4. Return to normal fitness
There isn’t a protocol that works for everyone. Everybody is unique and so his/her treatment and recovery. Always follow the “golden rule”: to start to practice your sport, you have to be pain-free.
In this post I will talk about Plantar fasciitis and with this injury the most important thing to take into account is that before you start to exercise again you have to make sure that you don’t feel any stiffness and/or pain with your first steps in the morning or after prolonged sitting.
Usually, the longer the rest period, the slower the return to exercise. You shouldn’t do straight away as much as you were doing before the injury.
Should you return to exercise?
By returning to exercise I mean to return to impact sports, sports where your feet need to bear your weight, affecting your plantar fascia (running is the typical one, as you have to run in the majority of the sports you bear your weight). You must have been exercising during all the treatment, but exercises with no impact, like swimming or cross trainer (as long as you are pain-free during the exercise and for the following 2 days after the exercise).
- To return to exercises with impact you need to have ankle and foot joint full range of motion. Usually, the most limited movement is dorsal flexion.
- You have to be pain-free. A bit of discomfort is allowed as long as it doesn’t become a pain. If you start to exercise and pain is back, visit your physio to find out why it happened.
- Inflammation is not one of the signs of plantar fasciitis. Although, you could have inflammation of surrounding structures as compensation of not walking properly. So, make sure that that inflammation is gone before you start running.
- You should have good ankle stability. You could have ankle instability as a result of being without exercising for a long period of time which could make your ankle weak.
- Don’t trust your lungs. You might feel that your breathing is great, but it doesn´t mean that your plantar fascia is that great and you should push it all the way your lungs allow you to go.
Also, you might need to change your running technique and/or wear insoles or orthotics to modify your landing, in case it was the cause of you getting plantar fasciitis.
How to start?
It depends on your age, injury, sport, and general health, among others (have a look at this post blog which gives you more useful information). I am going to tell you the way to start to run, as it is an impact sport as well as the base of many sports. These are the steps to follow:
- Go for 2 fairly high-speed 25 min walk to see how your legs feel (not the same day, but 2 days in a row). If you feel okay, you can start with 3 lots of 10 reps of single leg squats on stable surface to begin with (unstable surface, later on), heel raises, tip toe walk and hops.
- Now, start with a “walk-run-walk” to find your baseline (to find out how much your legs can handle at this stage). Your baseline is the distance you can run with no pain during the run and for the following two days. Once you know what your baseline is, make sure that you run a bit less than your baseline to reduce any possible risk of setbacks. Then, start from there, increasing your mileage progressively (10% week).
Another way I recommend, which is quite slow and therefore less risky is as follow:
|Week 1||10 min walk, 2.5 min run, 10 min walk, 2.5 min run/rest day/10 min walk, 3.5 min run, 10 min walk, 3.5 min run/rest day/10 min walk, 5 min run, 10 min walk, 5 min run|
|Week 2||7.5 min run/rest day/10 min run/rest day/12.5 min run|
|Week 3||15 min run/rest day/17.5 min run/rest day/20 min run|
|Week 4||22.5 min run/rest day/25 min run/rest day/27.5 min run|
|Week 5||30 min run/rest day/32.5 min run/rest day/35 min run|
|Week 6||37.5 min run/rest day/40 min run/rest day/42.5 min run|
|Week 7||45 min run/rest day/42.5 min run/rest day/45 min run|
|Week 8||47.5 min run/rest day/50 min run/rest day/52.5 min run|
The ideal surface to start to run is on a treadmill (have a look at this blog post) because your body will suffer less impact. If you can’t access to a treadmill, run on a soft surface (for instance, grass or track). Note that if you find it too easy, you can jump steps, without being too brave. After the 8th week, add the 10% weekly. Also, it would be recommended to visit your physio once a week for reassessment, strengthening exercises, stretches and/or feedback.
Click on Plantar fasciitis treatment part I, Plantar fasciitis treatment part II, Plantar fasciitis treatment part III and the last update on plantar fasciitis to know more about the treatment of this injury.
As always, comments are welcome, as they will make learn from each other.
If you have any questions, do not hesitate to contact me on The Physical Therapy, Physiotherapy Clinic based in Southampton, and I will be happy to help you.