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Trigger Points And Plantar Fasciitis

by Lisa Sabin, January 13, 2009

Yesterday I attended a fitness workshop from Perform Better. Perform Better is known for their hands on training seminars. Top profesionals in the industry provide education and training for physical therapists, trainers and coaches.

I learned about functional training for the shoulder, strength and power training for speed development and restoring fundamental movements with corrective exercises. The first half of the day is lecture. The second half is hands on drills and exercises.

Lee Burton, PhD, ATC, CSCS took us through screening to look for asymmetries. Asymmetries can be caused from muscle imbalances or postural problems. Participating in a repetitive sport can cause imbalances. Some muscles are weaker and others are stronger. For example: hamstrings may be stronger than the quadraceps in runners. We have to learn how to recruit the proper muscles in the right order. Burton’s screening used the squat, the hurdle step (stepping up and over a hurdle), and lying leg lift. These tests tell us what muscles aren’t being recruited properly to do the exercise. Inefficient movements cause compensations which move the joints in an unnatural manner. The body will always sacrifice quality for quantity. Movement patterns follow the path of least resistance.

The lying leg lift identified a compensation pattern. The lying leg lift testing procedure: Lie down in a supine position, lift one leg as high as you can and bring it back down. When I raised my left leg, a twist occurred in my right hip and my right quadracep externally rotated slightly. When I raised my right leg, I was able to lift it without any compensation on the left. I have been struggling with plantar fasciitis on my left foot.

The question is why? Why the left and not the right and left? I am compensating and I may have some referred pain. This referred pain may be coming from a trigger point in my soleus muscle.

Why is Pain Referred?

With certain muscles, the reality of referred pain can often be demonstrated by simply pressing on a trigger point that is bad enough to reproduce part of its referred pain pattern. It’s a little harder to explain why pain is referred at all.

Research on pain referral is difficult because the mechanisms of the human nervous system are so unimaginably small. The tiny electrochemical impulses in the nerves can be detected and measured to some extent, but not with accuracy or great discrimination.
In addition, there are ethical limits on how far you can go in pain experiments, whether with animals or humans. Nevertheless, scientists have made a number of suppositions about how pain can be displaced from its cause.

The easiest theory to accept regarding referred pain is that the signals simply get mixed in your neurological wiring. Sensory inputs from several sources are known to converge into single neurons (nerve cells) at the spinal level, where they are integrated and modified before being transmitted to the brain.

Under these circumstances, it may be possible for one electrical signal to influence another, resulting in mistaken impressions about where the signals are coming from.

The Functional Advantage of Referred Pain

On the surface, this looks like bad design, but the displacement of pain seems too consistent to be accidental. Referred pain occurs in very predictable patterns in everyone, with only small variations. This predictability implies that there may be some functional advantage to the referral of pain.

It’s notable that referred pain occurs very often in or near a joint, where pain is more likely to make you modify the activities or conditions that have created the problem.

Trigger point self-massage can help. Many massage therapists are familiar with the “trigger point” technique. Whether you are massaging yourself or getting a professional massage, using trigger points to release taut muscles can bring relief.

Sources:
Claire Davies
Lee Burton, PhD, ATC, CSCS

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8 Comments: :

Trigger Points And Plantar Fasciitis

January 14th, 2009 11:27 am

mickieblueeyes says:

Thank you for sharing that. Oh my gosh I have been suffering with plantar faciitis in my left foot for about two months. I wonder…my right hip flexor was really sore after a 1/2 that I ran in Oct. I took one full week off and tried to start running again but I was still week. Shortly after that my foot started bothering me, and between the foot and the hip I pretty much gave up until last week. They are both better somewhat, but my hip hurts in a wierd way now. It’s kind of on the top outside and it almost feels like a bruise. My foot does better when I stretch lots. Any more advise you might have on this would be greatly appreciated.

January 14th, 2009 11:47 am

mickieblueeyes says:

P.S. how do we fix this?

January 14th, 2009 4:13 pm

lisasabin says:

It’s possible that you are avoiding pain on the left side. Your right hip flexor may be working overtime or you may not be able to get optimal range of motion in either the hip or ankle joint on your left side. A sports doctor can help access the situation.

You might try stretching the right hip flexor, icing it to reduce inflammation and work on closed chain exercises on your left side. Try doing a one leg squat with your left side. Try the right side. Are they the same? If you aren’t recruiting core muscles or have limited range of motion of the joint, that could exacerbate the problem. Again, if the problem persists I recommend seeing a physician.

January 14th, 2009 10:50 pm

databasediva says:

I’ve been battling plantar fasciitis and peroneal tendinitis in my right foot for over a year. During that time I’ve seen 2 podiatrists and a sports medicine doctor. I’ve tried to engage all of them in conversation about possible referred pain from problems from my hip and hamstring, but they will not look beyond the foot and ankle. I’m not getting better. I completely agree with what you are saying, but like mickieblueeyes, I’m wondering how to fix it.

January 15th, 2009 12:36 pm

spin0 says:

Thanks for the tips, Lisa. I did the lying leg lift as you described, and was shocked to find my left leg doesn’t lift as much as right. I knew from the standing position that my left leg didn’t go backwards as much as right. So, if my left is so tight and my right leg swings more both front and back, I can see an imbalance here. I’ve been having a bad right ankle ache for the past 2 months. Perhaps it’s related to the tight left hip flexor? Also, I have plantar fasciitis for over 2 years on both feet, especially the left is worse. If my left leg doesn’t swing as much as right, I wonder if it stays on the ground longer and getting more impact? I’m going to work on flexing my left hip flexor and find out.

January 16th, 2009 7:59 am

mickieblueeyes says:

I just watched this video on taping for plantar fasciitis. It was on the Runner’s World web site. It was new to me so here’s the link for anyone else who wants to see it.

http://link.brightcove.com/services/link/bcpid5988543001/bctid6546407001

January 22nd, 2009 9:52 am

lisa sabin says:

It’s been my experience that foot specialists like podiatrists don’t look at the body holistically. They are experts with feet. When you aren’t able to complete a movement pattern without compensation, it’s usually due to a muscle imbalance which may be prohibiting joints from working optimally. Physical therapists are really your best bet for addressing the problem. They look at the body as a system rather than breaking it down and saying this is just a foot problem.

June 20th, 2010 8:55 am

Greg says:

I had a brutal case of plantar fasciitis for 5 years.
I tried everything, shoes, orthotics, stretching, etc.

I finally found (ART) Active Release Technique it was so simple and the relief was immediate. All it involves is deep tissue massage of your calf and Achilles tendon while simultaneously flexing your foot.

I also learned that the same technique can be employed to correct many cases of sciatica, tennis elbow, corpal tunnel syndrome, et al.

People are being fleeced by doctors that treat every thing but the cause. I wonder how many folks get unnecessary surgeries and 600.00 orthotics?

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