Why Didn’t Physical Therapy Help?

Monday, March 15th, 2010 At 2:14 pm

I would like to answer this question with a case history. I was treating an ultra-marathoner who was preparing for his 10th 50 mile race. It was a big deal for him as 10 is a *big* milestone (understandably, not too many people have run 50 miles, no less have done it 10 times!).

A bad case of plantar fascitis!

The ultra-marathoner had a bad case of plantar fascitis. In an attempt to attain his goal, he ventured down a quest to find the cure for his condition. His quest started at numerous sports medicine doctors, months of physical therapy at 2 different locations and treatment by his chiropractor. Each one addressed a different aspect of his condition.

Here is how it went:

• The MD gave him NSAIDS and also use an injection of corticosteroids. This gave him temporary relief but when he went back to his routine it came back.
• Because of his determination he read how chiropractic may help. So his quest led him to so-called alternative medicine. This next stop was to his chiropractor who manipulated his pelvis and hip. The chiropractor explained this was causing an abnormal gait pattern (how you walk and run) which affected how he was landing on his foot. His chiropractor also gave him some custom orthotics to help with an over-pronation of his foot.
• The adjustments did not seem to help (although they gave him relief of some low back pain he was experiencing) and the orthotics seemed to aggravate his feet. Increasing foot pain was not the reason for this visit so the quest continued.
• His doctor then sent him to a popular physical therapy clinic. This was a busy operation and what we call a PT mill. He was brought in as a number and run through the conveyor line.
• After 8 weeks of ultrasound, stretches, band exercises and told to ice at home he was losing hope. The ultrasound and ice helped a bit, but the calf stretches seemed to hurt so he stopped.
• Next stop, a physical therapist (PT) that was recommended by another runner. The PT was also a runner so this gave him some comfort. The program there was better. The PT spent one on one time , did some “massage on the fascia” that seemed to help and reviewed some stretching and even focused on a balance routine. He was improving quite well, but each time he tried to run, it would come back.
• The PT advised no running! This advice is almost impossible for any runner to comply with but the ultra-marathoner was desperate.
• After a few months he was better. He was ready to start training again. The race was getting closer only a few months out. After a few weeks though, the pain returned. He decided he would just run through the pain. He would finish this race if it killed him.

Still determined…

Still determined, this patient decided to continue his search. He researched on the Internet and found a technique call Graston. That is what lead him to our clinic. Graston is a very effective soft tissue technique that utilizes stainless steel instruments to break up the scar tissue and adhesions that build up with injuries such as this. He was sure this would cure him so he came in looking for the miracle pill and he was sure this was it.

On evaluation day, we informed him there is no miracle pill. Graston is fantastic but it is not your solution. Actually, it is not the only solution. The truth is everything he did along the way was correct. He needed manipulation of his SI joint as the restrictions in his low back were creating an abnormal gait, just as his chiropractor said. He also needed the orthotics. He was ovepronating and it was causing extreme stress on his fascia (this is why every time he went back to running the pain returned).

“Well the orthotics made it worse,” the ultra-marathoner shared. That is because of the adhesions and scar tissue that has built up over time. This is where the Graston will come in. It also needs to be applied to the calf, quad and low back as there are many muscular imbalances either as a result of this journey or one of the original causes.

We made all the corrections and treated him up to the race. We are happy to report the ultra-marathoner finished the 50 miles virtually pain free!

Important Takeaways

The moral of this ultra-marathoner’s story is two-fold:

• First, pain is usually not where the problem is.
• Secondly, the whole lower kinetic chain must be addressed when dealing with any runners injury.

This is why we have a multi-discipline clinic that combines the benefits of chiropractic, physical therapy, strength and conditioning for any injury. For additional information on Plantar Fascitis or the lower Kinetic Chain, view our article entitled Plantar Fascitis & Other Lower Leg Injuries or email us with any questions or comments.