- ♪ Bob and Brad, the two most famous physical therapists ♪
♪ On the internet ♪
- Hi, folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And we are the most famous
physical therapists on the internet.
- In our opinion, of course, Bob.
- Do you agree?
- Yes, I do.
- Okay, very good.
Today, we're gonna talk about plantar fascitis.
Why you must do this thing before you get out of bed.
Now, this thing is actually a series of things.
- Oh, so it's a, yeah.
- So it works that way.
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I don't know whether I said that or not, Bob.
I'm all mixed up now.
- Yeah, we're all--.
All right, so fascia, plantar fascitis.
What you have on the bottom of your foot
is a tough, flat, fibrous piece of material.
- Tissue, Bob, tissue.
- Tissue that actually helps form the arch,
and gives you some support.
This is a very rough version of it.
This is not how it looks.
- [Brad] No, but it's easy to see this way,
and it really gives the concept well, I think.
- [Bob] Right, so what happens in plantar fascitis,
you actually generally get some microtears,
and a common spot for that to happen
is right on the inside of the heel.
- [Brad] Yeah, oftentimes, close to that
calcaneus bone.
- [Bob] Close to the heel itself, yeah, right,
and that's because that's where the most stress is
when you're walking in on the arch.
So it starts to heal, and then overnight, it begins to heal,
and then the first thing that happens is,
you get up in the morning and what happens?
It was half healing, so you break it open again.
- [Brad] Well, because when you're asleep,
you're typically plantar flex, so this actually tightens up
a little bit, so the whole, all the tissue's kind of tight,
and then when you get up and stand on it,
and it stretches that out, and you can see right there,
when it stretches it, all the healing gets tore apart again.
- Yeah, so this is the hallmark of plantar fascitis.
Itis means, of course, it's inflamed.
You get up, you can take a few steps,
and you don't feel any pain, and all of a sudden,
ow, ow, ow, ow, ow, and generally, as the day goes on,
it feels a little bit better
because you've stretched it out now.
If it gets worse as the day goes on,
it's probably something else.
It's probably more a bursitis,
or there's a heel pad syndrome,
or there's a couple other things it could be.
So that's the hallmark sign.
You're gonna get up.
It doesn't hurt when you wake up in bed.
You take a few steps, and it breaks open again.
That is why you need to do these things
before you get out of bed, and even if you get up
in the middle of the night, you need to,
you will need to put some shoes on.
We'll talk about that.
- Okay, you bet.
- So the first thing we're gonna do is,
you're actually gonna stretch that fascia.
Now, the fascia goes up into the toes,
so you're actually gonna grab onto the toes, and pull on it,
and stretch the ankle, and the foot, and the toes,
all at the same time.
- [Brad] So that tissue, right now, is being stretched.
- [Bob] Yeah, so I'll show it on me, a real, live subject.
So you wake up in the morning.
This is usually how I sleep in the morning, Brad,
at night, because I don't want to get dressed
in the morning, so I'm all ready.
- [Brad] Well, that's very efficient.
- Yeah, I thought so.
- [Brad] We could have a video on that.
- So go ahead, you can just sit up on the edge of the bed.
Grab the end of your foot.
Grab the toes, and pull it this way.
Pull the toes towards the shin,
and I'm actually getting a stretch on the fascia
and even a little bit on the gastrocsoleus, too
here a little bit, so.
- [Brad] Right, right, which is all part
of the same unit, basically.
- [Bob] So stretch for about 15 seconds,
and you can repeat that five times, okay?
- [Brad] What if you don't have that many patients?
- [Bob] You don't have that much patience, you mean?
- [Brad] I'd have a hard time going 15 seconds, five times
if I've gotta go potty.
- [Bob] All right.
Ten seconds, Brad, ten seconds.
- [Brad] Well, you know, I've gotta be realistic sometimes.
- [Bob] All right, Brad's gonna show you the next thing
that you wanna do.
Now, I'm not saying that this is,
if you wake up in the middle of the night,
I don't think you're gonna be able to do all this stuff.
You're gonna probably have to just throw your shoes on
and hope for the best, so but in the morning,
I hope you can hold off.
- Okay, just saying.
- Okay, Brad's gonna show the massage, then.
- Oh, yeah.
So the fibers go this way on the plantar fascia,
so we typically like to go across the direction
of the fiber, and you can do it one thumb,
you can work both, and you can get in pretty deep,
and typically, right there is where the tender spot is.
If it's tender, you can work on that tender spot,
but if it just feels like it's irritating it,
work around it, and work the best you can around it.
If, however, if you work on it and it starts to feel better
after about 20, 30 seconds, then you can work on it longer
and you know, get that scar tissue to break up
so that it can reform in a stronger manner.
- [Bob] Can you show a splain massage, too?
- [Brad] And then there's a splain, thumbs together
right in the center, and then you pull apart,
and my fingers on the back of my foot
are the top of the forefoot, the dorsum, and I pull,
and splay, and stretch it out, and I like to start
up at the forefoot and work towards the heel
and splay that out, and your fingers get tired and sore.
When they're tired, then you're done.
It's a few minutes.
- [Bob] Some people use their knuckles, too.
I'm not sure how they really do that,
and some people use, oh, you've got them all there,
don't you, Brad?
- [Brad] Oh, yeah, I've got a variety.
- Yup some people use a golf ball.
Some people use a tennis ball.
I think the massage works better, personally.
I mean, you can really zero in on the right spots,
but, you know, if you don't want to touch your feet,
I mean, you can do ahead and use this instead.
- [Brad] Well, this is a little easier.
If you have a hard time getting up to your feet.
- [Bob] Right, right, that's a good point, too.
- [Brad] And I have someone that's using a golf ball
right now, and I gave them a ball similar to this
that's rough, and--
- [Bob] It lights up like that?
- [Brad] Well, no.
It's actually made for it.
This is actually something I got that,
it actually does feel pretty good
when you have those little spikes on there.
It stimulates it and can work it better.
Golf ball.
Here's the lacrosse ball.
- [Bob] So lots of balls there.
- [Brad] Yeah.
All right, next one.
You can keep a sheet, or a towel, or a belt
near the bed, and you're gonna just stretch the calf muscle
and the hamstring at the same time.
You can do this in a number of ways.
You know, one, you could just be laying down like this,
and hook it on the forefoot here,
and you're gonna stretch the calf and the hamstring
at the same time, and there's biomechanical reasons
why we're having you do this,
but it's just gonna make your gait pattern better,
your walking pattern better,
and you're gonna be less likely to cause stress
to the fascia.
So the last one, Brad, is actually doing,
it's just a good ankle warmup, and I put these in order.
If you're in a great hurry, at least do number one for sure.
- Sure.
If you have time, do, you know, one and two.
If you have real, a lot of time, plenty of time,
do all four of these,
and the last one is just doing the alphabet with the ankle.
- Okay.
- So, and Brad, you always say, like, take a piece of chalk
on the greater toe.
- Well, imagine it.
Imagine there's a piece of chalk there,
and there's a chalkboard,
and you're gonna make the capital letter.
- [Bob] The capital letters, and you go all the way through
the alphabet, and it really warms up the ankle.
- [Brad] Yup.
- [Bob] And gets a lot of mobility in it.
So, again, it'll put a little less stress on the fascia,
as you're using it.
The final thing, and this is just as important,
and this is the one that you don't want to miss
no matter what.
You're gonna have some comfortable running shoes,
or comfortable tennis shoes with a good arch support
near the bed, and you're gonna slip these on.
You don't walk anywhere barefoot.
Nowhere, at any time, no how, no why.
- Could you use a pair or slip-on shoes
that have good support?
- If they have good support.
A lot of them don't, you know?
- Yeah.
- A lot of them really do not.
So you want to make sure
you're gonna start off the day right,
so you wanna make sure that fascia is being supported
and it can heal, so in one of the future videos,
we'll show how you can actually just do a piece of tape
in the arch to keep it out of trouble.
- Sure.
- But right now, use the shoe.
A good support shoe.
- Right, yup.
Keep them by the bed stand.
- Brad, do we have anything else to say?
- No, I'm afraid not, Bob.
I think we're clear.
- All right, well, Brad and I can fix just about anything.
- Except for--
- A broken heart, but we're working on it.
- Yeah.
- Mike, have you broken any hearts lately?
- Oh, he's a heartbreaker.
- Yeah, he's a heartbreaker.
Yeah, he says, "No."
All right, thanks for watching.