Recently, I have been having some pain in the bottom of my right foot, in front of my heel. Or as my coach would call it, a “niggle”. After some research online, I self-diagnosed my niggle as plantar fasciitis. Don’t you love the internet? Look at me, I’m a doctor! Erring on the side of caution, I emailed my friends Dr. Doepper and Dr. Sanders at Capital Rehab of Winchester.
Here is how Wikipedia describes plantar fasciitis:
Plantar fasciitis (also known as plantar fasciopathy or jogger’s heel) is a common painful disorder affecting the heel and underside of the foot. It is a disorder of the insertion site of ligament on the bone and is characterized by scarring, inflammation, or structural breakdown of the foot’s plantar fascia. It is often caused by overuse injury of the plantar fascia, increases in exercise, weight, or age. Though plantar fasciitis was originally thought to be an inflammatory process, newer studies have demonstrated structural changes more consistent with a degenerative process.
If it’s on Wikipedia, it’s true, right?
After describing my ailment, Dr. Doepper and Dr. Sanders suggested I come in for a consultation. They are both well aware of my Boston Marathon aspirations, so anything that keeps me moving and pain free is the priority. Taking time off from training is a last thing I wanted to hear.
At the Capital Rehab office, Dr. Doepper’s friendly assistant got me set up in a patient room with a heating pad on my calf and heel while he finished up with his other patients. When he came in the room, I showed him where the pain was and when I would feel it the most.
- My foot doesn’t hurt when I run, but there has been a little tightness in my calf on the same leg as the foot issue when I run.
- The foot is usually sore after inactivity.
- At work, after sitting at my desk for extended periods.
- After relaxing on the couch in the evening.
- When I get out of bed in the morning.
Dr. Doepper had me lie on my stomach. He asked me to relax my legs. I thought they were relaxed. So I moved around a bit on the table to get comfortable. “You’re relaxed?” he asked. For some reason my right shin wasn’t lying flat on the table like it should when relaxed. He said I probably had some adhesions in my calves. He described the inner workings of my legs as having connective tissues, Fasica, that surrounds the muscles, nerves and blood vessels. It should be slippery and allow them to move and slide freely. Adhesions or scar tissue can cause the muscles to not move freely. This can cause pain or trigger points for pain in other areas. It also affects mobility of the muscles. The adhesions can be treated by breaking them down using the Graston Technique. The goal is to get that Fascia smooth and slippery again allowing the muscles a full range of movement. Here is a definition from the Capital Rehab website:
The Graston Technique® (GT) is an advanced form of instrument-assisted soft tissue mobilization, which incorporates the use of six patented stainless steel instruments. GT enables clinicians to effectively treat the adverse effects of scar tissue and fascial restrictions.
Ah, the Graston Technique … Just like you see in war movies; where the prisoner of war is held in a dingie back room while the sinister interrogator deliberates over his tool box, carefully selecting the proper implement of pain to coax secrets out of his captor; Dr. Doepper pulled out his case of shiny metal Graston tools and selected his weapon of choice. He chose a round bar that was shaped kind of like a small bicycle handlebar – straight on the ends, curved in the middle. He ran the curved part over my calf muscle. I could instantly feel where the adhesions were. More so, I could hear it. It was kind of a crunchy sound.
I’m not going to lie, it hurt. Somehow I carried on a conversation about Boston preparations and my training. After he finished the calves, that right shin was laying flat on the table. Finally he moved on to the soles of my feet. He selected a smaller tool for this area. This was not nearly as painful, even in the spot near my heal that had been giving me trouble. He said I probably have a bit of plantar fasciitis, but these treatments will help to fix other areas that contribute to that condition.
After the Graston session, which took about 20 minutes all together, Dr. Doepper showed me some stretching and strengthening moves I should add to my routine. Coach Kyle sends me daily strength and conditioning drills and exercises to do for varying areas of my body, so I will be adding these specific ones into that regimen.
I took that evening off from running to give my muscles a break. There was some bruising on my calves where the adhesions were. Dr. Doepper must have really worked those areas over. That evening while relaxing on the sofa, and in the morning, I did notice a difference in the level of pain and stiffness. There was hardly any at all.
Two days after the treatment, I ran a 5k and my time was 10 seconds faster than the result I had at the same race a year ago. My legs felt refreshed and not sore at all. The spot on the bottom of my foot did not hurt at all nor did my calf.
I’m a believer in the Graston Technique. I plan on getting several treatments to smooth out that Fascia and get rid of adhesions. After the muscles start to feel smooth again, I’ll start a routine of deep tissue massage to keep everything feeling great in the weeks leading up to Boston.
Maybe the increase in muscle mobility will help my running as well. Time will tell.
Dr. Doepper wrote an interesting article about the Graston Technique used on an Ultra Runner. You can read it here: Why Didn’t Physical Therapy Help?