Reader Renee says:
"Doug, I'm a proud Sports Center grad now living in
Boston (too far away for in-person visit!) and struggling with new
flare-up of plantar fasciitis (left foot this time; rehabbed right foot
with Christine couple of years ago). As soon as I think it's OK and
ramp up a bit on exercise, it re-injures. How can I break this cycle?
How can anyone know when they are pushing too hard *before* the injury,
especially with an injury like this?"
Great question and one that many people face.
I'm going to assume that you really do have plantarfasciosis and not something else that feels like it (such as a stress fracture, or a referred pain from the spine or inflammation of a bone). So, here are the essentials of understanding the injury mechanism in plantarfasciosis and similar conditions (e.g. tennis or golfer's elbow, rotator cuff tendonosis).
There are two basic scenarios that precede symptoms: an acute injury (trauma of some type) or progressive overload with inadequate recovery.
In the first scenario, you know you hurt your self. You know exactly what you were doing and when and how it happened. It's very clear. While jogging down the street, you had to dodge a puddle of water and stepped in a sharp edged rock, for example. Or, perhaps you were exercising and during the activity, you noticed that your foot hurt. From that point on, if the injury is inadequately managed, it can turn into scenario #2.
Scenario #2, progressive overload with inadequate recovery, happens a lot. It happens in two ways. One, you're aware that you're increasing the demands on your foot, in your case it was some type of exercise routine, or the other is that you think you've not done much different in your life but actually have.
Progressive overload with inadequate recovery is frustrating because you feel just fine, in some cases, for quite a while. You think all is well and decide to up the ante in your exercise routine only to discover many weeks later, that your foot hurts.
Exercise is controlled trauma and the benefit of that trauma takes place during the rest period. In progressive overload with inadequate recovery, there is usually not enough time between sessions or if you are allowing at least a day between sessions then your lifestyle, the things you do each day, may be interfering with the recovery process. But, you need to know what your rest and recovery cycle looks like and not just assume it's one day or two days. Some people need 3 or 4 days between sessions while others can tolerate one.
I know that often it really does feel as if the Pain Fairy dropped in
one night and sprinkled some Pain and Suffering Dust on your foot. In
the morning, bam, your foot hurts. It's natural to wonder, "What's
this? I didn't do anything unusual yesterday...How did this happen?"
The answers are almost always in the numbers and what I mean is the concrete measurements of what you're doing.
People often think I'm a numbers guy because it's one of the first things I ask or look into. When a student wonders if a client is progressing fast enough, I ask questions about things such as load tolerance, motion, load ranges, speeds, frequency. I find no joy in the numbers themselves. I use numbers to help me better understand the person.
So, in your situation, the things I would ask are these (and these are things you can ask your self and answer and then discover the areas that could be a source of trouble):
- Did you injure your self? Can you easily describe exactly what you did that created the symptoms? If the answer is no, then most likely you're in Scenario #2 (progressive overload).
- So, now questions to get to the root of things in Scenario #2. First, your exercise routine.
- What is your Load Tolerance for:
- Single Leg Squat?
- Single Leg Heel Raise (rising up on your toes)?
- What specific drills do you perform? What is the intensity of the drills?
- How much load? How many repetitions? How many days per week?
- What flexibility drills do you include?
- How long is your "thread" and how many "strings" do you have in the thread?
- Strings are the number of weeks in a training cycle and a training cycle is one thread.
- How long of a recovery cycle do you use?
- How long have you been doing the routine?
- What did you add that was different or new? What was the relative increase in either load or time or frequency or of all of those things compared to what you were doing?
- Now, questions about daily life:
- How many steps per day is a usual day for you?
- How many steps per day have you averaged for the prior three months and the three months before that?
- Have you changed your shoes? If so, to what type?
- Have you added any new amounts of standing to your day? Has the surface of the flooring changed?
- Have you changed your diet (for example, moved to a vegan diet)?
- How much protein do you ingest on average per day? Water? Omega III Fatty Acids?
A simple answer that you'll see if you search the Internet on this general subject of program progression is to not exceed 10% per week. From everything I've read, that number is entirely empiric. There's no hard evidence that it is better or worse than 5% or 20%. But, having some guideline is better than no guideline.
There are usually three things that people do wrong in the situation of progressive overload with inadequate recovery. One, they don't keep any data on what they do. They go to the gym, do a workout, don't write anything down, make a few tweaks here or there on the fly, one week turns into twenty and before long, something goes wrong and they wonder what happened. They can never know because they have no history of what happened. Some would call this chaotic but chaos is controlled disorder. I would just call it winging it. Training forces your body to adapt. If you don't keep track of what you've done, it makes it difficult to make judgments about what to do next and how hard to work. This is why people decide to start jogging, for example, when they haven't jogged in years
Or, two, they don't know their physical capacity. I know it seems unusual to know things like a Single Leg Squat Load Tolerance but to me it's just as important as knowing your blood pressure or heart rate. It's a vital sign for training. Just about everything that's done using the lower body or trunk pivots on that single datum. I think everyone should know how to perform this test on themselves and do it once a quarter. You'll see this number drop often before you develop symptoms. It's a key piece of information.
Finally, the third mistake is to not recognize the impact that their diet has on their tissue integrity and health. If you increase your training routine and fail to increase protein in your diet, your tissues have a harder time recovering from the trauma of the exercise. Do this over several months and you set your self up for problems.
A long response, perhaps, but the answer is not a simple one ( and there are some things that must be examined as well such as posture and movement patterns). It has several moving parts and I think that is what makes it difficult for most people to manage. But, the truth is, taking care of your body is probably one of the most important things to learn. It is the most important asset you have.
I hope this helps.
DK
