Please note that the advice below is directed at people experiencing symptoms related to plantar fasciosis/plantar fasciitis and may not be suitable for people experiencing heel pain due to other causes.
If you are unsure as to the cause of your heel pain or have not received a medical diagnosis, please seek medical advice before commencing a rehabilitation plan or following advice from this article.
Heel pain
Heel pain from running can occur due to numerous factors and pathologies.
The most common cause of heel pain from running is plantar fasciosis, commonly known as plantar fasciitis.
While plantar fasciosis occurs for several reasons, managing load is often overlooked and holds people back from progressing with their running.
What is load?
Load is a term used to describe the amount of stress your body or a specific structure is subject to while completing an activity. In this case, the plantar fascia while running.
Why is it important to consider load when running with heel pain?
Modifying load won't necessarily heal your injured heel, but it will give you some control over your symptoms and may mean you can continue running.
In theory, every tissue in our body can handle a certain amount of load at a given time without breaking down or becoming injured.
When we push the body too far, we can exceed the tissue's ability to handle the activity and open ourselves up to pain and injury.
Use a cup, for example. If we try to pour 1 litre of water (load) into a 500 ml cup (capacity), the cup will overflow. If we work hard, build the cup up to a 1.5-litre capacity, 1 litre of water (load) won't cause the cup to overflow anymore.
The ability of our tissues to tolerate load can change every day.
Without managing your load, treatment tools such as shoe changes, stretching and orthotics may not be as effective as they can be for heel pain.
What influences the ability of my heel to tolerate running?
Several factors influence how your body accumulates and responds to load when running. Below is a list of some of the factors we need to consider.
Training surface - Softer vs hard surfaces, athletics track vs concrete.
Footwear - Each shoe will load some tissues more than others.
Frequency - Running too often may not allow enough recovery time.
Duration - Running for too long each time may exceed the tissue's capacity to handle the activity.
Intensity - Faster running increases loads on tissues as some muscles work harder than others.
Age - For example, older athletes require more recovery time post activity.
Sex - For example, in the female body, a tissue's load tolerance can be influenced by the phase of the menstrual cycle.
Experience - Beginners will have a reduced capacity to handle load compared to similar people who have practised the same activity for years.
Strength - Improved strength increases the body's ability to handle running.
Nutrition - Humans are made from what we consume in our diet. Deficiencies may delay our repair response following exercise.
Medical conditions - For example, conditions such as diabetes can affect the quality of the tissues within our body. They may be less flexible and have a reduced ability to handle load.
Sleep - This is when our bodies actively repair structures that have been under strain. Inadequate sleep can lead to incomplete repair before the next dose of activity.
Stress - Life stress may influence several of the factors above. Reduced sleep quality when stressed is a good example.
How do I improve my ability to run when I have heel pain?
While you cannot control all factors when it comes to load, there are a few key areas we can nail to make sure you are giving yourself the best chance to succeed with your plantar fasciitis rehabilitation plan.
General lifestyle changes:
Diet - Eat a well-balanced diet with plenty of protein.
Sleep - 7 + hours per night.
Stress - Where possible, minimise overall life stress.
Direct changes on the injured heel:
Use tools such as footwear, stretching and orthotics to take pressure or load off the sensitive heel.
Use a pain scale to help monitor your response to running and other activities:
Using a pain scale of 0 - 10, you may be able to continue running while still experiencing some symptoms. As a general guide, managing your symptoms, so that pain stays around 3 - 4/10 at worst during the activity, will allow you to continue running without overloading and risking a significant flare in symptoms following your run. If pain is considerably worse for the rest of the day or the following morning, you may need to reduce your running further.
Identify what component of your run aggravates your symptoms, then modify it:
Consider the duration/distance, speed/intensity and frequency of your runs.
Most people don't need to stop running. Instead, if the duration of a run aggravates your heel, reduce the duration by half. From there, you can gradually increase the duration or reduce further if this is not enough to keep your symptoms manageable during, immediately after and the morning after your run.
For example, if a 90-minute run causes your heel pain to increase to 7 - 8/10, try running for 45 minutes for a few weeks. If this change allows your heel pain to calm down, you can gradually start adding time. This will enable you to continue running but minimise your chances of aggravating your heel for days on end. It may take a few runs to work out what works for you.
You can apply the same approach to speed/intensity and frequency.
Monitoring your symptoms during the run, for the remaining day after your run and the following morning can help inform you as to how you are responding to your running load. If there is a flare in symptoms during these three times, you may need to adjust your running load.
Don't be scared of a rest day:
An easy day or even a day of complete rest when feeling sore, stressed or just not up to it is OK. Often this is a sign that you need to look at your activities, diet, sleep and stress in the few days prior. The key is being honest with yourself and regaining control.
Get stronger via strength training:
The stronger and more robust you are, the more you can do without overdoing it and risking injury. Just like the cup, the same goes for your body. If we start small and build stronger muscles and a more robust plantar fascia, that run that was once hard and painful will become less so in future.
If you are frustrated, unable to run and require assistance identifying what is holding you back, get in touch or book an appointment online today.
Author: Andrew Apolloni