Plantar Fasciitis – What Causes It, Why It’s Happening and What to Do About It

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Are you ready to Break Up With Your PF™?

Plantar Fasciitis, that is.

If you do – first, you have to understand what it is and what’s causing it.

This issue is one of the most debilitating and least understood “injuries” a human being can experience.

I put “injuries” in quotations because (and this is why this issue seems to confound western medical science), there’s often nothing structurally wrong (visible to imaging machines or other diagnostic methods) to point to as the cause of pain.

There are no broken bones, nearby joints probably looks ok, and usually there’s nothing ‘wrong’ with the soft tissue either (other than inflammation), from a western medical standpoint. There might be a heel spur, or minor tearing of the plantar fascia itself – but this is often looked at in a vacuum as the cause and site of pain when it’s actually a symptom of something else.

Without knowing the cause of something it’s almost impossible to know the solution.

Any attempts to eliminate pain without first knowing the cause is like throwing darts at an unknown target in the dark! The chances of hitting the correct target are next to nil.

If you’re ready to say goodbye to plantar fasciitis and hello to happy feet, click here. If you want to understand it more first, keep reading.

What IS plantar fasciitis?

Traditionally, plantar fasciitis is described as “heel pain,” but people are often diagnosed (or self diagnose) with plantar fasciitis whether they have pain in the heel UNDER the calcanues (heel bone) on the bottom of the foot, on the inside or outside of the heel NOT on the bottom of the foot (so, below the inside or outside ankle), whether the pain is in the arches and sometimes PF can be classified as pain under the ball of the foot.

While these details may not matter for a diagnosis (and I am NOT in the business of diagnosing anyone), they sure as heck matter to figure out the solution. We’ll be talking more about the various kinds of PF pain in Part 2 of this 5-part series.

In the simplest terms, plantar fasciitis is “inflammation of the plantar fascia.”

Hmmmm…this doesn’t tell us much, does it?

While it doesn’t tell us much…it’s a start. The problem with most ‘diagnostics’ is, they stop here. But not us. We’re going to take this to its end point – or, root cause. We’re going to ask why like an annoying little kid who will not settle for anything less than the truth, until we get to the bottom of this! (Pun intended?! :P)

So, your foot hurts. And there’s inflammation present…

Why is the plantar fascia inflamed?

Ahhhh…by asking this question, now we can get somewhere!

The plantar fascia is inflamed because something (or several somethings) are irritating it. In order to understand plantar fasciitis, we have to understand at least a little about fascia. After all, it’s even in the name of this debilitating issue!

If you want a more comprehensive crash course on fascia, click here.

What is fascia?

fasciaecmFascia, or connective tissue, coats every nerve ending and then wraps the whole nerve. It wraps every fibril of muscle tissue, every fiber of muscle, every muscle bundle and then every muscle group is wrapped in large tough sheets of the stuff, which come together and turn into tendons and ligaments, also fascia – just a denser version – which connects to our bones. Every bone is coated in a layer of fascia, as are all of our organs.

We have MORE of this fascia stuff than anything else in the body! And this fascial system is meant to be elastic, flexible and able to move with us.

All fascia has within it something called ground substance and the extracellular matrix (ECM), and it is this ground substance that gives fascia its spring because it contains a gel-like substance that keeps the fascia hydrated and our cells nourished.

The ECM is responsible for distributing force and tension throughout the fascial system so we don’t damage ourselves from one hit (it’s our SHOCK ABSORBER!)

BUT – and we’re about to get into what the heck this has to do with plantar fasciitis here in a second – with overuse, under use, age and other factors like trauma and injuries, the fascial system starts to get dehydrated and then brittle. It LOSES ITS SPRING. It also sticks to itself in knots or adhesions, pulling muscle fibers with it and pulling on or irritating attchements.

It is this combo of dehydrated and knotted up restricted fascia that creates pain and inflammation in the plantar fascia.

Why does the fascia become unhealthy?

The posterior fascial chain. Photo rights belong to Anatomy Trains.

The posterior fascial chain. Photo rights belong to Anatomy Trains.

This is the topic of a future episode. For now, we’re sticking to the anatomical or physiological causes of PF pain.

Most of the time, plantar fasciitis pain is stemming from tightness and restriction in your calves and hamstrings. Sometimes it can come from fascial restrictions higher up the posterior chain or in the upper body like your traps, but those cases are rare in my experience and often indiciate a deeper underlying issue.

The most common pattern that falls into this category is a hip or pelvic instability problem. Going after the glute in this case though wouldn’t be the correct solution, because the glute isn’t the problem either, it’s another symptom of dysfunction! (Part 5 of this series is all about this hip instability issue, and I’ll break it down for you so no need to understand it right now!)

Bottom line is…your plantar fascia starts to get irritated and angry. WHY?

Something (or several things) UPSTREAM are starting PULL on the Achilles tendon and plantar fascia.

At the same time, if your entire lower leg compartment has fascia that is dehydrated and brittle, you’ve lost the ability to absorb and distribute force and tension or in other words you’ve lost your SHOCK ABSORPTION! And…

With EVERY step you take walking around, and especially running, there’s nowhere to distribute the impact – so it’s felt –

GUESS WHERE?

YOUR HEEL!

And now we have a scenario where all those tiny bones, tendons, ligaments and joints in your foot are bearing the weight and impact of your body and activities, when that job is SUPPOSED to be distributed throughout your entire lower body.
This is one reason why it can start to feel like you’re walking around on a bruise. In many ways this may be quite accurate, because the calcaneus bone and all the small tendons, ligaments and joints within your foot start to feel the brunt of impact from every step and over time may very well start to bruise.

Your body may give you a pain signal here, or it might not happen until the fascia in your foot ALSO loses its spring and if the plantar fascia becomes dehydrated, brittle AND overstretched it is now in danger of tearing. This is one reason people get heel spurs – the body is trying to throw something down to make up for the loss in plantar fascia spring/length/durability.

OR, you may get the pain signal simply due to fascial restrictions in the calves and hamstrings pulling on the Achilles tendon and plantar fascia.

At some point the body, which is extremely intelligent and doesn’t do ANYTHING without reason, isolates that area for healing via INFLAMMATION.

Guess what inflammation does? It puffs up an area and mimics that squishy gel like make up of ground substance!

The body is likely trying to rehydrate that area with fresh plasma and prevent you from using it because that could cause further damage.

Little do you know, because no one ever told you this, but YOU CAN REHYDRATE YOUR FASCIA and give your foot exactly what it needs to stop getting your attention with a horrible and debilitating pain signal.

Most of the time plantar fasciitis is dead simple.

Like – there’s a tack in your forehead? Let’s pull it out! BAM! Done. That simple.

Notice I didn’t say easy, I said simple – the process of getting out of pain involves effort, curiosity and patience, but if it took you years to get here and it only takes a week or two to get out of pain, I’d say that’s pretty great success!

Sometimes however, it can be more complicated. In Part II we’ll be going over the different variations of plantar fasciitis, and why this matters for getting out of pain.

If you’re suffering with plantar fasciitis and want to get out of pain for good, check out our brand new course by clicking the picture link below.

Break Up With Your PF™ - Say Goodbye to Plantar Fasciitis For Good!

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The One Rule of Effective Fascial Release, And Why Massage Doesn’t ‘Release’ Fascia

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Have you ever wondered why massage therapy doesn’t “release” fascia? I mean…those deep tissue massages hurt! They must be doing something, right?

I want to let you in on a little secret that will help you understand fascia and how to create changes within that soft tissue system that last.

First…let’s dive into a mini crash course on fascia, just in case you’re still unsure exactly what this stuff is.

What is fascia?

Fascia is a collagen-like substance that permeates the entire human body. Every nerve ending is coated in a piece of fascia, as is every muscle fibril and fiber, every muscle bundle and group, and all of this turns into tendon and ligament, which attach to our joints. Even our bones and organs are wrapped in fascia! We have more of this substance in our body than anything else.

While the picture to the right is a great example of how it wraps the muscle fibers, what that image doesn’t show is all the billions of nerves it wraps that travel within the soft tissue system, which means this stuff isn’t linear – it’s a vast and criss-crossing matrix.

Fascia is supposed to be elastic, flexible, STRONG and resilient. Since it wraps literally everything in the body that supports LIFE, I have come to believe it is meant to be almost bulletproof; like the Kevlar that protects our nerves, muscle fibers, bones and organs. (It’s much, much more than this, but this’ll do for today’s crash course).

If fascia were easily change-able we’d be in BIG trouble! Every time we bump into anything we’d damage ourselves. Heck, even sitting down would cause a re-molding of the fascia in our hips and butts if fascia were that quick to change.

Thus, it is my conclusion that fascia will not change easily due to ANY outside force attempting to change it (if it did, it would betray one of its primary roles in our evolution!)

This includes most methods of massage therapy as well as all those fancy new gadgets and gizmos one the market right now that claim to melt or release your fascia if you smash and blast it hard enough.

To truly change the fascial system, we have to ask the fascia to change itself.

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How to Choose a Body Worker for Pain Relief (Opinion)

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So you’re in pain or dealing with an injury and you want the help of someone in the bodywork field to sort you out. How do you choose the BEST person for you?

This can be a daunting decision, with thousands of choices that often looks similar on paper (or the web).

If you’re NOT in pain, then my opinion is simple: see whoever you want! Do what feels good. See the person you like the most.

When you’re in pain, however, there are a few critical distinctions to make and important points to consider if you want help actually getting out of pain AND finding the root cause so it doesn’t come back.

How to choose a body worker for pain relief:

First of all, here are some very basic things to consider:

  • MANY (I would say the majority of) manual therapists – massage therapists and other body worker practitioners – are not necessarily trained to help people eliminate pain.
  • Having said that, there certainly ARE capable manual therapists and body work practitioners out there who have been trained to relieve pain at its source, and this post is designed to help you find THOSE people and learn how to differentiate between your average massage therapist or someone you would go to for relaxation vs. someone who can help you get and STAY out of pain.

First off, let’s weed out the therapists who probably CAN’T help you:

Before I list these, I want to be clear I’m not knocking these therapists or discounting their work – I think there’s room for ALL of us and room for every modality. I just think it’s important for all of us (clients and practitioners alike) to know who we are seeing and WHY, with an honest look at scope of practice. I was a massage therapist for a year (8 long years ago!) and in that time I never helped my clients eliminate their pain for good. I wasn’t trained to do that and I went through a very comprehensive training that included myofascial massage, orthorpedic massage as well as the typical deep tissue, swedish etc.

Here are the modalities and people I would NOT consider seeing if you are looking for pain relief:

  • Your corner massage chain or generic massage therapist.
  • This includes therapists whose work consists mostly of Swedish, deep tissue or very general whole body massage.

Here are the practitioners and modalities you might consider, CAREFULLY: (and use my interview questions to make a wise decision here!)

  • Massage therapists or massage businesses who list “sports massage” or something like this as an option (often an “upgrade” that you pay extra for). A lot of the time these therapists are allowed to say they practice “sports massage” when they had a few hours of training for “athletes” while they were in massage school. This does NOT mean (in my opinion) that they know how to find the root cause of pain. MAYBE THEY DO. Some people have had extra training that gives them the authority to make this claim with confidence. This is where I want to encourage you to interview people, because you never really know from the average website bio (see below for questions to ask and what to look for when interviewing practitioners).
  • Manual therapists who say they do “myofascial massage.” Like I said above, I was trained in myofascial massage but NONE of that training included teaching us how to find the ROOT cause of pain. Generally speaking, THIS IS SIMPLY A MASSAGE MODALITY or technique. It does NOT mean this person will be able to release your fascia (it takes a very skilled person to do this with their hands. They absolutely ARE out there and if you can find one of these that’s AWESOME!)
  • All other modalities that do not (necessarily) include training to find the root cause of pain, from energy work to deep body work – reiki, craniosacral therapy, shiatsu, trigger point therapy, thai massage, reflexology etc. I like to speak from personal experience and personally, I haven’t directly experienced eliminating physical pain with any energy technique. Maybe I’m not open minded enough. That said, I have friends who have and I believe them. The mind is extremely powerful! If you believe in energy work and believe your practitioner is saving your ass, then they probably will! I definitely believe in energy being stored in the body, as well as emotions, trauma etc. My personal preference is to access that energy in a very physical way. So – if energy work is your jam, carry on! As for some of the other ones I listed above, it’s for the same reasons as the above two that I list these: most of the time the training for these modalities does not include how to find the root cause of pain. This doesn’t mean there aren’t some really skilled practitioners out there who specialize in shiatsu, Thai massage or trigger point therapy that can help eliminate pain. So once again – please refer to the interview questions to help you determine if one of these practitioners is right for you.
  • ALL other body work modalities fall into this category of being potentially supportive (if you interview them and like their answers): Alexander technique, Feldenkrais, Bowen, chiropractic, Trager and Rolfing, or Structural Integration, ART, Mashing, Rossiter etc (I’m sure there are many more).
  • Just because someone was trained in something potentially helpful does NOT mean they are GOOD! Your job is to find out if they are, and their job is to make sure you know it when you call or walk into their office.

Questions to ask when interviewing a practitioner:

The very FIRST thing I urge you to ask any professional before you see them is

Question #1:

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Master Mobility by Learning the Distinctions Between Flexibility, Inflexibility and Fascial Restriction Issues; Part 2: When to Increase Flexibility & When to Release Fascia

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This is Part II in a three part series. Click here for Part I.

Know YOUR goals:

If you’re trying to increase flexibility then I highly recommend you first get crystal clear on WHY you want this.

If you’re in pain and you think increasing your flexibility will get you OUT of pain, I’m here to tell you that the OPPOSITE is a far more likely and a safer approach: get yourself OUT of pain and you will probably (and quite quickly) recover the flexibility you lost when your nervous system detected danger and went about protecting you from further injury by restricting your mobility.

If you’re TRULY inflexible and you are NOT in pain, then by all means work on increasing flexibility – safely, in ways that don’t stress your tissues or put you in danger of injury (NOT static stretching).

If you’re not in pain and you’re a dancer, gymnast, runner, yogi etc…then you will be forced to do some static stretching, and I recommend you go about this in such a way that you don’t injure your soft tissue or joints.

If you are in pain AND you want to increase flexibility, then I highly recommend getting yourself out of pain FIRST. You’ll have a better baseline of what your actual flexibility level is like, and you won’t be running the risk of injury or increased pain by endangering your body with stretching that could cause more harm than good.

Know you’re why and you’ll begin forming an alliance with your body that will allow you to reach your goals safely, and far faster.

When to use fascial release:

  • If you’re in pain – anything from plantar fasciitis (all the itises) to knee pain, hip pain, back pain, shoulder issues, carpal tunnel pain, repetitive motion injuries, “pulled” or sprained muscles or ligaments etc
  • If you have restricted range of motion in one or more joints (hips, shoulders, knees, ankles, wrists) and you’re otherwise “flexible” enough to perform everyday tasks without issue (it’s likely a fascial restriction issue but this COULD be a true need for more flexibility – part 3 in this series is all about the overlap and how to know the differences)
  • Injury PREVENTION
  • If you want more SPRING in your system (and we should ALL want more spring!)
  • If you’re an athlete looking for an “edge” (optimize your fascia and you gain up to 10x better proprioception, not to mention you’ll be far less injury prone and you’ll recover faster)
  • If you want to feel lighter, more spacious and give your muscle fibers the freedom to move fluidly, no matter your age, activity level and even if you’re not in pain

When to increase flexibility:

  • You’re NOT in pain
  • You do a sport that requires more flexibility than the average person needs, such as gymnastics, yoga, dancing, ballet, CrossFit etc
  • You’ve ruled out fascial restriction issues and pain patterns that lead to lack of mobility as a reason for your inflexibility and you want to increase your natural bendyness
  • ……
  • yep, that’s all I got! Short list.

PARENTS AND COACHES OF CHILD ATHLETES:

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