I would like to wholeheartedly thank my Thai colleagues for their recent enlightening publication in Foot and Ankle International, “Effectiveness of the Simultaneous Stretching of the Achilles Tendon and Plantar Fascia in Individuals with Plantar Fasciitis.” [1] The upshot of this study says that for plantar fasciitis, simultaneous passive stretching of the plantar fascia and the gastrocnemius (the upper portion of your calf) is superior to just stretching the gastrocnemius alone.
We could not agree more!
This study has clearly confirmed an additional unique advantage of the One Stretch design: the patented, one of a kind curved surface will stretch the plantar fascia at the same time the gastrocnemius is stretched.
I do have a few critiques of this study, or at least what my colleagues will cherry pick as their takeaway:
It could easily be implied from this study that the plantar fascial stretch component is critical, and as I have seen so routinely, stretching of the gastrocnemius (upper calf) is minimized and thus put on the back burner. In fact, this study is about quicker resolution of symptoms, not just resolution of symptoms. The critical component of stretching both is stretching the gastrocnemius (the upper calf). Said another way, if the calf stretch is not emphasized, then its association (actually root cause) in so many other non-traumatic acquired foot and ankle pathologies will be lost [2,3]. Think bigger picture! Just examine the related work of Benedict DiGiovanni. In 2003 [4] and 2006 [5] he started the plantar fascial stretching craze with flawed, biased research. Then in 2011, the light finally went off and he and Patel [6] reported on the “association” between equinus (your tight calf) and plantar fasciitis.
Group 1, the group stretching only their calves, had a clearcut disadvantage using the leaning against the wall method. This is not a robust method to stretch the calf, and that needs to be taken into consideration.
Group 2, in contrast, stretched with the full weight of the body creating the stretch, particularly the calf. Sounds and looks much like the One Stretch, doesn’t it?
The authors allude to stretching less: both in days per week and time spent doing each stretch. With this I cannot disagree more. 30 years of clinical practice as well as the Level I study by Porter [7] inspired by my stretching protocol, says there is definitely a lower time limit of each stretch in order to achieve success.Put simply, there’s a threshold that needs to be achieved to see return on your calf stretching!
In fact, so many stretching studies fail because the method of stretch and/or the time frame is inadequate. 15 years of tinkering with stretch times with my patients bore out that two minutes or less three times everyday was much less effective and 4 minutes or more was no more effective than three minutes three times everyday.
So, three minutes, three times everyday it is! And of course on the One Stretch.
References:
1. Engkananuwat P, Kanlayanaphotporn R, Purepong N. Effectiveness of the simultaneous stretching of the achilles tendon and plantar fascia in individuals with plantar fasciitis. Foot & Ankle International. 2018;39:75–82.
2. Amis J. The gastrocnemius: A new paradigm for the human foot and ankle. Foot Ankle Clin. 2014;19:637– 647.
3. Amis J. The split second effect: The mechanism of how equinus damages the human foot and ankle. Frontiers in Surgery. 2016;3(38).
4. DiGiovanni B, Nawoczenski D, Lintal M, Moore E, Murray J, Wilding G, and Baumhauer J. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain a prospective, randomized study. The Journal of Bone & Joint Surgery. 2003;85:1270–1277 .
5. DiGiovanni B, Nawoczenski D, Lintal M, Moore E, Murray J, Wilding G, and Baumhauer J. Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitisa prospective clinical trial with two-year follow-up. The Journal of Bone & Joint Surgery. 2006;88:1775–1781.
6. Patel A, DiGiovanni B. Association between plantar fasciitis and isolated contracture of the gastrocnemius. Foot & Ankle International. 2011;32:5–8.
7. Porter D, Barrill E, Oneacre K, May B. The Effects of Duration and Frequency of Achilles Tendon Stretching on Dorsiflexion and Outcome in Painful Heel Syndrome: A Randomized, Blinded, Control Study. Foot & Ankle International. 2002;7:619-624.