I know almost everybody promotes “stretching” the plantar fascia for plantar heel pain (PHP) but I cannot get myself to believe that we can actually stretch this extremely tough leathery structure. Even if it were theoretically possible to stretch this fascia, why are we stretching it if the pain is often caused by the plantar fascia being OVER-stretched and being excessively pulled on?
One RCT demonstrated that a program of non-weight-bearing plantar fascia stretching was superior to the standard weight-bearing Achilles tendon-stretching exercises for the treatment of symptoms of chronic PHP.1
A more recent study showed that the simultaneous stretching of the Achilles tendon and plantar fascia for 4 weeks was a more effective that just Achilles tendon stretching alone.2
I honestly have not recommended the traditional calf stretch in a couple of decades but I do prescribe eccentric calf raises on the edge of a step which provide an excellent load on the Achilles tendon and the calf muscles.
So why does “stretching” the plantar fascia sometimes work? We can agree that actual structural lengthening of the fascia has little to do with symptom improvement as there is no correlation with the length of the fascia and pain.
I hypothesize that “stretching” provides non-nociceptive and non-threatening sensory input, which over time, desensitizes the sensitized plantar fascia.
I wish I could tell you the perfect number of reps and hold times, but I can’t. I leave the decision to my patients. I empower them by asking them, “How long do you want to hold the stretch for?” and whatever they say, I say perfect.
“How many times do you want to repeat the stretch?” and again, whatever they say, I say perfect.
“How many times a day do you think you can do the stretch?” and again their answer will be the correct answer!
I am learning that the more I empower patients, the more compliant they are likely to be with whatever I prescribe. After all, they chose the reps and the frequency.
1.Giovanni Bet al Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up. J Bone Joint Surg Am. 2006 Aug; 88(8):1775-81.
2. Engkananuwat P et al Effectiveness of the Simultaneous Stretching of the Achilles Tendon and Plantar Fascia in Individuals With Plantar Fasciitis. Foot Ankle Int. 2018 Jan;39(1):75-82