It’s winter again and for many of us, that means running on the ice. Unfortunately, this is also the time of year when many of us struggle with a varying degree of foot pain, also known as plantar fasciitis. Winter running seems to increase our susceptibility because running on uneven surfaces (snow, ice, slush puddles) challenges foot stability.
So what does all the Latin mean? The plantar fascia is a flat ligament on the bottom of the foot running along your arch from your heel to your toes. Fasciitis is the inflammation that you feel when your plantar fascia is overstretched or overused (i.e. bumping up your mileage too fast). This is caused by straining the ligament and repeated strain can cause tiny tears which in severe cases, can lead to rupture. Some other factors that can contribute are a tight Achilles tendon or high or low arches.
Plantar pain can strike anywhere along the ligament. Usually, it starts as a sharp pain in the heel and as it gets worse, spreads through the arch. Symptoms include pain in the morning or after standing or doing intense physical activity. The pain can feel aching, burning or stabbing and your arch will be tender to the touch.
If ignored, plantar pain can persist for months so it is best to catch it early. Anti-inflammatories, an ice cup massage for 10 minutes twice per day, and reducing your mileage or taking a few days off will help with immediate pain relief. Rehabilitation exercises can also be helpful. Place a towel on the ground and from a sitting position use your bare foot to scrunch the towel toward you. Calf raises and stretches can also help to relive some of the tightness. Range of motion exercises will help loosen up some of the stiffness and a deep tissue massage can ease out some of the crepitus, that crunching feeling you get along the bottom of your foot.
Check the mileage on your shoes as well, sometimes running in shoes that are not supportive can contribute to the tightness. Also, I have found that if you have high arches, adding some barefoot training can help strengthen your arches and reduce the occurrence of fasciitis. If treated judiciously, plantar pain can usually be alleviated within a matter of weeks.
One exception to the myriad benefits of hard training is that inherent and all too familiar foe: inflammation. Unfortunately, the more intense the training, the greater the level of inflammation accrued which bumps up your injury susceptibility. Essentially, inflammation is the body’s reaction to stress. Your body responds to stress by making cortisol, a catabolic hormone thus breaking down muscle tissue.
Inflammation is also the pain you feel with training injuries. Culprits such as plantar fasciitis, IT band syndrome, and stress fractures are common injuries that will probably send you to raid the medicine cabinet for relief. However, the problem with traditional anti-inflammatories (NSAIDs) like aspirin, ibuprofen and naproxen is that they are linked to stomach and kidney problems so they are not recommended for long term use. So that leaves us with the question: How can we curb inflammation, improve recovery and reduce cortisol release post training in a way that is safe but equally effective?
One possibility is with bromelain. Bromelain is a pineapple extract from the stem of the pineapple fruit. Although bromelain has been used by traditional societies for hundreds of years to treat indigestion and inflammation, research is just now studying the medicinal role of this enzyme. In addition to anti-inflammatory properties, bromelain has been shown to speed the healing of wounds and bruises, decrease swelling, and alleviate pain following soft tissue injury. Bromelain can also be used to relieve sinus congestion, upset stomach and arthritis pain.
How does it work? Bromelain indirectly targets the same pathway as NSAIDs so it keeps down pain, swelling and inflammation. When taken on an empty stomach, bromelain is absorbed rapidly and remains active in the blood for hours. Since the mechanism is different, bromelain is safe for long term use because it doesn’t stimulate the acid secretion associated with GI upset and other side effects.
So why not just eat pineapple? Supplemental bromelain is more concentrated, you would need to eat copious amounts of pineapple to derive the same benefit. For sports injuries, researchers suggest 500mg 4 times per day on an empty stomach. One caveat: As with any nutritional supplement, use caution when trying a new product. Bromelain may increase the risk for bleeding so always discontinue use two weeks before surgery.
- Taussig, S.J. The mechanism of the physiological action of bromelain. Medical Hypotehses. 6.1(1980), pp. 99-104.