Plantar fasciitis and the rolling ice stretch

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Once again i stumbled across this seemingly popular treatment for plantar fasciitis, this time, on Dr. Richard Blake's blog (http://www.drblakeshealingsole.com/2010/05/quick-tip-7-rolling-ice-stretch-for.html). This one has got me thinking for a while now....i cant find any RCT's specifically utilising this method as a stand alone treatment, although I know that anecdotally it seems quite effective at reducing symptoms. My question is this, is it effective for the reasons that are described in the above blog or by other means?

When a tissue is cooled (i.e. through the application of ice) it's load-deformation characteristics are altered. The tissue's ability to strain under load is reduced and therefore will not "stretch" as much. How does this affect the healing process? Does this mean that with the ice bottle less force should be applied than when using a golf/tennis ball that allows greater strain of the PF before reaching its plastic zone? Although more time consuming, wouldn't it be more appropriate to stretch the PF with a warm water bottle to reduce the amount of stress placed on the PF while elongating it to a more functional length. If the plantar fasciitis is in the acute phase or if inflammation still needs addressing then an ice pack could be applied afterwards for 10-20mins.

I came to the conclusion during my exercise science days that you should never stretch "cold" or before warming up the tissue to be stretched, this is probably why I am so confused.

I guess i just want to learn more about HOW this treatment works...

Regards,
Thomas Do Canto (3rd year pod student)

 

I agree, stretching cold is not theoretically effective.

As a part of my self-care protocol, I recommend cold water bottle 'massage' at the end of the day to reduce inflammation/acute pain, and warm water bottle 'stretching'. The patients can experiment with both and use which one best helps their pain. Some people tolerate cold poorly.

People who actually take advice say it helps. Most like the warm better, I've mostly seen chronic cases.

Unfortunately no statistics.

Sarah

 

Hey all,

Do we not want to cause a plastic deformation in a muscle when we target it with specific stretches.

If we stretch a warm muscle, using the visco-elastic properties of tissues then we would require greater strain in relation to its stress to reach the muscles plastic zone, which will normally not be reached and will result in only elastic deformation (not reaching plastic zone) . If however we stretch a cold muscle, the muscle will reach it's plastic zone sooner than compared with the warm muscle and therefore require less strain = plastic deformation = more effective stretch.

Just playing with thoughts between patients. Not sure if that makes sense to everyone else but it did to me at the time.

Cheers, Tim

 

Why is the frozen bottle exercise seen as a stretch ?

Think about what is happening when you put the bottle under the arch.

What action/motions do we usually see when we have tension in the plantar fascia ? And poor windlass is not the answer.

Tim point is a good one about plastic deformation, yet we are talking about fascia here and how putting a bottle under the arch will stretch the fascia ?

So frozen bottle stretching ?

 

Hey, thanks for the replies.
Tim, i totally understand what your saying but i thought that plastic deformation = mirco tearing = pain and inflammation (I.e. plastic deformation is what caused the injury in the first place).

Is it not more applicable that the therapeutic effect of stretching is due to the creep-response phenomenon? In that respect i agree with M Weber that rolling a bottle in the arch may not provide sufficient constant tensile stress in the plantar fascia to promote a creep-response.

 

Sarah, after reading your post again I like the idea of ice at the end of the day and heat in the morning. As the creep-response is not only time dependant but also heat dependant, it makes sense that a warm water bottle would be the way to go if attempting to actually 'stretch' the plantar fascia.

 

TDC what causes pain in the plantar fascia ?

 

Some reading around the subject if anyones interested....

If too much tension in the plantar fascia is the cause of pain in the plantar fascia, ie we get plastic deformation and micro tears - Ie plantar fasciosis why you put the plantar fascia under tension ie stretch it is beyond me.

We have studies which show eccentric training works for tendons, but not fascia.

So while warming the fascia up in the morning may make it more flexiable and therefore maybe stretch more before plastic deformation and therefore be less painful, its not the question asked.

A frozen bottle I believe does not stretch the fascia, but its mode of treatment is a form of cold massage.

I personally don´t do it, frozen peas at the end of the day works well, but then we have the debate that because there is no inflammation cells found in the fascia it is not possible to have inflammation. But there is blood and where there is blood there is white blood cells and where there are white blood cells there are inflammation markers and an inflammation response is possible.'

So we can have both fasciosis and inflammation.


'

 

Ice is an analgesic. Massage may affect collagen structure. Two different modes of action.

 

Yeah, I agree that excessive tensile stress is probably the major etiology of plantar fasciitis but shouldn't the level of stress be different when applying a stretch compared to the stress that causes injury. The reason the fascia has become symptomatic is because stress levels have gone above the upper threshold for adaptation and has most likely undergone plastic deformation. Stretching too much or too aggressively can be a bad thing but I believe the right amount of direct plantar fascia stretching (always below levels of plastic deformation) can help both the acute symptoms and long term prevention of reoccurrence.

One rationale for stretching - During the repair/proliferative phase of tissue healing collagen is deposited at the injury site in order to strengthen and rebuild the tissue. During the normal process of collagen formation, it dehydrates and shrinks to become a denser and structurally viable tissue. The problem with this is that during the night when optimal healing conditions exist, the shrinking component of tissue healing (which will effectively shorten the PF), predisposes it to increased tensile stress upon weight bearing, making new collagen fibers prone to re-rupture (micro tear) in the morning upon the first few steps. Please correct me if this isn’t the case or there are other more valid explanations for ‘first step pain’. I’m just trying to develop ideas on the pathophysiology of the condition.

So I think the best way to minimize this re-injury or micro tear phenomenon is with a soft tissue ‘warm up’ combined with a non-weight bearing stretching regime (all before they take their first step out of bed).

Does anyone find that stretching is more important for the pes cavus patient with plantar fasciitis? I still can’t get my head around why some people with seemingly minimal pronation, minimal lowering of the MLA and minimal WB hallux dorsiflexion resistance develop such persistent plantar fasciitis if the main etiology is excessive tensile stress…is compressive stress more common an aetiology in these patients?

After learning of the 'plantar heel pain gait test' as described by K. Kirby in another thread, i wonder if anyone has found a correlation between pain on heel strike in the pes cavus foot type and pain on heel off in the overpronating or pes planus foot type?

 

How does "fascia" physiologically stretch?