Pilates for Easing Plantar Fasciitis Pain Heather Jazayeri September 7, 2014 La Playa Pilates, Santa Barbara, CA
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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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).
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.
CONDITIONING PROGRAM BLOCK
Mat: Roll Down, Pelvic Curl, Spine Twist Supine, Chest Lift
Reformer: All Footwork
Reformer: Hundred Prep, Hundred, Coordination
Reformer: Frog, Circles (Down,Up) Openings
Reformer: Bottom Lift, Short Spine, Long Spine
Reformer: Standing Lunge
FULL BODY INTEGRATION F/I
Reformer: Standing Lunge, Side Splits Reformer: Scooter, Round Back, Flat Back
Reformer: Arm Series Supine
Reformer: Arms Sitting Series, Shoulder Push
FULL BODY INTEGRATION A/M
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
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.
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
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.
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