As many of you know, Brad is my longtime writing partner, host of the Primal Endurance podcast and host of the weekly keto show on the Primal Blueprint podcast. (He’s just started his own podcast recently called Get Over Yourself. You can check it out and even listen to an edition he’s called “The Ultimate Mark Sisson Interview.”) Our relationship goes back 30 years to when I was Brad’s coach during his career on the professional triathlon circuit. The start of Brad’s chronic plantar fasciitis ordeal dates back nearly that long, until he was completely cured in a matter of weeks back in 2011. Hence, the subject of today’s post! If you are a sufferer, pay close attention because we dove deep into this topic and are giving you the tools to never suffer again.
Indeed, as Brad will detail shortly, miracle cures are possible, even for extreme sufferers. About three years ago, Brad was over at my place on a Monday and noticed me spending a lot of time rubbing and stretching my chronically tight Achilles tendon; it had taken its weekly beating the previous day at Ultimate Frisbee. I tried the prolonged stretches he details in the article and experienced immediate relief. (Around the same time, I also started to experiment with the early supplemental collagen products on the market, which also helped my foot issues and other joint aches and pains clear up.).
Enjoy today’s article, and let us know your thoughts on this treatment protocol.
Plantar fasciitis—it’s painful to even pronounce, and if you contract this condition you’re in for a long, frustrating, painful ordeal. It’s characterized by a burning sensation around the rim and/or bottom of your heel, and assorted peripheral pains such as a sore or burning arch, sensitive nerve endings along your arch, inflamed bursa sacs in your heel bone that make the heel sensitive to touch and applied weight, a bumpy, lumpy sensation on the bottom of your heel that are often called bone spurs, and general stiffness, tightness, and pain in the foot, arch, Achilles tendon, and calf muscles.
Symptoms are typically worse first thing in the morning or after prolonged periods of sitting or standing. If you have a mild case, you can get some range of motion and blood flow going upon awakening and the pain will typically subside and not compromise your exercise. In advanced stages, you will have a hard time getting mobility going and even walking will be painful. When you do get sufficiently warmed up and into a workout, the burning pain will often continue during and after exercise. The condition can worsen over time until you are sidelined by the lack of mobility and subsequent chronic pain.
The plantar fascia is a super-strong ligament that runs the length of the bottom of your foot. On one end, the plantar fascia attaches to the metatarsal bones of each of your toes. It then fans out wide, like a sheet covering the length of the bottom of your foot. It subsequently tapers to attach into your calcaneus (heel bone). The plantar fascia acts as a prominent shock absorber when you walk, run, or jump. Consequently, it gets put under a lot of stress and can easily become inflamed when the muscles, ligaments, and tendons in your lower extremities are dysfunctional or overstressed.
Plantar fasciitis is extremely common among not only runners and competitive athletes but also folks who work on their feet all day like nurses, laborers and even standup desk user. Then there are people who have strong sedentary patterns (commute, desk job, insufficient exercise); people with arthritis, obesity, poor muscle tone, flexibility, mobility or generally poor physical fitness; and people who wear crappy modern shoes with stiff construction, encased toe compartments, and elevated heels. Does that pretty much cover the entire population of the developed world?
Indeed, no one is immune to the risk of plantar fasciitis, because the condition often comes about when there is any sort of weakness, overuse, inflammation, or dysfunction in the muscles, tendons, and ligaments in the lower extremities. For example, if your calf muscles or Achilles tendons become stiff and inflamed from doing chronic cardio or consuming an inflammation-boosting high-carb, allergenic-loaded, SAD diet, these dysfunctions may manifest most painfully as plantar fasciitis.
I don’t know many serious runners who haven’t had this condition at one point or another in their lives. I had the condition for the better part of 15 years—ranging from a mild lingering annoyance that vanished with some quick morning exercises that increased blood flow and mobility, to so debilitating that I couldn’t walk in the morning. Indeed, for several years in the midst of my professional triathlon career, I had to exit bed onto one leg, hop out the door into the backyard, then drop my right leg into my backyard spa. Only after a few minutes of working through ankle and calf range of motion with hot jets blasting could I apply pressure to the foot and walk normally. Then, I’d lace up my shoes and head out for a run of five, ten, or even twenty miles!
That’s a strange juxtaposition from cripple to endurance machine in a few minutes, but it generates an important reflection: plantar fasciitis almost never gets better with rest alone. On the contrary, it quite often gets worse when an injured athlete stops running or a nurse takes a leave from the ER floor for a desk position. For example, during one off season of my professional career, I decided (in consultation with my coach Mark Sisson) to take a six-week break from running in order to focus on swimming and cycling and allow the painful plantar fasciitis injury to heal once and for all. Upon my return to light jogging, you can guess what happened: the injury was more painful than ever!
Before we get to the prescribed treatment protocol, let’s look at what interventions are commonly suggested but generally don’t work well at actually treating the condition. (See how many look familiar.) As you might expect, athletes and active folks have tried all sorts of treatment modalities and remedies, most of them landing somewhere on the spectrum from ineffective but harmless to outright disastrous.
Well intentioned as it may be, rest is usually ineffective with plantar fasciitis. Getting off your feet or out of your exercise groove results in atrophy of both the large muscles and small stabilizer muscles in your legs as well as reduced range of motion, increased stiffness, shortened muscle, and—often—more pain when you try to return to your normal activities.
These approaches work like a Band-Aid works to stop the bleeding. If you have plantar fasciitis and have to perform for your country in the Olympics, a professional taping job is a great idea to keep the pain at bay and allow you to qualify out of your heat for the quarter-final. Alas, these support measures fail to address the cause, however.
Furthermore, they can very often compromise healing if you insist on using them long-term instead of making a sincere commitment to addressing and healing the underlying causes. Specifically, using artificial aids and supports will cause weakening and atrophy of the lower extremities over time. You make things easy for your feet, so they can wither away inside a cushy protective cocoon instead of be challenged to grow stronger every moment that you ambulate.
That said, remember that staying active is essential to ultimate healing of plantar fasciitis, and so using support measures to help you stay active by any means necessary can be warranted over the short term.
These and other feel-good techniques are generally focused on relieving painful symptoms—symptoms that are bound to return again and again over time until you address the cause. As previously stated, complementary therapies are fine to the extent that they help keep you active. Ice massage can also be helpful in the aftermath of performing some aggressive healing exercises, as we will discuss shortly.
This can be highly effective to undo some of the damage caused by chronic injury and facilitate healing. In particular, Active Release Technique (ART) and deep tissue techniques go a long way toward increasing the mobility and fluidity of muscles and connective tissue.
The caveat here is that deep massage and ART treatments set you up for success, but you have to do the healing work described shortly to make the effects stick. Otherwise, you will undo damage with the bodywork, then create the damage all over again by exercising on dysfunctional legs.
Can you say “rupture”? Not rapture, but rupture. Yes, ouch! Generally, cortisone injections provide immediate and amazing relief from pain symptoms, often at extreme risk to your long-term health. When you override your body’s natural inflammatory processes and pain signaling with a powerful drug, you gain instant relief, but increase injury risk because you no longer are governed by natural tightness and pain that is attempting to protect you from the damage of performing with a dysfunctional appendage. Furthermore, anti-inflammatory treatments (including chronic use of seemingly innocent NSAIDS before workouts) weaken your natural ability to regulate inflammation over time.
There are a tiny fraction of injury cases where a cortisone injection may provide enough relief to facilitate an aggressive rehabilitation process that results in healing, but I urge extreme caution here. I say “extreme” because you may face enthusiastic health care professionals who will pretty much beg you to accept an injection. I know someone whose decades long nursing career ended in large part due to a cortisone injection that preceded a rupture, multiple surgeries, and ultimately a downward spiral that ended in permanent disability status.
When you address the causes of plantar fasciitis, you’ll experience relief from the painful symptoms surprisingly quickly. To correct the cause, you must lengthen your calf muscles, increase mobility throughout the lower extremities, and start a methodical progression to a more minimalist/barefoot lifestyle. Commit to the following protocol every single day for just a couple weeks and it’s quite likely that even a severe and debilitating long-term condition will clear up to the extent that you will be pain-free and fully functional in a matter of weeks.
“Do the wall stretches several times a day. Hold each stretch for two minutes. You’ll be healed in a few weeks.” This brief quip was all I needed to cure 15 years of consistent pain and suffering from plantar fasciitis. The message was delivered to me in 2011 by a podiatrist in a booth at the race expo of the Sacramento, CA, Urban Cow Half-Marathon and 5k—where I am the announcer annually. I have tried in vain to figure out who the guy was, but I’ll extend my deepest gratitude to the mystery healer right here and now.
Here is what happened on that fateful day: I typically walk the grounds and meet the exhibitors, so I can give them a little plug over the P.A. I remember from that day a booth with signs about healing foot pain and exam tables set up for interested runners. An enthusiastic podiatrist greeted me at the booth and started talking about how he could easily and quickly cure conditions like plantar fasciitis.
I challenged his assertion, informing him that I’d had the condition for 15 years and had tried everything: morning Jacuzzi hopping, a heel lift in my right foot, removing the heel lift, returning the heel lift, expensive rigid orthotics custom molded from my footprint, expensive soft “dynamic” orthotics made of silicone gel, obsessive icing and stretching, wearing giant pillow cushion shoes from Nike, switching over to Vibram Five Fingers and other minimalist options, switching back to pillow shoes—basically everything short of the dreaded cortisone injection.
I eventually agreed to try the prolonged stretches, obviously with huge reservations but a sincere commitment. In a few weeks, my symptoms were completely gone for the first time in 15 years. I’d call it a miracle, but it was so incredibly simple I’m not sure you can call it a miracle.
Hopefully, you’re familiar with the wall stretch that is the runner’s bread and butter? You extend one leg behind you, lean into the wall at a 45-degree angle, and push against it like you are trying to push it over. With your rear leg straightened and heel grounded, the stretch focuses on the soleus, the narrow muscle running along either side of your leg and merging at the bottom into your Achilles tendon. When you bend your rear leg and lift your heel off the ground, you redirect the emphasis to the gastrocnemius, the ball-shaped muscle that gives you that sexy rock-hard definition on the upper part of your leg.
Holding each of the aforementioned four stretches (left leg straight, left leg bent, right leg straight, right leg bent) for two minutes is the secret to healing. In case you’ve never timed your stretches, holding a single position for two minutes will likely seem like an eternity. I’d speculate that the most devoted stretching enthusiasts might never hold a single stretch for than 10-20 seconds. Even the most deliberate of yoga classes won’t hold you in a single position for that long. As I mentioned, I had devotedly stretched my lower legs and feet in assorted ways for years in the tug-of-war against my condition, but never held any single stretch for so long.
When you hold a stretch for two minutes, you are sending a powerful message to your musculoskeletal and central nervous systems to lengthen the relevant muscle fibers. Witness ballerina dancers stretching for hours every day in order to maintain optimal muscle function for their demanding efforts—constantly reinforcing the message to brain and tissue that they need to by hyper-flexible.
This process of lengthening a muscle is complex but important to understand. If you listen to or read the Nutritious Movement commentary from noted biomechanist and author Katy Bowman, you may be familiar with the term proprioceptors. These are the nerve endings that help your muscles communicate with your central nervous system. When your proprioceptors detect a muscle fiber being stretched, something called the stretch reflex is triggered. This reflex causes a stretched muscle to contract—an excellent safeguard against injury during assorted day-to-day activities, including fitness activities and sports.
After a workout in which muscles have repeatedly contracted or absorbed impact, holding a few stretches for twenty seconds will send a nice little message to the fibers to relax and loosen up a bit as you transition from a state of exertion to relaxation. Then the stretch reflex kicks in, you experience a little discomfort, and end the stretch. When you go big time, work through the possibly uncomfortable stretch reflex sensation, and hold the muscle in a stretched position, you start to make some real progress. Here the proprioceptors in the stretched muscle, known as the muscle spindles, become habituated to the new length of the muscle such that the stretch reflex is muted. Instead, when specific thresholds of stretching frequency, intensity and duration are exceeded, a lengthening reaction occurs in the muscle. Here the muscles relax and allow you to deepen into the stretch. If you have ever been to a yoga class and noticed you can take stretches much deeper after you are warmed up and habituated with repeated stretches, you may know what this lengthening reaction feels like.
When your muscles relax due to the lengthening reaction, another key player on your healing team jumps into action: the golgi tendon organ. This is located in the tendon near the end of a muscle. It sends a message to your central nervous system, essentially: “Hey, this dude is sick of suffering with plantar fasciitis for 17 years. He wants some longer calf muscles for Christmas, so please comply.” Enjoy this much more detailed and scientific discussion of the science of muscle stretching.
If you want to heal quickly, strive to quickly work up to doing the wall stretch protocol several times a day (shoot for five times or more). As described previously, this will take all of eight minutes per session: two stretches on two legs for two minutes each. An aggressive stretching regimen will, in a matter of days, greatly relieve the stress on your arch and heel caused in large part by shortened muscles that don’t absorb impact optimally.
Because of the high degree of difficulty with two-minute stretches, you can expect some next day soreness. Take care to stretch only the point of mild discomfort instead of actual pain. This may mean you have to back off a bit during your wall push to survive until the two-minute bell. You will also likely discover that you will be able to hold a much deeper stretch in the evening than in the morning, and more easily reach the two-minute bell. Alas, doing these stretches first thing in the morning when your muscles are the shortest is critical to your progress. So is doing them as many times per day as you are willing. Remember, we are trying to work beyond the stretch reflex and achieve a lengthening reaction.
You may even consider getting the legendary Strassburg sock to assist your healing process. This device, a sock with a strap attached, places your ankle in a flexed position all night, putting the plantar fascia under tension so that it does not contract and cause the painful morning stiffness. Instead, you wake up with an elongated plantar fascia much like the afternoon version that feels much better to walk on than the morning version. Again, the sock is best used in conjunction with an aggressive healing protocol.
Please keep in mind this prolonged stretching protocol is designed for injury prevention/healing, and is not advisable right before a workout. You may have heard prominent accounts of how static stretching can temporarily weaken a muscle for up to 30 minutes, and this is a valid concept. After all, you are about to demand intense contractions from your muscles for the workout, so aggressive pre-workout stretching is not the best way to prime them for action. Instead, do a simple warmup—increasing body temperature and respiration to the extent that you break a little sweat.
Watch this video where I describe the power of the wall stretch to heal plantar fasciitis and direct you to do the stretches correctly.
Concurrent with your commitment to prolonged calf stretches is a commitment to achieve increased mobility and flexibility in the foot and leg, via a series of special movements and treatment modalities with colorful nicknames. If you’re in the Crossfit scene or otherwise a fan of Dr. Kelly Starrett, aka “K-Starr,” you might be familiar with some of the unique and colorful terminology—terms like bashing, tacking and mobilizing—that have become his custom lexicon and spread like wildfire into the fitness community. K-Starr is a former elite level whitewater kayak athlete, proprietor of San Francisco CrossFit, creator of the popular MobilityWOD.com website, and author of Becoming a Supple Leopard—perhaps the most comprehensive volume on mobility, flexibility, functionality, healing and prevention for athletic folks ever in the history of the world. Visit MobilityWOD.com to get a free 10-day dose of Kelly and his highly engaging, informal, and humorous style with which he conveys his unique and effective approach.
K-Starr is a big fan of using toys like massage balls, golf balls, lacrosse balls, foam rollers, voodoo straps (try this Voodoo Floss treatment for plantar fasciitis) and even elbows in an aggressive and focused manner to increase blood flow, improve range of motion, and facilitate healing in muscles and connective tissue. Once your mobility improves, you then have a fighting chance at exhibiting correct functional movement during exercise and daily life (e.g., running with a balanced center of gravity over your feet and an efficient dorsiflexion of the foot on each stride), such that you won’t be doomed to a lifetime of repeating injuries, both acute and overuse.
Regarding plantar fasciitis, Starrett recommends attacking the cause by working to increase mobility, flexibility, and functionality throughout the lower extremities. You can check out his full suggested regimen on YouTube.
Complete the prolonged stretching plus mobility work protocol several times a day until the pain and stiffness are nearly when you awaken in the morning. Then you can shift into maintenance mode where you might do the stretches once or twice a day instead of five to seven times a day. And you might do your bashing, tacking and mobilizing only in the aftermath of tough workouts when you experience next-day stiffness.
Your main objective is to prevent the shortening and lost mobility that laid the foundation for plantar fasciitis in the first place.
Look for Brad’s follow-up post on preventing plantar fasciitis from setting in (or re-occurring) later in just a couple weeks. In the meantime, give your focus to the treatment, and let these stretches do their magic. Thanks again to my friend, Brad Kearns, for stopping in and sharing his experience today.
Again, you can follow Brad on his new podcast, Get Over Yourself, where he gets to unleash his lively personality and cover broader topics including health, fitness, peak performance, personal growth, relationships, happiness, and longevity, always with humor and a little spice.
Thanks, everybody. Be sure to share your thoughts and questions on plantar fasciitis below. Have a great end to your week.
Phil Maffetone and Dr. Frykman, barefoot running podcast
Dr. Kelly Starrett Plantar Fasciitis
Plantar Fasciitis, Fix Your Feet