By: Dr. Victor Prisk M.D.
As a board-certified orthopedic surgeon who specializes in disorders of the foot and ankle, I see many runners in my practice. Although runners mostly come to me for treatment of problems like Achilles tendinitis, plantar fasciitis, stress fractures, and arthritis they are often surprised by the fact that I will examine their knees, hips, and back concurrently. You see, orthopedic problems often originate from our core and/or the joints above and below the problematic site. Thus, I must examine the big picture.
You also need to see the big picture. Besides, why wait until you’re injured and forced to see someone like me? An ounce of prevention is worth a pound of cure. As you read this post, I want you to realize the importance of stretching for injury prevention and optimization of recovery.
Plantar fasciitis is one of the best examples of how joints above and below the problem site can result in remote pathology. The plantar fascia is a band of tissue (technically a ligament) that connects the heel to your toes. Its job is to maintain the arch of your foot as you toe-off while walking or running. When it acts up and becomes painful it is the most common cause of heel pain. Pain in the heel stepping out of bed, getting up from sitting, walking on hard surfaces, or even a constant aching or burning can be related to plantar fasciitis.
If you think about your foot as though it is an ice cube tray, the job of the plantar fascia is to keep the ice cubes in the tray. The ice (bones of your arch) is pushed out by the pulling up on your heel by the Achilles tendon and its muscles, the gastrocnemius and soleus. The “ice” is also pushed out by weight pushing up on the ball of your foot (i.e. toe off, toe running, stairs, hills, etc). Further, if the joints of the foot are becoming arthritic and thus flattening the arch the “ice cube tray” itself is failing and putting more stress on the plantar fascia.
Now we need to look at how tight muscles at the knee can lead to problems with the bottom of the foot. The big posterior calf muscle is called the gastrocnemius or “gastroc”. The gastroc is a muscle that originates above the knee on the back of the thigh bone (femur). Because it crosses the knee it is tight, or “on tension”, when the knee is straight. The hamstrings also cross the knee from the thigh to the tibia and fibula in order to act as flexors of the knee. When we stand or run and our foot goes through stance with the knee straight, the tighter our gastroc muscles the more strain is placed on the arch (ice cube tray) and thus the plantar fascia.
Stretching the gastroc and hamstrings can help to off load forces transmitted from the knee to the Achilles tendon and subsequently the plantar fascia. We know through clinical studies that persistent stretching of the gastroc and use of night splints to stretch the calf while sleeping can resolve the symptoms of plantar fasciitis. This includes stretching the Achilles with the knee straight in order to stretch gastroc muscle crossing the knee.
Plantar fasciitis is just one example of how tight muscles can lead to problems in runners. A list of a few common sources of pain from tight muscles in runners are:
- Tight Gastrocnemius: Achilles tendinitis and plantar fasciitis
- Tight Hamstrings: Pes Anserine Bursitis
- Tight Iliotibial band: Greater trochanteric bursitis and ITB syndrome
- Tight Quadriceps: Patellar and Quad tendinitis, Patellofemoral Syndrome
- Tight Psoas: Anterior hip and Low Back Pain
There are many different ways to loosen up tight muscles groups. First, it is important to recognize that much of your muscle tightness might originate from improper running techniques, poor shoe wear, lack of supportive shoes, over training, or just delayed onset muscle soreness. Address your technique and training issues with a good doc or physical therapist who can perform a functional assessment exam to look for deficits in your kinetic chain. Once you have found supportive running shoes with excellent cushion, like my favorite Mizuno Wave Prophecy’s, you may find a gradual return to running with a daily stretching routine will be much easier. Use relative rest and cross training to recover; don’t just sit on your laurels and hope nature heals you.
One way to loosen up muscle groups is to get deep tissue massage. Deep tissue massage saved me during my collegiate gymnastics career. One way to accomplish this on your own is to try a foam roller. Foam rolling over your glutes, hams, quads, IT band, and calves is a great way to prepare for and recover from a good run. In situations of painful parts or injuries, using a Styrofoam cup filled with ice to do some ice massage can also be helpful to reduce inflammation and pain.
Beyond deep tissue massage, stretching comes in many types including everything from static to dynamic. Many of us learned along the way that we need to stretch prior to activity. Unfortunately, this is a myth. Researchers have found that static stretching where you hold a stretch for 10-30 seconds is an inadequate way to warm up leading to decreased performance and potential injury to the muscles stretched.
Rather, it is important to do an active warm-up getting blood flowing to the muscles and joints. Statically holding a stretch can actually limit blood flow to a body part. Thus it is suggested that before going for a vigorous run, do some light jogging for a few minutes as opposed to just sitting and stretching your hamstrings. There’s definitely a role for stretching and flexibility exercises after your training or at another time in the day. It’s important to recognize that static stretching before high intensity or impact exercise is not recommended.
Types of Stretching:
STATIC STRETCHING
This is where you stretch a particular muscle for a hold of 15 to 30 seconds without bouncing or moving. It should produce a mild, painless pulling sensation in the muscle and not hurt your joints
DYNAMIC STRETCHING
Stretching style where you swing your legs or arms through a stretched position at your limits of range of motion. Speed can be gradually increased.
BALLISTIC STRETCHING
This stretching forces a body part to go beyond its normal range of motion by bouncing in to a stretched position. It triggers the muscle’s stretch reflex (and thus muscle relaxation), but can make you more susceptible to injury if done by the inexperienced.
PASSIVE STRETCHING
This is basically static stretching with a partner who helps hold you in a stretched position. They can add a little extra stretch or get you into a position you might not be able to on your own.
ACTIVE ISOLATED STRETCHING
This involves holding a limb in a position without assistance of another limb or partner. For instance, holding your leg up in the air without using your hands or a support.
ISOMETRIC STRETCHING
Similar to static stretching, but during this stretch you contract the stretched muscle to resist the stretching movement.
PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION
This is a combination of static, passive, and isometric stretching. First, you stretch in a static position. Then you perform an isometric contraction resisted by your partner for ~10 seconds. After the contraction your partner passively stretches you past your last static position. This is a very advanced form of stretching.
Individual Stretching Routine:
- Warm-up Jumping Jacks or Jog in Place for 1 minute
- Standing Quad Stretch 15 sec each leg x 3
- Achilles Stretch each leg 15 sec x 3
- Hamstring Stretches hold 30 seconds x 3
- Straddle Stretch hold 15 sec x3 Left, Middle, and Right alternating
- Arch Ups to Crunch 15 sec in each position x 3
- Overhead Lat Stretch each arm 15 sec x3
- Behind the Back Chest Stretch hold 30 sec
- Behind the Head Triceps Stretch 15 sec x 3
- Cross arm Rear Deltoid Stretch 15 sec x 3
- Foam Roll: Calves, Quads, Hamstrings, Glutes, IT band, Lats, and Deltoids
Dr. Victor Prisk is a Board Certified Orthopaedic Surgeon, IFBB Pro Bodybuilder, All-American Gymnast, and Performance Lindy Hopper. Creator of “The GAIN Plan” lifestyle and XL Factor Performance Nutrition. Turning Dreams into Goals Through GAIN.