If you are pushing your limits in strength training and challenging your ability to produce or absorb high levels of force, you are not always going to feel great physically. Exercise is a form of stress on the body. That stress can be positive or negative depending on how well your body is able to respond and adapt to it. Everyone’s capacity to tolerate and adapt to physical stress is different and depends on many variables. This is why two people can follow the same training program and have completely different outcomes. When chasing a heavier squat, it is common for symptoms to show up in or around the knee during periods of higher load or increased intensity. This is often labeled an overuse injury, which simply means that the total stress placed on the knee exceeded what it could currently tolerate and adapt to. If your knee pain improves with rest but returns as soon as training volume or intensity increases, rest alone is not the solution. Rest can help reduce symptoms and allow tissue recovery, but it does not teach your knee how to handle increasing forces or adapt to different loading strategies. Below are some of my go to methods and the reasoning behind them to help build a more resilient knee when returning to squatting after a training related knee injury. 1) Use cable assisted split squats to improve the ability for the knee to absorb force [embed]https://www.youtube.com/watch?v=n1p8nYAR4zM[/embed] Split squats are a useful way to train each leg with a bias toward the front leg. While both feet remain on the ground, the front leg takes on the majority of the load. Using a front foot elevated variation shifts some weight toward the back leg, often creating a roughly fifty five percent to forty five percent distribution. This reduces stress on the front knee while still allowing meaningful loading. Adding a cable provides slight unloading of body weight and helps distribute force more evenly between the knee, hip, and ankle. This makes it easier to train deeper ranges of motion than traditional bilateral squatting may allow early on. This variation is especially helpful when rebuilding confidence in knee loading and retraining the knee to absorb force without placing all of the stress in one area. 2) Use regular split squats to load the knee more aggressively  A standard split squat without front foot elevation allows the shin to move farther forward over the ankle. This increases the amount of force going through the knee. I typically introduce this variation once someone can perform front foot elevated split squats comfortably and without hesitation. At this stage, I often emphasize higher rep sets, usually in the twelve to fifteen rep range, with moderate load. This helps build both capacity and confidence before progressing further. 3) Reintroduce bilateral squatting with an emphasis on absorbing force first  [embed]https://www.youtube.com/watch?v=wjk8LYtZy34[/embed] Once unilateral loading is well tolerated, it is time to bring back symmetrical squatting patterns. The box squat is a great option at this stage. It allows you to control depth, manage load, and focus on absorbing force on the way down. Start by using a box height that feels comfortable and allows a controlled descent. Sit fully onto the box, pause briefly, then push the floor away to stand back up. Progression can be as simple as gradually lowering the box height over time to increase range of motion as your knee tolerance improves. 4) Reintroduce training load of squatting without any constraints After improving knee tolerance through multiple loading strategies, the final step is returning to your actual squat pattern without external constraints. This step is critical. According to Physical Stress Theory, the body must be exposed to the specific stresses of the task you want to perform in order to adapt to it. Your knee needs exposure to the real demands of your squat to fully regain resilience. This is where you gradually build back toward your normal training loads while monitoring symptoms and recovery. Final Takeaway Knee pain related to squatting and overuse is common. While rest can play a role in managing symptoms, it is not a substitute for progressive exposure to load. A resilient knee is one that can absorb and produce force in many different ways. By gradually rebuilding capacity through thoughtful progressions, you give your knee the best chance to adapt and tolerate the demands of heavy squatting again. Try the strategies outlined above and reach out to a qualified coach or physical therapist if you need guidance tailored to your specific situation.

If you are dealing with low back pain, even basic daily activities can feel difficult, not to mention workouts. While these foam roller exercises are not meant to be long term solutions, they can provide a valuable window of relief. That relief can help calm symptoms so you can get through your day and continue moving while you work on addressing the deeper root causes of your back pain. Foam rolling in the traditional sense, meaning rolling out tight muscles, is often most effective as a warm up or for short term relief of tightness. However, foam rollers can be used in many other ways. They can help encourage pelvic and rib cage mobility, improve muscle activation, and reduce sensitivity in certain areas. Try the five exercises below and focus on the ones that feel best both during and after performing them. 1. Traditional Foam Rolling: Hip & Thigh Muscles (Glutes, piriformis, quads, hamstrings, IT band) Low back pain often stems from restrictions in the hips or thigh muscles. When these areas are tight, they can pull on the pelvis and limit its movement, which increases stress on the lower back. You may notice significant tenderness when rolling areas such as the IT band or deep hip muscles. This is often a sign that your pelvis is positioned in a way that increases load through these tissues and that hip range of motion is limited. While these positional issues need to be addressed for lasting relief, foam rolling these areas can temporarily reduce restrictions and create some relief. Spend extra time on the most sensitive spots and move slowly. Improving hip mobility can help give your lower back a more supportive foundation. 2. Lazy Rolling [embed]https://youtu.be/2rgBt_1D4bU[/embed] Low back pain can also come from a lack of relative motion at the pelvis. Relative motion refers to the ability of the hips and lower back to move independently from one another, which is necessary for walking, running, squatting, and most lower body activities. This lazy rolling variation encourages small, gentle movements at the pelvis. It is especially helpful for individuals with SI joint pain, which is located where the spine meets the pelvis. Try this exercise on both sides and notice if one side feels more sensitive. The movement should require very little effort and should feel slow and relaxed, just as the name suggests. 3. Wall Supported Hip Hikes [embed]https://youtu.be/jwQc2zq3iMA[/embed] Many people fall into what is often called a right dominant pattern. In this pattern, more weight is shifted into the right leg and hip, and the pelvis adapts accordingly. This can be difficult to notice on your own but is commonly identified during a movement assessment. One key to shifting out of this pattern is learning how to properly use the right glute to move your body back toward the left. You may have been told you have weak glutes, but often the issue is difficulty activating them rather than true weakness. This exercise helps specifically recruit the right glute to counteract a right dominant pattern. When performed correctly, you should feel a strong muscle burn in the right glute. 4. Hip Mobilizations: Sit Bone Decompression [embed]https://youtu.be/UA6h5ng74Js[/embed] The area around the sacrum and sit bones is another common location for muscle tightness and restriction. When these tissues stiffen, they can affect how the lower back moves and manages load. Sit bone decompression can feel surprisingly uncomfortable. If it does, that is often a sign that the area needs attention. Start with a small towel roll to reduce intensity and make the position tolerable. As comfort improves, progress to using the foam roller. 5. Rib Cage Mobilization [embed]https://youtu.be/JdF1w3ulrFs[/embed] While many low back strategies focus on what is happening below the spine, restrictions in the rib cage can also contribute to low back pain. The rib cage should expand during an inhale and close down during an exhale. When this movement is limited, the body can get stuck in one extreme. Lying over a foam roller helps close the bottom side of the ribs while allowing the top side to expand. This exercise can also be sensitive at first. If you have trouble relaxing over the foam roller, start with a rolled towel or folded pillow to reduce discomfort. As tolerance improves, gradually transition to the foam roller. These foam roller exercises can be a helpful short term tool for calming low back pain and improving how your body moves. If pain persists or limits your ability to perform these movements, it may be time to seek guidance from a licensed professional to address the underlying causes more directly.

Low back pain is almost as universal as catching a cold. Nearly everyone will experience it at some point in their lifetime, and how severe it becomes is often unpredictable, setting aside obvious traumatic causes. What is just as common as experiencing low back pain is being told that the solution is to strengthen your core or improve core stability. That advice is not always wrong, but it is often incomplete. In some cases, it can even work against long term spinal health and physical function, especially for people who have dealt with recurring low back pain. When most people are told to improve core stability, they are usually instructed to lock their midline into a fixed position, create high levels of tension through the abdominal and back muscles, and then move their arms and legs without allowing the spine to change position. Training the spine to resist motion is important. The ability to brace and limit movement is a necessary skill in certain situations. When carrying something heavy, creating tension through the trunk can make the task more efficient by reducing unnecessary movement and wasted energy. After an acute back injury, resisting motion can also be appropriate. When tissues are strained or sprained, the spine may not tolerate much movement early on. Exercises that emphasize resisting motion can allow someone to keep exercising and reduce pain without aggravating sensitive structures. Here is the part that often gets overlooked. Most people who experience low back pain will improve on their own with time. Many do not need to permanently change how their core muscles coordinate to recover. One factor that may slow recovery for some people is the belief that their back is fragile or unstable and that they must brace their spine for everything they do to avoid reinjury. Picking clothes up off the floor should not require squeezing your entire body as hard as possible. Brushing your teeth should not demand a perfectly rigid hip hinge. If, after the early phase of injury has passed, the only thing you ever train your spine to do is resist motion, you gradually lose access to the motion your spine is capable of creating. When motion is no longer used, the tissues involved are no longer exposed to those forces. Over time, they decondition and tolerate less stress. A strategy that was protective in the short term becomes limiting in the long term. If bending over feels difficult or threatening, it may not be because bending is inherently dangerous. It may be because your spine has been trained to stay rigid all the time. Clinically, when patients present this way, we often start with movements like a hooklying two arm reach. This helps reintroduce hip and pelvic motion that supports spinal flexion and allows the lower back to begin bending again in a controlled way. [embed]https://youtu.be/C7hLRzrWF_4[/embed] Once the foundational mechanics are restored, we progress to movements that directly retrain spinal motion while encouraging bending, such as a heel elevated toe touch. This helps move away from constant bracing and begins re exposing the spine and its supporting muscles to load through flexion. [embed]https://youtu.be/RQ28YFF8rdg[/embed] A full range of motion Jefferson curl is an excellent later stage option. It allows the spine to bend through its available range while building strength and control in positions where people often feel vulnerable. These are often the exact positions where back tweaks occur, likely because the spine has not been trained to handle load there. Training your back to resist motion is only one piece of the puzzle. A resilient spine should also be able to create motion when needed and tolerate load in a wide variety of positions. The body adapts to what it is repeatedly exposed to and allowed to recover from. In many cases, retraining your spine to bend is not harmful. It is the missing ingredient that restores lost function after a back injury and helps build long term strength and confidence.

Think you have a “bad back”? Maybe it’s time to check your knees and hips instead! Pain is not always what it seems. The body is a complex system where each part influences the others. While we often think in terms of individual body parts, the truth is that we always move as a whole. When one area is not moving the way it should, another area often steps in to compensate. This concept is known as regional interdependence. Physiopedia defines it as “the concept that seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient’s primary complaint.” In simpler terms, this means that pain felt in one area may actually be coming from somewhere else. For example, knee pain might not be a knee issue at all, but instead the result of an ankle that has been sprained multiple times. Similarly, low back pain may not be a back problem, but rather the result of hips that are not moving as they should. As shown in the image above, certain joints in the body are designed primarily for mobility, while others are designed more for stability. Mobile joints like the hips and shoulders move through large ranges of motion in multiple directions. Joints designed for stability, such as the knees, move through more limited ranges. The knee, for example, primarily moves forward and backward with minimal rotation or side to side motion. Problems arise when this balance is disrupted. Let’s look at a common example. Imagine a soccer player who suffers an ACL tear. The knee is meant to be a stable joint, but now one of its key stabilizing structures is compromised. As a result, the knee becomes more mobile than it should be. When this happens, the body looks for stability elsewhere. Often, this leads to reduced motion at the hip as it tries to compensate for the instability at the knee. This compensation can then continue up the chain. If the hip loses mobility but the athlete still needs to sit, run, jump, and cut, all of which require significant hip motion, the next area to make up the difference is often the low back. Over time, the low back begins to move more than it is designed to. The muscles in that area are forced to work harder and absorb stresses they are not well equipped to handle. Eventually, this can lead to persistent low back pain. In this scenario, what presents as low back pain may actually stem from an old knee injury. The body is remarkably good at adapting. It will find ways to work around injuries and limitations so you can continue functioning. Unfortunately, these compensations can eventually create pain in areas that were never the original problem. This is why low back pain, shoulder pain, or other chronic issues are not always problems of the area where the pain is felt. To truly resolve pain, it is often necessary to zoom out and look at how the entire body is moving. If treatment focuses only on the painful area, it is easy to get stuck in a cycle of treating symptoms without ever addressing the true source of the problem. If any of this sounds familiar, consider consulting a licensed professional who can evaluate your body as a whole and help identify what is really driving your pain. Reference: https://www.physio-pedia.com/Regional_Interdependence#:~:text=Purpose%20%26%20Definition,-The%20purpose%20of&text=Simply%20put%2C%20regional%20interdependence%20is,with%2C%20the%20patient's%20primary%20complaint.

A common question that comes up in the clinic is whether physical therapy for low back pain can actually work if an MRI or X ray shows positive findings. This concern makes sense. Traditional thinking often suggests that if something looks abnormal on imaging, that must be the source of pain. Not quite. In many cases, imaging findings only matter when they clearly match very specific symptoms. More often, they serve as a sign rather than the true root cause of pain. Relying too heavily on imaging can cause you to overlook deeper movement based issues that are actually driving your symptoms. A typical MRI or X ray for someone with low back pain may show disc degeneration, disc bulges or herniations, bone spurs, stenosis, loss of disc height, spondylosis, or spondylolisthesis. Some of these findings are completely normal age related changes. Others, such as disc herniations, do reflect structural damage. Even so, that does not automatically mean they are the source of your pain. Structural Damage Does Not Equal Pain One of the most important concepts to understand with back pain is that damage does not equal pain. Pain is one of the most complex processes in the human body. It is influenced by biomechanics, the nervous system, hormones, stress levels, and psychological factors. Because of this complexity, there is rarely a one to one relationship between structural damage and pain. Research consistently shows that many people with no back pain at all have disc degeneration or even disc herniations on MRI. At the same time, others experience severe pain despite having no significant findings on imaging. This disconnect is one of the biggest reasons imaging alone rarely provides a complete answer. Your Symptoms May Not be Related to Imaging Findings  Imaging results should always be considered alongside your clinical symptoms. Pain that is primarily driven by structural damage tends to be constant, unrelenting, and often accompanied by nerve related symptoms such as numbness, tingling, or burning. Sciatica caused by nerve compression is a classic example. On the other hand, signs that your pain may not be directly related to imaging findings include symptoms that come and go, pain that only shows up with very specific movements, or the absence of nerve related symptoms. If you have had back pain for a long time, there is also a strong chance that any initial structural damage has already healed. The body is remarkably adaptable. Research shows that disc herniations often heal within six to twelve months. In fact, larger herniations frequently heal faster than smaller ones. If pain persists well beyond that timeframe, it is often related to an underlying movement dysfunction that may have contributed to the injury in the first place. What the Root Cause of the Pain is Even when imaging findings are not the direct cause of pain, they can still provide clues. Disc herniations commonly occur due to weakening of the back portion of the disc. As the disc weakens, it becomes more vulnerable to injury. Often the final trigger is something minor like bending over or sneezing. This weakening process is frequently linked to reduced blood flow, which is essential for disc health. Blood flow to the disc decreases when the back side of the spine stays compressed for long periods of time. That compression often happens in positions that bias spinal extension, such as excessive arching or bending backward. If your body is stuck in postures or movement patterns that consistently load the spine this way, the disc becomes more vulnerable over time. These patterns are often influenced by stress, habits, and repetitive activities. The solution is not fixating on the disc damage itself, but identifying and correcting the movement patterns that led to both the damage and the ongoing pain. Understanding this bigger picture is often the missing piece in resolving persistent back pain when imaging alone does not give clear answers.

The inversion ankle sprain is the most common injury in the world. Walking down the stairs and missing a step. Getting bumped in the air during a layup and landing on the outside of the foot. In an instant, force is applied through the outside of the foot and ankle at a speed the ligaments and surrounding tissues cannot rebound from, as shown in Image 1 below. [caption id="" align="aligncenter" width="894"] Image 1: An inversion ankle sprain in the NBA.[/caption] Like most acute injuries, damage to the bones, muscles, ligaments, and tendons triggers inflammation. This response helps clear damaged tissue and initiate healing. Swelling follows as part of this process and gradually decreases as the acute phase of injury resolves. Once ankle and foot range of motion is restored, one of the most commonly prescribed interventions is unstable surface training. This usually involves standing on a foam pad, wobble board, or BOSU ball while maintaining balance and foot contact. The idea behind this approach is that standing on an unpredictable surface forces the ankle and center of gravity to adjust continuously. This is thought to retrain body awareness and reduce the tendency to place force through the outside of the foot, which could lead to another ankle sprain. [caption id="" align="aligncenter" width="929"] Figure 2: Single Leg Stance Balance Retraining on a Bosu Ball[/caption] There is nothing inherently wrong with this concept. For athletes and active individuals, the ability to respond to unexpected perturbations and regain control is important. The issue lies in how well this type of training transfers to real world movement and sport demands. Most sports are performed on solid surfaces such as hardwood courts, turf, grass, asphalt, or concrete. These surfaces do not yield the way unstable surfaces do. The yielding nature of unstable surfaces makes it difficult to place the ankle, foot, and rest of the body into positions that are optimal for producing force to slow down, absorb load, and change direction safely. Clinically, individuals with recurrent ankle sprains often struggle to control internal rotation through the foot, ankle, and hip. Internal rotation represents the ability to drive force down into the ground beneath the body. To slow down effectively during landing, the body must apply force into the ground over time. To redirect movement, it must quickly produce force again to push away from the surface. If you attempt to produce downward force while the foot and limb remain oriented toward external rotation, force continues to be directed toward the outside of the foot instead of directly beneath the body. This limits your ability to reduce sprain risk. In the example referenced above, notice how the foot may be on the unstable surface, but the shin remains oriented outward relative to the body. This brings up an important question. How do we retrain the ability to produce force directly beneath the body rather than outside of it? The first step is developing coordination in a low demand position, such as the supine cross connect shown in Video 1. [embed]https://youtu.be/TcsiqnDrd0g[/embed]  Video 1: Supine Cross Connect  This exercise helps align the foot, knee, hip, and rib cage while pressing into a fixed surface. The wall simulates the ground, allowing you to learn proper force direction without the complexity of standing balance. Progression: Low Step Up Cable Chop Once this pattern is solid, the next step is transferring it to a standing position. [embed]https://youtu.be/mGzNekn1g3o[/embed] Video 2: Low Step Up Cable Chop  In this exercise, the stance leg is positioned directly under the body while the cable or band chop helps guide force into the inside portion of the foot. This reinforces proper alignment and force production during upright movement. These exercises are just two examples of how to retrain the ability to absorb and generate force without directing bodyweight toward the outside of the foot. To be truly prepared for sport or high level activity, these principles must eventually be trained at higher speeds, under greater loads, and repeatedly without fatigue altering mechanics. If you have tried unstable surface training and still feel that your ankle does not function the way you expect after an injury, this approach may be worth exploring. If you have questions, feel free to reach out and continue the conversation.

For something as small as a toe, it can be surprising how much influence the big toe has on the rest of the body. With every step we take, the big toe helps us sense the ground and plays a major role in how we push off from one foot to the next. When big toe extension is limited, especially the motion needed to rise up onto the toes, walking mechanics can change significantly. Those changes often lead to compensations that do not stop at the foot. Over time, they can affect the knees, hips, low back, and even travel upward into the upper back, shoulders, and neck. Basics of Walking:  To understand why the big toe is so important, we first need to review some basic anatomy and the gait cycle, or how we walk. The big toe is designed to extend backward roughly 70 degrees, creating nearly a right angle with the bottom of the foot. This extension can become limited for several reasons, but two of the most common contributors are altered joint positioning and tightness in the muscles that flex or curl the toe downward. Changes in joint position can occur for many reasons and are best identified during a full evaluation with a physical therapist. Factors such as high or low arches, excessive pronation or supination, or pushing off the outside of the foot instead of the big toe can all alter how the bones of the foot align. When alignment changes at the big toe joint, the available motion is often reduced. The important takeaway is that these changes are often modifiable. With the right interventions and exercises that address the root cause, big toe position and movement can frequently be improved. The second contributor is tightness in the muscles that hold the toe in a flexed or curled position. It is important to understand that muscle tightness is usually a response, not the original problem. Muscles typically become tight due to the positions they are placed in or the demands repeatedly placed on them. It is uncommon for someone to be born with muscles that are simply too tight. More often, tightness develops as a reaction to how the foot is functioning. That is why identifying and addressing the underlying cause is essential for long term improvement. Gait Cycle: Push Off To further highlight the role of the big toe, we need to look at the terminal stance and toe off phases of the gait cycle. During this phase, the heel lifts off the ground and the body moves forward over the big toe. This motion requires adequate extension at the big toe joint. Because we take thousands of steps each day, even small impairments in this phase can add up over time. Diagram: Phases of the normal gait cycle, including heel strike, loading response, mid stance, terminal stance, pre swing, toe off, mid swing, and terminal swing. When the big toe cannot extend properly, people often compensate by rolling toward the pinky side of the foot during push off. Another common compensation is the development of a bunion, which occurs when force is driven through the inside edge of the toe instead of allowing the toe to extend backward at the joint. Both of these compensations can lead to pain in the toe or foot itself. They can also increase stress on the knees, hips, low back, and other areas as the body adapts to keep walking smoothly despite the limitation. Whether you are dealing with foot pain, pain elsewhere in the body, or are concerned about a developing bunion, the big toe is often an overlooked but critical piece of the puzzle. If you have been focusing only on the location of your pain without success, it may be time to zoom out and look at the entire body, quite literally from head to toe. A thorough assessment by a physical therapist can help identify movement limitations, compensations, and how they may be contributing to ongoing pain.

I used to train in martial arts pretty extensively. I even competed for both glory and tiny trophies. I studied several styles, but I went the furthest in Judo. There is something deeply satisfying about getting into your opponent’s head and navigating every move and counter move. It felt like chess, but with actual fighting and no getting punched in the face. This article is not about my love for throwing people. It is about how I used to sprain my ankle every few months. One wrong step. One moment of lost focus. Suddenly I was off the mat and out of the gym for two to four weeks. This frustrating cycle kept me from getting as strong and as skilled as I wanted to be. It left me feeling fragile. What was the point of training so hard if something so simple could take me out so easily and so often? I no longer deal with this problem, but if any of this sounds familiar, keep reading. Understanding Ankle Sprains There are several types of ankle sprains, but we are going to focus on inversion sprains since they are the most common. An inversion sprain occurs when the heel rolls inward and the outside of the foot collapses toward the ground. This usually happens for one of two main reasons. Either your center of mass shifts outside of your base of support, or the peroneal muscles on the outside of your lower leg do not activate quickly enough as the ankle begins to roll. The peroneal muscles work to evert the foot and ankle, essentially resisting the exact mechanism that causes an inversion sprain. You want these muscles on your side. For the purpose of this article, we are going to focus primarily on delayed muscle activation. The term sprain means damage to a ligament. Ligaments are connective tissues that attach one bone to another. When it comes to inversion ankle sprains, the ligaments most commonly involved are the anterior talofibular ligament and the calcaneofibular ligament. Unlike muscles, ligaments do not contract and they do not have their own direct blood supply. Because of this, they heal more slowly and they cannot actively change their length once healing has occurred. Here is an important and often overlooked fact. The number one predictor of a future ankle sprain is a previous ankle sprain. Let’s unpack why that matters. Why Ankle Sprains Keep Coming Back We are often taught that ligaments are what hold our bodies together. That is only partially true. Ligaments are not especially strong. Muscles are what truly stabilize us and allow us to move through the world. Ligaments do have an important role though. They are loaded with mechanoreceptors, which are sensory structures that help your brain understand where your body is in space. As your joints move, ligaments stretch and send signals to the brain, providing constant updates about joint position. This sense of body awareness is called proprioception. Without proprioception, movement would be clumsy and uncoordinated. When you sprain a ligament, it is forcibly stretched and partially torn. As it heals, it does so at a slightly longer length than before. Ligaments cannot shorten themselves after healing. This means that after an ankle sprain, the ligaments are a bit looser than they used to be. Because these ligaments help provide positional feedback to the brain, the signals they send are now slightly delayed. The delay may only be fractions of a second, but during high speed or high intensity movement, that delay matters. Here is the good news. Muscles also contain mechanoreceptors. By retraining the muscles of the foot and lower leg, especially those on the outside of the ankle, you can help make up for the lost feedback from the injured ligaments. This is why proper rehabilitation is not just about strength. It is about timing, awareness, and control. What Comes Next Now you know why ankle sprains tend to repeat themselves and why simply resting until the pain goes away is not enough. In Part 2 of this series, I will walk you through a few foundational exercises that we consider mandatory in any complete ankle rehabilitation program. These drills are designed to restore confidence, improve control, and help stop the cycle of rolling your ankle over and over again. Stay tuned.

You are reading this because either you, or someone you care about, has been dealing with a persistent burning or aching pain on the bottom of the foot. Maybe it only hurts when walking. Maybe it hurts all the time. Maybe it is in the middle of the arch or closer to the heel. Either way, chances are a podiatrist or orthopedist has told you that it is plantar fasciitis. Here are three things they probably did not tell you. There is typically nothing wrong with the foot itself Typical solutions do not address the root of the problem Exercise is the only way to truly eliminate it Let’s get into it. There is Typically Nothing Wrong With the Foot Itself Plantar fasciitis is classified as an inflammatory condition, but inflammation itself is not the problem. Inflammation often gets a bad reputation, but it is actually a critical part of the healing process. When tissue damage occurs, even at a mild level, inflammation shows up to start repair. Think of a car accident on the highway where a guardrail is damaged. Police arrive to secure the area, tow trucks remove vehicles, street cleaners clear debris, and construction crews rebuild the rail. Inflammation serves a similar purpose in the body. It clears debris and delivers materials needed for healing. Inflammation only becomes an issue when it never resolves. If inflammation represents the first step in healing, then chronic inflammation means the body is constantly trying to repair damage but never catching up. This is the definition of an overuse injury. With plantar fasciitis specifically, the pain in the foot is usually the result of a problem, not the problem itself. Flat feet, high arches, or family history are rarely the primary cause. If the structure of your foot were the issue, pain would have shown up much earlier in life. Typical Solutions Don’t Address the Root of the Problem Common treatments include rest, boots, stretching, massage, cortisone injections, and orthotics. While these can help reduce pain, they often miss the bigger picture when used alone. The goal of early treatment is to reduce stress on the plantar fascia so healing can occur. A boot, night splint, or rest period lowers overall load. Pain decreases and things feel better for a while. Then the boot comes off, life returns to normal, and weeks later the pain slowly creeps back in. That is not bad luck. The strain did not happen randomly. You felt better because support and reduced activity offloaded stress. Once normal movement and load returned, the same stresses were placed on the same tissues. Stretching and massage often follow next. Rolling the foot on a frozen water bottle and stretching the calves can feel great temporarily. Relief lasts an hour, then symptoms return, so the cycle repeats. Temporary relief is mistaken for progress. Cortisone injections often come next. They can dramatically reduce pain by suppressing inflammation. The problem is that inflammation is not the root issue. Removing the warning signal does not eliminate the stress causing the problem. All of these approaches treat symptoms, not causes. They can create a window of opportunity to do the real work, but they are rarely sufficient on their own. Exercise is the Only Way to Truly Eliminate It If most treatments focus on reducing pain, then exercise must address why the pain exists in the first place. That usually means strengthening the foot and improving how forces move through the body. Strengthening is straightforward. Strong tissues tolerate more stress before breaking down. This allows you to do more without accumulating overuse. Unfortunately, seated calf raises and toe curls only take you so far. To truly change capacity, exercises like walking, farmer carries, step ups, step downs, split squats, lunges, and light plyometrics must be part of the plan. The other major factor is motor variance. For this discussion, motor variance means how many movement options you can access and control. The more positions your foot, ankle, and lower leg can move through, the less wear any single tissue experiences. Think of it like shoes. If you wore the same pair every day, they would break down quickly. Rotating through several pairs spreads the stress. Stretching and massage temporarily improve range of motion, but range of motion is driven by muscle activity. If stiffness keeps returning, those muscles are doing a job. The key is figuring out why. That often means looking above the foot. What if plantar fasciitis pain is influenced by your upper back? The position of your center of mass has a major impact on your feet. If the upper back, lower back, or hips are stiff, they can push your body weight forward. As your weight shifts forward, your calves and feet must work harder to keep you upright. You push your toes into the ground to prevent falling forward, which increases stress through the plantar fascia, calves, and Achilles. Muscles tighten to protect you from tipping. Suddenly foot pain is not just a foot problem. This is why any approach to plantar fasciitis that ignores center of mass is incomplete. If you have been dealing with foot pain for a long time and nothing seems to work, widen your lens. Do not stare at one tree so closely that you miss the forest.