Plantar Fasciitis and Massage Therapy

Many years ago – in what seems like the Dark Ages, I was in school to become a registered massage therapist (RMT) in Ontario, Cananada and was taught a standard massage treatment for plantar fasciitis and runners. 

The massage therapy mostly focused on the foot. It involved stretching the plantar aspect of the client’s foot by cranking the toes into extension forcefully and pulling the bottom of the foot tight. Then while your client was face down and you had this position achieved, you were to take your thumbs or even an elbow and dig away at the tissue until you had eradicated all of the ‘granular’ scar tissue. 

I quite clearly remember my teacher saying that we needed to then ice the bottom of the foot immediately, as he slapped an ice pack on my friend who was a runner and triathlete. I remember her gingerly limping off post-treatment. I can’t remember how long it was before she ran again after that. Who knows?  No explaination was ever given for the method of treatment. They never explained that the purpose was to break down tissue and re-injure the site to facilitate healing. But it surely stank of that mode of treatment, and it did not make sense. 

Why do we need to hurt someone to make a massage work? 

Now let me ask you a question, a question that I will likely repeat in multiple blog posts: If you come to me, as a medical practitioner, and you complain of a black eye, and I punch you in the same eye and tell you it will facilitate healing, does that make sense? No! So why is it acceptable in massage? Certainly it applys to plantar fasciitis and massage. 

Years later, I now teach a very different method to address runner’s issues to the therapists at Body Mechanics. It is far more gentle, treats the entire lower leg as well as upper (depending on time constraints), engages the brain by moving the body, and involves a referral to PT or exercise depending on the level of experience the runner or athlete has. 

The Plantar Fasciitis Massage Treatment

When assessing, we are looking at a far wider spectrum of dysfunction than simply plantar fasciitis. Indicators that there might be an issue or impending problem include heel pain, pain in the bottom of the foot, and sometimes calf pain. Of course with any assessment, we screen to rule out red flags as well. The symptoms listed above can also correlate with a recent increase in mileage or speed work for runners, or a weight change, plyometrics or recent changes in health. If there is no connection to the assessment you’re probably going to want to refer out regardless to check for bone Spurs and tendon issues. 

For the purposes of this blog let’s focus on the lower leg. I generally combine in-prone, general massage with gentle pin and stretch. Having the patient flex and extend the ankle as well as pronate and supinate. I am looking to see a full articulation of the foot and ankle. Often you will see that those with foot pain also have poor articulation. Resistance in these areas can be added to help cue the body into moving better. Once we have warmed the area with massage and movement, adding resistance to those movements is helpful. While many massages focus on the muscles, at Body Mechanics Orthopedic Massage I like to include tendon work, like “bowing,” as well. We want soft supple moving parts so practicing flexibility is helpful. 

When treating the bottom of the foot, I no longer use that awful stripping technique that requires an ice pack. Instead, I use a hot towel to warm the foot and then use a deeper gliding technique across the sole, while I have the patient flex and extend the toes, or spread them and let them fall to neutral. Here, if things are still not moving well we would add in some mobilizations between the tarsals and resisted exercises for the toes. 

As for home care, if the problem persists, we will refer you to a physical therapist and if it does not, then we would advise you to a program of foot and calf strengthening as injury prevention. As a massage therapist, I am not rehabbing you.  My job is to get you more comfortable while your body does what it does and what it was designed to do. It is adaptive. It will adapt, with or without me.

Summing up…

A warm towel? Simple exercises? No digging thumbs or elbows into the client’s foot? This is a far cry from the painful techniques that I was taught! No one is limping painfully off our tables before a run. The clinical outcomes seem just as effective and I’d say are more beneficial. If you are looking for a therapist who will not hurt you to help you, ask questions before you book. Look for someone who listens well and has a wide variety of techniques at their disposal. It would be a shame to miss your next run due to foot pain… especially if it was caused by the person trying to help you.

Check out more on plantar issues

 

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