Home ยป Solving the mystery behind plantar fasciitis

Solving the mystery behind plantar fasciitis

    The pain of plantar fasciitis is real. And it can last a long time. But consider this pain a good thing: it’s a sign from the body that something needs to change. There’s a pattern of movement that isn’t serving you and the body is letting you know about it. Thanks body!

    However, the problem can be figuring out WHAT needs to change. It can be like a puzzle or mystery that needs solving. Here’s some guidance on how to approach this in the hopes of a long-term solution that treats the problem, not the symptoms.

    There are lots of solutions out there to ease the symptoms (i.e. pain). While this can be helpful, it’s always temporary because the underlying issue hasn’t been resolved – which means there’s a likelihood that it will surface again.

    What is plantar fasciitis?

    Plantar fasciitis is a problem on the bottom of your foot.  The suffix “itis” means inflammation, so it’s inflammation of the fascia on the plantar (bottom) side of your foot.  The plantar fascia is the flat band of tissue (ligament) that connects your heel bone to your toes. It supports the arch of your foot. The inflammation exists either because the bottom of your foot was overused, OR it is responding to being tugged all the time. These are two different things, but have the same effect.

    Let’s look at this in more detail: your feet are used in walking and running. When you step forward, the foot moves into dorsiflexion. Here the top of the foot comes toward the shin, so your heel can reach for the ground.  After the foot lands (which stretches the tightened fascia – Ouch!), it comes into plantarflexion. Here the bottom of the foot flexes, which helps you push your leg behind you (into extension).

    Patterns of movement

    Now, what is the big pattern of movement associated with pushing your leg behind you?  Well, the whole back line of the body has to work together. As mentioned, this involves the muscles on the bottom of the foot, and it also involves the calf muscles, hamstrings, glutes, and the muscles of the low back, particularly on the same side that the leg is extending. 

    If any of these muscles on the back line are tight, you’ll feel a pull and tug on that whole line with each step forward. And in this case, they are pulling and tugging on the bottom of your foot. (For an explanation of how tight hamstrings affect the plantar fascia, go here.)

    You can see how it’s no longer a problem with the foot (where the pain is) but rather the problem could be anywhere along the whole back line of the body.  You can’t just focus on the foot, when the foot is connected to the rest of the body! The body moves holistically in a specific pattern.

    The centre of the body is everything

    The other thing to note is that the muscles at the centre of the body – your centre of gravity – control the peripheral limbs (e.g. legs, arms, head). These big muscles of the centre include: the abdominals, the obliques, and the back muscles.  

    To move your arms requires muscles in the centre to fire and coordinate with your arms. To move your legs, requires muscles in the centre to fire and coordinate with your legs. Picture a ballet dancer. Their spine (centre) needs to move in a fluid way to help “express” the arms and legs. And when we walk, our centre is moving to allow the arms and legs to swing back and forth.

    We need movement and freedom in the torso in order for the arms, legs and head to move freely. It’s all connected. And so it follows that if any of the muscles in the centre of the body get tight, it can affect the mobility of the periphery such as shoulders, neck, hips, legs, knees and of course feet.

    Pain is our teacher

    I’ve been experiencing tightness in my right Achilles tendon for several months. This is in the same “neighbourhood” as plantar fasciitis. It’s manageable, but persistently annoying. This is a great message from my body that something is up that I need to change. Even though I don’t feel like I’m doing anything to contribute to this pain, clearly I must be doing something, but I’m just not aware of it.

    This disconnect – between what I feel and what actually is happening – is called Sensory Motor Amnesia (SMA). Basically, it’s like my brain has “forgotten” how to control some of my muscles. Remember, it is the brain – through the sensory motor nervous system – that controls movement.

    Why has my brain forgotten? Because this maladaptive pattern has been so well established and “learned” that this information is stored in the sub-cortex part of my brain (same part of the brain where we store “autopilot” movements such as how to walk and brush our teeth). So, tuning in to what I’m doing that I’m not aware of? That’s challenging! This takes lots of patience, exploring, moving slowly, and breaking patterns down in to their component parts, all with great awareness.  Sometimes you need the help of someone else to spot things, because you are so amnesiac. (I’ll share what I did shortly.)

    Gathering the clues

    It’s often recommended to stretch the calf muscles if you have plantar fasciitis. In my experience, stretching the calf muscle relieves the tightness temporarily, which is helpful, but the pain keeps returning. Why? Because I haven’t resolved the underlying issue.

    So then I have to look at the big pattern: what other parts of my back line are tight? Well, I have noticed that my left glute is tight and that the right side of my back starts to ache when I sit for too long. (My guess is that I feel like I’m slumping, so I unconsciously arch my back to “sit up taller”.) Also, when I twist or side bend, I’ve noticed that I’m more limited on my right side. These are all clues.

    Now I have something to work with: left glutes, right side of mid-back, right waist area.

    How to loosen these tight muscles: pandiculation

    Over the last two weeks I have used Somatics to lengthen these tight muscles, with a specific technique called pandiculation. Pandiculation is a voluntary contraction of a muscle or group of muscles, followed by a slow, conscious release. In this instance it would be the muscle group of the back line of my body.

    Here’s what that looks like: lying on my belly, with my head resting on stacked hands, I point my toes (plantarflexion) and slowly lift my right leg off the floor, at the hip. I might also lift my head a little bit to engage more of my back muscles. I feel and notice what’s working to do this, and then slowly release the head and leg back down (and I’m talking super slow, like a count of 10). The reason to go slow is to make the brain pay attention. This is neuroplasticity in action. Remember: you can’t change what you’re not aware of. You have to pay attention.

    I repeat this a few times. Then I do the same things with my left leg. The key for me is to pay particular attention to the 3 areas I identified earlier. If these areas are amnesiac, then I want to bring them back into my control. I do this by paying attention to them, as they are contracting and releasing. I might do some other things: try the legs at a different angle, do it with a bent knee, try pandiculating my calves, etc. But the basic key is learning to release tight amnesiac areas that are contributing to your pattern’s tightness. Here I am unlearning my maladaptive movement pattern.

    Progress!

    As I mentioned, I’ve been working on this for the past two weeks and I am seeing some progress! When I get out of bed I no longer wince when I place my foot on the floor and start walking (more like limping!). Certainly muscles do get tight after inactivity (such as sleeping or sitting) but there shouldn’t be pain. Note that it can take a week or two for a new pattern to be established, and reinforcing this new healthier pattern with repetition is the best way to learn.

    Once you understand the concept of movement patterns and how they contribute to pain, you can solve a lot of problems. We have talked about the back line of the body as it relates to plantar fasciitis. I will write another blog in the near future how a pattern of movement might look for other issues, such as shoulder or hip pain. Keep an eye out.

    Where to go from here

    I like to use Somatics because it lets me take control of my own wellness. As a result, I get to know my body better and have the tools to be able to take care of any problems that arise in the future. If this resonates with you, then here are a few options. Try a Somatics class, so you can learn about the patterns of the body and find out where you have sensory-motor amnesia. Or maybe a hands-on Somatics session would be more appropriate if you’ve tried different things and nothing is helping, and want guidance on your specific issue. Finally, if you’re interested in learning more about Somatics, I recommend Thomas Hanna’s book Somatics.

    Has this been helpful? Please comment below to let me know. Or ask me any questions, and I’d be happy to help.

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