeah. But then if you don't see the person again, it becomes permanent. Yeah. And so we've seen this with our patients. We work through telehealth and in-person in SoCal, but we've seen this with our patients sometimes of, we see them for a little bit, they disappear, and then they come back, like, two years later, and they're still doing the things that were meant to be temporary help.

And now they are either super reliant on that or they have had, like, a rebound effect because they're just band-aiding the problem and not actually, like, addressing the cycle. If we stop, you know, if they disappear part of the way through treatment. Yeah. That's part of management, long-term management, is making sure the person uses the right steps in the right places, then just get rid of them and become a normal runner. Yep. Yeah. Last one is, can we run through plantar fasciitis? Is there any big dangers with it? Yeah, I do, personally. we went over this in a different video too, but typically if you're getting above, like, a four out of ten with a six being, you would not start a race that you train for.

If you're getting above that regularly, probably some rest would be good, or you're missing something big in your injury cycle that hasn't been addressed yet. So that's where you can start kind of scaling training back, or if you are starting to look weird when you run and getting the limping thing, both, you know, visually if your friend tells you, like, hey, you're running weird, or for most people, they'll feel it. Sometimes, in my experience, when I've had problems, especially on one side, if I do a big run, I'll only be fatigued and muscle sore on the other side. So even if I'm not noticing the compensation pattern, like, I can tell just based on how sore I am, that I'm using the other side only.

But those are kind of the two rules of thumb of if it's getting above a 4 out of 10 regularly, or you're limping, that's the time to scale back. Otherwise, if it's not swollen, it's not bruised, I run through it. I usually tell my patients to run through it as long as they feel comfortable with that. But you have to be doing something to address it. Yeah, you can't just be ignoring it. And obviously, you know, we're not your healthcare providers, we're not telling you what to do, but if you want to contact us, we can. But there's plenty of reasons to not really be afraid of using your body and having a little bit of pain despite it.

I know that I, I didn't tell you this story, so we went hiking this last weekend in Yosemite. And so going up, it was perfectly fine. Going down was not. And then once we had to hit a couple rolling hills, I noticed I was dragging my leg. And I thought, maybe if we cut some mileage out of this, I probably would have been a lot better. But you know what, I got to get back to the car anyways. So what am I going to do? Ask someone to walk me down? Right, yeah. Just hop on someone's. Yeah. At some point, like, yeah, if you're stuck in the backcountry, you got to get out. Yeah, it is what it is. Yeah.

But the tricky part for folks that are looking online for stuff is differentiating between damage and sensitivity. So the signal says, oh, there's damage, you know, it's in pain. They're not always the same thing. So if you've had damage in the past, say you've had an inciting incident like a month ago, and then, or really more like a few months ago, and it's still just as painful, but it's not swollen or bruised anymore, that might just be sensitivity now, rather than damage. So parsing out between those two is the hard part. If it's just sensitivity, I have my patients run through it. If it's damage and you're redamaging it, that's what you need to pull back and really figure out what's going on.

Yeah. There's actually, in case you guys want to read stuff on it, I'll see if I can put a link. Actually, I won't put a link. I'll just tell you what's searched. So there's a consensus statement of muscular injuries that you can look, I think it's 2012, but it's a free PDF out there. It covers different types of muscular injuries. And the reason I'm bringing it up is because we talk about sensitivity versus damage. There's plenty of injuries or plenty of reasons for pain that have no structural damage to it. Yeah. And it's a strong majority of them, but I was talking to a lady the other day and they were really concerned about why they're still in pain, but they don't have any positive imaging findings.

Like, yeah, you're the majority, but I don't get it. I'm sorry. Like, I think it was bad information over time that people are getting, but it's a, but there's plenty of reasons why. Yeah. This is the tricky part when people get imaging and it shows a little bit of edema or swelling in the plantar fascia and then it ends up not being plantar fasciitis. Like sometimes you'll get an image and there will be results, but that's not necessarily what's driving the pain. The most common one is a heel spur into the plantar fascia because it looks like, bam, there it is. Like, that's definitely what's causing the pain.

Most of those are asymptomatic, but if you're treating it like a heel spur and it's not getting better, like, okay, that's a sign you got to look elsewhere. If anything in today's episode resonated with you, visit the link the link in your podcast player. There you'll find any free resource that we mentioned in the show, any guest links, and a link for a free discovery call with us. We're licensed to work with our outdoor active people via telehealth across many states in the U.S. at this point. In fact, we cover almost half of the population in the U.S. and we add more states every year. Thanks for listening.

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