Key to Recovery from Injury and Pain is Fascia Treatment
I was just reading CBS sports and read about the fascia injury to NFL Seattle Seahawks player Greg Olsen. It’s being reported Olsen has a plantar fascia rupture. Pete Carroll, head coach of the NFL team said, “It’s a little early, but he has a fascia tear injury that he has had before in his other foot.” Carroll further stated the typical recovery times for this kind of injury is around four to six weeks. Everybody wishes Olsen the very best in getting back as soon as possible, but it is worth bearing in mind that within Greg’s 14yr football career, he has a long history of foot, ankle and knee injuries. This kind of injury could have the potential to bother him for the rest of his career.
Fascia is connective tissue. It connects every part of the body with every other part, wrapping around muscles and holding organs in place. Addressing issues in the fascia can reduce pain, increase range of motion, and help nourish muscles and nerves.
Typical rehab for a plantar fascia injury (tear) begins with immobilization of the foot such as a walking boot or crutches. This is normally followed by physical therapy and other supportive techniques and devices such as taping and orthotics. This should all help the fascia injury by removing tension from the facia as it heals. Eventually you will want to restore mobility, function and strength back to the foot with a range of treatments and therapies. The therapies you receive to rehab the foot – or any injury – are critical to fully and efficiently resolving your injury.
Olson, as a professional athlete, is exceptionally fit and will very likely recover from this fascia injury and return to play soon. Like most athletes, he has suffered numerous injuries throughout his long career. However since many athletes play hurt, it’s possible this fascia injury may not fully heal before Olsen begins to compete again. Olsen likely has other nagging injuries that have gone through this same cycle and that are still symptomatic
We see this type of scenario often in our physical therapy clinic here in Anchorage. In a nutshell, old injuries that are still irritating will produce a host of other compensatory movement patterns that can lead to further injury. In these situations the previous yet ongoing injury sets the foundation for re-injury to the same point of the body and or other part of the body.
While we’re confident Oslen is receiving excellent treatment despite not knowing the details of the treatment – we think that a key cause of an athlete being more susceptible to injury is because their fascia has embedded or stored in it the history (and problems) born from previous injuries. Previously embedded fascia injury issues will be explained in this blog.
Normally you would expect a seasoned veteran of the NFL like Greg Olsen to be dealing with the effects of past injuries, and it is noticeable that the more experience the player has the better his team needs to be to keep him in front of suffering from wear-and-tear and injury. However, the problem is not just a question of age and playing time; there is something far more fundamental going on that affects players of all sports, whatever their age. We are talking about the under-appreciated role of your body’s fascia in injury and pain, particularly how fascia can spasm and then inflame as a natural response to injury. And it is this natural spasm that can get stuck and locked into the body, such that it does not fully release without the right help. The consequences of this in the long-term can be detrimental to an athlete’s career, particularly if the fascia injury problems accumulate over the years.
The Fascia is Fundamental to Injury Issues
Why is fascia so important? Why is it so fundamental to injury issues? Well, for one thing, fascia isn’t just at the bottom of your foot or in your muscles.
Fascia is what wraps around and pervades through the whole body, continuously linking everything from head to toe. It is present in your bones, ligaments, muscles, arteries, nerves, veins, lymph vessels, cartilage, skin, and more. If you don’t treat the right fascia correctly, it can stay stuck in spasm. This superbly-designed protective reflex has an inherent mechanism that can sustain the fascia pain and spasm indefinitely, allowing the body to be able to permanently protect an injury site. Unfortunately this is a dysfunctional fascial spasm. In fact, the fascia pain and spasm dysfunction actually recruit muscles to “guard” it. This is because muscles are the body guards to your body, such that if a small bit of painful spasming fascia sends a distress signal, they step in and tighten to help guard the fascia and stop it from being over-pulled/stretched and further hurt. This process that causes permanent spasming of a bit of fascia is called a fascia dysfunction and this can precipitate changes in muscle activity when your body assumes certain positions, and can eventually lead to an increased likelihood of injury.
How a fascia reflex can take over a muscle
This natural process effectively provides the mechanism for muscles to become “hijacked” by their role as protectors of fascia and the body. This means that even though in sports you can control your muscles, there will be limits to how much they will let you do certain things – particularly if they have been given an extra role of protecting a vulnerable part of the body from further harm. What is worse is that your ability to control your muscle strength and position can become overridden because the body subconsciously prioritizes the protection of itself over your desire to use the muscles to do what you want them to do. This process that overrides the muscle strength is a neurologic reflex, which means it isn’t actually a reflection of how strong you are; instead, it reflects your body’s innate ability to automatically coordinate muscles to protect a specific area of the body.
What causes this neurologic reflex to kick in is when your fascia is stretched in a certain way so that the nerve endings in it get aggravated to the point that they send a “DANGER ALERT!” message to the spine and brain. This reflex message will then cause muscles to immediately guard the fascia and its nerve endings by producing tightness and potentially temporary pain around the stretched fascia.
Translated into the real world, this means that when your body gets into certain positions in sports and activities there is a mechanism that kicks in that’s controlled by your nerve endings in your fascia that tells certain muscles to tighten. This is actually a normal process and happens whether your fascia is normal or dysfunctional, and it protects the body during sports or everyday activity. However, when you have a fascia pain and dysfunction that has caused a specific injured bit of fascia to remain permanently tight, it is almost constantly hijacking your muscles to guard the area. You might feel this as weakness, tightness, or suffer an injury with no warning at all.
How a fascia reflex can lead to weakening of a muscle
This is because if a muscle has to tighten and be strong for a vulnerable bit of fascia, this will cause other muscles to temporarily and artificially be weakened. This occurs through a mechanism called reciprocal inhibition. Reciprocal inhibition of muscles is a fancy way of saying that in order for one muscle to shorten (squeeze or contract), another muscle must lengthen (or relax….somewhat). A classic example of this is the biceps muscle: in order to flex the arm and bend at the elbow, the biceps muscles contract, shorten, and bulge while the triceps muscles have to relax and lengthen. If the triceps didn’t relax and lengthen, the arm would stay stuck straight. You may not notice any weakening in overall strength while working out, and there are several reasons for this:
You could have a great set of compensations that serve you well, so you don’t notice much obvious muscle weakness or much pain. Unfortunately, and especially if you’re an athlete, you might not be alerted that minor strength differences or minimal pains are a problem. However, subconsciously your body could still be aware of remaining fascia pain and dysfunction around an old injury. Thus, the body will learn to compensate around that injury….until it can’t.
The position of the exercise is not stressing the fascia, so your muscles won’t actually be weakened: no stress on a fascia dysfunction means no muscles get hijacked into weakness.
However, if you do notice tightness that won’t go away or a difference in strength between either side of your body (and you don’t have an obvious injury to one side), there is a pretty good chance that fascia pain and dysfunction is the cause.
A Healthy Fascia is the Key to Recovery from Injury and Pain
It is well appreciated by therapists working on the body that issues in the trunk and hips can affect gluteal muscle and hip strength. In our experience, it is usually fascia pain and dysfunction creating the loss in hip strength. This loss in strength requires the body to compensate. Normally the calf muscles will have to fill in for the reduction in glute strength. This requirement puts the calf muscles in a disadvantageous position as they have to partially fulfil the role of the glute and the role of the calf while you squat, walk, or run.
Although the calf and glute muscles work together and have similar roles in movement, the ability for the calf to cover shortfalls in the glutes will have limitations. This is because your glutes primary role is to generate power in the hips while running, squatting and walking. The calf muscles are both smaller and aren’t as ideally placed, being stuck down in the lower leg, to help with this. It’s the equivalent of the tuba player in a band disappearing and requiring the much smaller trombone to cover both his part and the part the tuba normally plays. The music created should be okay and identifiable, but it won’t sound quite as good or be what the composer meant it to sound like.
With the calf muscles making up for the shortfall in glute strength you would expect them to fatigue more quickly. This increased stress on the calf muscles will eventually lead to increased stresses being put into the knee and ankle joints. This will then expose the knee and ankle joints making them more prone to injury and fascia pain and dysfunction as the calf muscles are less able to protect those joints from damage when playing sports.
You can take this one step further and consider what is left as back-up if the glutes and calf muscles are not working fully: the next group of muscles to normally step in and help out are the smaller muscles of the foot. The smaller 20 muscles of the foot now not only have the responsibility of looking after the foot, but now have to substitute for covering the roles of the calf and glute muscles.
You would expect the muscles of the foot to more quickly fatigue as they are poor substitutes for those other muscles, leading to injuries of the foot like plantar fasciitis and other conditions. It is the equivalent to now asking a flute player to cover both the trombone and the tuba parts, as both have gone out for a beer – you might still be able to recognize the piece played, but it isn’t going to sound right because distinct parts are missing. In this way you can see how muscle weakness can lead to someone becoming progressively more prone to injury.
Greg Olsen’s history of right knee, ankle, and foot problems indicate not only that specific types of fascia in those areas might require attention, but also certain fascia in the trunk and hips likely needs help. With Greg’s new fascia injury to the left foot, we can’t be sure what the cause is, but it could be related to compensations around other fascia problems. If so, Olsen could potentially benefit from an experienced Fascial Counterstrain therapist to complement his current treatments.The Fascia Counterstrain therapy would zero-in on his fascia pain and dysfunctions from his previous and current injuries, focusing on releasing the permanently spasming fascia around these areas. This should help improve both his recovery time and his prospects of not only a full recovery, but actually increase the quality and longevity of his career.
Why fascia can prevent you from fully healing and how this affects performance
When you heal up after an injury, you might normally believe that the effects of that injury are over. Unfortunately, with the potential for fascia pain and dysfunction, that may not be entirely accurate. In fact, symptoms like chronic pain, tightness, and inflammation are indicators that you haven’t fully healed – even when an MRI or X-ray suggest that you have fully healed or have no identifiable condition. The reasons for this require their own article to properly explain, but, in short, several types of treatment miss the key role fascia inflammation and spasm play in injury, particularly when it comes to allowing you to finish the healing process and removing protective spasm and guarding. Thus, a previous injury which hasn’t undergone Fascial Counterstrain theapy may be more likely to create a situation where you are susceptible to getting a new injury because your body is still dealing with the fascia pain and dysfunction of the first injury.
When your body compensates for an old injury, this is perfectly natural and actually healthy, and most people don’t realize that this is even a problem as it doesn’t cause pain and is hardly noticeable. However, someone like Greg who is regularly experiencing the equivalent of a car crash a week playing NFL will start to accumulate more and more serious injuries, which in turn will cause more and more long-term compensations that his body is required to perform.
The body is a marvel and you can often stress it like this for years and years with multiple injuries, and it is able to hold itself together. But you might notice reductions in speed, strength, and flexibility, but nothing too detrimental to overall performance. However, at some point all the accumulated compensations existing “under the radar” that have held Greg Olsen together for years leave him very susceptible to injury. His compensation options effectively run out, such that even a relatively minor thing can cause a major injury like a fascia injury tear.
Fascial pain and dysfunction is seen in many injuries and conditions across the whole body, but as a common treatment, Fascial Counterstrain therapy is not widely known about or applied. Therefore, most people don’t know how much better they can feel and move when they get effective treatment for the different types of fascial dysfunctions that have accumulated in their system, whether they are from current or previous injury sites.
Put simply, Fascial Counterstrain therapy could be a very useful addendum to anyone’s current rehab treatments, whether you are a professional athlete or not.
As an aside, here in our physical therapy clinic in Anchorage, we handle cases of plantar fasciitis routinely. This is a far more common facial injury to the foot than what Greg Olsen had happen to him (i.e. a plantar tear). In fact, medical research indicates 1 in 10 of us will get plantar fasciitis in our lifetime (Rosenbaum et. al., 2014). A tear to the plantar fascia is not as common as plantar fasciitis, in part because the plantar fascia is just so darn strong.
However, people who play sports that require explosive power and fast pivoting (football, basketball, rugby, soccer, tennis, baseball, volleyball, etc.) are maybe more likely to suffer from this. Plantar fasciitis often causes pain, particularly in the morning just after you get out of bed. I would suspect that Greg Olsen may have had plantar fasciitis symptoms in that same foot prior to his plantar tear.
Plantar fasciitis treatment in Anchorage
If you are suffering with plantar fasciitis, please consider Fascial Counterstrain therapy as a treatment since it’s likely that the cause the fasciitis is not just in the foot or calf, and that it will likely require fascial dysfunctions of other injuries to be fully addressed before you will be able to get full resolution of your plantar fasciitis. In our clinic we will check and treat every type of fascia in every part of the foot in addition to finding the hidden fascia problems around the body from past injuries. All this will help ensure that your plantar fasciitis can heal optimally.
Contact us if you have any questions or would like to learn more about your plantar fasciitis and any other injury or pain you are experiencing.
Rosenbaum AJ, DiPreta JA, Misener D (March 2014). “Plantar heel pain”. The Medical Clinics of North America. 98 (2): 339–52. doi:10.1016/j.mcna.2013.10.009. PMID24559879.
