Plantar Fasciitis No More
by Adam Reger
Almost a year ago now I wrote a long account of my battle with plantar fasciitis, and wanted to update the record with some advice for anyone in the same boat.
First of all, I no longer have any real idea what was wrong with my foot, Achilles, posterior tibial tendon, calf, or any other part of my leg during that time. Plantar fasciitis is the handiest thing to call it based on the symptoms and likely cause (overuse). But after having rested my foot for the better part of a year and finding the discomfort still there, I have to believe something else was wrong. And the things I’ve tried and had success with since then have borne that out.
My road to recovery began with an e-mail from Runner’s World advertising the book Fixing Your Feet by John Vonhof. It sounded like exactly what I needed: a book that would address any conceivable pain afflicting the feet and lower legs. I ordered it (not directly from Rodale Press for $25, as the e-mail suggested, but from Amazon for $14. (What is up with your pre-internet sales appeal, Rodale?))
I’d recommend Fixing Your Feet to anyone with foot problems from running, hiking, or the infliction of punishment from day-to-day activities. And I’m glad to have it on hand for future reference. But its real value to me lay in turning me on to another book that has made the greatest difference to my recovery.
That book is The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief by Clair Davies. Since checking it out of the library I’ve bought a copy for myself and one for a family member, and later pressed my copy onto a coworker who was having leg pain. (The book covers pain throughout the body, not just in the legs.)
Trigger point is basically a kind of massage that alleviates tension, relaxes, and breaks up knots. The crucial thing to know about to understand the value of trigger point therapy is the idea of referred pain.
If you’ll excuse my language, referred pain is a real bitch. I was familiar with it from a previous episode in which I was having toothaches that were not alleviated by several root canals, leading me, after lots of visits to dentists, endodontists, and maxillofacial surgeons (all while uninsured, no less), to have the tooth pulled. When the “toothaches” continued, I discovered that what had likely happened was that an earlier incident (a marathon root canal in which my jaw was propped open for several hours) strained a muscle in my jaw. Instead of feeling the pain at the point where the muscle was strained, however, the pain ran along nerves to the socket where my tooth was; the tooth itself was most likely fine.
In other words, the body redirects pain along the nerves, giving you the false impression that your heel is in pain when in fact your calf and hamstrings are extremely tight. The key insight of The Trigger Point Therapy Workbook is twofold: one, it provides detailed diagrams showing where the pain is felt and where its origin lies (i.e., where to go to work to alleviate the pain); two, it’s oriented toward self-therapy, giving a lot of ideas for effective ways of massaging your own trigger points, from “supported fingers” to using the kneecap as a massage tool to more intense options like the Thera Cane Massager.
(There may be an element of bluster to it, but Clair Davies’ foreword describes how he came to the topic of trigger point and to write the book, and it is a weirdly compelling story, one with an almost occult aspect that made me think of Davies’ work here as being this Prometheus-like act of stealing knowledge from the gods. In a nutshell he saw a physical therapist who used these techniques on him with great results, and during a visit saw a massive academic tome on the PT’s desk; the PT later moved away and Davies never found another therapist who could help him; almost as if via recovered memory, Davies recalled the name of the book, an academic text on trigger points geared toward PTs, tracked it down, and began translating the dry academic language into usable techniques. He went to school for physical therapy (after an esteemed career as a rebuilder of pianos, which is an entirely separate, also fascinating, element of the foreword) and found his teachers totally unreceptive to trigger point. Classmates with tight necks and cricks in their shoulders, however, loved it and begged him to teach them.)
A key problem that trigger point addresses, one that I identified with strongly, is the catch-22 of needing to stretch certain muscles and yet risking injury (or exacerbating existing injuries) by stretching. My case was a prime example: to address plantar fasciitis I needed to do lots of calf stretches, but those stretches tended to inflame my posterior tibial tendonitis, making it feel like the tendons and other junk inside my heel were ready to tear. By instead massaging my gastrocnemius and soleus muscles, I was able to cut this Gordian knot and relieve the tension/tightness affecting my heels.
Trigger point was one huge factor in my recovery. Another crucial part was submitting to the Graston technique. I learned about Graston through a coach at CrossFit Athletics on Pittsburgh’s south side, checked it out, and decided it looked like a good fit. I went for a few sessions at Squirrel Hill Physical Therapy Center, after watching the useful videos of Graston posted on their website.
Two things to know about Graston. One, somewhat similarly to trigger point, the idea is to relieve pain and tension through massage. With Graston the idea is that there are scar tissue and adhesions that lead to tightness and chronic pain; Graston claims to break these up so the tissue can be reabsorbed into the body. It often describes this tissue as “grit,” which is about how it feels when you’re undergoing Graston. Two, Graston hurts like hell. Just watch this video and you’ll see what I mean. I had to sign a waiver acknowledging that there might be bruising and that I understood Graston to be extremely painful.
But it worked for me. I decided to go one day while doing air squats; I felt there was tightness and pain in my right ankle area; later, the idea of “grit” really resonated: I had thought of it almost as “static” there in my muscles, but grit gets at the same idea.
(I feel I should acknowledge that both trigger point and Graston technique seemed from the outside to fit in this category of New Age-y, flaky, hippie dippy alternative-medicine-type treatments that I’d usually go out of my way to avoid. Davies bemoans this perception of trigger point, the way it’s often lumped in with acupuncture and Tai Chi. Graston seemed almost too painful to belong to the broader category of alternative medicine, but in fact the Squirrel Hill Physical Therapy Center offers things like acupuncture and massage cupping, which made me a little uneasy at times. But my final verdict was, in effect, “Screw it. That helped.”)
This is an overly long explanation of a few things I found useful, but hopefully these ideas and links will provide some additional alternatives to anyone going through feet and leg problems of their own.
On a final and semi-related note, this weekend I’ll be participating in a relay at the Pittsburgh Marathon, running about 6.5 miles. Wish me luck!
Very well written post! I am sorry you have struggled for so long. I am a Performance Physical Therapist that specializes in feet, and the greatest challenge most of my patients face with Plantar Fasciitis is that it is rarely the only mechanical dysfunction present, and that usually there is a failure of integrating stability and mobility throughout the entire system. Good for you for identifying trigger point release as a means to self manage. Thank you for the post, I enjoyed reading it. Andy