2unrelated Qs: plantar fasciitis and efficacy of stretching for scar tissue

Plantar fasciitis Q: I know from reading articles on this site and listening to podcasts, that rest is not usually recommended for most pain, but instead thoughtful movement. I am wondering about whether the recommendation away from rest applies to plantar fasciitis. I’m also wondering if there is really any data supporting stretching to help, and if so, which ones.

History: I had plantar fasciitis about 1 1/2 years ago that lasted several months. I put off going to the podiatrist for a while because it didn’t seem that bad, but then it worsened. He prescribed staying off the foot as much as possible, stretches (didn’t give specifics), orthotics insoles (not custom), & supportive shoes to be worn at all times. Also NSAIDs, but i chose not to take them. At the point I developed the plantar fasciitis, I was jogging, doing Zumba, and lifting. Both deadlifting & squats hurt the heel, as did a leg press when I tried that instead. Eventually, it went away, but it’s starting to come back. After several months pain free, I got lax about wearing the supportive shoes in the house, and since I prefer bare feet or socks inside, that’s what I was doing. I did continue to wear the insoles for jogging & Zumba.

Recently I started practicing some hip-hop moves that place a good bit of force on the heels in socks and it’s started back intermittently. So I’m back to wearing shoes, especially while practicing dance moves and continue my cardio and lifting. However, I don’t want to end up with it worsening again.

Is it really necessary to “stay off the foot” to prevent it from progressing? And is there any evidence that stretching helps? (I was annoyed b/c the doctor, who works at a major teaching hospital, didn’t specify stretches last time so I gleaned what I could from the internet. I’m inclined to just be mindful of it but, like I said, don’t want to end up with it worsening and a long period of problems exercising.

Stretching for scar tissue Q: I had a radical mastectomy and radiation 8 years ago and have a lot of scar tissue as a result. (More than the typical patient according to my docs.) It inhibits full ROM, which doesn’t affect normal life tasks, but does affect lifting. (Can’t do overhead lifts b/c the arm won’t go straight up. It’s about 30 degrees from vertical. It also affects bench pressing, but not too bad, just a little uneveness between the two arms. I also have a hx of “frozen shoulder” on both sides if that matters. Lost a bit of ROM. I think it’s the external abduction (?) with elbows at sides, bent at 90 degrees, if I try to open up my arms, I can only get to about 45 degrees from my torso)

Again, from this site, I’ve read that stretching isn’t particularly helpful in recovery (which was a big relief—I always hated facing another 10 minutes of stretching after I’d pushed myself during a workout!) . However, I am wondering if it’s helpful in keeping ROM where scar tissue is involved, or to try to improve the lost ROM from the frozen shoulders.

Thanks very much for your help! I appreciate this site so much for its mission to give evidence-based recommendations to help people maximize their health with strength training. It is an awesome resource!

Hey @Naturegirl - great questions. Plantar Fasciitis is a bit of a misnomer similar to tendonitis. I typically reference symptoms in the plantar surface of the foot that are activity related as plantar fasciopathy to move away from the idea it is an inflammatory based issue necessitating particular interventions. I don’t recommend complete rest (“staying off the foot”), stretching, orthotics, or a particular shoe for this issue and instead typically discuss load management specific to the goals of the individual.

You would likely get some beneficial information from our tendinopathy podcast: Stream episode Pain and Rehab Podcast Episode 7: Tendinopathy by Barbell Medicine podcast | Listen online for free on SoundCloud

I also put together a free pdf for tendinopathy - Dropbox

Scar tissue - No, I don’t recommend stretching for this either. Fibrosis (scar tissue) is a part of the healing process, albeit can reach disruptive amounts based on case context. However, If someone is experiencing reduction in range of motion like in your situation, then we’d figure out how to dose in movement to tolerance while trying to increase range over time via loading the desired movement. This can be a bit of a process but typically we can make good improvements. Let us know what other questions you may have. You may benefit from a consult with us so we can develop a game plan to help you through these issues. Contact Us | Barbell Medicine

Thank you. That is very helpful–and I wish I’d known about this site before when I was off any substantial exercise for way longer than I would have liked!

Since the Plantar Fasciopathy is just intermittently resurfacing, I will look to manage load . Since I set it off with dance moves that drive through the heel, I’ve already modified that. I have just started the Beginner’s Template, coming off work on machines at the gym, so the weight lifting load is light right now. The only other thing I have to watch is that I embed 5 or more 1-m jogging intervals and three 20-s sprints into my walks for cardio.

I can definitely feel the stretching that comes with bench pressing. An overhead press is not possible right now, but I’m going to do either an inclined press or landmine press in its place.

wrt the consult, do you take insurance?