Why exercises help Plantar Fasciitis, and other soft tissue injuries

We all know that when our body become injured we should rest, but did you know that stopping exercises, in conditions such as Plantar Fasciitis, can in fact weaken our tissues, resulting in an extended recovery time. In this article Senior Podiatrist, Katie Green, discusses the importance of activity modification and exercise during recovery from Plantar Fasciitis.

What is a soft tissue injury?

There are a number of soft tissues in our bodies; tendons, ligaments, cartilage, muscles and fascia. If
too much stress (often referred to as load) is placed on these they become damaged or injured. Plantar
Fasciitis is an example of a soft injury to the large ligament like soft tissue in the bottom of the foot
and is a common cause of heel pain.

Why do soft tissue injuries occur?

Our soft tissues have a certain ability or capacity to take load. When the load that is applied to them is more than the capacity they currently have damage occurs.

If stress or load causes injury how do exercises help?

Our soft tissues respond to loading in both good and bad ways. Too much load that is increased too quickly causes soft tissues to become damaged. But gentle loads that are increased slowly cause soft tissues to become stronger (increasing their ability to take load.) Exercises provide this controlled load to a tissue which stimulates the cells to send signals to each other. These signals stimulate the repair process leading to an increase in the tissues ability to tolerate load.

But I’m injured… isn’t total rest best?

Surprisingly no! The load an injured tissue is subjected to needs to be reduced but not removed, then once pain is at a manageable level specific exercises are commenced to build the tissues capacity to tolerate load. Low loads can actually cause a reduction in a tissues ability to tolerate load so we want to be careful not to neglect other uninjured tissues (this neglect will weaken them and make them more susceptible to injury). This is why modifying activity rather than total rest is best.

How should I modify my activity?

There is no simple answer to this question and this will depend on the injury and your current ability to perform certain tasks pain free. A podiatrist can perform a full assessment and determine factors that have led to the load being placed on the tissue exceeding what that tissue was able to take. They can make suggestions regarding how to modify your activities (for example switch running for cycling or water based exercise) in addition to giving you exercises that are targeted to strengthening the specific tissue you have injured.

A podiatrist can also implement other strategies to help reduce load on the affected tissue like footwear, orthotics and taping.

What exercises can I do to help with heel pain caused by Plantar Fasciitis?

Studies have shown that exercise targeting the small muscles of the foot, in addition to high load strength training, are effective in treating Plantar Fasciitis. Two of the recommended exercises for Plantar Fasciitis are the Short Foot and Towel Curl Calf Raise exercises.

How long does it take to work?

It takes time to restore or improve the capacity of a soft tissue to tolerate load and it is a gradual process. In the first few weeks it can seem like exercises aren’t helping BUT changes are happening within the tissue. The ability to progress to more difficult exercises and higher loads will vary greatly between individuals which is why regular monitoring and assessment by a Podiatrist is vital. The time it takes for a tissue to recovery from injury is dependent on a number of things but in general will take at least 12 weeks.

References:

  • Huffer, D., Hing, W., Newton, R., & Clair, M. (2017). Strength training for plantar fasciitis and the intrinsic foot musculature: A systematic review. Physical Therapy in Sport, 24, 44–52. https://doi.org/10.1016/j.ptsp.2016.08.008

  • Rathleff, M. S., Mølgaard, C. M., Fredberg, U. , Kaalund, S. , Andersen, K. B., Jensen, T. T., Aaskov, S. and Olesen, J. L. (2015), HL strength training and plantar fasciitis. Scand J Med Sci Sports, 25: e292-e300. doi:10.1111/sms.12313

  • Brukner and Khan clinical sports medicine (5 th edition) Mc Graw and Hill (2017) Sydney

  • Khan, K. M., & Scott, A. (2009). Mechanotherapy: How physical therapists&#39 prescription of exercise promotes tissue repair. British Journal of Sports Medicine, 43(4), 247. doi:http://dx.doi.org.ezproxy.scu.edu.au/10.1136/bjsm.2008.054239