The Use of Pilates Exercises in the Alleviation and Treatment of Symptoms of Plantar Fasciitis Batul Al Saigh June 2015 Comp. 10/13 1/14 Herndon, Virginia
Abstract: Plantar fasciitis can be a debilitating condition that is characterized by a sharp, stabbing pain in the heel of the foot. It usually occurs with the first few steps in the morning, or when getting up and walking after a long period of rest. The condition is one of the most common causes of heel pain. It is caused by the excessive pulling of the fascia band on the bottom of the foot from the insertion at the heel bone (calcaneus), and can occur unilaterally or bilaterally. This paper outlines specific Pilates exercises that can be helpful in alleviating and treating the symptoms of plantar fasciitis, notably foot work exercises on the Reformer, Cadillac and Wunda Chair. Included is a case study of Mary G., a 40 year old female, with plantar fasciitis displaying in her right foot. The most likely reason for her plantar fasciitis is loose ligaments. 2
Table of Contents: Section Page No. Anatomical Description of the Plantar Fascia..4 Introduction. 5 Case Study. 6 Conditioning Program.7 Conclusion 12 Bibliography 13 3
Anatomical Description: The plantar fascia is thick connective tissue (aponeurosis) composed of collagen located at the bottom of the foot. It originates from the heel bone (calcaneus) and spreads wide and flat to connect to the base of the toes (metatarsals) of the foot to form the longitudinal foot arch. The function of plantar fascia is to act as a shock absorber and stabilizer of the foot as weight bearing activities are performed. 4
Introduction: Mary G. is a 40 year old woman who cannot enjoy the simple pleasure of wearing fashionable shoes. She would like to wear the stylish high heels of her professional career and the cute ballerina slippers of her youth, but has been suffering with the pain of Plantar Fasciitis in her right foot. From the time she gets out of bed in the morning to the time she climbs back into bed at night, she is wearing shoes with full arch support and cushioned heels. She wears athletic foam slip ons at home and shoes with orthotic insoles or shoes made especially to provide substantial arch support when out of the house. None of these are the types of shoes Mary wants to wear on a regular basis. She has been told by her orthopedist that she may want to consider Pilates exercises to help strengthen her feet, especially the top of her feet, so that it maintains a proper arch and does not flatten to the ground as she stands. It is the flattening of her foot that pulls on the fascia band, which cannot stretch, that in turn pulls on the heel bone (from where it originates), thus causing the heel pain. Mary has extreme incentive to get her feet back to normal because her first and oldest niece will be getting married in six months and Mary wants to look her best at this event. This paper will outline specific Pilates exercises that will help Mary with pain alleviation and that can provide treatment of her Plantar Fasciitis, hopefully in time to have her wearing stiletto heels in six months. 5
Case Study: This case study is of Mary G., a 40 year old female, with plantar fasciitis displaying in her right foot. The most likely reason for the plantar fasciitis is loose ligaments. She has been using over the counter orthotics for several months and consistently wears arch supportive indoor slippers when at home. She does not want to be hampered by the continuous use of orthotics in her shoes and would like to be able to wear varied footwear. Mary is 5 4 and 125 lbs. Excessive body weight and/or excessive weight bearing exercises, i.e. running, can be a reason the development of plantar fasciitis. In this case, neither of these reasons seems likely. Most likely, it is loose ligaments of the muscles of the feet that are allowing the plantar fascia to stretch more than it should as she walks. The arch of her right foot is almost completely flat on the floor as she stands, and she shows excessive pronation of the right ankle from that arch falling during the gait cycle. The excessive pronation during her walk leads to an imbalance at her hip (Sacroiliac joint SI joint) that displays as a slightly forward, almost jutting like, movement. As she walks, her right ASIS (anterior superior iliac spine) moves slightly forward and down towards the midline of her body instead of remaining parallel to the floor. At this time, she shows relative stability in the right SI joint, but it may be from compensation at the left SI joint and right hip flexors and extensors. Over time, without any rehabilitation of her plantar fasciitis, she may develop SI joint issues. 6
Conditioning Program: The program of rehabilitation for Mary G. should include exercises that will strengthen the muscles at the top of her foot, her ankle plantar flexors, hip flexors and extensors and should include various exercises to stretch and strengthen in the full range of motion of the hip joint. Overall core development must be included to enable the most long term and productive rehabilitation. Following the BASI Pilates block program will provide a complete, full body session of work. Warm Up: Begin with several roll downs, taking special note to observe the imbalances that are present on the right side of the body. Cue Mary to distribute weight evenly on both feet. Warm up the spine and feet with Pelvic Curl and watch for any shifting or uneven rolling up or down of the pelvis. Also, be aware of any rolling of ankles as her body weight shifts onto the feet during the execution of pelvic curl. Continue warm up with Spine Twist Supine, Chest Lift and Chest Lift with Rotation, making sure the pelvis stays evenly on the floor during the rotation. This will help her with stability in the SI joint. Foot Work: Foot Work will be one of the most important series of conditioning work for Mary and, more specifically, single leg work should take precedence in her program. All Reformer, Cadillac and Wunda Chair foot work, which include: Parallel Heels, 7
Parallel Toes, V Position Toes, Open V Heels, Open V Toes, Single Leg Heel, Single Leg Toes, Calf Raises and Prances all will be instrumental in strengthening the ankle plantar flexors and the top of the feet. Prehensile on the Reformer should be one of the most effective exercises in helping strengthen and in turn stabilize the loose ligaments of Mary s feet, helping to alleviate the symptoms of plantar fasciitis. Hip Opener on the Cadillac should also be included in Mary s regimen. Performing this specific exercise as single leg work will help with any imbalances in the hip by strengthening the hip external rotators separately from each other, as well as the provide the benefit of continued strengthening of the ankle joint. Abdominal Work: Abdominal work should include the fundamental exercises of Roll up and Hundred Prep. Roll up with the Roll up Bar on the Cadillac will be useful if Mary is unable to perform the mat Roll up. As Mary s core strength improves good exercises to progress into would be Cadillac abdominal work including Mini Roll up, Mini Rollup with Oblique and Roll up Top Loaded. Also a modified Hundred, with bent knees instead of straight legs would be another good core strengthening exercise. Hip Work: All of the Hip work on both the Reformer and Cadillac would be great for strengthening and stretching Mary s hips in their full range of motion, some of which are Frog, Circles (Down and Up) and Openings. As with foot work, precedence should be given to single leg hip work to independently strengthen each 8
hip joint. The Cadillac Single Leg Supine series including: Frog, Circles (Down & Up), Hip Extension and Bicycle should be instrumental in disposing of any imbalances in Mary s hip joint movements. Spinal Articulation: The spinal articulation exercise of Monkey Original would be a fantastic choice to use during the articulation block because the movement of plantar and dorsi flexion of the feet would continue the focus of strengthening and stretching of the ankle plantar flexors and the top of the foot. Stretches: Standing Lunge on the Reformer and Hip Flexors on the ladder barrel would be a great choice in the stretch block to allow Mary s hip flexors to stretch independently of each other and would be helpful in observing any excessive tightness in the hip flexors. Full Body Integration: The Reformer Full Body Integration (FBI) exercises of Up Stretch 1, Elephant, Stomach Massage Round Back, Flat Back and Reaching would be good choices to use for Mary because the positioning and movement of the feet in these exercises would continue to encourage the strengthening and stretching of her feet. 9
Arm Work: Shoulder Push and Shoulder Push Single Arm on the Reformer would be a great follow up exercise to the FBI exercises listed above because the top of Mary s feet will get a gentle stretch (from her body weight) while the arm work is being performed. Leg Work: Reformer Single Leg Skating would be a good leg work exercise because not only does the active leg hip abductor get strengthening work, the standing leg hip joint works to maintain stability. This will be beneficial to Mary who needs to independently work the hip joints to reduce any compensations her hip may already be predispose to doing while she is excessively pronating her foot during the gait cycle. Lateral Flexion/ Rotation: Both Side Lift and Corkscrew on the Step Barrel would be ideal Lateral Flexion and Rotation exercises for Mary. The Step Barrel will provide stability for her pelvis as she focuses on strengthening of her oblique muscles and allows for lateral and hip flexor stretches. Back Extension: Back Extension on the floor and Swan Prep on the Step Barrel would be good choices for the back extension block. Both of these exercises provide support for the 10
pelvis and allow Mary to focus on strengthening her back and not worry about the stability of her pelvis during the execution of the exercise. Having Mary do several roll downs at the end of her session would be a good way to complete the conditioning program. Be sure to observe if there are any differences in her roll down from the beginning of her session and to theorize what might have changed it and why. 11
Conclusion: With consistent Pilates work, the symptoms of Plantar Fasciitis can be substantially improved and in some cases eliminated. The Pilates Foot Work of the Reformer, Cadillac and Wunda Chair will be instrumental in the treatment program. Specifically, the Reformer Prehensile exercise should prove to be instrumental in strengthening the top of the foot, and in turn will help the foot maintain it s arch and keep the plantar fascia from being pulled. Also, it is important to note that the condition of Plantar Fasciitis can cause imbalances in other parts of the body as it has in the case of Mary G. Therefore, it is important to include a complete, full body work session for the client. Core development and hip joint strengthening are important in any full body workout. Adhering to the BASI block system while teaching will ensure a thorough session has been performed. 12
Bibliography: Blahd, William H., Jr., MD. "Plantar Fascia Ligament." WebMD, 12 Mar. 2014. Web. 17 May 2015. "If We Cannot Stretch Fascia, What Are We Doing?" Massage-St. Louis, 12 June 2012. Web. 04 June 2015. Laskowski, Edward R., M.D. "Joint Hypermobility: What Causes Loose Joints?" Mayo Foundation for Medical Education and Research, 08 July 2014. Web. 04 June 2015. Overstreet, Julia, M.D. "Plantar Fasciitis Explained by a Podiatrist." YouTube, 25 Oct. 2011. Web. 04 June 2015. "Plantar Fasciitis and the Anatomy of the Foot." Mend Me Shop (aidmyplantar.com) N.p., n.d. Web. 17 May 2015. "Plantar Fasciitis." Family Foot Care NYC. New York Foot Doctor, 2010. Web. 04 June 2015. " Plantar Fasciitis." Mayo Clinic. Mayo Foundation for Medical Education and Research, n.d. Web. 17 May 2015. "Plantar Fasciitis." Mayo Clinic. Mayo Foundation for Medical Education and Research, 27 Feb. 2014. Web. 04 June 2015. Young, Craig C., M.D., Darin S. Rutherford, M.D., and Mark W. Neidfelt, M.D. "Treatment of Plantar Fasciitis." American Family Physician, 1 Feb. 2001. Web. 04 June 2015. 13