A Real Pain in the Heel
In this article, we discuss plantar fasciitis, how MMA fighters have a higher
risk of getting the condition, and how we helped Skywalker 101 Boxing athlete,
Seth Bass, recover from the condition and keep up hip cardio training using
cold laser therapy in addition to our PT2 program. He ended up winning his
4th professional fight on June 3rd at Victory Fighting Championship's
VFC Fight Night 5 at Harrah's Stir Cove with a first round submission.
What is Plantar Fasciitis?
For those unfamiliar with the condition, we have another article in our
“Injury Prevention” section that goes into more detail discussing what can
cause it and how we’ve used cold laser therapy to heal the pain in a very
short amount of time. Basically, plantar fasciitis just another name for
chronic and constant irritation and inflammation of the thick-banded
ligament that runs along the bottom of the foot from the heel (calcaneus)
to the ball of the foot and toes (metatarsals and phalanges). There’s five
layers of muscle down there too. As the body’s foundation, it’s crucial this
area be as strong and reinforced as possible. The plantar fascia creates a
strong mechanical link between the heel and the toes, and should act like
a shock-absorbing bowstring supporting the arches in the foot. Just like
any machine, if the tension and stress on the support system (in this case
the plantar fasciitis) is more than what the system can handle, tears of all
sizes can occur. Doing this day after day, like running on concrete instead
of a track (seen in overtraining injuries), landing poorly after a jump, or even
carrying around excess body weight (both muscle and fat) can cause small
microtears that make the plantar fascia irritated and inflamed.
What Causes the Pain?
Our foot has a LOT of bones in it. Twenty-six to be exact, and there’s a ton of ways athletes put more force through their feet than what the plantar fascia can handle and stay healthy. Athletes that spend a lot of time on the balls of their feet, like Muay Thai kickboxers and wrestlers, have a higher risk of getting plantar fasciitis because when they go up on the ball of the foot, the plantar fascia gets “shorter.” If you think of it like a rubber band, the plantar fascia is stretched out when we’re standing flat on our feet. When we go up on our toes, the actual ligament doesn’t change size, but pulls the heel and the ball of the foot closer together. When the athlete steps down on a flat foot after an explosive movement like a kick or landing a jump, it sends a large amount of force through the ligament in a short amount of time to it stretch back out. Spending hours a day multiple times a week up on the balls of the feet going back and forth between the shortened and lengthened position creates tiny microtears leaving the inside of the heel and possibly up through the arch in a lot of pain. This is similar to the reason people have a lot of pain taking the first couple steps out of bed in the morning or after sitting in a chair for a while. When we’re sitting or lying down, there’s no body weight being applied to the bottom of the foot to stretch out the plantar fascia and the foot spends that longer amount of time in a shortened position. Taking those first couple steps out of bed in the morning puts stress through the tissue to stretch, and until the ligament is warmed up relieving the tension, those steps could be painful.
Why Warm Up?
Think about how different your body feels in the winter versus the summer. I used to dread the warm-up during the first half hour of gymnastics practice when there was snow on the ground because my body was so cold it hurt. One hard landing sent pins and needles through my feet and shins. Come summer time, everything felt so much better and my body seemed to move effortlessly. My muscles were already warm. I use the example of a stick of gum when I talk with athletes about the importance of a good warm-up. In the winter, the gum easily snaps in half. But in the summer, if you try to break it it's more likely to bend like taffy and you have to actually tear it in half. Our muscles, tendons, and ligaments work the same way. Heat, or a good warm-up, sends a rush of blood to the muscles, tendons, and ligaments getting them ready to take on the high forces we put them through during a workout.
Cold Laser Therapy, PT2, and Plantar Fasiitis
Seth came to us while he was training for his fourth professional
fight for the Victory Fighting Championship's VFC Fight Night 5
at Harrah's Stir Cove. He was running on average 5-6 miles
5 times a week and 8 miles 2 times a week and having a lot of
pain in his feet during the run. He had a lot of pain with ladder
drills, box jumps, and jumping rope during conditioning with
his coach, Danny Molina, owner of Skywalker 101 Boxinghere
in Omaha. As part of our PT2 Program, we immediately started
him on a cold laser therapy program, gave him some simple
stretches, and altered his running schedule to include more
appropriate distances and a healthier split to protect his feet
while making sure he was getting in enough cardio to last
through the fifth round if needed (he won with a first round
When we worked with Seth, we did a total of three treatments
over the course of one week. He noticed that when we did cold
laser therapy to his feet BEFORE practice, he didn’t have any
pain at all. The term “cold” laser therapy is a bit misleading
because it actually acts more like heat than ice. Applying cold
laser therapy to his feet before practice acted like a strong,
localized warm-up, sending a rush of blood to the plantar
fascia and surrounding 5 layers of muscle which let everything
relax and stretch much easier. Then, when he landed a box
jump or finished a ladder drill, the plantar fascia were ready
to stretch and take on those high forces without any discomfort.
We followed up by doing cold laser therapy after practice to
jump-start the healing process because even though he was
warmed-up, the plantar fascia was still under stress during his
workouts causing tiny natural microtears to happen (the same
microtears that cause post-exercise soreness for a couple days
after a workout). Interestingly, he noticed that on days we weren’t able to do cold laser therapy after practice,
the pain had returned about a half hour after practice was over. Remember from above that the plantar fascia tightens back up as the tissue cools down, and so by doing cold laser therapy after practice, we were able to decrease the amount of pain he felt in the following days.
We also had him include some very simple stretches.
One of my personal favorites is using a frozen water
bottle like a rolling pin under the arch of the foot. This
gave him the opportunity to get a really good stretch of
the plantar fascia just like one would use a foam roller
on a tight hamstring. One of Brian's favorite stretches is
to gently stretch one toe at a time, holding it for
15-30 seconds. Remember from above that the plantar
fascia attaches to the ball of the foot, and when an athlete
goes up on the toes this stretches the plantar fascia. By
pulling up on each toe individually, you get the opportunity
to stretch the plantar fascia in a localized way multiple times
from multiple attachments, the same way you would want
to stretch your pectoralis major in three different directions
because of it's three different parts.
Think You May Have Plantar Fasciitis?
M&B Wellness Solutions offers multiple services to help relieve the burning,
sharp pain and heal the specific sources of mild to moderate cases of plantar
fasciitis. Whether it’s cold laser therapy, traditional, insurance-based physical
therapy, or our PT Squared Program where our physical therapist works
together with the highly qualified trainers at iThinkFit Gym to design the
perfect plan that will help athletes train through the recovery process, we
have what it takes to help athletes recovery quickly and stay at the top of
The best way to start your road to recovery is to see a healthcare professional
specializing in movement and rehabilitation who can assess your range of
motion, strength, and quality of movement to determine if your pain is due to chronic overuse, from strength and flexibility imbalances, or something more severe. Stop by M&B Wellness Solutions located inside iThinkFit Gym for an evaluation with a licensed physical therapist so we can get you on your way to moving the best you possibly can.
Michaela Cantral, PT, DPT
June 22, 2017
M&B Wellness Solutions
Your Complete Rehabilitation and Wellness Specialists