Having trouble with back pain or hip pain? There’s a quick self-release technique using a lacrosse ball that may help you alleviate the problem. Learn how to do it with this video showing an example of a Tensor Fascia Lata (TFL) self-release.
We make a ton of training videos for our staff and other PTs around the world. Occasionally we share them on our blog so those suffering needlessly can see how our approach to hands-on physical therapy helps others to get back to the living the active lifestyles they want and deserve.
Carter Physiotherapy is awesome. I had issues with my hip from running so I went to see Jarod. I had initially gone to my general doctor, a sports doctor, and then finally to Carter Physiotherapy. I was happy that he told me I shouldn’t stop doing what I loved to do: run. He is so knowledgeable and friendly too. He worked on my hip a couple of times and I have never had a problem since and I still run!
LAURIE H, AUSTIN, TX
If you are dealing with hip or back pain and would like to know how we can help, call or text us at (512) 693-8849.
Video Transcription [Please excuse grammatical errors due to the conversational nature of the video]:
Hey, guys! Jarod, from Carter Physiotherapy.
Here’s a quick video on how to use a lacrosse ball to loosen up the front side of the hip called the Tensor Fascia Lata or TFL.
TFL is a muscle that runs from the front point of the pelvic bone to a little bit over the top of the pelvis down. It attaches into the IT band and this area really gets tight in a lot of different people.
We sit a lot, so the IT is usually held in a shortened position. And when we stand up, if it’s real tight, the muscle will pull us into kind of what we call an anterior pelvic tilt, which can compress the low back.
There are many things that can be caused by tight TFL. I’d like to work these out on a foam roller, but quite often it doesn’t really get in deep enough. It’s a little easier to really get pointed pressure with a lacrosse ball. So it’s quite simple. We’re just going to lay down as if laying on a bed. So I would suggest doing this on the ground, yoga mat, carpet, or something like that.
Basically, you are going to put it down and have it right below the front point of your pelvic bone. Then tilt out the legs and modulate your weight with your arms legs and the further leg away.
Then, you find those tender or tight areas and just do some tiny movements in that area. Make sure you won’t hit the front part of the pelvic bone. You should be in the soft tissue right below that point or slightly to the side.
A lot of times people will do this and they get a little too medial or too inside. Now, you’re looking at potentially pushing on the inguinal ligament on the femoral arteries and nerves. You don’t want to do that either. You find that point on the bone going right below it and don’t go any further inside than that. It’s there and out. This is the area right here that we’re working for loosening up the TFL.
Plantar fasciitis is a very common cause of heel pain. Unfortunately, it can be even harder to get rid of than it is to spell.
If you’re suffering from plantar fasciitis or heel pain, call/text 512-693-8849 to request your free consultation today!
But when it strikes, it can completely disrupt your lifestyle. It makes any standing, walking, or jogging extremely painful and frustrating. If you’re reading this and already experiencing heel pain, you probably know what I mean … pain with simply being on your feet, dreading that first step out of bed in the morning, unable to go for a jog (or having to push through tons of pain to get your daily exercise), and the list goes on. It can be incredibly debilitating, and that’s no way to live! That said, please know that—although it can be more difficult to resolve than most tendinosis issues—plantar fasciitis is very treatable!
I’ve seen this injury make previously fit runners cringe at the idea of going for their beloved runs around Austin. It can make even ‘workout junkies’ horrified by the thought of getting in a ‘leg day’ at the gym. Without the right treatment to get rid of the problem, many end up gaining weight and literally becoming depressed because of the limitations this stubborn heel pain is putting on their life.
We’ve had patients at our Austin physical therapy clinic who had been suffering for years. Their heel pain made them unable to exercise, walk around Lady Bird lake, or enjoy many of the fun activities available in this beautiful area. This is such a shame because it doesn’t have to be this way! However, it does happen all the time because people receive plantar fasciitis treatment that’s directed at symptoms rather than the true underlying causes. Further, it can happen when they receive treatments that don’t fully address all the causes.
Why plantar fasciitis heel pain is tricky to treat
As you’ll read in this article, plantar fasciitis can have a daunting number of different causes that are easily missed by a busy, rushed clinician. For this reason, this form of tendonitis has a higher tendency to become a chronic problem than most others.
Unfortunately, a stubborn case of plantar fasciitis doesn’t typically go away on its own. Rather, it will usually get worse if you don’t get the right treatment or just try to push through the pain. So if you’re having heel pain and reading this article, our goal is to give you the knowledge you need to make the right decisions about treatment. We want to get you back to the active Austin lifestyle you deserve.
More specifically, the aim of this article is to:
Give you an understanding of why plantar fasciitis (often misspelled as “planters fasciitis”) can be so difficult to fully resolve.
Explain how the right treatment addresses those difficulties.
Arm with you extremely important information on how to choose the right plantar fasciitis treatment so your heel pain doesn’t linger for years.
Provide a number of self-treatment techniques to start easing your heel pain.
Get you back to the activities you’re currently limited from or unable to do. (See video below)
Why plantar fasciitis treatment often fails to get rid of your heel pain
Too little time
I believe a big reason plantar fasciitis becomes a chronic, longterm problem for many is that most treatment approaches do not fully address ALL the CAUSES of their heel pain. Most physicians and therapists are forced to rush from one patient to the next. Consequently, they simply don’t have the time to identify and treat all the potential causes of your pain (explained below).
Furthermore, depending on who you see for help, many treatment approaches are aimed at symptoms rather than causes. For example, many physicians will simply tell you to rest and take anti-inflammatories. They may offer a steroid injection into your heel. Though people occasionally get some relief from this approach, I can promise you that your heel is not in pain because it is deficient in a manmade steroid like cortizone.
Painful inflammation is a symptom caused by something else, and cortizone is aimed at decreasing inflammation rather than resolving the cause of the inflammation. Many people who get relief from this approach only find themselves dealing with the same heel pain less than a year later because the underlying causes of the problem were not addressed.
Another reason this injury is often unsuccessfully treated is that the potential causes of the problem are so numerous that you can’t throw a ‘cookie-cutter’ set of treatments at every case and expect a high level of success.
Each case is different. Further, there doesn’t seem to be any particular ‘type’ or ‘profile’ for whom plantar fasciitis is more likely. Our patients with this and other forms of heel and arch pain span a wide variety of body types and activity levels. From ultra-marathoners to sedentary desk workers, a huge variety of people develop this debilitating condition and make their way to our clinic.
“After suffering from chronic, debilitating and excruciating pain from plantar fasciitis for almost a year, I had given up all hope of ever being able to walk without pain again. By a miracle I stumbled upon Carter Physiotherapy. They made some custom orthotics for me, did hands-on manual therapy, and I could walk pain-free within two days. And my pain was so bad that I had to use a cane or crutches to get around on some days. I even went to three podiatrists who all used very conservative treatment methods which didn’t help me at all. I highly recommend Carter Physiotherapy. They get to the root of the problem and fix it.”
As I said, there’s only one way to completely get rid of this heel and arch pain. And that is to fully address every causative factor involved. And there can be a very long list of causes, depending on the situation. Here are some examples of common and not-so-common causes of plantar fasciitis:
Tight tissues in the foot
Stiff ankle joints
Stiff joints in the foot
Joints in the foot that are too loose and unstable
Flat feet / Over-pronation
High Arches / Over-supination
Decreased range of motion in your toes
Weak muscles in the foot and lower leg
Tight hip flexors
Weak hip flexors
Weak hip rotational muscles
And the list goes on…
Interestingly, some of the things listed are the exact opposite of each other. For example, loose joints vs. tight joints or over-pronation vs. over-supination.
And just because you have a common cause of plantar fasciitis doesn’t mean you’ll develop it. Nor does it mean it’s actually a major contributor to the pain you’re experiencing. We’ve had patients with perfectly flexible calves and fascia of the foot that still developed plantar fasciitis. In those cases, it was often the mobility of the foot and ankle joints that were the primary cause.
Finding the root cause is complicated
Many of the causes of plantar fasciitis are interlinked. In addition, one cause often leads to another or may have been present as a result of an old injury you completely forgot about. For example, an old ankle sprain that left you with decreased ankle range of motion led to tightness in the calf muscles. The tightness then transfers abnormal forces to the bottom of the foot. And that force transfer is a primary cause of your plantar fasciitis. In that situation, you could massage, roll out, and stretch your calves all day long—but it won’t result in a longterm fix. The ankle mobility must first be resolved for the calf to loosen up and stay loose.
Let’s look at some other causes on our list above …
Some people get confused when they read that tight hip flexors and weak hip muscles can contribute to plantar fasciitis. However, tight hip flexors can lead to you shift your weight more toward your toes when you’re standing. And this results in an ongoing increase in the strain through the plantar fascia and calf muscles.
Weak hip muscles can contribute to excessive internal rotation of the legs with walking and running. And that rotation can contribute to over-pronation. Consequently, the overpronation creates higher levels of strain through the arch and plantar fascia.
Can plantar fasciitis treatment still work with a heel spur?
In some cases, plantar fasciitis pain can actually be coming from a “heel spur.” That is, a bony growth off your heel bone (calcaneus). These can also be called “calcaneal spurs.” Making this diagnosis requires an x-ray, and unfortunately even an expert manual physical therapist can’t get rid of a heel spur with his/her hands.
HOWEVER, even when we’ve had patients with heel spurs, there are typically other factors aside from the bony growth causing their pain. So addressing those other factors is a must if you’re going to fully resolve the problem. And that’s true even if you have a heel spur.
We’ve even seen pain completely resolve with hands-on manual therapy techniques and changes in footwear. This is surprising because those techniques do not remove or change the actual bone spur. In fact, many people have heel spurs and don’t know it because they don’t all cause pain. In some cases though, if the heel spur is a primary driver of your symptoms, it may ultimately have to be removed. That is, if pain persists even after receiving good treatment.
The best plantar fasciitis treatment in Austin, Texas
I’ve written all the above to make the point that every case of plantar fasciitis is different. Therefore each case requires an expert clinician to identify all the various components of the problem. Missing even one part of the puzzle can be enough to keep treatment attempts from fully resolving your heel pain and the limitations it is imposing on your life.
Depending on which factors are causing your heel pain, different types of practitioners will be best suited to help you. Choosing the right one will enable you to get rid of the pain and back to the active lifestyle you desire.
Important Side Note: It’s our opinion that identifying all the different factors causing your pain and creating a solid plan for getting rid of it shouldn’t cost you a dime.
How long should it take to treat plantar fasciitis?
We are, of course, a little biased. But we can honestly say that good physical therapy treatment and advice should be able to resolve at least 90% of plantar fasciitis cases without interventions from other providers (like steroid injections or surgery to remove a heel spur). Sometimes relief can be achieved quite quickly. Other times it can take a large number of treatments. Fortunately, most cases of heel pain are ultimately fixable with the right treatment.
Physical therapy for plantar fasciitis
A physical therapist who is also specialized in hands-on manual therapy is equipped with a massive number of potential treatment techniques and strategies. But not all physical therapy approaches are created equal. Therefore, there are a few things you need to make sure of when seeking physical therapy—or any form of treatment for that matter:
They are trained in, and use, hands-on manual therapy techniques as part of their treatment plans.
They see very few patients per hour so they actually have the time to identify all the factors causing your pain. Further, they have time to treat every one of those factors.
Does your healthcare provider is not using some form of hands-on manual therapy? If not, you are likely not getting everything you need to completely get rid of your heel pain. Are they are rushing from one patient to the next, seeing multiple patients per hour or multiple patients at one time? Then it’s impossible to give you the highest quality of care. With how stubborn plantar fasciitis can be to fully resolve, you need high-quality care and undivided attention in your treatment sessions.
Treatment at Carter Physiotherapy
At Carter Physiotherapy, treatment sessions are always 1-on-1 with a physical therapist certified in manual therapy. In addition, we offer 30- and 60-minute treatment sessions at our clinic in Austin. This allows us all the time and focused attention we need to fully treat every aspect of your plantar fasciitis. This is the best way to get you back to the exercise and activities you’re missing out on as quickly as possible.
We teach our patients everything they need to be doing on their own time. That means we do not have patients come to the clinic to perform exercises they can do at home or the gym. Therapeutic exercises and stretches are a vital part of any plantar fasciitis treatment plan. But we believe patients shouldn’t be spending time and money in the clinic doing things they can do on their own time. We also offer dry needling services, which can occasionally be a key component of successful treatment of plantar fasciitis.
What Are the Best Plantar Fasciitis Exercises and Plantar Fasciitis Stretches?
The video below provides a handful of plantar fasciitis stretches, exercises, and other self-treatment tools and resources. You’ll also learn strategies to keep your first few steps out of bed from being really painful and worsening your tendon irritation.
***Please note that this is not a complete list of potential self-treatments nor is it likely that what’s included in the video will completely resolve your heel pain. Diagnosis and hands-on treatment by a qualified healthcare provider is necessary to get rid of almost all cases of plantar fasciitis.
What else can I do to relieve my plantar fasciitis?
Another question we often get from patients is, “Should I get plantar fasciitis shoes?” This is typically referring to shoes with extra arch support. However, sometimes patients asking this question are actually referring to a type of “boot” that is worn overnight. It prevents the muscles and fascia in the foot and calves from tightening up. (The plantar fasciitis night boot and other forms of arch support and sandals are also described in the video above, and here is a link to a recommended night boot).
A plantar fasciitis night boot is something we suggest for pretty much every patient we have with heel pain. However, robust arch support may or may not be helpful. Some patients really feel improvement with arch support or custom orthotics. Others actually do better with minimal arch support. It’s strange, but unfortunately, we typically have to take a “try it and see” approach with footwear. This means patients try additional arch support. If it doesn’t help or seems to get worse, then we move to a more-minimal shoe type.
Don’t let plantar fasciitis keep you from living an active Austin lifestyle
As our home page states, we help active people in Austin quickly recover from injury. That means they can keep playing their sport, exercising, and enjoying life. Don’t let plantar fasciitis or any form of heel and foot pain keep you from being as active as you’d like. Let us help you get to the bottom of the issue and create a plan to get you back to the active lifestyle you deserve.
So now that we have a better idea of how fascial distortions can cause pain in the same area, I’d like to explore an example of how they can lead to pain elsewhere in the body. The patient I am about to describe is actually quite common, though I often see patients like him after unsuccessful visits to multiple practitioners. Why? Because the underlying cause of his pain was not in the area he was experiencing symptoms.
One year prior to meeting ‘Mr Smith,’ an avid runner, he had strained his right lower back lifting a heavy box. The discomfort from that injury faded over the next couple months, and since the symptoms were getting progressively better he decided he would not get checked out by a healthcare practitioner. (more…)
My Fascia has a twist, tear, separation, adhesion, or some other sort of distortion from normal … why does that necessarily cause pain? Well, these things Don’t always cause pain. This post is not about the mechanisms of pain generation in the body, so I’ll keep this part brief and simplified, but pain is only experienced if signals from specific types of neurons/nerves are registered by the brain. There are many other details and factors involved in that process, but again, I’m not writing this to describe them. I’m writing to make the point that for a change in the myofascia to cause pain in the same area of the body that it exists, it must directly or indirectly result in these pain signals being sent to the brain.
So how does this happen? There are a number of examples, but for the sake of brevity I’ll just choose one for today … (more…)
I’m starting my posts with a focus on Fascia because I believe it has so much more to do with musculoskeletal pain and injuries than most give it credit. Over time as I write about a variety of injuries and conditions, a common factor in these discussions will be the role Fascia plays, so it makes sense to give some good information about it up front. (more…)