How Do You Treat Plantar Fasciitis?

In the world of manual therapy there are an infinite variety of techniques and approaches to dysfunctional patterns. I have been engaged in a conversation with other manual therapists about how to treat plantar fasciitis. Some want to treat the symptoms by ice therapy, splint therapy, or ultrasound. I agree that these techniques are very useful. But do they change the biomechanics that cause the dysfunction in the first place? Other therapists want to do cross fiber friction on the plantar fascia. When someone’s plantar fascia is extremely irritated and inflamed, this technique can cause an exacerbation. Myofascial therapists would work the calf muscles and locate trigger points that would mimic the pain in the heel. This I believe is a step in the right direction. Hypertonic calf muscles will cause a pull on the plantar fascia causing it to tighten and become vulnerable to inflammation. The question we have to ask ourselves now is what is causing the calf muscles to be tight?

When a muscle is tight and strong it is almost always compensating for a weak muscle. We know that to be true from scientific evidence ( please see my blog on the scientific basis for NeuroKinetic Therapy ). The motor control center in the cerebellum will select a related muscle to compensate, either an antagonist or a functional synergist. In this case I find that the calf muscles are compensating for weak gluteal muscles. Is it any wonder that the gluteal muscles are weak? We have a majority of our population working in a sedentary position. This is not to say that the calf muscles are always compensating for the gluteals. They can also compensate for weak hamstrings, quadriceps, or hip flexors. The job of a good manual therapist is to figure out which of these patterns is operating within the motor control center and to restore it to proper function.

NeuroKinetic Therapy is designed to accomplish such a task. In this case first test the calf muscles. If they test strong then test the gluteal muscles. If they test weak then touch a spot ( usually a sore spot ) on the calf and retest the gluteals. If the gluteals now test strong, you know you have to release that point on the calf. Continue releasing that point until the gluteals test strong in the clear. This is an example of the protocol of NKT. It is simple to do. You can use whatever technique you like to perform the release part of the protocol. The testing, releasing, and then retesting reprograms the dysfunctional pattern that has been stored in the motor control center. Once that is accomplished, the client must perform a home program. In this case it would be stretching the calf muscles followed by strengthening the gluteal muscles. It is important that this is done twice daily so that a new pattern can be burned into the motor control center. It is through repetition that the brain changes itself.

The question for us as manual therapists is do we want to treat symptoms or causes? I know all of us intend to heal our clients. Unless we find a way to identify the causes of dysfunction and treat them, we are simply working in the dark hoping things will get better.