Plantar Fasciitis – a form of “Leftar Rightiitis”?

I came across a fascinating (but old) concept for treating plantar fasciitis as I was searching for my next research topic. The importance of body symmetry in a patient with this painful condition was stressed by Brian Bradley from the Egoscue Method in the Peak Running Performance publication in 2007.

The eyes of folks in our profession are trained to scan bodies stood in front of us and pick out malalignments and asymmetries. However, it can be argued that the findings rarely become the focus of our treatment for plantar fasciitis. Only a few people would look beyond and above the pelvis like an osteopath when the site of pain is in contact with the ground – even the patient would be confused by where we are assessing.

The eyes of folks in our profession are trained to scan bodies stood in front of us and pick out malalignments and asymmetries.

Also, some asymmetries are widely accepted as “normal” especially when asymptomatic, such as shoulder levels, range of shoulder medial rotation, and longitudinal trunk/pelvic rotations. This concept challenges me to rethink what is normal/abnormal in people with persistent musculoskeletal pain which does not response fully to conventional treatment.

Long story short, 5 exercises were proposed to encourage whole body symmetry and help with plantar fasciitis:

1. Auto-assisted cervical + thoracic + lumbar spine twist sitting in a chair,

2. Active cervical + thoracic + lumbar spinal flexion and extension in sitting,

3. Hand behind back + hand behind head bring the two hands together,

4. Shoulder external rotation in 3 positions in prone – full abduction, 135-degree abduction and 90-degree abduction, and

5. Fingers and toes interlocking to mobilise the whole foot in circular as well as dorsi/plantarflexing direction.

It was an interesting observation that in exercises 1-3, there was an emphasis on keeping “feet pointing straight ahead”, as well as keeping hip loose and heels pointing outwards in exercise 4.

I know I need to improve my understanding of the system of fascia and slings in the body to be able to understand the beauty of this concept further. At the moment, I often imagine the spine being like a spring found in a pushing and clicking ball pen, or a straight piece of wire/ pipe cleaner straight out of a bag of craft supply – once sharply bent at one point it will always be the weak point of the whole piece against a bending force applied to both end of the spring/wire. Therefore, increasing the pliability of the entire piece of metal,like exercise 1 and 2, seems to me a good choice of exercise comparing to only mobilising local spring coils (spinal segments)… Many theories to be researched, but I am not brave enough to get dirty with experimental studies.

For now, this mark the end of my warm-up writing exercise.

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