Physical Therapy

http://www.bayareapt.com/

By the beginning of August of 2017, I'd tried treating my PF pain with cortisone shots, custom orthotic inserts, and night splints. As you already know from reading my other posts, none of these things worked for me. Unhappy with the lack of progress, I decided to see a new podiatrist by the name of Dr. Nazia Shah, who was, at the time, working with Riverview Foot and Ankle Associates in Red Bank, New Jersey. From the very beginning, I had a positive experience with Dr. Shah. She was in disbelief that I'd been in pain as long as I had been and hadn't yet been told to try physical therapy (PT), so she gave me a prescription for PT right away.

It was up to me to shop around for a PT facility. I took recommendations via word of mouth, and when I confirmed what would be covered by my health insurance, I wound up making an appointment at SportsCare Physical Therapy in Red Bank, New Jersey. The facility was very clean and the staff was extremely friendly and helpful. They also had flexible hours, which was important to me considering that I work until 6:00 PM and couldn't make it in most nights until 7:00 PM. 

My therapist, Carl, started by asking me questions about my level of pain, which foot was worse, when I felt the most pain (as in morning, midday, or nighttime), and which activities were hardest for me to do. My level of pain, as it was then and is now, can be anywhere between 5 and 8 (or more, on bad days) on scale of 1 to 10. My right foot has always been worse than my left. The pain lasts from when I wake up to when I go to sleep, but is worse when I stand up after sitting for a long time, and at the end of the day. Walking, without a doubt, is the hardest thing for me. Hearing all this, he knew, as I did, that we had our work cut out for us.

I wound up having 9 sessions with Carl, starting on August 18 and ending September 18. A session ran anywhere from 40 minutes to an hour. We usually started out by wrapping a hot towel around my right calf. That was my favorite part of the night. Why my calf and not my foot? As Carl explained it, some people, like me, experience PF pain because their calf muscle is super tight. Having a tight calf will pull on your Achilles' tendon and put stress on the plantar fascia. 

http://www.footmedictechnology.com/stretching-and-plantar-fasciitis.php

After the hot towel, I did 8-10 minutes on the exercise bike to stretch my calf a bit. Depending on my level of pain that day, I sometimes did short walks on the treadmill. Other exercises I did, usually in sets of 20, included leg presses, bridges, squats, and calf raises. 

Resistance bands are super helpful when you're in PT for PF pain, and we used them a couple of different ways. First, Carl's assistant would have me sit on a table, my legs lying flat in front of me, and tie a resistance band around my foot. While he pulled on the band, I pulled my foot back toward me, creating resistance. I sometimes did it by myself, like this:

https://guidedoc.com/best-types-physical-therapy-equipment-tools

Second, we did this same exercise from the side, where he'd pull to the left and I'd pull to the right, and vice versa. Third, he would have me lie flat on the table, put a band around my thighs, and have me open and close my legs while keeping my ankles together. (There's a name for this exercise that I can't remember.) 

After using the bands, Carl had me do runner stretches, which look like this: 

https://www.runnersworld.co.uk/health/injury/7-mistakes-every-runner-makes-when-stretching

After my exercises came the painful stuff, starting with Carl massaging my calves. A massage doesn't sound bad, right? But this is a massage from a physical therapist, not a massage therapist. It involves thumbs digging deeply and painfully into your already sore muscles, and it isn't pleasant. He attempted to massage my feet once, until I had to tell him that 1) I'm extremely ticklish (you should see me getting a pedicure), and 2) I couldn't stand to have pain on top of pain. Luckily, he didn't try that again. The worst part of the night, by far, was when he would have me lay on my stomach and use this tool that looked like a butter knife on the back of my calf. I cannot and will not lie to you - this was extremely painful. The first time I saw that thing I was intimidated, as it literally looks like a knife - but I assure you that it is in no way sharp. In fact, it isn't the tool itself that hurts, it's the way it's used that is. You can see a video of how this technique, called the Graston technique, works here: 

(If that video doesn't show up, here's the link: https://www.youtube.com/watch?v=9hn8jPv2ofM)

Conclusion? PT was my least favorite form of treatment for my PF pain. It was expensive and, like everything else I'd tried so far, it didn't work for me. However, like I've said in all of my other posts, don't not try it just because it didn't work for me. PT can be an amazing thing for relieving PF pain, and I know of many people who have had success with it. Mention it to your doctor, if you haven't already. If he or she is okay with it, I say give it a try. If you do, here are some pieces of advice and things to remember:

1. Do your research. PT is an investment of your time and money. Unless your doctor recommends or sends you to a certain facility, do your research. Prices vary, so shop around. Don't be afraid to ask your physical therapist about his or her experience and/or education. (I did.) You want to make sure that the person you'll be working with is highly qualified. Question the exercises he or she has you do, and why and how they will be helpful.
2. Don't be afraid to speak up. You know your body and level of pain more than anyone else. If whatever you're doing in PT is too painful, speak up. If you don't, your physical therapist won't know how you're feeling, and you'll put yourself at risk of serious injury. The techniques Carl used on me caused numbness in my second and third toes on my right foot, so I had to tell him to ease up. (This numbness, according to Dr. Shah, was a normal side effect of this type of PT, and went away within a few weeks.)
3. Know that it will be painful.  If you haven't gotten the point by now, yup - PT is painful. Total honesty here. You'll be moving your muscles in ways that you aren't used to, and leaving most of your appointments feeling pretty worn out. PT is hard work, but if it's done right and safely, it can be very beneficial to you.
4. Do PT outside of PT. The exercises and stretches that Carl taught me were simple enough that I was able to do them on my own at home or at the gym. Don't just save your PT for your appointment - do it at home, too.
5. Ice is your friend. Your physical therapist will probably tell you to ice your leg and/or foot after your session. For me, ice was a must after my appointments. Unless your doctor or physical therapist tells you otherwise, don't forego icing.  
6. PT takes time. Don't expect your pain to be eliminated or lessened after one session, or even two or three. In fact, you'll feel more pain before you feel less pain - and that's okay. That's how it works for a lot of people. You'll need to go multiple times, depending on the severity of your pain, to really notice a difference. Be patient and keep at it.   

In my next post, I will discuss my experience wearing a walking boot to relieve my PF pain.

As always, I can be reached on my Facebook page, https://www.facebook.com/plantarwhat/ or via email (wsmalls12194@gmail.com) to answer any questions.

Thanks for reading,

Becky