PilatesforthealleviationofsymptomscausedbyPlantarFasciitis

BobbieGarzaSeptember-December,2017

Comprehensive–FoundationandGraduateCostaMesa,CA–2016

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ABSTRACT

PlantarFasciitisisaverycommonconditionthatcausesintensepainintheheelandbottomof

thefoot.Theconditioninvolvesinflammation,irritationand/ordegenerationoftheplantar

fascia,aflatbandofdenseconnectivetissuethatconnectstheheelbonetothetoes,and

responsibleforsupportingstructuresinthebottomofthefoot.Plantarfasciitisoccurswhen

sometypeofstressordisruptstheattachmentpointoftheplantarfasciaattheheelbone.(5)(6)

Thehallmarkofplantarfasciitisispaincauseduponwakingandtakingthefirststepswhen

gettingoutofbed.Atnightwhileyousleep,yourfootrelaxeswiththeligamentsinashortened

position,allowingthedamagedsofttissuetobegintorepairitself.Whenyouawakeandput

weightonyourfoot,thearchlowersandincreasesthestretchintheplantfascia.Witheach

step,re-tearingofthehalf-healedligamentoccurs,causingpain.(5)

Severalfactorscancontributetothedamagethatoccursintheplantarfascia,including

improperfootwear,highorlowarches,walkingonhardsurfaces,tightmuscles,injuries,aging

(over40),excessbodyweightandpregnancy.Everyexpertsuggestsadifferentandvariable

rangeoftreatmentsfromicingtomassagetoorthotics.Thereare,however,twopointsthat

theseexpertsallagreeon:1)theproblemmustbeaddressedandtreatedintheacutephase,

beforeatearintheplantarfasciaoccursoraheelspurdevelops;2)idealtreatmentincludes

stretchingandstrengtheningtheintrinsicmusclesandligamentsofthefoot,stretchingthecalf

musclesandcorrectposture.Pilatesaddresseseachoftheseneedsandisanexcellent

modalitytouseforthetreatmentofthesymptomandpainassociatedwithplantarfasciitis.

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TABLEOFCONTENTS

ABSTRACT………………………………………………………………………………………………………………………2

ANATOMICALDESCRIPTION..…………………………………………………………………………………………4

CASESTUDY……………………………………………………………………………………………………………………7

CONCLUSION……………………....………………………………………………………………………………………12

BIBLIOGRAPHY……………………………………………………………………………………………………………..13

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ANATOMICALDESCRIPTION

Thefoot,whichservesdoublefunctionbearingtheweightofthebodyandperformingdynamic

movementsnecessaryforwalking,iscomprisedof

26bones,31jointsand20intrinsicmuscles.Pain

associatedwithPlantarFasciitisislocatedinthe

plantarfascia,orplantaraponeurosis,astrong

layerofwhitefibroustissuelocatedbeneaththe

skinonthesoleofthefoot,connectingthe

calcaneustothemetatarsals.Itstabilizesthearch

ofthefootandallowsflexionofthefirstmetatarsal

(hallux),enablingthehalluxtocarrythemajorityof

thebodyweight.Italsoprovidesshockabsorptionwhenthefoothitstheground.(1)(2)

Laterally,theplantarapoeurosisisdividedintothreesections:themedial,thelateral,andthe

central.Thecentralportion

isthemostimportant

structurallyand

functionally,andis

attachedatitsorigintothe

medialcalcaneus.Towards

thefrontofthefoot,atthe

mid-metatarsallevel,thecentralportiondividesintofivesections,eachextendingintoatoe.

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Themedialportionoverliesthemusclestothehallux(bigtoe),whilethelateralportionoverlies

musclestothefifthmetatarsal(littletoe).(2)

Inadditiontotheplantaraponderosis,threemoreligamentscomprisethemajorligamentsof

thefoot.Theseligamentsarelocatedatthetransverstarsaljointandareessentialin

maintainingstabilityinthelongitudinalarch.Twolayersofplantarcalcaneicuboid(short

plantar)ligamentextendfromthecalcaneustothecuboidandthebaseofthemetatarsals.

Thelongplantarligamentislocatedsuperficialtotheshortplantarligament,extendingfrom

thecalcaneustotheridgeonthecuboidandontothebasesofmetatarsalsII-V.Lastly,the

plantarcalcaneonavicularligamentattachesthesustentaculuntalitothenavicularbone.Itis

importanttomentiontheseadditionalligaments,astheclientexperiencedsecondarypainin

theareaoftheplantarcalcaneonavicularligamentanddeepintotheshortandlongplantar

ligaments.(1)(3)

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Alsoimportanttoaddress,arethemusclesandtendonsofthelowerlegandankle,specifically

thecalfmusclesandAchillestendon.TightnessinthecalfmusclesandAchillestendonwillpull

theheelupandback,causingareductionindorsiflexionandplacingtensionontheplantar

fascia.Reductionindorsiflexioncanbeamechanicaldeterminantinplantarfasciitis.(4)

Thecalfmusclesarecollectivelyknownasthetricepssurae;thestrongestmusclegroupofthe

leg.Itconsistsofthreemuscularheads,allofwhichterminateontheAchillestendon,which

insertsonthecalcaneus.Soleusisthe

deepestoftheheadoftricepssurae,and

originatesontheposteriorsurfaceofthetibia

andfibularshaft.Thesoleusiscoveredby

thetwosuperficialheadsofthe

gastrocnemiusthatshapetheoutlinesofthe

posteriorcalf,originatingfromtheposteriorsurfaceofthefemoralcondyles.(1)

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CASESTUDY

Jenniferisa43-yearoldmotheroftwowhobeganexperiencingintenseheelandfootpain,

believedtobecausedbyplantarfasciitis.Hersymptomswereconsistentwiththoseassociated

withthecommonfootproblem–extremepainwhentakingthefirstseveralstepsaftergetting

outofbedinthemorning,painthatfeltlikewalkingonabedofnailsbutwouldsubsideafter

15-minutesorso.Jenniferwasalsosensitivetopressurewhenappliedtothebottomand

insideoftheheel.Thesymptomswereconsistentinherrightheelandfoot,howeverthepain

wouldonlyoccasionallyoccurintheleftheelandfoot.

ThiswasnotJennifer’sfirstexperiencewithplantarfasciitis.Shortlyaftergivingbirthtoher

secondchildshebegantoexperiencethesamepain.Atthattime,Jenniferworehighheels

dailytoheroffice,experiencedweightgainwithhertwopregnanciesandhadjustturned40

yearsold.Afterdiscussingthesymptomsandriskfactorswithherprimarycarephysician,they

concludedthatitwasinfactplantarfasciitis.Togethertheyestablishedatreatmentprocess

includingmassage/reflexology,acupunctureandfrequenticing.Afterseveralweeksfollowing

theplan,thepainreliefwassubtleandwouldstillcomeandgo.Withtwosmall,veryactive

childrenandademandingcareer,shedecidedtoreceiveacortisoneinjection.Thepainrelief

wasimmediateandallsymptomsdisappeared.

Threeyearslaterthesymptomsreturnedsuddenlyandthepainwasevenmoreintense.Inthe

threeyearsthathadpassed,manythingshadchangedinJennifer’slife.Jennifertransitioned

toapart-timejob,workingfromhome.Onewouldassumethatnolongerhavingtowearhigh

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heelswouldlessenthesymptomsofheelpain.However,Jenniferrarelywearsshoeswhile

walkingaroundonherhardwoodfloorsathome,andwhensheleavesherhomeofficesheis

oftenwearingflip-flopsorothernon-supportiveshoes.

JenniferhasbeenpracticingPilatesforseveralyears,butrecentlyhasonlyparticipatedinan

“advanced-levelclass”.Mostexercisesperformedareverychallengingandprovidean

excellentworkout.However,FootWorkisofteneliminatedinthisclasswithamorefocus

placedonstrengthbuildingandlittleattentionpaidtostretching.

Duringourinitialmeeting,myfirstobservationwasaslightdeviationinhergait.Shewalked

withaslightlyincreasedpronationinherrightfoot,indicatinginadequateankledorsiflexion.I

alsoobservedadeviationinperposturecommonwithtighthamstringsandhipflexors.This

wasconfirmedduringmyassessmentofherpostureandalignmentinherinitialroll-down.

IndevelopingaPilatesprogramforJennifer,Ichosetofocusonfourgoalswhenselecting

exercises:

1. Stretchandstrengthentheintrinsicmusclesandligamentsinthefoot

2. Stretchthecalfmuscles

3. Stretchthehamstringsandhipflexors

4. Focusonpelvicstabilitytoimproveposture

Consistentwithmostofmyresearchonthetreatmentofplantarfasciitis,Jenniferwas

experiencingaslightincreaseofpainwhenherfeetwereinapositionwithweightbearingon

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theballandtoes(ex.UpStretch1,2and3).ThereforeIdecidedtoeliminateanyexercises

wherethefootwasplacedinthispositionforourfirstsession.Wewereabletoaddthese

typesofexercisestoallsubsequentsessions,withoutlimitationandwithoutpain.

FIRSTSESSION-REFORMERONLYBlock Exercises FocusWarmUp PelvicCurl

SpineTwistSupineChestLiftChestLiftw/Rotation

PelvicCurl-focusonfindingandkeepinganeutralpelvis,watchingthatkneestrackoveranklesandfeetremainflat

FootWork EntireFootWorkSeries,excludingPrehensile

AmajoremphasiswasplacedontheFootWorkBlock!Eachoftheexercisesstrengthenandstretchtheintrinsicmusclesandligamentswithintheentirefoot.Calfraisesandprancesallowforidealstretchingofthecalfmuscles.Attentionwasalsofocusedonmaintaininganaturalpelvisandwatchingthekneesandfeetremainedparallel

AbdominalWork ShortBoxSeries Allabdominalworkwillhelptoimproveposture.IchosetheShortBoxSeriesfortheadditionallateralflexionandrotation

HipWork FrogCirclesUpCirclesDownOpenings

HipWorkisessentialforworkingonpelvicstabilityandtostrengthenhipflexorandextensors,andhenceimprovingposture

SpinalArticulation ShortSpineLongSpine

Bothexercisesareexcellentforkeepingthespineandhipshealthy,thereforeimprovingposture.

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Stretches StandingLunge AllexercisesfromtheHamstringStretchGroupareidealforstretchingtighthipsflexorsandhamstrings.IchosetheStandingLunchtoavoidputtingtoomuchpressureontheballofthefoot

FullBodyIntegration-F/I Elephant Elephantprovidesanexcellentstretchforthecalfandhamstringmuscles

ArmWork RowingSeries RowingSeriesfortheadditionalspinalflexionandextensionofferedintheexercise

FullBodyIntegration-A/M EliminatedLegWork SideSplit ForthatextrainnerthighstretchLateralFlexion/Rotation Mermaid Again,forthatlittleextrastretch

andforkeepingthespinehealthy,improveposture

BackExtension Breaststroke Strengthenthebackextensorstohelpwithposture

Inournextthreesessionsweincorporatedseveraladditionalexercisesthatwouldlend

themselvestothefocusofourfourprimarygoals:

Block Exercises FocusWarmUp CadillacWarmUpSeries TheWarmUpSeriesontheCadillac

isgreatforpromotingpelvicstability(Roll-upw/RUBar)

FootWork EntireFootWorkSeriesontheCadillac

Again,theFootWorkSeriesiscriticalinachievingeachofourfourgoals.HowevertheCadillacprovidesevenmoreopportunityforagreaterstretchinallareasofourfocus,alongwithgreatpelvicstability

AbdominalWork StandingPikePikeSittingStandingPikeReverse

ThesethreeabdominalexercisesontheWundaChairprovideagreatstretchinthehamstringandcalfmuscles

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HipWork SupineSingleLegSeries ThisseriesontheCadillacallowsforextraattentiontobeplacedonpelvicstability

SpinalArticulation MonkeyOriginalTowerPrepTower

ThecalfandhamstringstretchisintenseintheseCadillacexercises.Themusclesandligamentsinthefootwillalsobestretchedandstrengthened

Stretches GlutealsHamstringsAdductorsHipFlexors

TheLadderBarrelstretchesareanexcellentoptionforstretchingalmosteverymuscleinthelegandhip

FullBodyIntegration-F/I SittingForwardSaw

ThesetwoCadillacexercisesaregreatfullbodyexercisesthatalsoallowforastretchinthecalfandhamstring

ArmWork ArmsKneelsSideSeries ThisseriesprovidesangreatstretchinthehipflexorswhileperformingtheDeltoidReach

FullBodyIntegration-A/M TendonStretch Thenamesaysitall!Thisadvancedexercisenotonlychallengesmyadvanced-levelclient,butalsoprovidesanexcellentstretchinthecalfmuscleandAchillestendon

LegWork LyingSideSingleLegSeries

MaximumpelvicstabilityisrequiredforthisCadillacseries.AslighthamstringstretchcanalsobeachievedintheCirclesForwardandCirclesBackexercises

LateralFlexion/Rotation SideLiftwithPTBar Obliqueworkisnecessaryforimprovingpostureandpelvicstability

BackExtension HangingBack InthestartpositionofthisCadillacexercise,youwillfeelagoodstretchintheglutealsandhamstrings…anditisafunexercisetoroundoutaPilatessession

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CONCLUSION

Priortothestartofourfourthsessiontogether,Jenniferreportedthatsheawokethatmorning

andtookherfirststepspain-free!Shestillhadslightpainwhendeeppressurewasappliedto

thebottomandsideofherheel(whenpressingwithherthumb).OneweeklaterALLpainwas

gone.

InadditiontothePilatestreatmentprogramIdevelopedforJennifer,Iaskedherto1)usea

“spikymassageball”torollthebottomofherfootandheeldaily;2)iceherfootdailyby

freezingwaterinaplasticwaterbottleandrollingitunderherfoot;3)wearproper,more

supportivefootwearwhileworkingaroundthehouse.AfterjustfourPilatessessionsand

followingtheprogramoutlined,Jenniferwasfreefrompaininherfootandheel.

Pilatesistheidealexerciseprogramforthetreatmentofplantarfasciitis,ifusedproperly.The

incorporationoftheFootWorkSeriesiscriticalinthestrengtheningandstretchingofthe

intrinsicmusclesandligamentswithinthefoot.Additionally,focusingonexercisesthatstretch

thecalfmusclesandAchillestendonisimportantinthetreatmentprogramaswell.Aslongas

thesymptomsareaddressedwhilestillintheacutephase,Pilatesshouldabsolutelybeincluded

inthetreatmentprogramandcontinuedontopreventfuturepainandsuffering.

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BIBLIOGRAPHY

(1) Calais-Germain,Blandine.AnatomyofMovement(RevisedEdition).Seattle:Eastland

Press,2014.Print

(2) HealthlineMedicalTeam.“Plantaraponeurosis.”Healthline.com.April13,2015.Web

(3) HumanAnatomyAtlas.ArgosyPublishing,Inc.,2007-2015.Version8.0.27.Visible

Body.App

(4) Bolivar,Y.A.,P.V.Munuera,andJ.P.Padillo.“Relationshipbetween,Tightnessofthe

PosteriorMusclesoftheLowerLimbandPlantarFasciitis.”Foot&AnkleInternational,

34,no.1(2013):42-48

(5) Dombroski,Colin.“ThePlantarFasciitisPlan:FreeYourFeetFromMorningPain.”

LioncrestPublishing,2016.Print

(6) Best,George.“PlantarFasciitisExercisesandHomeTreatment.”GeorgeF.Best,D.C.,

2014.Print

Images:

http://ptsummit.com/plantar-fasciitis-symptoms-causes/

https://web.duke.edu/anatomy/lab15/lab16_prelab.html

HumanAnatomyAtlas.ArgosyPublishing,Inc.,2007-2015.Version8.0.27.VisibleBody.App

http://www.susaningraham.net/calf-and-shin.html