Pilates for Easing Plantar Fasciitis Pain

              Pilates  for  Easing  Plantar  Fasciitis  Pain                                                               Heather  Jazayeri   Septem...
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              Pilates  for  Easing  Plantar  Fasciitis  Pain                                                               Heather  Jazayeri   September  7,  2014   La  Playa  Pilates,  Santa  Barbara,  CA      

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ABSTRACT       In  today’s  society,  plantar  fasciitis,  a  condition  that  is  commonly  described  as  an   intense  heel  pain,  can  plague  anyone  from  major  athletes  to  the  average  soccer  mom  to   the  obese  population.      This  paper  will  take  a  look  at  the  cause  to  this  problem  that   affects  10%  of  the  United  States  population  and  how  Pilates  can  help  them  achieve  their   activities  of  daily  living  with  less  pain  (1).  A  structured  Pilates  regimen  will  not  only   increase  flexibility  of  the  plantar  fascia  and  calf  muscles  but  also  strengthen  them  to   relieve  pain  so  that  daily  activities  can  be  achieved.                                

 

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TABLE  OF  CONTENTS     Title  Page  

 

 

 

 

 

 

 

 

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Abstract  

 

 

 

 

 

 

 

 

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Anatomical  Description  

 

 

 

 

 

 

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Case  Study  

 

 

 

 

 

 

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Conditioning  Program  

 

 

 

 

 

 

6-­‐9  

Results  

Table  Of  Contents  

 

 

 

 

 

 

 

 

 

 

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Bibliography    

 

 

 

 

 

 

 

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ANATOMICAL  DESCRIPTION    

The  images  below  are  of  the  plantar  fascia  and  the  points  of  pain  associated  with  

it  when  it  becomes  inflamed  and/or  degeneration(2)  of  the  collagen  sets  in.  The   plantar  fascia  is  a  broad  ligament  that  runs  along  the  bottom  of  the  foot,  connecting   to  the  calcaneus  (heel)  and  the  metatarsals  (base  of  toes)  and  can  become  inflamed   or  overused  from  prolonged  standing,  intensive  exercise,  tight  calf  muscles,  obesity   or  naturally  occurring  high  arches.  Pain  is  typically  associated  with  the  calcaneus   (heel)  region  and  is  reported  to  be  especially  painful  during  the  first  few  steps  of  the   day  after  waking,  as  the  plantar  fascia  has  contracted  overnight    (4).    

  (3)            

 

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  CASE  STUDY   NAME:  Tonya  Jazayeri   AGE:  49   LIMITATION:  Tonya  has  been  diagnosed  with  chronic  plantar  fasciitis  and  cannot  stand   for  prolonged  periods  or  get  involved  with  high  impact  activities  such  as  running.   REHABILITATION  TREATMENTS:  Tonya  has  tried  physical  therapy,  acupuncture,   massage  and  prescribed  orthotics   My  mother,  Tonya,  has  been  dealing  with  plantar  fasciitis  for  the  past  five  years.   She  has  never  been  extremely  active,  but  has  managed  to  maintain  a  healthy  weight  and   stays  fit  with  her  day-­‐to-­‐day  activities  such  as  walking  the  dog  and  working  as  a  speech   pathologist  in  an  elementary  school.  She  often  complains  of  foot  pain  and  can  get  flare-­‐ ups  quite  easily  from  over-­‐exertion  or  even  from  cooking  in  the  kitchen  for  a  few  hours.   She  has  tried  various  non-­‐invasive  methods  of  rehabilitation  and  nothing  seems  to  help   as  a  long-­‐term  solution  to  her  pain.      Clinically  made  orthotics  help  support  her  high   arches  and  make  her  pain  manageable  throughout  the  day  but  as  soon  as  she  switches   shoes  or  takes  them  off  for  the  evening,  her  pain  comes  right  back.  Her  one  and  only  5K   that  she  ever  ran  put  her  in  so  much  pain  for  an  extra  two  months  after  the  race  that  she   is  afraid  to  do  any  runs  again.  This  Pilates  regimen  will  hopefully  strengthen  her  body  as   a  whole  and  give  her  body  adequate  flexibility,  especially  in  the  foot,  ankle  and  calf   region  so  that  the  plantar  fasciitis  can  be  manageable  in  the  long-­‐term.        

 

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  CONDITIONING  PROGRAM   BLOCK  

 

SESSIONS  1-­‐10  

SESSIONS  11-­‐20  

WARM  UP  

Mat:  Roll  Down,   Pelvic  Curl,  Spine   Twist  Supine,   Chest  Lift  

FOOT  WORK  

Reformer:  All   Footwork    

ABDOMINAL  WORK  

Reformer:   Hundred  Prep,   Hundred,   Coordination  

HIP  WORK  

Reformer:  Frog,   Circles  (Down,Up)   Openings  

SPINAL   ARTICULATION  

N/A**See  Below**  

Reformer:     Bottom  Lift,  Short   Spine,  Long  Spine  

STRETCHES  

Reformer:   Standing  Lunge  

FULL  BODY   INTEGRATION  F/I  

N/A**See  Below**  

Reformer:   Standing  Lunge,   Side  Splits   Reformer:   Scooter,  Round   Back,  Flat  Back  

ARM  WORK  

Reformer:  Arm   Series  Supine  

Reformer:  Arms   Sitting  Series,   Shoulder  Push  

FULL  BODY   INTEGRATION  A/M  

N/A  

N/A  

 

Mat:    Roll  Down,   Pelvic  Curl,  Spine   Twist  Supine,   Chest  Lift  (W/   Rotation),  Single   Leg  Lift,  Leg   Changes,  Roll  Up   Reformer:  All   Foot  Work.     Reformer:     Hundred,   Coordination   Cadillac:  Bottom   Lift  W/  RU-­‐Bar   Cadillac:  Frog,   Hip  Circles  (Down,   Up),  Walking,   Bicycles  

SESSIONS  21-­‐30   Mat:  Roll  Down   Pelvic  Curl,  Spine   Twist  Supine   Cadillac:  Roll  Up   W/  RU-­‐Bar,  Mini   Roll-­‐Ups  (W/   Obliques)   Cadillac:  All  Foot   Work  including   Hip  Opener   Cadillac:  Bottom   Lift  W/  RU-­‐Bar,   Breathing  W/   Push  Through  Bar   Cadillac:  Frog,   Hip  Circles  (Down,   Up)  Frog  Single   Leg,  Hip  Circles   Single  Leg   Reformer:   Bottom  Lift  (With   Extension),   Semicircle   Reformer:   Kneeling  Lunge,   Side  Splits   Reformer:  Up   Stretch  1,   Elephant,  Down   Stretch   Reformer:  Arms   Kneeling  Series,   Shoulder  Push   Single  Arm   Reformer:  Up   Stretch  2,  Long   Stretch  

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  LEG  WORK  

  Mat:  Gluteals  Side   Lying  Series  

LATERAL   Mat:  Side  Lifts,   FLEXION/ROTATION   Saw,  Spine  Twist    

  Reformer:   Hamstring  Curls,   Skating   Wunda:  Side   Stretch,  Side   Kneeling  Stretch   Reformer:   Breaststroke  Prep,   Wunda:  Swan   Basic  

  Reformer:  Jump   Board  Series  

Reformer:   Mermaid,  Side   Over  on  Box   BACK  EXTENSION   Mat:  Back   Reformer:   Extension,  Single   Breaststroke,   Leg  Kick,  Cat   Pulling  Straps  1   Stretch,   Wunda:  Swan  on   Swimming,  Rest   Floor   Yellow  indicates  that  those  exercises  are  specifically  targeting  Tonya’s  condition  with   plantar  fasciitis,  slight  anterior  pelvic  tilt  or  slight  kyphosis.   **  SPINAL  ARTICULATION  //  Mat:    Spine  Stretch  (Extension),  Rolling   **  FULL  BODY  INTEGRATION  //  Mat:  Front  Support,  Back  Support  (Bridging)   We  begin  all  of  Tonya’s  sessions  with  the  Roll  Down  to  assess  her  posture,  take   notes  on  her  spinal  articulation  and  where  her  alignment  is  on  the  plumb  line.  I  noticed   she  there  is  slight  kyphosis  in  the  thoracic  spinal  region  in  addition  to  her  locked  knees   and  slight  hyperlordosis  of  the  lumbar  spine.    Since  Tonya  is  a  beginner  to  Pilates  and   completing  a  physical  fitness  regimen  in  general,  I  incorporated  her  first  ten  sessions  or   so  with  some  mat  work  to  condition  her  core,  which  was  especially  weak.  For  the  sake  of   maintaining  a  good  flow  throughout  these  beginner  sessions,  we  began  with  basic   foundation  mat  work  and  then  finished  the  warm  up  on  the  Reformer,  which  continued   into  various  blocks  of  the  comprehensive  system.    After  Arm  Work  has  been  completed   on  the  Reformer,  we  moved  down  to  the  mat  to  finish  up  the  last  three  blocks  of  the   comprehensive  system  as  well  as  integrate  some  Bridging  and  Spinal  Articulation  to   simulate  what  cannot  and  should  not  be  attempted  at  such  an  early  stage  of  her  Pilates   career.    

 

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The  goal  of  the  foot  work  Warm  Up  in  each  session  is  to  increase  her  ankle,  foot   and  calf  range  of  motion.  On  the  calf  raises  exercise,  I  will  gently  pull  on  her  heels  further   under  the  foot  bar  to  give  an  added  stretch  to  the  Achilles  tendon  and  plantar  fascia.  The   abdominal  work  was  designed  to  allow  her  to  progress  from  basic  to  some  intermediate   and  advanced  work  that  will  challenge  her  but  mostly  strengthen  her  core  to  hold  herself   more  upright  and  maintain  a  more  neutral  posture  throughout  the  day.  The  hip  work   will  be  especially  beneficial  to  opening  the  iliopsoas  (hip  flexors)  to  allow  for  a  more   neutral  pelvis  during  day-­‐to-­‐day  activities.  It  will  also  strengthen  her  hip  adductors  and   abductors  with  will  make  activities  of  daily  living  more  fluid  and  natural.     Spinal  articulation  once  again  contributed  to  her  core  strength  and  a  major  tenet   to  Pilates,  control.  The  basics  were  first  taught  on  the  mat  and  then  progressed  to  work   on  the  reformer  as  her  spinal  extensors  became  more  flexible  and  strong.  The  standing   lunge  stretch  and  variations  were  selected  to  lengthen  and  stretch  Tonya’s  hip  flexors,   which  was  causing  an  anterior  tilt  of  the  pelvis.  Arm  work  contributed  to  Tonya’s  overall   strength  and  also  helped  to  address  some  issues  of  having  a  slightly  kyphosis  thoracic   spine.  We  targeted  the  latissimus  dorsi  muscles  with  exercises  in  the  Arms  Series  Supine   as  well  as  chest  opening  exercises  from  the  Arms  Series  Sitting  and  Kneeling.    Full  body  integration  exercises  were  introduced  in  the  middle  of  her  Pilates   conditioning  program.    It  was  a  full  testament  to  having  a  body-­‐mind  connection  as  well   as  a  strong  core  to  control  the  movements.  The  leg  work  was  important  as  we   strengthened  her  glutes,  hamstrings,  quads  and  calves  to  make  movement  in  her  lower   body  fluid.  We  incorporated  mermaid  and  side  over  bend  to  give  her  a  good  stretch  

 

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along  her  sides  and  this  will  help  improve  her  overall  range  of  motion.  Back  extension  is   especially  good  for  her  slightly  kyphotic  thoracic  spine.     RESULTS   This  Pilates  regimen  has  not  been  tested  on  Tonya  but  the  perceived  results  are   anticipated  to  help  make  her  pain  from  plantar  fasciitis  more  manageable.    Each  block  of   the  Comprehensive  System  is  strategically  designed  to  work  her  body  in  the  best  way   possible  for  its  current  state.    The  anticipated  results  of  following  this  Pilates  Regimen   would  strengthen  her  body  as  a  whole,  but  specifically  address  the  strength  of  her  core,   which  would  improve  her  posture  and  also  allow  her  to  move  with  more  ease  and   fluidity.  Her  flexibility  would  be  greatly  increased  in  specifically  the  hip  flexors,  the   spine,  and  the  calf  and  foot  muscles.  Combined  with  a  low  impact  cardiovascular   program  such  as  swimming,  biking  and  elliptical,  Tonya’s  overall  body  fat  would   decrease  and  she  would  notice  significant  tone  to  areas  of  her  body  such  as  upper  body   and  core.       CONCLUSION    

It  is  perceived  that  a  tailored  Pilates  regimen  is  beneficial  to  decreasing  pain  for  

people  with  plantar  fasciitis.  Pilates  incorporates  many  stretching  and  strengthening   exercises  for  the  feet,  ankles  and  legs  that  can  ease  pain  with  increased  mobility.  With   the  proper  Pilates  conditioning  program,  a  person  with  plantar  fasciitis  can  experience   overall  increased  strength,  better  posture  and  functional  movement.  I  would   recommend  a  structured  Pilates  regimen  for  those  with  plantar  fasciitis  pain  in  the   future  to  accompany  traditional  therapies  for  overall  healing  and  relief  from  pain.    

 

 

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BIBLIOGRAPHY   1. Riddle  DL,  Schappert  SM.  Volume  of  ambulatory  care  visits  and  patterns  of  care   for  patients  diagnosed  with  plantar  fasciitis:  a  national  study  of  medical   doctors.  Foot  Ankle  Int.  May  2004;25(5):303-­‐10.  Retrieved  from   http://emedicine.medscape.com/article/86143-­‐overview#showall   2. Lareau  CR,  Sawyer  GA,  Wang  JH,  DiGiovanni  CW  (June  2014).  "Plantar  and  Medial   Heel  Pain:  Diagnosis  and  Management".  The  Journal  of  the  American  Academy  of   Orthopaedic  Surgeons  22  (6):  372–80.  doi:10.5435/JAAOS-­‐22-­‐06-­‐372.  Retrieved   from  http://en.wikipedia.org/wiki/Plantar_fasciitis   3. Benjamin,  C.  Ma,  MD,  Zieve,  David,  MD,  MHA,  Ogilvie,  Isla,  PhD,  and  the  A.D.A.M.   Editorial  team.  (2014,  March  8).  Retrieved  from   http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004438/   4. Goff  JD,  Crawford  R  (September  2011).  “Diagnosis  and  treatment  of  plantar   fasciitis”.  Am  Fam  Physician  84  (6)  676-­‐8  PMID  21016393.  Retrieved  from   http://en.wikipedia.org/wiki/Plantar_fasciitis            

 

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