Ankle Sprains (SPORTS MASSAGE THERAPY EXETER)

Ankle Sprain

Ankle sprains are some of the most common sports injuries, and can be recurrent. In most cases the ankle is rolled outwards, resulting in damage to the ligaments on the outside of the ankle.

Here you will find everything you need to know about treating and recovering from a sprained ankle. Alongside a comprehensive view of rehabilitation options, we also provide preventative measures to ensure the sprain does not reoccur.

Symptoms may vary from being very mild to very severe. With a mild sprain the athlete will likely be able to continue with training or competition. A very sever injury could result in hospital treatment and take longer to heal than a broken ankle.

Symptoms may vary from being very mild to very severe. With a mild sprain the athlete will likely be able to continue with training or competition. A very sever injury could result in hospital treatment and take longer to heal than a broken ankle.

The injury usually occurs from a sudden trauma, twisting or turning over of the ankle. Pain will be felt in the ankle joint itself although will specifically be felt on the outside of the ankle when pressing in on the damaged ligaments. Swelling or bruising may be present but not always in the more mild cases. Pain can also be felt on the inside of the ankle from compression of bones and soft tissue.

Sprains are graded 1,2 or 3 depending on severity and a professional therapist will carry out a full diagnosis and assessment which will include range of motion tests and resisted movement tests to determine the structures injured and extent of the damage.

How bad is my ankle sprain?

Grade 1 symptoms will cause only mild pain with little or no instability. There may be some joint stiffness with difficulty walking or running but the athlete is likely to be able to play on. Some stretching or perhaps minor tearing of the lateral ankle ligaments may have happened resulting in mild swelling around the bone on the outside of the ankle.

Grade 2 symptoms will result in moderate to severe pain with difficulty walking. The athlete is unlikely to be able to play on and will limp. Minor bruising may be evident along with swelling and stiffness in the ankle joint. There is likely to be some instability of the joint resulting from moderate tearing of some of the ligament fibres.

Grade 3 usually results in a total or almost complete rupture of a ligament. Severe pain will be felt initially with lots of swelling and extensive bruising. The athlete will experience gross instability of the joint.

Anatomy

The most common is an inversion sprain or lateral ligament sprain where the ankle turns over so the sole of the foot faces inwards, damaging the ligaments and other soft tissues on the outside of the ankle. The ankle can turn inwards, called an inversion sprain although this is much less common and will usually coincide with a fracture of the fibula bone in the lower leg.

The two main ligaments involved are the talofibular ligament which connects the talus bone in the ankle to the fibula bone and the calcaneofibular ligament which connects the calcaneus or heel bone to the fibula. A less severe ankle sprain will most likely result in damage to the talofibular ligament. However, more severe injuries cause stretching or tearing to the calcaneofibular ligament lower down as well.

Complications

In addition to the ligament damage there may also be damage to tendons, joint capsule, bone, cartilage and other tissues. Severely sprained ankles may result in complete ruptures of the ligaments along with dislocation and fractures of the ankle bones.

• An avulsion sprain or fracture occurs when the ligament pulls a small piece of bone away with it. This is not always obvious initially but can be suspected if the injury fails to heal.
• Osteochondral lesions which are tears of the cartilage lining the top of the talus bone are also complications of moderate to severe injuries.

If possible an X-ray should be done, particularly if the patient is unable to put weight on the foot, or it fails to heal properly over time.

Ankle sprain treatment

Immediate first aid for a sprained ankle is RICE (Rest, Ice, Compression, Elevation) as soon as possible. Cold therapy or ice should be applied for 10 to 15 minutes every hour for the first 24 to 48 hours. Often pitch side therapists will bind the ankle tightly in a compression bandage as soon as the injury has occurred to restrict swelling, although this must be done with caution for only 10 minutes at a time to prevent starving the area of blood resulting in further injury. Do not apply ice directly to the skin as it may burn. Treatment with ice may continue for some time during the rehabilitation process.

Rehabilitation program

Our step by step ankle sprain rehabilitation program takes you from injury to full fitness. After the initial acute stage which is usually 24 to 48 hours (but could be longer with a bad sprain) rehabilitation and exercises may begin although only if pain allows. The program is based around three phases of reducing pain and inflammation, restoring normal mobility and building up strength and proprioception (or coordination of the ankle joint).

See ankle sprain rehabilitation program.

Ankle sprain taping

Taping the ankle can provide support and compression post injury and later in the rehabilitation process can give support when returning to full training. Taping can also be helpful if the ankle ligaments have suffered permanent stretching resulting in ankle instability. Professional Football Physiotherapist Neal Reynolds demonstrates how to build up a simple ankle taping technique in four parts. Part 1 is a simple figure of 8 taping and depending on the level of support required builds up to a full basketweave ankle taping.

See ankle taping techniques.

Ankle sprain exercises

Mobility exercises help restore full, pain free range of movement. In the early stages it is important not to stress the ligaments which have been injured so up and down movements of the foot are done as opposed to lateral movements.

Strengthening exercises build up gradually from isometric or static exercises through dynamic exercises involving movement. Some exercises target specific muscles which are important in helping prevent future ankle sprains. It is essential that the proprioception or coordination of the ankle is developed as this is likely to have been damaged at the time of injury making recurrence more likely. Wobble balance board exercises can be beneficial.

Finally functional exercises are more sports specific or activity related to bridge the gap between rehabilitation and full fitness. Functional exercises include hopping, bouncing changing direction and activities more specific to sports training and competitive games.

See ankle sprain exercises.

Expert interviews

We have interviewed professional football physiotherapist Neal Reynolds about how he treats a player with a sprained ankle. We have broken it down into three sections. The first talks about early stage treatment and exercises, the second looks at late stage rehabilitation and the third focuses on future prevention of ankle injuries.

• Exercises and rehabilitation
• Late stage and return to sport
• Ankle sprain prevention

Sports massage

Massage can be beneficial in treating a sprained ankle, particularly in the later stages or with a particularly stubborn injury. We demonstrate some simple cross friction massage techniques to help align scar tissue on the ligaments and interview a teacher of sports massage.

The injury usually occurs from a sudden trauma, twisting or turning over of the ankle. Pain will be felt in the ankle joint itself although will specifically be felt on the outside of the ankle when pressing in on the damaged ligaments. Swelling or bruising may be present but not always in the more mild cases. Pain can also be felt on the inside of the ankle from compression of bones and soft tissue.

Sprains are graded 1,2 or 3 depending on severity and a professional therapist will carry out a full diagnosis and assessment which will include range of motion tests and resisted movement tests to determine the structures injured and extent of the damage.

How bad is my ankle sprain?

Grade 1 symptoms will cause only mild pain with little or no instability. There may be some joint stiffness with difficulty walking or running but the athlete is likely to be able to play on. Some stretching or perhaps minor tearing of the lateral ankle ligaments may have happened resulting in mild swelling around the bone on the outside of the ankle.

Grade 2 symptoms will result in moderate to severe pain with difficulty walking. The athlete is unlikely to be able to play on and will limp. Minor bruising may be evident along with swelling and stiffness in the ankle joint. There is likely to be some instability of the joint resulting from moderate tearing of some of the ligament fibres.

Grade 3 usually results in a total or almost complete rupture of a ligament. Severe pain will be felt initially with lots of swelling and extensive bruising. The athlete will experience gross instability of the joint.

Anatomy

The most common is an inversion sprain or lateral ligament sprain where the ankle turns over so the sole of the foot faces inwards, damaging the ligaments and other soft tissues on the outside of the ankle. The ankle can turn inwards, called an inversion sprain although this is much less common and will usually coincide with a fracture of the fibula bone in the lower leg.

The two main ligaments involved are the talofibular ligament which connects the talus bone in the ankle to the fibula bone and the calcaneofibular ligament which connects the calcaneus or heel bone to the fibula. A less severe ankle sprain will most likely result in damage to the talofibular ligament. However, more severe injuries cause stretching or tearing to the calcaneofibular ligament lower down as well.

Complications

In addition to the ligament damage there may also be damage to tendons, joint capsule, bone, cartilage and other tissues. Severely sprained ankles may result in complete ruptures of the ligaments along with dislocation and fractures of the ankle bones.

• An avulsion sprain or fracture occurs when the ligament pulls a small piece of bone away with it. This is not always obvious initially but can be suspected if the injury fails to heal.
• Osteochondral lesions which are tears of the cartilage lining the top of the talus bone are also complications of moderate to severe injuries.

If possible an X-ray should be done, particularly if the patient is unable to put weight on the foot, or it fails to heal properly over time.

Ankle sprain treatment

Immediate first aid for a sprained ankle is RICE (Rest, Ice, Compression, Elevation) as soon as possible. Cold therapy or ice should be applied for 10 to 15 minutes every hour for the first 24 to 48 hours. Often pitch side therapists will bind the ankle tightly in a compression bandage as soon as the injury has occurred to restrict swelling, although this must be done with caution for only 10 minutes at a time to prevent starving the area of blood resulting in further injury. Do not apply ice directly to the skin as it may burn. Treatment with ice may continue for some time during the rehabilitation process.

Rehabilitation program

Our step by step ankle sprain rehabilitation program takes you from injury to full fitness. After the initial acute stage which is usually 24 to 48 hours (but could be longer with a bad sprain) rehabilitation and exercises may begin although only if pain allows. The program is based around three phases of reducing pain and inflammation, restoring normal mobility and building up strength and proprioception (or coordination of the ankle joint).

See ankle sprain rehabilitation program.

Ankle sprain taping

Taping the ankle can provide support and compression post injury and later in the rehabilitation process can give support when returning to full training. Taping can also be helpful if the ankle ligaments have suffered permanent stretching resulting in ankle instability. Professional Football Physiotherapist Neal Reynolds demonstrates how to build up a simple ankle taping technique in four parts. Part 1 is a simple figure of 8 taping and depending on the level of support required builds up to a full basketweave ankle taping.

See ankle taping techniques.

Ankle sprain exercises

Mobility exercises help restore full, pain free range of movement. In the early stages it is important not to stress the ligaments which have been injured so up and down movements of the foot are done as opposed to lateral movements.

Strengthening exercises build up gradually from isometric or static exercises through dynamic exercises involving movement. Some exercises target specific muscles which are important in helping prevent future ankle sprains. It is essential that the proprioception or coordination of the ankle is developed as this is likely to have been damaged at the time of injury making recurrence more likely. Wobble balance board exercises can be beneficial.

Finally functional exercises are more sports specific or activity related to bridge the gap between rehabilitation and full fitness. Functional exercises include hopping, bouncing changing direction and activities more specific to sports training and competitive games.

See ankle sprain exercises.

Expert interviews

We have interviewed professional football physiotherapist Neal Reynolds about how he treats a player with a sprained ankle. We have broken it down into three sections. The first talks about early stage treatment and exercises, the second looks at late stage rehabilitation and the third focuses on future prevention of ankle injuries.

• Exercises and rehabilitation
• Late stage and return to sport
• Ankle sprain prevention

Sports massage

Massage can be beneficial in treating a sprained ankle, particularly in the later stages or with a particularly stubborn injury. We demonstrate some simple cross friction massage techniques to help align scar tissue on the ligaments and interview a teacher of sports massage.

Sports Massage for Ankle Sprains

Simple sports massage techniques for treatment and rehabilitation of ankle sprains.

 

Sports massage for ankle sprains

Sports massage can be effective in treating a sprained ankle in a number of ways. Initially, light massage around the ankle, calf and shin muscles can be used to help reduce swelling from around 3 days after injury. As pain subsides, deeper techniques can be incorporated to help loosen the calf and shin muscles and improve range of motion. See sports massage for calf muscles

After the acute phase, cross friction massage directly to the ligament can help in preventing scar tissue formation. This type of deep massage can be commenced from around 7 days after injury, or as pain allows.

Cross friction massage

Oil or any other lubricant should not be used as you need to get a good feel of the ligament. Oil reduces the control you have over your movements.

Cross friction massage should be applied with the ligament in the stretched position. Apply direct pressure with a single finger to the tendon and massage deeply (but within the limits of pain) backwards and forwards across the tendon - not along its length. The ligament should be felt under the skin. This is why it is important to have a knowledge of the anatomy involved and where the ligament attaches to.

Gradually massage deeper but within the limits of pain. This technique is likely to be a little painful but not so much that the athlete tightens up with pain. It might be easier to start treatment slightly away from the point of injury and gradually work in towards it.

The duration of treatment can be for around five to ten minutes. It is a good idea to use massage techniques every other day rather than every day. This gives you a chance to assess how the injury responds. If swelling increases of pain is worse the next day then refrain from massage until the acute stage has passed.

• 
  

  • Sports Massage for Ankle Sprains

    Simple sports massage techniques for treatment and rehabilitation of ankle sprains.

     

    Sports massage for ankle sprains

    Sports massage can be effective in treating a sprained ankle in a number of ways. Initially, light massage around the ankle, calf and shin muscles can be used to help reduce swelling from around 3 days after injury. As pain subsides, deeper techniques can be incorporated to help loosen the calf and shin muscles and improve range of motion. See sports massage for calf muscles

    After the acute phase, cross friction massage directly to the ligament can help in preventing scar tissue formation. This type of deep massage can be commenced from around 7 days after injury, or as pain allows.

    Cross friction massage

    Oil or any other lubricant should not be used as you need to get a good feel of the ligament. Oil reduces the control you have over your movements.

    Cross friction massage should be applied with the ligament in the stretched position. Apply direct pressure with a single finger to the tendon and massage deeply (but within the limits of pain) backwards and forwards across the tendon - not along its length. The ligament should be felt under the skin. This is why it is important to have a knowledge of the anatomy involved and where the ligament attaches to.

    Gradually massage deeper but within the limits of pain. This technique is likely to be a little painful but not so much that the athlete tightens up with pain. It might be easier to start treatment slightly away from the point of injury and gradually work in towards it.

    The duration of treatment can be for around five to ten minutes. It is a good idea to use massage techniques every other day rather than every day. This gives you a chance to assess how the injury responds. If swelling increases of pain is worse the next day then refrain from massage until the acute stage has passed.

    • Ankle Sprain
      • Assessment & Diagnosis
      • Rehabilitation Program
      • Ankle Sprain Exercises
      • Ankle Taping Part 1
      • Ankle Taping Part 2
      • Ankle Taping Part 3
      • Ankle Taping Part 4
      • Sports Massage
      • Expert Interview Exercises
      • Expert Interview Late Stage
      • Expert Interview Prevention
      • Expert Interview Massage

FROZEN SHOULDER

August 23rd 2015

SPORTS MASSAGE THERAPY EXETER

If you are experiencing shoulder pain it could be caused frozen shoulder. Find out how to recognise frozen shoulder symptoms and what the treatment options are with our useful guide.

Frozen shoulder syndrome occurs when ligaments around the shoulder joint swell and stiffen

If you're over 50, it's quite likely you know of someone who's had frozen shoulder – and that’s because, according to a survey,* 72% of patients are over the age of 50.

Frozen shoulder syndrome, or adhesive capsulitis as it’s medically termed, occurs when ligaments around the shoulder joint swell and stiffen to such an extent that normal healing doesn't take place. This makes it difficult to move the shoulder, making everyday activities such as getting dressed or reaching for a cup from a shelf painful. As the condition progresses, the stiffness may continue to the point where range of motion can be severely limited.

Research has shown that diabetes patients are more than twice as likely to suffer with condition, and other risk factors include recent surgery, having a stroke, overactive or underactive thyroid and heart disease.

If you suspect that you have frozen shoulder, see your GP for a diagnosis. Your doctor should also rule out shoulder arthritis via a scan or X-ray, as it produces similar symptoms. With frozen shoulder the surfaces of your shoulder joint are normal and motion is limited because the tissues surrounding the joint have become tight, preventing you from moving your arm and shoulder as you usually would. With shoulder arthritis the joint surface is damaged.

Possible causes of frozen shoulder

Because frozen shoulder is a catch-all term, one person's symptoms and causes might be slightly different from another's, making it difficult to say what has caused the problem.

Frozen shoulder does, however, seem linked to certain activities. For example, any activity that involves you having to rotate your arm, such as freestyle swimming or throwing a ball overarm (for cricket, for example). Also, overhead weight lifting and sudden stress to the shoulder muscles via injury.

It's thought that frozen shoulder is caused by inflammation in the joint - this inflammation could arise after an injury but also as a side effect of other illnesses, such as diabetes, a known risk factor for frozen shoulder.

Early symptoms of frozen shoulder

• A feeling of pain and tightness in the shoulder area.
• A feeling of tightness especially when putting the arm up and back, as you would do it you were throwing a ball overarm.
• Pain on the back of the wrist. (This specifically relates to frozen shoulder caused by subscapularis trigger points.)
• As time goes on, the symptoms will worsen although the pain may be reduced.

Rehabilitation and Strength work post knee injury/op

Restoration Of Functional Muscle Strength After Knee Injury Or Surgery

Functional muscle strength refers to whole limb force expression during multi-joint, multi-muscle group movements specific to a person’s unique activity or purpose. 

With regard to the lower limb, force production predominantly occurs in a closed kinetic chain (CKC), and functional muscle strength of the lower limb is expressed during the concentric phase of CKC activities such as sit-to-stand, stair ascent, and taking off from a jump. Conversely, force absorption also predominantly occurs in a CKC, and so functional muscle strength of the lower limb is also expressed during the eccentric phase of stand-to-sit, stair descent, and landing from a jump. 

Relative to the simple functional observations just described, it is not surprising that CKC muscle performance tests such as one repetition maximum (1RM) squat or leg press demonstrate a stronger relationship to lower limb function defined by hopping, jumping, and running tasks than open kinetic chain (OKC) muscle performance tests such as a 1RM knee extension. This, in turn, indicates that CKC training methods (e.g. squats) should eventually be the dominant method of strength training if enhanced performance in hopping, jumping, and running tasks is desired. 

Soon after knee injury or surgery, however, OKC strength training should first be used as the dominant training method in order to reverse isolated knee muscle weakness and prepare the knee for functional training, after which CKC strength training should become the dominant training method to optimize whole lower limb function. Thus, both OKC and CKC training methods should be used throughout the rehabilitation process. The key is to implement the correct training method at the correct time. 

Here are some links for you that look at some of the above further: 

1. 
http://bjsm.bmj.com/content/38/3/285.full.pdf+html 

2. 
http://www.ncbi.nlm.nih.gov/pubmed/9440034 

3. 
http://www.ncbi.nlm.nih.gov/pubmed/9617729 



Regards, 

Nick. 

Nicholas Clark. 
Knee Consultant Physiotherapist. 
SKS Group Moderator. 

Business Website: 
http://integratedphysiotherapy.com/ 

Business Facebook Page: 
http://www.facebook.com/pages/Integrated-Physiotherapy-and-Conditioning/245721042146590?sk=wall 

Neck and shoulder pain ( sports massage therapy exeter )

Suboccipital Muscle Tension

Posted on June 5, 2015 by SMRT in Anatomy, Head & Neck, NCBTMB approved continuing education, Physiology, Spontaneous Muscle Release Technique. 

I want to explore tension in the suboccipital muscles and what the causes of that tension may be. First, let’s make a direct connection between the position of the occiput on the atlas (C1) and tension in the suboccipital triangle muscles (namely: rectus capitis posterior major, rectus capitis posterior minor, obliquus capitis inferior, and obliquus capitis superior). These suboccipital triangle muscles have attachments on the occiput, the atlas, and the axis (C2). To maintain normal tension in these muscles – tension that is balanced from left to right in which the muscles are not painful and have no restriction – the occiput needs to sit straight, balanced, and buoyant on the atlas. Does this sound like anyone you know? How about yourself? Is your occiput in that position?

So, assuming that my facetious questions above have not been answered with resounding yeses, how does the occiput become twisted on the atlas? The first thing we need to look at in the world of technology we now live in is a muscle in the front of the neck called longus capitis. Longus capitis originates from the transverse processes of C3 through C6 (this will become important to us in a bit) and it inserts on the basilar aspect of the inferior occiput. Basically it inserts anterior to the foramen magnum on the bottom of the occiput. You have two longus capitis muscles, one on each side of your anterior neck. The longus capitis muscles contract during flexion of the neck (think of the position your head may be in now if you are reading this on a tablet or phone – chin toward chest) and same side rotation (so, if you are holding that tablet or phone in one hand while trying to do something else with the other hand, like drive or something).

When one longus capitis becomes tightened and short from the chin being toward the chest with the head slightly rotated in that direction, that muscle pulls the occiput to that side. Instantly the suboccipital triangle muscles are shortened on one side, generally the same side that longus capitis is shortened on. Maybe you never find yourself in this posture with the neck flexed and off slightly to one side. There is another possible way that longus capitis can become shortened and pull the occiput into a twist. Earlier it was noted that the muscle originates from the transverse processes of C3 through C6, which happens to be the exact origin of the anterior scalene muscle.

A shortened anterior scalene muscle can reduce the space between these four cervical vertebrae. When that space is reduced, longus capitis will become short in response and pull the occiput to that side. So what makes anterior scalene tight? Well, many things, but one specifically would be an imbalance in the first rib position. Why? Because anterior scalene inserts on the first rib. The first ribs can become imbalanced by sleeping with one shoulder hiked under the head, carrying a bag predominantly on one shoulder, cradling the phone between an ear and its corresponding shoulder, etc.

So, to recap what we know so far, tension in longus capitis can pull the occiput to one side and cause tension in the suboccipital muscles. That tension can be caused by tech neck and what it does to the anterior neck or by an imbalance in the first ribs. For another possibility as to why the occiput may be shifted on the atlas let’s look into the cranium. The occiput articulates with the sphenoid in the middle of the cranial base to make the sphenobasilar joint. The sphenoid articulates with almost every other bone in the head.

While it is absolutely possible that the position of the occiput can create pressure on the sphenobasilar joint and the sphenoid itself, it is just as possible that jaw issues, sinus issues, or any number of other things going on in the head can shift the sphenoid. This would put pressure on the sphenobasilar joint and could potentially shift the position of the occiput. Let’s say that the sphenoid has shifted very mildly to the right in response to an issue in the right upper jaw. This mild shift will put pressure on the sphenobasilar joint. The sphenoid will enlist the occiput to help take that pressure off the joint. The occiput responds by twisting to the right and creating a right side rotation of the head. This right side rotation could shorten the right longus capitis, which could create reduced space between the third and sixth cervical vertebrae, which could shorten anterior scalene, which could pull the right first rib superior toward the neck and head…..

And where would all of this be felt in the human body? Most often it would be felt as pain and restriction in the suboccipital muscles, those small tissues at the base of the skull (or top of the neck, if you prefer) that are fighting to regain the balance of the occiput. So, if you are a massage therapist, do not beat up on the suboccipital triangle, work with other structures first to allow the occiput to regain balance and then work the suboccipital muscles. If you are a person who gets headaches in this area, put the ipad and phone away, lift your head up, and tell your massage therapist to work with these other structures to give you lasting relief.

Plantar Fasciitis

Sports Massage Therapy Exeter by Liam Clarke

A condition I come across on a frequent basis, here's some important information regarding the condition, which if not treated by a therapist with a great understanding of the 3 fascia bands of connective tissue, can leave you with pain and dysfunction for many months, even years. Don t suffer Sports Massage Therapy Exeter can use a vast variety of techniques to from ultra-sound to manual/physical therapy, complementing kinesiology tape to lift the pain receptors that compress on the connective tissue which causes the inflammation.

Visit www.sportsmassagetherapyexter.org.uk today to book an appointment 

What is plantar fasciitis?

Plantar fasciitis is an overuse injury, like carpal tunnel syndrome or tennis elbow in your foot, a kind of tendinitis: an inflammation and/or thickening3and/or degeneration of the plantar fascia. It’s especially common in runners, and in menopausal women. “Many people are afraid of running because between 30 to 70 percent (depending on how you measure it) of runners get injured every year.”4 And roughly 10% of those are PF cases.5
I’ve just used the familiar terms “tendinitis” and “inflammation” to introduce plantar fasciitis in the most familiar and conventional way. However, these are misleading terms and the truth is more complicated. The plantar fascia is not really a tendon: it’s a sheet of connective tissue (“fascia”), more like a ligament than a tendon. It stretches from the heel to toes, spanning the arch of the foot, from bones at the back to bones at the front (whereas tendons connect muscles to bones).
The “itis” suffixes in tendinitis and fasciitis mean “inflammation,” Many people are afraid of running because between 30 to 70 percent of runners get injured every year.but the tissue is rarely inflamed the way we usually understand it (maybe at first, not for long). Instead, the plantar fascia shows signs of collagen degeneration and disorganization. In 2003, Lemont et allooked at 50 cases and found so little inflammation that they declared that plantar fasciitis “is a degenerative fasciosis without inflammation, not a fasciitis.”6 So it would be better to use a more generic suffix — like opathy(diseased) or osis (condition).
In fact, this is true of all so-called “tendinitis” — inflamed tendons are not so very inflamed. “Recent basic science research suggests little or no inflammation is present in these conditions.”7 And Khan et al wrote that “numerous investigators worldwide have shown that the pathology underlying these conditions is tendonosis or collagen degeneration. This applies equally in the Achilles, patellar, medial and lateral elbow, and rotator cuff tendons.”8
And in the plantar fascia, where the degeneration is “similar to the chronic necrosis of tendonosis.”9 Necrosis is bad. It’s Latin for “tissue death.” In plantar “fasciitis,” the plantar fascia is not just hurting, it’s dying — eroding like a rotten plank.10 And this isn’t just to make you squeamish: inflammation and “necrosis” are not the same medical situation, and understanding the difference is essential for effective treatment.

Foot arch-ery

The arch of the foot functions like a bow (as in a bow and arrow), and the plantar fascia is like the string of the bow. The tension in the “bow string” holds the shape of the arch. But every time you step, the “bow string” stretches… and when stretched too hard and too often, it gets irritated, and then it’s like a bow shooting you in the foot!

So why does it happen? Plantar fasciitis is basically caused by chronic irritation of the arch of the foot due to excessive strain.
If the arch of your foot is like a bow, think of the plantar fascia as the bow’s string. The plantar fascia, along with several muscles both in the foot and in the leg, supports the arch and makes it springy.11 Too springy, and the foot flattens out, overstretching the plantar fascia. Not springy enough, and the plantar fascia absorbs too much weight too suddenly.
Either way, it starts to burn with the strain.
Other than the fact that it’s on the bottom of your foot and you step on it a lot, why is the plantar fascia vulnerable to strain? Why exactly? What happens?

Getting to the root of plantar fasciitis: could it be bone spurs?

Clever-sounding biomechanical explanations for plantar fasciitis are as common as plantar fasciitis itself. Many therapists and articles on the internet will insist that you must treat the “root cause” of plantar fasciitis. It would certainly be a good idea — there’s no disputing that. Now, if only it were possible to identify the root cause!
There are three particularly common biomechanical “explanations” for plantar fasciitis, which I will cover over the next three sections. None of them is completely useless, but none even remotely qualifies for “root cause” status:

• bone spurs
• flat feet and/or pronation
• tight calves

Unfortunately, there are so many possible causes of plantar fasciitis — probably several of them happening at the same time — that it is effectively impossible (or just extremely impractical) for therapists to make any confident biomechanical diagnosis. It’s simply too complicated an equation, and the scientific literature is riddled with contradictions. Let’s start breaking this down with bone spurs…

Surely hard bony growths in the arch are painful?!

Bone spurs on the heel (aka heel spurs and calcaneal spurs) seem like they must be a smoking gun — a simple and obvious cause of plantar fasciitis. They are common — about 10–20% of the population12 has an extra bit of bone growing on the front of the heel. They often get the blame for plantar fasciitis because it seems so obvious that having a bony outcropping on your heel would indeed cause heel pain, for much the same reason that you wouldn’t want a rock in your shoe. Even more damning: they are indeed found more in people with plantar fasciitis than without.

Not as bad as it looks. Having a bone spur is more like stepping on a cracker than a nail. A very thin cracker.

Seems straightforward, right? Wrong.
Unfortunately for common sense, bone spurs aren’t very bone-y: they’re merely a modest calcification of the plantar fascia. The spur is brittle and thin. It’s not much more like bone than tinfoil is like a sheet of steel. It makes the plantar fascia a bit crispy and crunchy.13 So bone spurs aren’t as much of a painful mechanical problem as they sound: more like stepping on a cracker than a nail. A very thin cracker.
So perhaps it isn’t too surprising that lots of people have painless spurs. And there is good evidence that, when there is pain, it’s not the spur that hurts but the plantar fascia itself or other soft-tissue structures.1415 And surgically removing a bone spur does not necessarily relieve pain, which makes it a lot less likely that it was causing it in the first place.1617 Spurs also tend to just grow back. No wonder a 2007 study concluded, “Overall, the presence of a calcaneal spur [was] not correlated with patient satisfaction and recurrences.”18 And it’s why there is a broad consensus that they are not the culprit. In a 2014 review in the journal Foot & Ankle Specialist, Moroney et alwrote:

Though once synonymous with plantar fasciitis, calcaneal spurs have, for several decades, largely been regarded in the orthopaedic literature as incidental findings. 

But they probably aren’t completely irrelevant. They also wrote:

However, it may be premature to completely dismiss the significance of plantar calcaneal spurs.

It’s clear that spurs are probably more painful and problematic when other tissue X factors are present, but those factors can and do also cause plantar fasciitis symptoms whether you have a heel spur or not — and heel spurs may be completely painless without those factors!
Of all the possible “root causes” of plantar fasciitis, bone spurs superficially seem like the simplest and most obvious — and yet it’s neither. As tempting as it is, it turns out that you just can’t count on a nice straightforward connection between heel spurs and plantar fasciitis.
Other alleged root causes are even less satisfying.

Maybe it’s my pronation? Or flat feet?

“My therapist said I’m a pronator.” I hear this a lot. It’s not clear that it matters.
Pronating is rolling the foot inward. It is almost synonymous with having flat feet, because the arch tends to collapse as you roll the foot inward. They don’t necessarily go together, but they often do, and they are both routinely claimed as root causes of plantar fasciitis. Personally, I think therapists just like to accuse their patients of “pronating” because it makes us sound like we know what we’re talking about. Sound a little harsh? Some experts believe the idea of pronation is so useless — and yet so common! — that they have called for it to be abolished:19

[Overpronation] contributes nothing to our understanding — it is not definable, not reliable or valid, not diagnostic, its relationship to injury is not fully understood, and it does not dictate what the most appropriate management plan may be. It should not be replaced, it should be removed.

Ian Griffiths, Overpronation: Accurate or Out of Date Terminology?

It’s just as likely that under-pronation and high arches are a problem. While flat feet are a more popular cause, one professional will blame high arches, and the next will say it’s flat feet … sometimes about the same patient. Surprisingly, professionals often seem to have trouble deciding whether a given foot has a flat arch or a high arch!20
So why are experts contradicting each other? Probably because both flat and high arches are likely causes of plantar fasciitis.212223
For years, I incorrectly told plantar fasciitis clients with high arches that they were exceptional, because I knew only the conventional wisdom: namely, that plantar fasciitis afflicts the flat-footed. Now that I know better, it seems obvious that the plantar fascia can also be irritated by an excessively tall arch. If the arch is high, it means the arch-support system may be too rigid and not springy enough, so it absorbs too much force too quickly.
This is a Goldilocks case: the arches need to flex and give just the right amount — not too little, and not too much.
Pronation is one side of a Goldilocks equation too. The truth is that excessive supinating — rolling outwards — is probably just as much of a problem24 — but that gets almost completely ignored. You never hear about supinating — there’s little research about it.
As much as the body likes things to be just right, it’s also remarkably adaptable. Many flat-footed pronators and high-arched supinators in fact do not have plantar fasciitis. And many people who do have plantar fasciitis have completely normal arches, and neither pronate nor supinate excessively. 
Arch height and pronation are almost certainly risk factors … but not root causes.

If you walk in a shoe store and their sole basis for choosing a shoe for you is how much your pronate and what your arch looks like, turn around and walk out the door. The science simply does not support this protocol.

runblogger

Probably my calves are too tight!

Could be. Tight calves are another classic plantar fasciitis scapegoat, and the gastrocnemius and soleus muscles (the big calf muscles) certainly can put a strain on the plantar fascia.25 This situation is typical for people with a leaning-forward “ski jumper” postural pattern. And of course it is the predictable side-effect of wearing high-heeled shoes for many years.26
For interesting contrast, the Twa people of Africa grow up climbing trees, which earns them amazingly limber calves that allow their ankles to bend halfway (45˚) to the shin27 — two to four times greater than the average urban person! Look at them go: