If you’re suffering from piriformis issues, ranging from simple weakness to pain, then you’re in the right place.
Piriformis strengthening is crucial if you want strong and stable hips. In this article, I’ll cover how to start from very simple to more advanced, and also address how to approach exercising if you’re dealing with a painful piriformis.
Note: If you’re dealing with piriformis issues and need a specific step-by-step protocol, be sure to check out my Piriformis Protocol program.
Piriformis Muscle Location And Movement
The piriformis muscle is one of 6 muscles called the “Deep Six” that are found on the back of the hip. Together these muscles externally rotate the leg.
It attaches at the sacrum bone and inserts into the greater trochanter.
It’s also important to note the sciatic nerve is located just under the piriformis muscle (and in some individuals the nerve travels through it.
How To Strengthen The Piriformis
Since the piriformis primarily is an external rotator of the leg, the main exercises for this muscle involve external rotation. It also functions as a stabilizer for the hip, so it can be trained with single leg balance exercises as well.
While it is not discussed often, the piriformis, due to its location, acts as a medial/internal rotator of the hip when the hip is position at greater than approx 60 degrees of hip flexion.
Since this dual function is fairly confusing, I’ll tackle how to strengthen the internal rotation function in a separate post.
This muscle works with other paired muscles in this movement, so you will not be able to directly isolate it.
Critical Notes If You’re Dealing With Piriformis Syndrome
Stretches and exercises for piriformis syndrome can be a bit of a mine field. The nature of the condition is one of varying levels of nerve sensitivity and tolerance to movement and exercise.
While its common for many people to self-diagnose via “Dr. Google” these days, it is important to have a proper screening and diagnosis before doing any self therapy.
In particular, piriformis syndrome and sciatica, although two completely different conditions, often are used to explain the same symptoms.
Sciatica involves irritation of the sciatic nerve, most commonly originating at the lower spine. When buttocks region pain is due to sciatic nerve compression, it should be treated at the spine level to begin with.
Piriformis strengthening isn’t likely to have much if any positive impact.
Piriformis pain is more complex. The condition called piriformis syndrome is not clearly defined. Like many other issues with the “syndrome” label, its a collection of symptoms, although no specific cause can be identified.
Its common for a muscle to become weakened as a result of pain, due to inhibition, so strengthening exercises are often assigned to “fix the weakness”.
This is a chicken egg scenario. Did the pain cause the weakness, or the weakness cause the pain?
Regardless, it has been my experience in working with many challenging piriformis syndrome cases in my career that many have responded poorly, not at all, or made worse with aggressive piriformis strengthening programs.
Thus I’ve developed a very cautious approach to assigning exercises for this type of situation.
Exercises Virtually Guaranteed To Aggravate Piriformis Syndrome
This may come as a surprise, but I commonly help people improve from piriformis syndrome without doing any direct external rotation isolation exercises.
I find they tend to create flare ups very quickly that sometimes can take days to recover from. This is frustrating and defeating to many people dealing with this problem, especially when they have been told by many well-intentioned therapists to just “work through it”.
I disagree with this approach. I find the following exercises, particularly when initially beginning an exercise program, to be very triggering:
Sidelying Clamshells
Banded Hip Abductions
Tubing Walks
Machine Hip Abductions
As you can see, these are the MOST commonly advised exercises for piriformis syndrome!
Now to be clear, I’m not saying these exercises will not help anyone. What I am saying is that they tend to be too aggressive for more challenging cases of piriformis syndrome.
Non-Aggravating Exercises For Piriformis Syndrome
Piriformis syndrome exercises should be done with primarily the intention of allowing for NON-threatening movement. The outcome is pain relief, not muscle strengthening or endurance training.
Its simply to be able to perform movement with excessive stimulation or fatigue that may result in a flare up of more pain.
My go-to movements are ones that are extremely low loading on the muscle, can be performed for approximately 2 minutes at a controlled pace, and generate virtually no direct muscle fatigue.
This allows for nerves to calm down after being exposed to movement that doesn’t provoke threat, and therefore reduces guarding and apprehension. Another way to think about it is to convince the nerves they are OK.
Prone Hip Extensions
Sidelying Hip Shifting
Supine Hip Shifts
Step Ups
Split Squats
Piriformis Strength vs. Endurance – Which Is Better?
As mentioned above, isolating the piriformis muscle is not possible. It works in a group of gluteal muscles that externally rotate the hip.
The larger glute muscles are far stronger and more powerful than the smaller, deeper external hip rotators, so traditional strength training exercises such as squats and lunges should be employed to address them.
The piriformis, like most muscles does need to get stronger, needs a good dosage of endurance training as well. This means moderate to higher repetitions (greater than 15).
This will serve as a nice foundation of low resistance training to encourage blood vessel and capillary development in the muscle to resist fatigue and prepare the tissues for more strenuous training later.
Piriformis Stretching
Is the Muscle Actually Tight OR Just Feels Tight?
This is often a very confusing topic, but it’s important to understand. Muscles and joints have “normal” ranges of motion. These are generally well established in orthopedic and physical therapy textbooks.
Testing for normal range of motion should be done to determine if there is indeed shortness in a particular muscle group. However, in my experience, most often the muscle/s FEEL tight or tense, but there is normal range of motion present in the muscle.
When this occurs, a better word to describe the muscle tension would be “facilitated” or over-active. Stretching can still be an effective means for reducing the tightness symptoms, but it changes our intentions when doing stretches and exercises.
I have found the piriformis muscles often have normal range of motion upon testing. The muscle can certainly “feel” tight especially when dealing with piriformis syndrome due to the pain and likely guarding of the muscle. Piriformis release techniques can be helpful as well to reduce over-activity in this muscle without stretching.
Getting The Perfect Piriformis Stretch
Stretching the piriformis isn’t too complicated. Since the muscle externally rotates the hip, we can accomplish a stretch by doing the opposite, which is internal hip rotation.
The additional variable to manipulate is how much flexion in the hip is used. There are 2 primary positions that work best for piriformis stretching; supine and seated.
The standard recommendation for stretching is 3 repetitions, holding for 30 seconds on each stretch.
I always advise against aggressive stretching, and the number of repetitions and/or holding times can certainly be reduced if the nerves are very sensitive to stretch. The key is to find a good tolerance point to start, then build up from there over time.
We have all experienced the occasional achy back. In fact, most people will experience back pain at some time in their lives. At first the discomfort is short lived and tends to go away on its own.
But over time, these episodes can become more frequent, lasting longer and longer. Friends, fitness specialists and health care professionals may recommend stretching to alleviate your back pain.
After a little research, you add a nice stretch routine. Unfortunately, you find that your lower back is worse after stretching. Well, you are not alone. If your back feels so tight, why does stretching make the back pain worse?
What is pain? (A useful re-frame!)
The experience of pain is our brain’s way of notifying us of an unpleasant and potentially damaging stimulus. Pain is our body’s way of reacting and protecting itself from tissue damage.
There are receptors in our muscles, joints, skin, bones, and tendons, called nociceptors. Nociceptors are sensory receptors that respond to mechanical force, chemical irritation and temperature.
Nociceptors will be stimulated by potentially harmful joint forces, tissue stretching or pinching, and chemical irritation such as inflammation.
When you experience back pain during stretching or soreness after stretching, the nociceptors were sufficiently stimulated to notify the brain about the potential of injury or damage to the body.
So what exactly is stimulating nociceptors in the low back pain with stretching?
First it is important to point out that pain is highly subjective and every body is different.
This is especially true for proper selection of exercises, including stretches. There are many potential causes of pain during stretching – inflammation from injured tissues, tight tissues being stretched further, or compression of joints or tissues to name a few.
Furthermore, your current physical and even mental status will affect your pain. Issues such as repetitive stress injuries, degenerative changes in the discs, joints, and soft tissues, acute injury, and autoimmune disorders can influence your experience of pain as well.
The good news is that stretching can be used to treat many of the underlying triggers of pain, but it is important to choose the right stretches for you. If you experience lower back pain with stretching, it is important to listen to your body.
Stretching needs to be tailored to each individual’s specific needs.
Lower back pain when you stretch or soreness after stretching is your body’s way of telling you that the tissues are being irritated or even damaged. To understand how to stretch without making your back pain worse, it is helpful to understand how your body works.
Specifically, the structure and function of the spine.
The spine is the body’s pillar of support, the foundation for all movement. Our spine holds us upright and provides a stable base for our arms and legs to move from.
For safe and effective movement, the vertebrae should have optimal stability and mobility. Proper positioning and motor control of the vertebrae helps to protect the joints and nerves from injury and maximize the effectiveness of the muscles that attach to them.
The spine is naturally curved, somewhat like an “S”. Correct posture is posture that preserves the shape of these curves – this is known as a “neutral spine” position.
These natural curves serve to distribute forces evenly across the vertebrae and discs, and decrease compression of the discs and the nerves as they exit the spinal cord.
Neutral spine is generally considered the least stressful position for the spine.
The low back is designed for stability. The joints of the lower spine are supported by many strong ligaments and muscles – they are not designed to move very much. The shoulder and hip joints by comparison are large ball and socket joints – joints designed to move a lot.
Without a stable low back, we would not be able to stay upright, and it would be difficult to use our arms and legs very efficiently or effectively.
Low back pain can be caused by persistent stimulation of nociceptors during suboptimal body positioning and mechanics during daily tasks such as sitting, lifting, pushing, carrying, and squatting, etc.
The joints and soft tissues of the spine work in coordination to control movement. Optimal body positioning and mechanics are a function of having sufficient mobility, stability and motor control.
Dysfunctional joint mobility and muscle balance can result in excessive movement at some levels of the spine and not enough movement at others.
Over time, this can lead to degenerative changes in the discs and joints, muscle imbalances, and irritation of the nerves and soft tissues.
The most common reasons for low back pain after stretching
Choosing the wrong stretches
Your tolerance and response to a chosen stretch is specific to you – your current health status and level of fitness. Not all stretches are appropriate for everyone.
Stretches that involve flexing or extending of the spine can increase low back pain by compressing or pinching the discs, joints, nerves and soft tissues that are already vulnerable or sensitive. Stretches should not be painful.
Choosing the correct stretch but using poor form
A good example of this is stretching the hamstrings by bending forward at the waist instead of the hips. Bending forward at the waist flexes the spine and increases the spinal compression.
In this case, the hamstring stretch may be an appropriate stretch, but when done with poor form, the stretching may make the lower back pain worse by compressing the spine at vulnerable points.
Overstretching
Stretching a muscle too far or too hard can stimulate the nociceptors, causing the muscle to tighten to protect itself. Pushing the muscle to lengthen past the signal of pain can result in irritation or tearing of the tissues.
Stretching should not cause low back pain or even discomfort. The goal is to lengthen the muscle and give the tissue time to relax into its new length. Stretching a muscle that is already within its normal range can lead to instability of the joint.
Avoid stretching into pain or past the muscle’s “normal” range.
Stretching an injured muscle or tendon
If you have an injured muscle or tendon, whether it was a traumatic event or result of overuse, stretching the soft tissue can cause more damage. It is not uncommon for an injured muscle to be pain-free until it is stretched.
Stretching without warming up
Muscles and tendons become more flexible when they are warm. Stretching a cold muscle can lead to irritation or even damage.
Underlying pathology
It is important to rule out undiagnosed underlying pathologies such as fractures, infections, autoimmune disorders, and disease processes. Indications for further medical consultation include:
History of trauma – i.e., a fall or impact
Family medical history – i.e., autoimmune disorders, osteoporosis
Other symptoms – even if seemingly unrelated, i.e.: fever, changes in bowel or bladder, weight loss or gain with no known reason, GI issues, numbness and tingling, new or extreme muscle weakness, unrelenting pain, night sweats.
Can you really loosen tight lower back muscles?
The feeling of tightness in the lower back can be temporarily relieved by using the appropriate stretches. Long term management of lower back pain requires identifying and correcting the cause of the muscle tightness.
There is some confusion about whether a muscle is actually tight or if it just feels tight. This is an important distinction to make. Every muscle has a “normal” range of movement.
Muscles lengths that fall short of the normal range are described as being tight – they are in a shortened position. Muscles can shorten if they are not used through their full range of motion.
For example, if you always wear shoes with heels the calf muscle is held in a shortened position. Over time the muscle will tighten up in that shortened position and prevent full ankle motion.
Muscles can also contract without changing length. For example, tightening up the abs. No movement takes place, but you can feel the increased tension in the muscle tissue.
This is an example of an active muscle but not a short muscle. Muscles that stay contracted, even when you try to relax them, are overactive or “facilitated”. Muscle overactivity is commonly a result of joint instability, the muscle is trying to stabilize the joint.
Muscle overactivity can interfere with normal joint mobility and even decrease blood flow to the tissues – both can cause pain.
Muscles do not just tighten up without cause. Muscles are naturally in a relaxed state unless they are working. When muscles contract they can produce movement, but they also act to protect the joints from too much movement, compression or impact.
Stretching the lower back, when done correctly, is a great way to get quick and easy pain relief. Loosening the muscles in the low back can reduce the compression on the spine and increase the blood flow to the muscles.
How to Determine If A Muscle Needs To Be Stretched
Overstretching a muscle can lead to joint instability. Each muscle has a normal range of motion. If the muscle is within it’s normal range, it does not need to be stretched unless the range of motion is needed for activities that require it (like certain sports).
Assessment of the muscle’s length involves understanding where the muscle originates and where it attaches. The position for assessing the muscle length, and for stretching the muscle, is just a matter of increasing the distance between where the muscle starts and where it ends.
For example, the hamstring originates on the back of the lower pelvis and attaches to the back of the lower leg just below the knee. To test the hamstring length, lie on the floor. Leave one leg stretched out flat on the floor to prevent the lower back from flexing and the pelvis from tilting posteriorly.
Bring the other thigh up so that it is perpendicular to the floor. Straighten the knee until you feel resistance from the hamstring. Make sure the thigh and lower back do not move.
If you are able to get the knee completely straight or nearly straight – about 20 degrees short of straight, then your hamstring is within normal limits.
Stretching To Get Relief From Low Back Pain
The majority of lower back pain is due to too much movement in the joints of the lumbar spine. In that respect, it seems counter-intuitive to stretch.
But the body works as whole – when the joints above and below the lower back are not moving enough, the lower back will move more. The increased movement in the lumbar spine causes the back muscles to contract to limit the movement.
Stretches to relieve low back pain focus on increasing the mobility in the hips, thoracic spine, and shoulders and decompressing the spine.
A great stretch that can relieve lower back pain fast by addressing all of these issues is Down Dog or Inverted V Position. This stretch decompresses the spine, while lengthening the muscles, fascia and other soft tissues that can limit shoulder, hip and thoracic spine mobility.
It also has the added bonus of strengthening the core, arms and legs.
The standard version of this stretch is done on the floor. The stretch can be modified using a chair or wall.
How To Strengthen Lower Back Muscles To Build Resilience
Experiencing low back pain after stretching is a good indication that you need to make some changes. For long term management of low back pain it is necessary to identify why the muscles are tight or overactive.
A successful therapeutic program addresses the cause the dysfunction – which is usually poor posture and body mechanics. Healthy posture and body mechanics requires normal joint and muscle range of motion, and sufficient strength and motor control of the trunk and limbs.
A treatment plan would include:
Identifying and correcting limitations in hip, shoulder and thoracic spine mobility.
Training the motor control and endurance of the core muscles so they can align and stabilize the spine during static and dynamic posture.
The beginning exercise can seem easy but it is critical to make sure that you are activating the correct muscles. Once you are familiar with finding your neutral spine position, these beginning exercises are a great way to start:
Along with the core exercises, strengthening the legs and arms helps to reduce stress on the spine. Once you have mastered the beginning exercises you can begin to incorporate the core muscle activation into all of your strength training exercises.
You should focus on maintaining a relatively neutral spine while moving through the shoulder and hip joints during common gym movements like squats, lunges, hamstring curls, hip abduction and adduction, deadlifts, upper body presses, rows, and lat pull downs.
Conclusion
If you’re experiencing lower back pain when stretching, be sure to rule out underlying issues which may be at cause, and also spot-check your form to ensure you aren’t making the most common mistakes.
Massage therapy can be helpful as a part of a larger TMJ treatment strategy. TMJ pain is often multi-factorial, so proper expectations should be set regarding what massage techniques can realistically accomplish.
Muscles that close the jaw such as the temporalis are commonly associated with tension headaches. Individuals that experience teeth grinding or clenching at night are likely to have increased tension and muscle fatigue that can contribute to pain.
A properly trained massage therapist can assist with these techniques.
How Does The Temporomandibular Joint Work?
These highly complex joints consist of the connection between the bones on the side of the head called the temporal bones, and the mandible (jaw bone).
The joints, along with the connecting muscles, allow the jaw to move up and down, side to side, and forward and backward.
When these joints in proper alignment and the muscles are relatively balanced, normal motion is accomplished during activities like yawning, chewing, and swallowing.
When disharmony exists, temporomandibular joint disorders (TMD) can emerge.
Contributing Factors For TMD And Jaw Pain
TMJ disorders are a fairly complex topic, mainly because there are many contributing factors.
For example, experts have discovered various psychological, genetic, and nervous system inputs that can trigger or exacerbate TMJ disorders.
When it comes to structural inputs, the neck should not be overlooked when it comes to temporomandibular joint issues. Due to the close relationship between the position of the head, neck, and jaw, it’s no wonder many individuals present with a wide variety of symptoms such as neck pain, headaches, pressure over or behind the eyes, and more!
TMJ Muscles
There are many muscles that influence the movement and position of the TMJ joints, but the primary ones that tend to produce the best results with released at the following:
Temporalis Muscle
The temporalis muscles can be found on the side of the head, from the temporal bones, and insert into the coronoid process on the mandible.
This muscle contributes to closing the jaw, although not as powerful as the masseter. The temporalis is commonly associated headaches since we tend to rub these muscles for quick relief.
Masseter Muscle
The masseter muscle is arguably the most powerful muscle in the body. These powerful closers of the jaw are often the primary candidate for TMJ massage and treatments, including botox injections.
Pterygoid Muscle
The pterygoid muscles are often underemphasized jaw muscles, usually due to the challenge in directly addressing them.
The lateral pterygoid depresses the jaw and opens it. The medial pterygoid elevates the jaw and laterally shifts it.
Both of these muscles can be massaged both externally and internally to some degree.
TMJ Massage In-Mouth Techniques
While a portion of the muscles can be accessed easily at the side of the face and head, the attachments of the masseter, temporalis, and pterygoids in particular can only be addressed from inside the mouth.
Arguably these are the most important fibers, especially the medial pterygoid. Massaging these muscles is relatively simple, however its important to be mindful of the delicate tissues in the mouth.
In addition, proper sanitation is important. Proper hand-washing and use of a latex or vinyl glove is recommended.
Intra-Oral Masseter and Temporalis Release
The masseter muscle is the first to locate and massage. It can be found by placing the thumb between the clenched teeth and cheek.
This muscle can be massaged with a pinch-style technique using the index finger and thumb. Its important to avoid using excess pressure in this area. Even though the masseter is a dense muscle, there are salivary ducts in this area that you don’t want to irritate or damage.
Intra-Oral Pterygoid Release
The pterygoids (medial and lateral) can be addressed from inside the mouth. While its not always possible to make contact with these tissues on everyone right away, they can be worked into over time.
The key to finding them is placing the index finger next to the upper row of teeth, and sliding straight back and up toward the ear. A slight lateral shift of the jaw toward that side will open up a small pocket to allow the finger further access.
There will be multiple tender spots in this area, and the pterygoid will be the most.
TMJ Trigger Points
Trigger points are a commonly discussed phenomenon when it comes to chronic musculoskeletal pain.
While these tender points are not fully understood, we should be on the lookout for them, especially when they refer sensations to other areas when pressed on. This topic will be covered more in another post regarding specific techniques.
Self Massage Techniques
Self massage is an excellent way to follow up on visits with a professional massage therapist. The techniques shown above can be done on your own, and there are additional TMJ massage tools which can be very helpful, especially if you don’t have the finger strength or endurance.
Stretching and exercises for the jaw muscles can also be very helpful as an adjunct to TMJ massage.
Conclusion
Treating TMJ with massage is a simple conservative approach that can be immensely helpful for those suffering from chronic pain, but should be seen as a piece of the overall strategy for overcoming jaw pain.
*TMJ massage therapy should be performed by a qualified professional that is trained in these techniques. As always, be safe!
And in today’s product review, again, we’re taking a look at the Thorax device. And we’ll see what applications we can use this tool for. So first and foremost, it comes in a nice box. Here it’s got a little product card with it. Just taking a look at this here gives you some of the benefits and some of the areas that you can work on. Uh, we’ll talk about that in a few moments here.
And of course, you have the device. The device is pretty straightforward. It is just a set of wheels on top of this heavy base here, and it has a couple of great features to it actually, which I do want to comment on. First and foremost, this thing is pretty heavy duty. It’s pretty common these days to see a lot of products that are not seemingly made very well or they’re not very sturdy and they’re not going to last very long.
And I would say that that is not the case with the Thorax here. This thing is pretty solidly built. The chances of actually breaking this thing, you can tell right away from the from the density of it, is pretty pretty low. So that’s pretty cool.
So one of the areas that I’ve been looking for, and the reason why I wanted to do this product review, is finding tools that will work really well for assisting and mobilizing not only the spine, the mid to upper portion of the spine in particular, but also something that’s going to be able to address the soft tissues in that area pretty effectively. So I’m going to grab the skeleton here, we’re going to have a look.
All right, so pull out the skeleton here so we can have a look. So we have multiple areas of spine: we’ve got the lumbar spine, thoracic spine, and the cervical spine. Different curvatures, different areas that we need to be able to focus on. They’re oftentimes going to require different tools.
So I have specific tools that I like with the lumbar spine, others with the cervical spine. I’ve reviewed those elsewhere on my channel, so make sure you take a look at those videos. But in particular, let’s talk about this thoracic spine, which is the center section.
Classically, what most people use to mobilize the thoracic spine is a foam roller. And the foam roller is placed essentially perpendicular to the spine, so that you can lay back and extend over it. So that’s obviously good for creating or improving some extension in there. We’re creating a fulcrum that we can basically fold over.
The challenge with this is, the benefit I should say, is it’s a little bit more precise to certain areas depending on the size of the roller and where you’re emphasizing on. The downside to this is that we’re not getting an equal dispersion of forces throughout that portion of the spine.
So it’s hard to actually reduce the intensity in some areas and then gain in others and so forth. It’s harder to kind of manipulate certain areas with a degree of precision. Now, the other thing we have the problem with the foam roller is that the foam roller makes contact with the spinous process for the most part, depending on how thick your extensor muscles are.
So when you lay over it, you’re going to be making contact with the spine. You’re not going to get much effect on the soft tissues that are next to the spine. We’ve got the big thoracic extensor muscles, and then as we start to move up in between the shoulder blades, you have the mid traps, you have the rhomboids, and again, some of those extensors kind of coming off to the side here.
The serratus posterior superior is actually back there too on the side of the ribs. These are all areas that are easy for a massage therapist to get their hands into, but when you’re trying to get leverage on a roller or to try to get those areas worked on with tennis balls and so forth, if they’re not exactly like the right size, it’s very hard to get pressure into those areas.
So the Thorax actually works quite well for this because of its length and the way that it distributes the forces a little bit more, as I just talked about. It’s a little bit easier to be able to get the right amount of pressure in these hard to reach areas.
Now, one of the things that comes up right away is that people say, ‘Well, why don’t I just put, you know, two tennis balls together or lacrosse balls?’ You can absolutely do that, but the primary problem that you have here is that when you place them into certain areas of the back, it’s hard to adjust the pressure.
Most of the time, if you’re using the right size ball, it for the most part, you’re using too much pressure in that area and it’s just too sensitive to be able to even relax. So you’ll find yourself laying over that thing struggling because the pressure is just too much. On the opposite end, you’ve probably tried already using a couple of tennis balls, and just because it’s so easy for you to fold over it, you’re not going to get enough pressure. So it’s the Goldilocks situation: what we want is it to be just right, the right amount of pressure.
So what I found is very quickly when I started rolling on this Thorax, first of all, I rolled on it toward the mid to the lower portion of the spine. Did pretty well and it has, because of the way that this is designed, your spinous process is going to drop inward relative to the wheels. So you’re going to be making contact with those muscles on the side of the spine.
So right away you’re going to get some soft tissue work in particular in that area. You’re going to get some clicks and pops in the thoracic spine as well, so it will help with the spinal extension mobilization portion, but what I’m emphasizing here is the value of doing the soft tissue work on the extensor muscles as you start to roll up even higher there.
Because a lot of your weight is still on the lower rollers, you’re going to get an appropriate amount of pressure there in those upper thoracic lower cervical muscles. So believe me, it’s not super wimpy. You will feel it when you get up there. And in particular, at the top of the shoulder blades there, you’ll oftentimes hit some trigger points that will tend to refer into the shoulder area.
So I think the most surprising part of giving the uh, the Thorax ago was how good it was in working that upper thoracic area in particular. So when you look at a tool, obviously it talks about all of these other different areas that you can work.
You can roll in your calves, you can roll on your thighs and so forth, and those are okay, but the most important, you know, piece of this is again this entire thoracic area. I think the purchase price of this thing, if you have particular needs for that area, which a lot of my clients do in certain circumstances, that alone warrants a good product review and and this is the best tool for the job.
Okay, so in a moment here, I’m going to show you some of those other areas, but all right, so let’s give this guy a go. When I’m laying down on this thing, it’s pretty easy to situate your spinous process, that’s the middle of the spine, in between these these guys, and in the beginning, I always like to start kind of at the top of the lumbar spine.
I don’t really advocate people rolling on the lumbar spine very much without some oversight from a clinician who knows your individual scenario, but the thoracic area is pretty safe.
So as I lay on this thing, just from the get-go, that feels pretty good. I’m already getting some sensitive areas next to the spine, near the upper lumbar spine, lower thoracic area. Very common to have areas in there that are sensitive and or have trigger points at the bottom of the ribs.
So of course I can hang out there. As with anything that you’re laying on with the extension, it’s not comfortable just to hold your head up. Your neck’s going to get tired. Okay, so you can put your hands behind your head here and that’ll allow you to rest down, and of course now we’re not so heavily over the fulcrum here. It’s still pretty comfortable, and I could just hang out here until those tissues start to release.
Once they start to feel a little bit better, I can get a little bit of rolling action here. So I have to just push my heels down into the ground and got some tender areas there. So like I said, if you’re concerned that this thing’s not intense enough for you, then don’t worry about that. Okay, it definitely is. And as I work my way up there, I can work up toward the spine or up to the scapula,
Now I’m starting to get up there, and I’m already hitting a couple of trigger points that are referring into my shoulders in my upper thoracic area, which is just again a hard to reach area, and it’s fantastic. So I can extend back over the roll a little bit more if I want, just to give a little bit of spinal extension mobilization, or I can just stay with the muscles and keep working.
Now I’m quite a bit off the roll, or off the uh, the thorax. I don’t know what to call it. I think I’m going to call it a roller here, but the mid thoracic area is making contact, and now the wheels are pretty much underneath my head. I can rest my head there, and again, this is where you start to get that little teeter-tottering motion where it’s hard to get that pressure.
So if I wanted to now, we’re gonna have to see if I can tolerate this. We’ll lift the hips up a little bit, and woo, now we start to put that pressure into that upper thoracic area again, onto those muscles. So again, I’m not working very hard here, and that’s the part that I like. If you’re working hard, it’s hard to relax, and that’s the point of getting a soft tissue release, is relaxing into it.
And if you’re straining, trying to hold yourself upright, or it’s too intense, then it’s going to be much harder to achieve that effect. Okay, so again, pretty good for that, and come back off of it, and here.
So we start to roll other areas, and we start talking about the glutes, and we start talking about the hamstrings. It’s definitely possible to do that. So I could just sit right on the side here. Now, because of the surface contact area, which is much smaller, it’s harder to get that up into the tissue, into the glutes.
I mean, I definitely feel it here, and I can work my way around. It’s pretty comfortable, probably not the best tool for the job in terms of rolling the glutes, but like I said, you can use almost any tool for multiple applications. If you just want to pick one thing, you can certainly do this. Okay, you can roll on that. If you want to roll on the lateral thigh, certainly doable there as well, and again, the part of it that is nice is that it rolls pretty well because it has so many wheels. Okay, so you can roll and work your IT band area. Of course, you can work on hamstrings.
Okay, still with hamstrings, always the challenge with this is getting enough pressure down into the hamstrings. So not really an ideal tool for a lot of people who are going to need something a little bit more hefty or direct. Okay, calf we can roll that as well. So again, if you want to just use one tool for multiple jobs, then that will get the job done. Okay, but my final verdict here: Thorax, is it worth it just for the spinal extensor rolling in particular, the muscles more than the joint mobilization itself?
This thing gets an A plus. It’s really, really good. I’ve had a lot of clients try it who are happy with it and who want one. So to me, that’s the litmus test. After I’ve done a lot of manual therapy on them, and then I let them try out the tool, do they like this, and would they buy one at home?
And a lot of my clients said yes they would, so to me, that gives it a positive, uh, positive review. So I would highly recommend it if you’re interested in something that’s going to help with that upper thoracic area. You’re going to get a lot of use out of it. All right, I hope that was helpful.
Massage percussion guns are all the rage right now in the self-care arena. While no one doubts their overall usefulness in helping to reduce muscle tension and pain, they have some big limitations.
Perhaps the biggest is the inability reach many areas on the back side of the body, including the majority of the back muscles.
Fortunately this problem has been successfully solved with wall mounted massage gun holders. The Monkee Mount is one of the best options.
I had the opportunity to review this product, and it does a fantastic job for its primary purpose.
Take a look at the video above to see my Monkee mount review.
I was recently able to review the Achedaway Scraper tool, which is the first heated muscle scraping tool. This tool seriously belongs next to any therapist’s IASTM tookit.
Grab this tool at a discount with the link below and use the coupon code SAMVISNIC at the checkout.
The Achedaway muscle scraper is charged with an included USB cable. This isn’t much of a problem for me, because I have a multi-port connected to my desktop Mac, but other’s may find this slightly annoying. You can always use an adapter to plug it into the wall, but this is not included.
Heated Temperature Settings
This tool has 3 heat settings:
40 c (104 degrees)
45 c (113 degrees)
50 c (122 degrees)
The setting is push-button on the top of the scraper. I find most the middle setting of 113 degrees to be most suitable majority of the time.
The top setting can be too hot for some people, especially if you’re working on a smaller area of the body.
I am thrilled to introduce back with us today on direction, not perfection. Sam Visnic, owner of Release Muscle Therapy. Sam has studied dozens of systems and methodologies for uncovering the root causes of aches and pains, and along with postural and movement issues, pain, science, the art and science of hands on soft tissue, massage techniques, myofascial release coaching movement, how that’s essential. And so excited to get more of your wisdom today. Welcome back, Sam.
Sam Visnic (00:32):
Thank you so much for having me. Great to be here again.
Lyndsey House RD (00:35):
Yes. So in case any of our listeners love you today, and they will, they can go back and listen to episode 1 58 where we really honed in on chronic pain and why didn’t my doctor tell me that? It’s one of my favorite episodes, and I’m not just saying that cuz you’re with me today, <laugh>.
Sam Visnic (00:53):
Thank you. I’ve always referenced that now when people say, Well, can you send me more information about your work? Or whatever, It’s the absolute best podcast example, I think. And it was such a great discussion.
Lyndsey House RD (01:04):
Oh, yay. That’s awesome. And today we get this whole new topic, which I shouldn’t say whole new. I’ve had psychologists come on and talk about hypnotherapy before, and I feel like my brain can kind of grasp it from a past trauma or even changing of behaviors. And we get to speak with you today on all of your science and studies of how it really comes in with chronic pain and, and more of your business. So can you set us up for what to expect today?
Sam Visnic (01:36):
Well, there’s a, there’s a lot of different ways and approaches to discuss topics like hypnotherapy, and it is this bizarre topic that it, it’s very not well understood. Even most scientists have a hard time describing the definition of what hypnosis is. So within the field of evidence in research and so forth and science, it’s challenging to discuss. And that’s not even looking at how the general public views this topic, which is much more different. And in particular, the exposure to hypnosis as a topic is mostly the stuff that we see on television and stage hypnosis and so forth. So there’s, there’s a lot of misinformation about this topic, and I, I hope to clear that up and to, to give you the, the what’s what when it comes to hypnosis and how incredibly effective as a tool it is and how popular it is becoming in scientific communities.
Lyndsey House RD (02:31):
It’s interesting that you mentioned the <laugh>, the stage type hypnotherapy, and that’s so real. I think people see hypnotherapy as very fluffy, very, it’s a performance and man to have to backtrack from that for individuals to, to backed out of that thinking, just to start at the beginning of trying to help people understand its benefits. Is that a bit frustrating?
Sam Visnic (02:58):
It is a little bit, and, and I think in particular, it’s not, you know, everything could be used for, for fun and the, you know, human perception is so malleable, you know, in how we interrupt people’s thought processes and their behaviors and get them to do different things and to influence, That’s all fun stuff to play with. But it’s important to understand and to segment, you know, things like fun, entertainment based hypnotherapy, or I’m sure I don’t wanna use that word, hypnosis as being something that people willingly engage in, and it’s something that they’re doing with the intention in that context of, of having fun. Stage hypnosis is meant to, in particular lots of different styles with it is very much akin to doing a magic show. When you, when the, the magician wants to select somebody from the audience, there’s certain parameters that they’re gonna use, they’re gonna look out into the crowd and look at the person that’s the most engaging into the process and looks like they’re willing to participate.
(03:54):
They are going to select that person to come up on stage, and they’re gonna have much more bombastic responses from the person because they wanna engage and have fun with the show. And that’s kind of how, how stage hypnosis works. It’s, you know, you can’t make somebody do something, and we’ll talk about this a lot, like, you know, you know, flap their arms like a chicken and bark like a dog unless they’re willing to do it. And so that’s the part I think that people don’t understand. Then first and foremost, you have to clean out from the idea of, of hypnosis is somehow that mind control can occur. And that’s absolute nonsense. People have to be a willing participant in order for one person to influence somebody to do something that’s abnormal, that’s outside of their values and their moral code and their ethics.
(04:38):
And I think that’s the thing that a, right away separates these two things when people go, Oh, really? So that’s not possible. That is correct. It is not possible. And the frustrating thing for me is more like on one of the major podcasts kind of at the Joe Rogan level ish mm-hmm. <Affirmative>, there was a hypnotherapist who went on to this show and actually started making these types of claims as saying, you know, he influenced people to do essentially ridiculous things and, and somewhat immoral things just to to trick coworkers and to do all of these things. And the way that he was expressing this was my problem and saying, Wow, you’re, you’re not doing this field any good. You’re doing it damage by making people a huge audience of people, huge audience, and trying to at the same time build credibility to the field of hypnotherapy while simultaneously making these types of statements as utter hogwash. It’s very disappointing to hear that sort of thing.
Lyndsey House RD (05:35):
Absolutely. It only takes a couple and all of a sudden our battling back on the good of it is so hard. Yes,
Sam Visnic (05:42):
Absolutely. Absolutely.
Lyndsey House RD (05:44):
Yeah. Thank you. That was so well said. I kind of wanted to point this out too, because in my head, this is new to you and like you’ve gained some, some inspiration or passion behind it. And then I was looking back through your podcast bio and it’s actually a question that’s been on there for years. Like, have you actually been practicing this for years and you’re just trying to really hone in on it a little bit more? Or have you gained some momentum behind it?
Sam Visnic (06:08):
Well, hypnosis is, and this is something that’s kind of a challenge, is that there are people whose primary focus is hypnotherapy. That is what they do. You come in, sit in a chair, and then you go through this kind of coaching based process. Now that is one way of doing it, but it, it is a limited scope of understanding the hypnotic phenomenon and which we’ll talk about. But hypnosis is really a, a idea of essentially looking at a current circumstance or state of consciousness or set of behaviors in conditions that an individual has that contextually is for the most part we think about is giving them problems. So if they have pain, they have back pain or they have neck pain or something like that. And the outcome is to interrupt that process to throw a wrench in the wheel, so to speak, and to give their nervous system a new way to do operations in a way that doesn’t cause problems and to set forth those new behaviors so that the issue doesn’t come back.
(07:08):
So if you think about it in that regard, hypnosis is simply a set of tools and techniques to accomplish that same outcome. So whereas it’s classically thought of, of sitting in the chair and being hypnotized, that’s not the way it has to be carried out. When we consider that in conversation, because we’re using language, language itself can carry forth hypnotic outcomes and processes just by the way that we communicate. So I would say that my first training in hypnosis and hypnotherapy was almost probably about 18 years ago. So to say that I haven’t been using hypnosis because I haven’t been sitting across from people doing it in that way. No, that’s not true at all. And that’s one of the, again, fundamental misunderstandings we have about hypnosis and the process. So I’ve been using it for a long time, but what happened is, is that there’s been a lot of advancement in, I think maybe not so much in the value of hypnosis, because hypnosis has been effective for a long time as we’ll talk about in particular using hypnosis and hypnotherapy.
(08:12):
I think the first study came out in the mid eighties on ibs and it was a successful study. Nobody talked about it, but after a few decades, now we have more advances in technology that are lending the scientific mind to move into the direction of trying to study these phenomenon and what is occurring. One of the big advances is brain MRIs, functional brain MRIs, and looking at what’s going on with the brain while people are in states of hypnosis. And they’re starting to find that there’s some real meaningful changes that are occurring here. And now it’s, it’s just kind of hitting more of the mainstream of having an evidence based backing behind it. So now is kind of the time that I’ve found is, you know, maybe it’s time as people are more receptive to this to start, you know, educating more on this topic. And there’s certainly a lot of different ways that I can assist people with using hypnosis services when they’re already getting good therapy and good coaching and so forth, but they’re missing this one element so I can help them fill in the gap.
Lyndsey House RD (09:14):
Okay. I think it would be super helpful for our listeners to hear a case study, someone walks in your door, they are fighting X, Y, Z, and you have this treatment option plan. Can you kind of walk us through what that would look like?
Sam Visnic (09:28):
Yeah, everything starts off with individualization, right? So people come in the door and oftentimes in, in my world, they’ve been to multiple practitioners and they’ve done a lot of different things. And I have nothing wrong with that. You know, somebody comes in with a back issue or, you know, a digestive issue, they’re gonna see an assortment of practitioners and carry out some basic things. So say somebody’s been to a chiropractor, they’ve been nutritionist, they’ve done some, I’ve cleaned up my diet, I have started exercising or whatever, and I’m not getting the results that I wanted. I’m still having this issue. So you’re always gonna look at that and say, Well, what are the conditions by which this issue exists? Is it something that happens when you’re sitting at your desk and you’re working or is it something that happens when you’re off riding a bike and your back hurts?
(10:17):
There’s always these conditions that cause the issue to come forth. So you have to do an evaluation of that. A lot of questions to try to understand how this exists. And rightly so, most people have never been asked these questions before and can oftentimes find it little challenging to answer these questions. Sometimes there are things that they know very well, Oh, it always happens when I do this. But other times they say, I don’t know, it just seems to occur. So you have to actually define the problem space and understand the components around it. Not all of those answers are gonna come out on the first session. Sometimes it takes some guided questions to ask somebody to say, I want you to, you know, grab a journal and pay attention and write these things down. And that might be able to help people find some of the contextual elements that cause their, their issue to come up.
(11:05):
So once you do that we identify the sticking factors and so forth, and a lot of times, let’s say moving this into the direction of what we would find with gut directed hypnotherapy and individuals who are dealing with gut issues, we always end up finding if we could just put a big label on this, a contributing factor of stress, of some kind of stress. Maybe it’s an environmental stressor or a work stressor or something the person is having to constantly cope with or interact with. And it seems to be related to an increase in their symptoms. So that would, once we define that, that might be an issue that we would go after, is teaching them how to deal with that stress in a way where we can interrupt it, where we can get symptomatic relief.
Lyndsey House RD (11:51):
Interesting. Okay. And getting the symptomatic relief through interrupting, we’re talking about hypnosis at this moment. Is that where we’re going with this?
Sam Visnic (12:01):
Yeah, and I, the best way of, you know, saying, and overall what we’re trying to do is a problem that is well defined is 50% salt. So at the first, you know, session, we’re trying to gather lots of information about how this is all affecting things. And once you identify the problem, and a lot of times it kind of distills down into this is what I’m feeling and I don’t wanna feel this way and this is what I want to feel instead. And I don’t know how to feel that in this context. And that way we would at that point introduce hypnosis techniques to assist the person in actually doing that mechanical process of getting their nervous system to, to reduce or to open up that space where they’re feeling the way they don’t wanna feel and exchange the feelings of what they wanna feel instead. I know that’s a lot, that it’s kind of like almost fundamentally no different than somebody saying walking in the door and saying, My back is really tense. I would like my back to not feel tense. I’d like it to feel relaxed, but they don’t really know how to consciously do that. So the massage therapist or the chiropractor, whatever, would employ techniques to make that outcome happen.
Lyndsey House RD (13:13):
Right? Do you ever pair this or are they sitting across from you? Or is this paired with another form of therapy that’s going on, like massage therapy plus this?
Sam Visnic (13:24):
It can be, And that’s the cool thing. So I think that one of the challenges is with any technique is that we know that human beings are very capable of doing the things that we want them to do. So for example, if you’re dealing with ibs, it is very possible, very possible. And because everybody can do it, that you can employ relaxation techniques or use your brain in a way to directly calm your gut down. Now the challenge is if you have no idea that that is even possible or remotely how to do this, we’re going to have to give you an experience of it occurring. So the, that is walking through those processes or teaching people how to do things and sometimes verbally talking about them is not going to get the job done. So it can be done in a state of hypnosis or through some other technique.
(14:14):
If I were to do a massage technique by putting my hands in and giving somebody a form of mechanical stimulation pushing into the tissue, and then I say, Now breathe. And then every time you exhale, just relax and let me know if that pressure feels more tolerable. And they say, Well, yeah, it’s getting better. That’s an exact example of a feedback loop that lets you know you are capable of relaxing against that stimuli. Now when we teach people that they say, Okay, that’s what it’s supposed to feel like, then it’s far easier to progress the techniques forward to utilizing them in their day. So it’s kind of like a practice, practice session also for learning how to modulate your own nervous system under different circumstances.
Lyndsey House RD (14:58):
Thank you. That example was that hugely helpful. So they can walk out of your office or even, and I wanna talk about this, if it could be a virtual session or if it does need to be in person, but they’re going to keep implementing something that they have just been taught over and over until the relief comes. Am I hearing that correctly?
Sam Visnic (15:18):
Yes. And learn human hypnosis is a lot about learning and about skill development. The idea that the hypno therapist, just like any other type of therapist, is, is what you need to do. The work to you is very limiting. The job of the hypnotherapist is to open up that doorway for learning and understanding and to assist you with having that experience so that you can learn to replicate it yourself. Just like anything else with human beings, we are learning machines, and when we develop certain behaviors and subconscious responses, it kind of drops into the outside of awareness. So therefore it has become kind of a neuro pattern, right? So when we want to change a behavior, sometimes just like a lot of different therapies, you can do a one hit wonder, you can do it once, and the problem never seems to come back. I’ve had many cases of that over the years back, problems, gut issues, all sorts of things.
(16:17):
But we don’t wanna set that expectation that that happens every time. So what we wanna do is to teach people the skills to say, as you go back to your environment, if this pattern continues to play, we’re gonna teach you two skills. Number one, how to interrupt it when it is happening so that you can change something. But also important is how do you prevent the pattern from starting to begin with. So if you can change it from even turning on that facilitated pathway, that is phenomenal, but also if it does happen, it’s not the end of the world because we’re gonna give you some techniques to interrupt it so that we can essentially metaphorically scratch the record so the record can’t play the same way over and over again.
Lyndsey House RD (17:04):
I like this. Okay, so I’m picturing like highly stressed individual who they can tell it’s their stress and then immediate IBS issues throughout their day. They’re coming to you for reprieve out of this, but one, what if they don’t believe that this is even like a thing or they don’t believe that it can help? And and for the person who is like, they can barely settle into their own skin for a minute, to really listen to what you’re saying. Like are there levels of where you’re like, Okay, we have to at least get you to here before we’re even gonna be able to shift you to phase whatever?
Sam Visnic (17:41):
Well, the, the, the research on this part is very interesting because when you look at what the research says, and there’s been many studies on this now, and obviously a lot more in development on gut directed hypnotherapy, is that many of the participants, I think as high as 50 to 60% were very skeptical of, of hypnosis before they, they walked in the door to, to participate mm-hmm. <Affirmative>. And the funny part is, is that it had no effect on the outcome. Meaning that almost all of them had the same positive response afterward, and their skepticism of hypnotherapy dropped dramatically. <Laugh>. So we know now that part of hypnosis is because the, the question always comes up is the is hypnotherapy versus placebo, and these are not the same thing. They’re fundamentally different processes. So hypnosis is not a placebo effect. I’m sure just with any therapy there is placebo involved, but there is an actual change that can be measured in the brain as a result of doing hypnotherapy.
(18:41):
So there are things that are occurring. So when people come in with the skepticism, it’s usually because of the stuff like we talked about at the beginning of the interview, they do not understand what this is. And if they’re under the assumption that this is somehow just manipulation or it’s just placebo, they’re going to be a bit more resistant. And just with any other therapy this is something where I have the conversation with peoples to say, in order to achieve a benefit out of something you really need to be willing to play, You know, you need to play full speed. What is the point in going to a hypnotherapist with the intention of saying, You can’t hypnotize me? Why would you want to say that? Because if the outcome is, I don’t think I’m hypnotizable, but you know, feel free to try, I’m willing to play.
(19:29):
That is the goal. And people will say this, and in the studies, you, you see suggestibility scales and the degree that people can be hypnotized, none of that makes any difference. And that is based upon this misunderstanding of what hypnotherapy or hypnosis really is. Human beings are in hypnosis all the time. And to say that an individual can’t be hypnotized is about the same as saying you can’t go to the movie theater when a movie that you wanna see comes on and be fully immersed in the movie. Everybody can do that. It’s just a matter of whether or not the movie that you’re watching is interesting to you or not, you know? So none of these things are, are are things that really get in the way of the fact that hypnotherapy therapy actually works other than the person’s skepticism and, and resistance to actually participating.
Lyndsey House RD (20:22):
Right. I liked this, I wrote this down, we need to play it full speed and Yep. I, I wanna like highlight that and pause for our listeners to just go, hang on a second. Do I walk into, whether that’s doctor’s appointments or therapy sessions, or am I ready to play at full speed or am I always coming in wanting that other person to have to prove themselves or prove that it’s gonna work? Like what if I come in with all of those expectations? Thank you. That was a great way to put that. And I, this has been explained to me this way, and tell me if you agree kind of to your point of the hypno hypnosis at different levels like that we’ve all, if we can all picture we’ve driven somewhere and not really remembered how we got there because we’re just so used to driving to that place that that’s a form of hypnosis in itself that maybe all of us can relate to to some extent. Do you agree with that?
Sam Visnic (21:21):
Yeah. And the same thing is the movie theater. What what occurs is, and let me give you the definition that comes from the Mayo Clinic and we’ll, we’ll, we’ll talk real quick about why this is so confusing. Hypnosis has referred to as hypnotherapy or hypnotic suggestion is a trans like state in which you have heightened focus and concentration. Mm-Hmm. <affirmative>. Now that statement right there is erroneous. So hypnosis is not a state, okay? Hypnosis is a process by which you go from one state to another. So another way to explain this is is that the, the moment between when you’re awake and when you fall asleep, you go through a transition somewhere and that transition is hypnotic. It’s a state that kind of exists as the inter between that you move through. So hypnosis itself is almost like a system or a process or techniques.
(22:15):
And the outcome is to use these various techniques to make that transition happen with some degree of intention or purpose. So you’re doing it on purpose. So the way that that’s described, a trans like state in which you have heightened focus and concentration, a state of focus and concentration is a state not unlike being in a state of anger, right? So to defining hypnosis as a specific state of, you know, focus, concentration, anger, anything is not true focus. You could say being in a hypnotic like state is being in an intense state of focus and concentration on something probably is a bit more accurate. So, but you’re right in what you’re saying is that when somebody isn’t in a state of hypnosis, let’s say with this, you know, they come in and we might induce a state of relaxation, you know, the outcome is to have somebody immersed in some type of internal experience or focusing on something in a way where they’re less, they’re paying less attention to other stimuli. That is kind of in essence what we think about hypnosis can do.
Lyndsey House RD (23:25):
Okay. Someone’s loving listening to you right now going, I wish Sam lived <laugh> 10 miles down the street from me. I know he doesn’t. Two questions behind that. Are other practitioners jumping on board with this? Could you almost pick people out in every state or county who can do what you’re doing? Or are you pretty unique to this? And then my other question would’ve been like, do you take people on virtually?
Sam Visnic (23:50):
Yeah, I’d say first and foremost there are, there are quite a bit of, of hypnosis based practitioners skill level can vary dramatically. So that’s kind of the bad news. But the good news is, is that hypnosis seems to be quite universally effective. Again, even at basic levels, you know, being able to use a, a hypnotic induction with somebody to assist them with relaxation as long as the person is a willing participant as we talked about. So what I looked at very interestingly is that I’ve done more advanced hypnosis trainings and the complexity that’s involved in, in being just a very, very advanced skill hypnotherapist is a immense there are some really, really skilled hypno therapists. And then what we find is when I looked at the literature on pain and using hypnotherapy for chronic pain, when I read through the scripts that were highly, highly effective in the research, they were so basic, it blew my mind almost to the point where I’m reading them and I’m like, that’s what they did.
(24:51):
And that worked. I just didn’t feel com it didn’t feel complex enough, if you know what I’m saying. And it was very effective and I was like, Wow, you know, I must be working too hard. But that’s kind of what you get with this is that I think for most people the good news is, is that hypnosis can oftentimes be like pizza, even when it’s bad, it’s good and it will still work. So you wanna find practitioners that have a good amount of experience with it, but I think it’s far more important to work with practitioners who have experience in the type of problem that you want to have. So as a general, I wouldn’t take for example as a hypnotherapist, somebody that comes in and says, I wanna stop smoking, I wouldn’t do that. I mean, well generally I’d know hypnotherapy and I can assist people with changing behaviors.
(25:39):
I’m not a specialist within all of the things of understanding how people or what contributes to people smoking and you know, how to get them to stop specifically. So you can use general trans work to do that and you might very well be successful with a good number of people, but I really believe that you should be a specialist in, in that area. So my specialty with hypnotherapy is with individuals suffering from chronic pain because I understand the scope and the depth of dealing with chronic pain and also gut directed hypnotherapy, which in essence is the same thing. The brain is interpreting the information from the gut as almost being a painful type of stimuli and it is responding that way. So my specialty, and that’s why it’s, it’s very much conjoined there is gut directed hypnotherapy with chronic pain because they’re in essence the same kind of of story that’s going on in there. So I think that that piece is probably the most critical. Number one, finding a hypnotherapist with some experience obviously, but also some experience with focus in the area of the issue that you’re trained to solve.
Lyndsey House RD (26:47):
So I do feel like gut digestive issues has a, a big, it’s a big movement going on with all of that at the moment. Like we’re a lot of microbiome talk, a lot of food sensitivity testing, all of that. When we talk about this, you always, pain always comes out. So really the person has to be experiencing some level of pain, not just like bloating or not just, you know, off bowel movements. Like does there need to be a level of pain where you’re like, Now I can participate in help in this?
Sam Visnic (27:22):
Not exactly. I mean, I think that there’s a, there’s a common thread with individuals who have ibs that gut pain and discomfort is probably one of the top symptoms that they experience. But there’s also a lot of other issues associated with that. Generally speaking, the research shows that gut directed hypnotherapy has been highly effective for some things that you might not think motility issues has been a big one. There was actually some studies that showed that hypnotherapy was able to increase gastric acid secretion or lowering, so you could actually increase or decrease stomach acid levels with hypnosis, which is very interesting. And all of the things that essentially affect, like essentially you have to think about, we talk about the gut as being the second brain, so it’s just very sensitive to our e emotions and so forth. So when we’re stressed, we go into that state of fight or flight and fight or flight has changes in our gut and what our gut is in a state to do.
(28:19):
So if we’re stressed and then we get tightening and so, so forth and we get digestive issues, then hypnosis is gonna be effective with that because it’s calming the parts of the brain that are in a state of fight or flight and you’re seeing a reflection of that status in the GI tract. So everything you can imagine that we’re trying to do with nutritional approaches, which is to gut get the gut to calm, to get the gut to be less reactive, to get the immune system to be less reactive, is what we’re trying to accomplish with hypnosis work as well. But just through a different mechanism.
Lyndsey House RD (28:53):
Right? And what I’m picturing with this, I think the hardest thing about the gut is sometimes we don’t get the, like a fast visual, it’s getting better, you know, and until we can see internally or until we can really measure, which would take a lot of insight like I am feeling less bloated or I am feeling less discomfort, bowels are better, all of that, that they’d have to stick with it, right? Like a, again, just setting people’s expectations around. It’s not a one and done if it is hooray for you, but for, for most people you gotta like trust in the process and keep going and then you will see,
Sam Visnic (29:29):
Well this is the amazing thing with hypnotherapy is that the amount of volume of sessions that are necessary, it could be as little as two and then the research has gone up to about 12 weeks. So these sessions were done front loaded, but I think the lion’s share of the work a lot of times were within the first four to five visits. Then after that the sessions were spaced out and as long as the individual was doing some of their homework and was sticking with it and applying the techniques, the results had been frankly spectacular. And in particular the long term value. Because the big question is with the, especially with these refractory cases of IBS that just don’t respond to anything is this something that will last over the long run? And the answer to that is yes. Amazingly some of these patients received as much as 50 to 60% relief from their symptoms and it lasted in the long run. So, and the recommendations, and there hasn’t been that much research on this, is that over time many authors do suggest that follow up sessions and refreshers might be very helpful because this is a long term condition. But it was amazingly this short intervention of just getting a bundle of visits in and addressing this issue had such number one profound effects. And number two, it lasted for a long time.
Lyndsey House RD (30:49):
Very cool. I love that you always, throughout research, I just feel like for any of our medical professionals tuning in right now, can we use that word evidence based again and just one more time highlight the fact that this like truly is evidence-based?
Sam Visnic (31:04):
Yeah, it is. And there’s a lot to it right now. All you have to do is look up gut directed hypnotherapy online. Number one, you’ll probably end up finding, you know, a lot of medical sites and research right now. And we should link to the study that we had thrown out there. There’s a couple of them that I have, I have a huge file of all of the evidence-based literature on, on, on hypnotherapy. If you read through this and you’re not highly convinced that this is where everything is going, you’re not paying attention. I find that in, in most health practices. The challenge is even when we say we’re being evidence-based, a lot of times we’re not following what the evidence shows and the evidence shows that hypnotherapy works, number one for the primary reason why is because it’s non-invasive. We’re not even touching somebody.
(31:48):
Two, the side effects are virtually nil. The only times where hypnotherapy might be problematic is for individual with psychiatric conditions, which we need to be mindful of. And they need to be treated oftentimes with hypnotherapy by a psychotherapist who can also handle those COC conditions. There’s, there’s no risk and it’s highly effective and relatively cost efficient, especially when you consider healthcare costs that are associated with managing these functional gastrointestinal disorders. So everything about it just makes a hundred percent sense. It is evidence-based, why aren’t we doing it? And number one, because just education not knowing. And two, having availability and working with practitioners who actually can do that work. I’d say 99% of the time as I do outreach and I talk to nutritionist and clinicians and so forth, they say, Well, I’ve read that research, it’s very impressive. I have absolutely nobody to send this work to.
Lyndsey House RD (32:44):
Yeah, I could see that. That’s where I feel so fortunate to even be sitting across the, the mic from you right now to be like, I have the resource whether or not I can get you past Sam, he could get you to the next one. But I think that’s the beauty of podcasting in general is my little resource library is growing and I think it’s such a amazing thing and I’m sure you do too as a practitioner to be able to be like, I don’t know if I can help you in this area, but I know who can. And it just brings me a lot of comfort and joy to be able to refer. I love referrals and, and the people who are good at doing what they do are easy, ready to refer out when they know it’s not in their wheelhouse or somebody else can do it, you know, more efficiently or better, but
Sam Visnic (33:32):
Well, and we all have those stumbling blocks or those, those issues with people that are like, this is what we do really well. You know, one of the things that the somebody that I had learned from who talked about this a lot is says, Can you imagine the patient load by gastroenterologists of these refractory cases of IBS that they can do nothing for? The medications don’t work for them. They’re constantly getting calls in, you know, having setbacks and the doc and saying, Doctor, do something. And they say, I have no tools for you. There’s nothing that I can do that is at I’m, we’re at the end of the rope here in terms of, of options and, but yet now hypnotherapy can be in there yet, you know, et cetera. So there really is this opportunity for everybody to get on board with something that will help these patients.
(34:16):
A lot of individuals with IBS needs some medication management. Absolutely. They also need to be working closely and predominantly with a nutritionist because that’s the, the person who’s gonna help them the most in their day to day, which is, you know, whether that’s low FODMAP or a CBO program or whatever it is that they’re doing long term. And then they should be working on gut directed hypnotherapy as well. And it creates a perfect little vacuum of, of interdisciplinary support for these, for these types of issues. So, and, and one thing I would throw out there, we’re talking about this, I do not recommend doing gut directed hypnotherapy without working with those other two practitioners that I just met. You wanna have good results. Gut directed hypnotherapy does not fix ibs. It is an interdisciplinary multi support system that works together. Now, the research that we just talked about looks at comparing fo lo FODMAP diet, which is oftentimes the go-to for managing IBS and CBO symptoms. And it works in hypnotherapy done by itself rd the exact same results. And I think there were a couple of studies that showed the hypnotherapy patients that six weeks had better results. But we don’t wanna make that into a only do this therapy or that, I think that’s a bad idea. What we wanna do is imagine what happens when you are, your medications are properly being managed. You’re on a low FODMAP diet or equivalent or whatever’s working for you and you’re doing gut directed hypnotherapy. Now we’re talking the magic.
Lyndsey House RD (35:49):
Yes. And I love that you’re pointing this out. I feel this way all the time, and I probably told you this last time we talked, but I have a client who kind of named hers a dream team of professionals that she works with. And I always think if we could all build our own specific dream team around what our issue is or what we’re really trying to accomplish. And I think about this with planner fasciitis, you know, for me as a dietician and personal trainer, I get a lot of individuals who a wanna lose some weight. You know, a lot of weight management talk, a lot of getting good momentum going and then, and then this barrier of oh my gosh, my foot’s so my heel’s so inflam that I can’t walk anymore. I can’t. And then to be able to pull in both the physical therapists as well as massage therapists. Like I, I have the teams all the time working with one client and I can’t imagine not having that interdisciplinary team. And a lot of times it’s nurse practitioner to your point of meds physician, it’s all of it. And not that we use everyone all in one moment, not all in the same week, not all in the same month, but it’s being able to know exactly who we’re gonna pull from in the, in the moment that we need them. So thank you for coming at it in your direction too.
Sam Visnic (37:04):
Exactly. And I think that, you know, the more there’s, there’s all of those elements are being taken care of, the less ultimate sessions and so forth you need like my program is, is generally speaking about three visits cuz that they find that that’s generally what people need. Now they could do more, they may not need to do more depending on what else they’re doing. I just had somebody the other day who was dealing with immune system issues and he had chronic pain but I, you know, of course looking under the hood, I find that we’re dealing with sleep apnea issues and he’s has a c pap cannot wear his C pap because it’s so obnoxious and it wake him up because it feels like a tornado going down his throat. So I had to stop what we were doing, send him to a dentist who would make a mouth appliance for him to move his jaw forward so he could wear that C pap. Now I know that that guy’s gonna come back and he is gonna feel 10 times better within a few weeks and his pain levels and his tolerance levels are gonna be better and we’ll resume the work. But how he not do that, I could spend the next three, four months with him doing micro progressions of exercises because he can’t get the rest that he needs. And he’s so sensitive to any new introduction of exercises. That’s exactly how this should work.
Lyndsey House RD (38:22):
Exactly. And you’re debunking the whole theory when people are like, ah, they just want more sessions cuz it’s more money. And I’m like, ah, no <laugh>, maybe, maybe this very small percentage is out there doing it that way. But like, you’re such a good point. No, I stop my treatment until my client’s ready to come in and we can get optimal success out of
Sam Visnic (38:44):
It. Seeing miracles is awesome. Yes. I’d rather see those.
Lyndsey House RD (38:48):
Right, a hundred percent. So where can people contact you to, and I’m, I feel like I ask this and I keep interrupting you. Do you do virtual gut, gut hypnosis type sessions? Or is that really just for the person walking through your doors?
Sam Visnic (39:07):
No, and actually the the interesting thing out of this is that I used to to be very anti virtual stuff, right? Because I think that having people in person made a bigger difference. I’m actually changing my opinion on that. And in hypnotherapy I’m finding the complete opposite. I’m finding that most people feel very comfortable doing zoom or virtual hypnosis for two reasons. Number one, they can be on their computer in a comfortable environment. It removes all of those elements of feeling out of control or potentially unsafe with somebody. So all of that stuff gets outta the way, even if there’s a smidgen of that, it can interrupt the process. And also a lot of additional features can be gained by doing things virtually. When you have a headset on and we’re talking virtually music can be added and so forth to enhance the hypnotic process and everything can be recorded for follow up visits as well. So there’s a lot of bonuses and with, with zoom based or virtual hypnotherapy that I’m now saying that that is the way to go. And number one, it allows anybody to access it and two, for all of those additional reasons that I talked about. So I offer them distance wise and actually very rarely actually considering this, do most of those things in in office.
Lyndsey House RD (40:22):
Oh that is so promising and I love hearing that. I think all of us who listen to podcasts don’t accidentally go, Oh, this would be really good for maybe not only me, but this person or this person. So what’s the best way for people to send links or to reach you if they want, wanna get something started like that?
Sam Visnic (40:41):
So with this kind of work, there’s a, a consultation process that’s necessary in order to understand the scope of what somebody’s doing and to see if they’re a good fit. Number one, the practitioners that they’re working with and making sure that they have a good team with them. And also to rule out certain conditions that they may need to work with a psychotherapist on with hypnosis work. So those are things that we talk about. I am not a psychotherapist, I am a hypnotherapist, which is a little different, but that process can be done through a, a brief consultation call. It’s usually about 15 minutes just to review their ca case. I oftentimes have questions to ask to find out where they’re at, to see if they’re a good candidate, cuz of course we always want the successful outcome. So good screening process on the front end and asking questions. If you’re a good candidate, then I can determine that and then we can proceed after that. So there is a space on my website@releasemuscletherapy.com. If you go up in the menu under services, you’ll see gut directed hypnotherapy. When you go to that page you can learn more information about the process and how it works and if you are interested in it, you can fill out a form there and then I’ll connect with you about scheduling a 15 minute consult and we’ll see if it’s right for you.
Lyndsey House RD (41:48):
Okay, that sounds awesome. Is there anything that I’m not asking that I should be on this?
Sam Visnic (41:53):
Well I think that for most people, I think they need to do a little bit of extra homework on this and to go and look at gut directed hypnotherapy and in particular take a look at the results and I think you’ll be immensely impressed at what’s available out there and how this is such a great option. And like I said, you have to just connect with the right practitioners who have experience with it and of course, you know, be doing all of the stuff that you need to be doing on the nutritional fronts as well. But you know, I think that once you take a look at those two items, you’ll realize where I’m going with this and why I’m, I’m steering my practice in this direction to help with this type of issue.
Lyndsey House RD (42:31):
Yeah. And I just wanna point out one more time that you fill these gaps, these hopeless gaps with hope for the people who feel like, well this is just me, I’m just gonna live in pain. This is just me. I’m just forever gonna live with gut issues. That there is this, Sam is offering this 15 minute free consultation to just let you ease in and see if it’s a good fit because quit stopping at that barrier of this is just it, this is just me cuz it’s not. And there’s always that next extra step. And I think, no, I don’t think I know, Sam, that you bring so much hope to this space, this gap of we’re not there yet. We’re not at maybe like curing, but at least finding some maintenance and peace behind some of these, these issues or diseases. So thank you for filling that gap.
Sam Visnic (43:23):
<Laugh>. Yes, there’s one thing that I’m confident at in, in human beings is their ability to learn. And if nerves can learn to do certain things, they can learn to do other things. And that’s kind of what we’re talking about is we’re saying that unless there is actually structural damage to the nerves, you know, we’re talking about a neuro behavioral problem. So you know, to say that you’re stuck with IBS and it will never change is the same thing as saying, I keep making these certain decisions or having these certain behaviors that I’ll never be able to change. And that’s just false. You just don’t know how to change them yet. And as you learn to change them, you’ll start to see the, the pathway and the door will be open for you is that not only interrupting and changing behaviors, but also changing and framing how you think about the things that are happening to you as well. And paradoxically, a lot of times when you change how you feel about your situation, it changes the situation as well. So there’s so many different avenues and ways to make these kinds of improvements that you just have to be open and and willing to, to go the path with it.
Lyndsey House RD (44:24):
Yeah. You’re so good. Thank you. And we have to add in one more time. You not only have to do all that, you have to come in and be ready to play at full speed, so you have to Thanks for joining us. Yes,
Sam Visnic (44:34):
That’s right. Anybody who says they can’t be hypnotized, well I might take that as a challenge, but yeah, <laugh>, I’m willing to go that with you, but you still have to be willing to play.
Lyndsey House RD (44:44):
I love it. Thank you so much for all your wisdom, Sam.
Graston technique belongs to a family of techniques referred to as IASTM, is an effective tool for soft tissue therapy. In this guide, I’m going to show you how to use Graston for plantar fasciitis release.
Grab your tool and let’s go!
Update! The new Achedaway scraper has just launched, and its a great tool for addressing plantar fasciitis. Check it out!
Nothing gets between you and having a great day than a stabbing pain that keeps you from moving around. Specifically, a pain that originates at the bottom of your heel.
If you are experiencing pain, it would be wise to first visit your doctor or podiatrist for a proper diagnosis and a recommended treatment plan before going any further.
The pain may originate from your plantar fascia ligament. Usually, exerting too much pressure on the area results in irritated fascia, making it inflamed, which could be the primary reason for your foot pain.
Based on your unique case and the extent of the inflammation, your doctor may recommend temporary immobilization or specific non-surgical treatment. There are a lot of options in this area but at the top of the list is a physical therapy program, which may include a variety of modalities including exercises, stretching, orthotics, or other tools to help alleviate discomfort like a massage gun, or kinesiology tape.
However, in severe cases, your doctor may also recommend surgical procedures, depending on the extent of your condition.
In this article, we’ll delve deeper into plantar fasciitis⸺ a very common painful foot condition, its causes, symptoms, treatment options, plus how to prevent it, and what to avoid when you have the condition.
What Is Plantar Fasciitis
Plantar fasciitis is a painful foot condition highlighted by a sharp stabbing pain originating at the bottom of the heel (but it may present more toward the forefoot in some cases).
Usually, this pain occurs when the plantar fascia is irritated, thanks to the combination of precipitating factors and the wear and tear of daily life. Plantar fascia is a weblike ligament that is thick and runs from the heel of your foot to the toes.
The plantar fascia ligament supports the foot’s arch to help you walk. It also absorbs shock.
When you place weight on your foot, such as during prolonged standing, regular walking, running, or weight bearing, over time, that puts stress and tension on the plantar fascia, which is completely normal.
However, the plantar fascia can lose its resilience or elasticity, which causes it to tear or become irritated with daily activity.
Symptoms of Plantar Fasciitis
Many patients who present with plantar fasciitis complain about pain in the bottom of the heel or occasionally in the midfoot area. Plantar fasciitis usually occurs in one foot, but sometimes the condition can affect both feet.
Plantar fasciitis pain can come and go, but the worst pain occurs with the first few steps when you get out of bed. This is due to the position of the feet during sleep, as they are in plantar flexion (think calf raise).
As you stay on your feet, the plantar heel pain usually reduces but can reoccur when you suddenly stand after sitting for too long or standing for too long.
The heel pain may also intensify on bare feet or when you wear worn-out shoes that offer no heel and/or arch support.
The pain can evolve gradually, and as the condition worsens, it will move from dull to sharp. Although some people describe the pain as a burning ache starting at the foot’s heel and spreading throughout the bottom of the foot.
Causes and Risk Factors of Plantar Fasciitis
A common misconception has been that heel spurs or bone spurs could cause plantar fasciitis. However, that misconception has now been disputed.
Yes, heel spurs can exacerbate plantar fasciitis as they also cause stress on foot ligaments, but it’s also possible the heel spur is caused by the plantar fascia tension. Regardless, focusing on the heel spur itself may miss the additional factors that are contributing to the pain.
Many factors can predispose you to develop plantar fasciitis, including your foot structure, age, gender, or level of physical activity (more on this below).
Plantar fasciitis commonly occurs in women more than in men. In addition, pregnant women, especially during the later stages, may experience bouts of heel pain.
Plantar Fasciitis Risk Factors
Sometimes plantar fasciitis can develop without any apparent cause. However, certain factors can increase your probability of developing heel pain. Such factors include:
Obesity and weight. The excess weight caused by sudden weight gain or obesity increases pressure on the foot ligaments.
High-impact training. Aerobic dancers, ballerinas, runners, and high-impact athletes do intense exercises that place a lot of stress on the feet muscles and support structures, and can result in severe pain in the heel.
Active jobs that keep you on your feet. Doctors, factory workers, waiters, barbers, and teachers spend long periods on their feet, either walking or standing.
Foot structure (pes planus). Flat feet or pes planus occur because of weak ligaments. Pes planus make the plantar fascia and other tendons in the foot work harder to support the foot, which may cause the fascia to wear and tear much faster.
Tight Achilles tendon. Your Achilles tendons connect your calf muscles to your heel. Tightness in the Achilles tendon can reduce ankle flexibility (dorsiflexion) and add more pressure on the connective tissues.
When you often wear shoes that are old and need to be replaced. Wearing supportive shoes with orthotics (shoe inserts) can relieve pressure on your plantar fasciitis muscles, mitigating the development of heel pain. However, soft soles and shoes that have too many miles on them have poor arch support.
Reduced ankle dorsiflexion due to lack of joint mobility and/or calf muscle shortness.
Complications That Can Result From Plantar Fasciitis
Not treating plantar fasciitis can result in chronic heel pain that can keep you from participating in regular activities, lowering your quality of life, and ultimately your health.
Patients with plantar fasciitis, like any other group dealing with chronic pain may also deal with increased anxiety and risk of depression.
Chronic pain can also make you change your walking style potentially leading to back, hip, knee, and foot issues.
How Doctors Diagnose Plantar Fasciitis
If you are experiencing plantar fasciitis and feel pain that is not resolving, consult your podiatrist for proper diagnosis and treatment. While at the doctor’s office, they will take an appropriate medical history, and perform a few checks to confirm that your foot pain is caused by plantar fasciitis and not any other conditions with similar symptoms.
Treatment of plantar fasciitis should be multidisciplinary, so other practitioners may need to be consulted to get a full understanding of the factors contributing to your case.
Physical Examination
During the physical examination, your doctor will check for:
Muscle tone
Balance
Coordination
Tenderness
Image Testing
Your doctor may perform imaging tests to identify the cause of your heel pain.
An X-ray will rule out a stress fracture. An MRI will show swelling or thickening of plantar fascia tissues, while ultrasound imaging will identify the thickening or calcification of any tissues. They can also check for the presence of heel spurs.
How Plantar Fasciitis Is Treated
There are a number of options for plantar fasciitis treatment. Home therapies such as night splints, heel cups, icing, and anti-inflammatory drugs are usually the first things you see online when searching for plantar fasciitis relief, but none offer the “magic bullet” for this problem.
Let’s dig into plantar fasciitis treatment options a bit more.
Non-Surgical Treatment for Plantar Fasciitis
Physical Therapy
Your therapist can recommend stretches for your Achilles tendon and heel ligament to relieve pressure off relevant tissues.
They will also guide you on exercises that strengthen the right muscles to lessen the load on the irritated fascia. Graston technique also seems to be quite popular amongst therapists as well for treating the soft tissues of the foot.
Plantar fasciitis can improve quite a bit as a result of strengthening these muscles in some people. Others may need much more.
Stretching Exercises
Plantar fasciitis leads to reduced ankle flexibility, which in turn leads to alteration in weight-bearing in the foot, putting more pressure on the plantar fascia ligament. Tight muscles additionally may be either a contributing factor OR the result of pain, but regardless they are an important factor to address even if they are not the cause of plantar fasciitis.
Tight calf muscles can pull on the Achilles tendons and may be a contributing factor in heel pain. Gently stretching your calf muscle can help loosen the muscle and reduce pain. The key is to start slowly, otherwise it can result in making the pain worse.
When you perform the best plantar fasciitis stretches consistently, you can expect significant improvement in just three months. Research shows plantar fasciitis improves fairly consistently with adherence to an appropriate stretching program.
The stretches work so well because they alleviate tension in the calf and lower foot muscles leading to greater flexibility and a reduction in heel pain.. Calf stretching has additional benefits to the overall muscle balance of the lower extremity as well.
Some individuals may benefit from wearing a night splint, which is meant to passively stretch the tissues and reduce morning plantar heel pain.
Plantar Fasciitis Exercises
With a mild case of plantar fasciitis, general stretches for plantar fasciitis will get you well on your way to recovery.
However, with severe plantar fasciitis, you may need a more precise exercise outline and information about which exercise to avoid so as not to exacerbate your painful heel condition.
Before you begin your exercise regime for plantar fasciitis, you’ll need to take a break from any significant activities that apply pressure to your plantar fascia. This can include running, standing for too long, or any daily activity that requires being on your feet for too long.
When you eventually get back on your feet, be sure to have supportive shoes. Night splints may also help fasten the recovery process.
With exercises, symptoms may take weeks or even months to improve. Generally, the longer you have experienced the symptoms or the more chronic your condition, the longer the span of the time it takes to see a good response.
Running and jogging. Repeated stumping of the foot on the ground with running and jogging puts a lot of strain on your fascia and foot ligament.
Burpees. Burpees or squat thrusts apply a lot of pressure to the fascia and heel ligament as you drop to a squat, shift to a plant, then jump back into a squatting position before standing.
Aerobics and cardio dancing. The quick footwork, jumping, hopping, and the amount of time you spend on your feet while doing cardio and aerobic dancing leads to faster degradation of your fascia and heel ligament, causing inflammation and eventually pain.
High-impact team sports. Sports like basketball and football involve a lot of running and jumping, which can cause a tear in the ligament.
Plyometrics. Jumping trains put the worst strain on your fascia ligament. A sudden impact jolt can easily tear your fascia ligaments, leading to severe pain.
You don’t necessarily need to stop exercising after developing plantar fasciitis. However, you should consult your doctor first beforehand to see if there are any specific recommendations on what to do/not to do.
This is because incorrectly exercising the areas may lead to a flare-up or worsening of plantar fasciitis.
With that said, it’s still possible to get your workout in or burn calories without putting strain on your fascia and heel.
A few alternatives to high-impact exercises come in handy here. For example, you can opt for power walking in the pool, swimming, or even rowing instead of jogging or running.
A plantar fasciitis-friendly alternative to burpees would be performing the squats without jumping and doing the planks on your knees.
The point is, there are many ways to get and stay fit without placing unnecessary strain on your already aggravated tissues.
Icing and Medication
Putting ice on the painful heel several times daily may help with inflammation and pain relief. A popular way to do this is to roll on a frozen water bottle.
It’s common to reach for the nonsteroidal anti-inflammatory drugs (such as ibuprofen) to help with pain management, but there is strong evidence that chronic plantar fasciitis is not a true inflammatory condition, but more like tendinosis. This is why you often come across the term “plantar fasciopathy”. In this case, these drugs don’t make sense to use!
Surgical Treatment
Your doctor will only recommend surgery in case of severe pain that lasts more than six to 12 months or if all other treatment options fail.
Surgery is generally considered a last resort, because it is not without risks and it may not work for many patients with plantar fasciitis. Nonsurgical treatment options should always be exhausted when appropriate.
Plantar Fascia Release
In plantar fascia release, the orthopedic surgeon will cut a part of the plantar fascia ligament or entirely detach it from the heel bone.
This should relieve tension in the area and reduce inflammation. However, because the surgery may involve entirely detaching the plantar fascia ligament from the heel bone, it may result in loss of full function of the foot due to a weakened foot arch.
Relief is not guaranteed either. I have personally seen a number of clients that have the same pain after the procedure.
Gastrocnemius Recession
With gastrocnemius recession surgery, your orthopedic surgeon lengthens the gastroc tendon, a part of the Achilles tendon, so the ankle can be more flexible and move about easily. This results in reduced stress on the plantar fascia.
The success of this is likely going to be correlated with the degree of involvement of the achilles tendon.
Other Non-Surgical Remedies for Plantar Fasciitis
Often, the conservative treatment for plantar fasciitis is the first-way heel pain is managed.
Outside of the usual stretching and exercise protocols, there are different measures that can be taken, some more evidence backed, while others purely anecdotal, but seem to work for some people.
Cortisone Injections
Although injections are a common approach to treat plantar fasciitis, they are not without scrutiny. Some experts believe steroid injections can increase the risk of plantar fascia rupture. Torn fascia obviously would be a disastrous outcome, so this one may be only reserved for those who are desperate for relief.
Massage Guns For Plantar Fasciitis
I’m mentioning this one because these massage tools are all-the-rage right now and sold as a cure for virtually everything. Clearly they are not, but there may be some short term benefit if you already have one.
A massage gun on your foot can help alleviate plantar fascia symptoms because of the vibration the device produces, which can contribute to “novel stimulation” and a temporary interruption of pain perception.
The vibration helps with fluid and blood flow in the foot muscles. As the massage gun vibrates, more nutrient-rich blood flows to the affected area, supplying all the compounds necessary for the healing process to begin.
Over time, consistent massaging of the tight calf muscles and the fascia can reduce nerve sensitivity, increase flexibility and mobility, and reduce tightness in the plantar fascia muscles of the foot.
It would help to choose the right massage gun for your painful foot condition for the best possible results.
Kinesiology Tape For Plantar Fasciitis
Along with exercise, your therapist may also recommend traditional Low Dye taping, or kinesiology taping on the affected foot area to help with the pain. This is a common and widely used treatment of plantar fasciitis.
A 2015 study revealed that taping your foot offers temporary pain relief from plantar fasciitis.
Kinesiology tape is another option which can also help reduce some loading, but also allow less restricted movement (which may defeat the purpose for some people!).
Your physical therapist may also recommend taping other muscles around your ankle and foot to control the activity of muscles contributing to your plantar fasciitis.
Here are the primary functions of taping for plantar fasciitis:
Take the pressure off of your plantar tissues (unloading)
Decrease the pain
Help the muscles surrounding your foot to provide more support
Support the foot’s natural arch
Sport or Kinesiology tapes (KT taping) are usually safe and do not cause any reactions. But if you begin to itch or notice redness in the area with the tape, it may indicate an allergic reaction. Gently remove the tape and consult your doctor or therapist for another option.
Self Massage For Plantar Fasciitis
Additional therapy, like massage therapy, can help with pain relief. With this type of therapy, the brain is given something else to focus on, therefore, it shifts focus from pain. On top of that, massage relaxes the tight and painful muscles, encouraging blood flow and may reduce the effects of acute inflammation.
If you are not able to consistently see a professional massage therapist, self-massage is the next best thing.
Self-massage, together with stretches and exercises, can be effective in curbing plantar fasciitis before it becomes chronic.
Self-massage techniques for chronic plantar fasciitis should feel good or just a little uncomfortable but not too painful. It would be best to start with soft presses against your foot and increase the pressure as the nerve sensitivity improves.
Because plantar fasciitis pain is usually intense with your first step out of bed, do some self-massage techniques while you’re still in bed before you get up.
This will warm your feet, get the blood flowing, and alleviate tension while prepping your foot to bear your full weight on standing.
Orthotics to Help With Pain
Orthotics are custom-made support devices sometimes prescribed by doctors to help with foot or back problems, but are even more commonly used in the treatment of plantar fasciitis.
The devices are designed according to limb contour to either reduce motion or stabilize the limb, depending on the specific treatment application.
For plantar fasciitis, your doctor may recommend devices such as orthotic inserts, wearing night splints, heel cups, or specific shoes specifically designed to support the foot and to reduce chronic plantar fasciitis pain and the effect of heel spurs.
Your podiatrist may recommend orthotics in conjunction with other treatments, such as taking nonsteroidal anti-inflammatory drugs (NSAIDs), leg braces, or physical therapy.
So how do orthotics work?
First, the devices work to reposition your feet correctly. For example, when your feet overpronate, they roll inward as you walk. For some patients with plantar fasciitis, this can result in a reduction in acute irritation due to the repetitive stimulation of the painful area.
The edge of your heel gets to the ground first, then the rest of the foot rolls inward towards the arch.
This phenomenon is also common in people with flat feet. Orthotic devices and/or arch supports provide support to the arch to try and correct this phenomenon. Orthotics may also offer cushioning and additional support in crucial foot areas such as the ball or heel of the foot.
Orthotics are custom-made, so they focus on the individual’s footwear needs. Here are a few types of orthotics for feet:
Full shoe inserts
Small heel inserts for the back cup of the shoes which can reduce heel pain discomfort
Ankle foot orthotics that include an upright part extending from the heel upward to round the calf area, and a shoe insert.
Extracorporeal Shock Wave Therapy
Extracorporeal shockwave therapy has shown promise in recent research. This therapy involves using a tool to send shockwaves into the plantar fascia to trigger healing.
Only time will tell is this unique therapy pans out, but it is an option for particularly stubborn cases.
How Long Does It Take To Recover From Plantar Fasciitis?
Most people have reported that simple cases of plantar fasciitis symptoms or heel pain usually go away after a few months of home remedies which can include resting, stretching, icing, and using the modalities listed above.
Proper REST is essential for many people, but this advice is often only partially adhered to. Oftentimes when someone feels slightly better, they quickly start increasing activity levels only to get setback with another bout of pain.
Start simple first. Things like a night splint to stretch lower leg muscles could provide a great result, and avoid jumping to the most aggressive approach before doing the basics.
In chronic cases, this condition can last on average around a year, and for some people, much longer.
How to Prevent Plantar Fasciitis
Making a few positive lifestyle changes can keep plantar fasciitis at bay.
Avoid shoes that aren’t supportive and find alternatives that offer excellent arch supports.
It’s also good to regularly replace your exercise shoes. The wearing time for athletic shoes is about 400 to 500 miles. After that, it would be best to get a new pair.
Stretching your plantar fascia, calf muscles, and Achilles tendons is also a great idea before any workout sessions. And try to limit your high-impact exercise. Instead, opt for low-impact activities like swimming or cycling.
Always perform an appropriate ramp up of new activities. One of the common triggers for any type of heel pain or tendonitis issue is a sudden increase in activity levels and/or intensity. Starting a new job that requires long periods of standing is something to avoid as well!
Get Your Life Back From Plantar Fasciitis.
Plantar fasciitis affects 85 percent of Americans annually. Unfortunately, most people experiencing these symptoms do not seek proper medical attention to manage the condition.
Notably, plantar fasciitis can lead to severe ongoing pain if not adequately treated. Therefore, visit your podiatrist and discuss the learnings from this post to see what’s right for you.
