In Part 1 of this blog series, Physiotherapist Michael Rizk of iMove Physiotherapy, Sydney talked us through 2 of the most common injuries seen in runners – Plantar Fasciitis and Achilles Tendonitis – and how a multi-modal treatment approach works for their clients. Here in Part 2, Mic outlines Phase 2 and 3 of their treatment process.
It is not uncommon that we will apply all of the previous points in the first 2 weeks. This has most of our patients feeling 50-75% better during that time. You need to be diligent in setting up your rolling, your exercises and having a footwear strategy. You have no choice though – do it, or have issues for 6-12 months. Get on top of it. Attack it from all angles. At this point in time your symptoms should be down to about 2-4/10 and you’re finding your exercising is leaving you with less symptoms. We now enter Phase II, which is all about finding the right load and staying in a decent symptom range. Not symptom free but a decent symptom range.
The 10% rule with pain scores
So you’ve been hovering at around 50% of what you normally do, your symptoms are settling, although still there. This is where big mistake number 2 occurs. You increase your load too soon. We pulled you back to 3km runs and you went out and did ran 5km. We pulled you back to non-impact gym sessions and you went out and did skipping or box jumps.
In Phase II you should only increase your weekly load by 10%; any more and you will enter the downward symptom spiral of Plantar Fasciitis and Achilles Tendonitis.
To help you with this, use your pain/symptoms scores. You should only be at a 2-3/10 both when performing the activity, after the activity and the next morning. If either of those has elevated to a 5-6/10, then whatever you did the day before is too much. You need to review what you did, and do even less for the next 1-2 weeks. That is your new base. If you find the right base, you win. If you keep pushing, you lose.
Physio exercises are load
Yes, our exercises can make you worse. This is all part of it. This is normal. We need to find a base that can get the muscles stronger AND keep you exercising. Sometimes we don’t give you enough. Sometimes we give you too much. Stick with the process and keep up constant communication. Contactus if you have questions. Let us know as it’s happening. Adjusting on the fly is better than letting it go a week and giving up on the exercises.
Keep in mind the only evidenced based treatment to get both plantar fascia and Achilles Tendonitis issues better is graded exercises. However, when we introduce these you are actually adding more load, albeit controlled load. This may mean that the 3km run you were doing at a 2-3/10 now has you feeling slightly worse. This is OK. We adjust. This is often where patients will discharge because something we did together made symptoms worse. It is important to understand we will overload you on the journey and we will underload you on the journey but your overall trajectory is up!
Now we’re getting somewhere!
After the initial bumps in Phase II you will start getting into a rhythm of doing your physio exercises and increasing your activity by 10% per week. You may still have a 1-3/10 pain score but you are now able to walk in the morning and complete exercise sessions. This phase can last anywhere between 2-12 weeks. The good news is you can see the light at the end of the tunnel. You’re increasing your activity and you feel you’re finally getting somewhere.
Big Mistake 3 – Returning to your normal load, pain free, and stopping your exercises. “WHAT!!??, I’ve got no pain, I’m back doing what I need to be doing, but I’m not done yet?” – not even close. If you want to keep this away and progress your activity you need to get better than pre-injury status. This is our goal for everyone that comes through iMove Physio. “Better than pre-injury status”. It was your pre-injury status that got you injured, right? So we need to be stronger than that.
Strengthen to keep it away
You need to progress your exercises over the next 3-6 months. You should be doing single leg calf raises and single leg soleus raises with 10-15-20% of your body weight in a backpack. This is loading you beyond body weight, getting you stronger, allowing for spikes in load, allowing for fatigue and most of all helping you to prevent injury. We see too many people discharge themselves and they are only doing basic calf raises, pain free, but they go back to their normal loading pattern. This is a recipe for recurrence of injury.
If you are having persistent plantar fascia pain, Plantar Fasciitis and Achilles Tendonitis/Tendinopathy then get in touch with iMove Physiotherapy, based in 3 Sydney locations.
Original article by – iMove Physiotherapy