Study Shows Benefit of Eccentric Strengthening Exercise for Plantar Fasciitis Treatment
By Larry Huppin, DPM
A 2014 study by Ratcliff demonstrated that doing high load strength training has potential to improve plantar fasciitis symptoms faster than stretching. This is so far the only study on high load training for plantar fasciitis but it is certainly worth considering as another treatment option. High-load training is, however, a standard treatment for conditions such as Achilles tendonitis.
There is some question as to why this treatment is effective for treating plantar fasciitis. The most accepted hypothesis is that the high load exercise acts to break down the tissue a bit leading to a new healing cycle and an increase in production of collagen (the plantar fascia is made up of collagen fibers). For detailed information on all of the most effective treatments for plantar fasciitis visit our Heel Pain / Plantar Fascitiis Treatment Guide.
We have been using high-load strength training as an effective treatment as long as it is used in combination with other treatments for plantar fasciitis. It should not be used as a standalone treatment. For example, these exercises should be used in combination with treatments designed to reduce tension on the plantar fascia such as plantar fasciitis specific orthotics.
High load strengthening should only be used under the direction of a medical professional and should not be used for self-treatment as this type of strengthening can slow healing time in some situations. We do have information on recommended self-treatment suggestions for plantar fasciitis here.
If you are in the Seattle area contact us for an appointment for the best treatment.
Where Does High Load Training Fit Into Plantar Fasciitis Treatment
When treating plantar fasciitis I follow this protocol:
- First, reduce load on the plantar fascia. This can be done through the following techniques:
- The use of shoes and foot orthotics that reduce tension on the plantar fascia
- Modification of activities to reduce pressure on the heel and tension in the plantar fascia
- Stretching of the plantar fascia and Achilles tendon
- Second, if reduction of force does not lead to rapid pain relief then we institute treatments that facilitate healing. Depending on the patient this might include:
- Shockwave therapy
- Third, move on to using high load therapy to progressively increase the ability of the plantar fascia to handle greater loads.
- Perform one-legged heel raises on a stair with a towel inserted under the toes to elevate the toes (Figure 1). The towel should be thick enough that your toes are bent up as far as they will go at the top of the heel raise. Rather than a towel you can also use the Fasciitis Fighter device shown below.
- Perform the exercises every other day for three months.
- Every heel-rise consists of a three second concentric phase (going up) and a three second eccentric phase (coming down) with a 2 second isometric phase (pause at the top of the exercise).
- Start at twelve repetition maximum for three sets.
- After two weeks, increased the load by using a backpack with books in it and reduce the number of repetitions to 10 and at the same time increase the number of sets to four.
- After four weeks, perform eight reps and perform five sets. Keep adding books to the backpack as you become stronger.
To maximize the benefit of this exercise it is important that the toes by bent up to the end of their range of motion.
The exercise is often done with a rolled-up towel to position the toes. The toes are more effectively put in the proper position, however, using something more firm than a towel.
A number of our patients have found that this exercise is much easier and more effective to perform using the device shown here. We have found that the Fasciitis Fighter (figure 2) is the appropriate density and size to place the toes in the correct position.
This is the device we recommend to our patients and this is also an affiliate link so we may receive a small commission at no additional cost to you if you order from the link.
Video: How to Perform High Load Strengthening of the Plantar Fascia
We don’t have our patients start progressive high load training until the initial symptoms have resolved.
See Us in Seattle if You Have Heel Pain
Don’t live with heel or arch pain for another day. The experts at the Foot and Ankle Center of Seattle specialize in the treatment of plantar fasciitis and other forms of heel pain. Contact us today for an appointment and be sure to check out other home treatment options for heel pain here.
Reference for High Load Training:
Rathleff MS, Mølgaard CM, Fredberg U, et al. “High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up“. Scand J Med Sci Sport 2014
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