Pilates for Plantar Fasciitis Written by: Heather Light Date: August, 2011 This is a student paper, submitted to BASI Pilates by the writer as a requirement for completion of the BASI Pilates Comprehensive Teacher Training Course. The contents are not endorsed by BASI Pilates. The paper is being provided by the writer and BASI Pilates as a service to the Pilates community. Copyright 2013 BASI Pilates All rights reserved. This paper or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of BASI Pilates, except for the use of brief quotations with the appropriate attribution. 1
2
Abstract Our feet are not only our sensory input, telling us where and how to step, but also they set up the balance of our pelvis and translate through the spine. How you use your feet has a direct influence on your core. The way we stand on our feet, or how we move the feet, recruits different muscle lines up the leg into the pelvis. Body weight from our spine and pelvis is placed on the legs through the femur into the tibia. At the end of the tibia sits the talus. (http://www.pilates-pro.com/pilatespro/2009/3/24/pilates-for-feet.html ) Many people experience foot pain, whether from shoes that are too small or incorrect biomechanics of the feet or any of the myriad other causes. Plantar Fasciitis, the most common cause of pain on the bottom of the heel, according to the American Academy of Orthopedic Surgeons (http://orthoinfo.aaos.org/topic.cfm?topic=a00149), occurs when the strong band of tissue that supports the arch of the foot becomes irritated and inflamed. (http://orthoinfo.aaos.org/topic.cfm?topic=a00149) The test case in this paper (my father) battled plantar fasciitis for several years before having surgery. My aim is to show that he could have benefitted enormously from Pilates. 3
Table of Contents Introduction.. Page 2 Anatomical Description... Page 4 Case Study... Page 5-6 Conditioning Program... Page 6-8 Reason for selecting the conditioning program... Page 8 Desired Results... Page 8 Conclusion... Page 9 Bibliography... Page 10 4
Anatomical Description Plantar Fasciitis occurs when the long fibrous plantar fascia ligament along the bottom of the foot develops tears in the tissue, resulting in pain and inflammation. The pain of plantar fasciitis is usually located close to where the fascia attaches to the calcaneus, also known as the heel bone. The plantar fascia ligament is made of fibrous bands of tissue and runs between the heel bone and the toes. It stretches with every step. The most common complaint from plantar fasciitis is a burning, stabbing, or aching pain in the heel of the foot. (http://www.plantar-fasciitis.org/) The diagram below shows where the plantar fascia ligament is located and where the inflammation occurs. Case Study My Dad, David Light, first experienced Plantar Fasciitis in July of 2009, at the age of 62, while playing tennis. Between his tennis, rock climbing and running, he has always been active, so it was definitely hard for him to accept that he had to limit his activities, at least until it got better. About two weeks after his initial injury, he went to see an orthopedic doctor, who diagnosed the problem in his left foot as Plantar Fasciitis in his left foot. The doctor recommended some stretches and rolling the foot on a frozen water bottle. 5
It wasn t any better by September, so the doctor injected cortisone into the affected heel. The shot helped for about four to five weeks, after which the pain returned. Even walking was difficult. In October, the doctor recommended a specially designed orthotic for the shoe. The orthotic made general walking much less painful, but without it he was still experiencing pain. The situation hadn t improved much by mid-december. As long as he was wearing the orthotic, my dad was fine, but he felt pain as soon as his foot wasn t supported. At this point, the doctor felt comfortable recommending surgery, all typical non-surgical options having failed. The surgery was scheduled for January with the intention that he would be healed by summer time to play tennis. The pain has definitely lessened since surgery, but he is still wearing the orthotic and he still experiences pain, especially in the mornings and when he is not wearing the orthotic. He has not returned to tennis. Conditioning Program My dad is a beginner and has not done Pilates before, so I wouldn t utilize the whole Block System until he was more advanced. This is the conditioning program I would have put him through. I would first start with a roll down and look at his alignment. I would look at his walking pattern and whether e had any pronation or supination in his feet. I would begin his program by teaching him about neutral pelvis and breathing. Warm up: This would consist of a few exercises to get his muscles working and get him in good alignment; for example, pelvic curl, chest lift and chest lift with rotation. Footwork: This is a really important block for him, whether done on the Chair, Cadillac or Reformer, but especially on the Reformer. It s a great block to help strengthen and stretch the ankle plantar flexors, as in parallel toes and v-position. I would pay close attention to the alignment of his ankles, making sure he used his full range of motion, especially while doing calf raises and prances which could have a big influence on his plantar fasciitis. All of the footwork series exercises would be great. Starting off with just a few reps per exercise, then increasing as he gets stronger. Exercises can protect the plantar fascia from injury and inflammation by making the plantar fascia and calf muscles more flexible and by strengthening the foot and ankle muscles that support the arch. (http://www.webmd.com/a-to-z-guides/exercises-to-reduce-plantar-fasciitis#) Abdominals: For strengthening his core, with exercises like hundred prep, and standing pike on the Chair. Hip work: An excellent way to stretch and strengthen his hip adductors and also work on hip disassociation with up and down circles. In general, he is very tight and would greatly benefit from the hip work. 6
Spinal Articulation: I would leave it out because he is a beginner. Stretches: Standing lunge or stretches on the Ladder Barrel for the adductors, hamstrings and hip flexors, would be great for him. He is very tight in his hamstrings and his alignment and balance would improve if he were to become more flexible. Full Body Integration 1: I would leave it out in the beginning, but eventually exercises like Scooter and Elephant would be great to work on his trunk and shoulder stabilization. Arm Work: The arms supine series would be a great way to establish his scapulae stabilization and shoulder mobility. Additional Leg Work: Leg Press Standing would be an excellent exercise to help work on his balance and control. Eventually, the Jump Board would also be a good way to work on plantar flexor strength. Lateral Flexion/Rotation: The side stretch on the Chair or side lifts on the mat are great ways to help him strengthen his abdominal obliques. Back Extension: Breaststroke Prep on the Reformer or Swan on the Chair would be an excellent exercise for him to access his back extensors and stabilize his scapulae. Reasons for selecting the conditioning program The program I put together for my dad covers all the major areas of the body, as per the BASI Block System. It. The footwork is particularly important, as it works on the strength and flexibility of his plantar flexors. In general, he is very tight. A full-body program will increase his flexibility and strength, allowing him to have better alignment and thus helping his plantar fasciitis. Desired Results I wasn't able to work first-hand with my dad, but I feel confident I would have received a positive result. Over the course of many sessions, I believe he would have seen more strength and flexibility in his feet and ankles, along with his whole body. His overall alignment would have improved. Conclusion Millions of people experience Plantar Fasciitis every year due to a variety of causes - exercise overload, wearing incorrect shoes and bad foot mechanics are just some of them. My dad tried many options before opting for surgery, but not Pilates. I have no way of knowing if it would have helped in his case, but I feel strongly it would have made a difference. With the correct 7
program and careful observation and guidance, he would have felt stronger and more flexible throughout his whole body. With improved mechanics in his feet and ankles, his whole body would have been better aligned. With the right conditioning program and the vigilant eyes of a quality instructor, I believe many would find relief from heel pain in Pilates. 8
Bibliography Black, Madeline. "Pilates for Feet." Pilates Pro - Pilates-Pro.com: The Pulse of the Pilates Industry. Pilates Pro, 03 Mar. 2009. Web. 06 Aug. 2011. <http://www.pilates-pro.com/pilatespro/2009/3/24/pilates-for-feet.html>. American Academy of Orthopaedic Surgeons. "Plantar Fasciitis and Bone Spurs - Your Orthopaedic Connection - AAOS." AAOS - Your Orthopaedic Connection. American Academy of Orthopaedic Surgeons, June 2010. Web. 06 Aug. 2011. <http://orthoinfo.aaos.org/topic.cfm?topic=a00149>. The Plantar Fasciitis Organization. "Plantar Fasciitis, Heel Spurs, Heel Pain." Plantar Fasciitis: From Causes to Treatment. The Plantar Fasciitis Organization, Jan. 1997. Web. 06 Aug. 2011. <http://www.plantar-fasciitis.org/>. Frey C, ed. (2005). Plantar fasciitis chapter of Foot and ankle section. In LY Griffin, ed., Essentials of Musculoskeletal Care, 3rd ed., pp. 667 674. Rosemont, IL: American Academy of Orthopaedic Surgeons. Green, MD, William M., and Barry L. Scurran, DPM. "Exercises to Reduce Plantar Fasciitis." WebMD - Better Information. Better Health. WebMD Medical Reference from Healthwise, 26 Oct. 2009. Web. 06 Aug. 2011. <http://www.webmd.com/a-to-z-guides/exercises-to-reduce-plantarfasciitis>. 9