Going back to tennis after PF - Need advice

Discussion in 'Health & Fitness' started by bharat, Apr 9, 2012.

  1. bharat

    bharat Rookie

    Joined:
    Nov 5, 2009
    Messages:
    140
    Location:
    WI
    Hi All

    After suffering with PF for over 8 months and have tried stretching, orthotics, icing, rest, finally my doc gave a cortisone shot to my foot and I have been out of tennis for about 6 weeks now, I am getting ready to go back to tennis shortly and am looking for some advice on how to get back.

    My foot feels normal now, no pain during day nor is there pain in the mornings. I am currently on stretching routines at least once a day if not twice.

    Is it advisable to start with workout routines for the legs and foot? My plan is to start with cycling and elliptical, then go to calf raises and squats etc.

    planning to play some tennis this weekend, just hitting with a friend, nothing serious or intense

    been looking around for some tennis workout routines on the forum but cant find any, can someone point me to a post if there is one? i am working on getting one together based on "Tennis Fitness: For the love of it" but too many in there to choose from

    --Bharat
     
    #1
  2. charliefedererer

    charliefedererer Legend

    Joined:
    Feb 13, 2009
    Messages:
    5,639
    It sounds like you are taking the right approach of getting back to tennis gradually, so as to prevent an early recurrence of plantar fasciitis.

    Also your plan to improve your fitness after a long layoff with cycling and ellipticals is a great one.



    Everyone loves Suzanna McGee. If you want to take her approach from "Tennis Fitness: For the love of it", you may want to put together these three workouts:
    Mini Workout - Legs, Core and Foot Work for your Tennis Fitness
    http://www.examiner.com/la-in-national/mini-workout-legs-core-and-foot-work-for-your-tennis-fitness
    Legs, Core and Upper Body Stabilizers Strength Routine to Improve your Tennis Fitness http://www.examiner.com/la-in-natio...rength-routine-to-improve-your-tennis-fitness
    Mini Workout - Core and Shoulder Stabilizers http://www.examiner.com/la-in-national/mini-workout-core-and-shoulder-stabilizers


    If you are looking for a more complete workout to help prevent shoulder, elbow and wrist problems, the best is probably
    Thrower’s 10 Exercises Program http://www.muhlenberg.edu/pdf/main/athletics/athletic_training/throwers10.pdf


    If you are looking to improve your cardiovascular fitness once it seems clear your plantar fasciitis is better, consider
    HIIT - High Intensity Interval Training http://www.intervaltraining.net/hiit.html

    If you want to work on your cardiovascular fitness, but also want to work on the ability to start, stop and change direction quickly, consider doing
    USTA agility drills: http://assets.usta.com/assets/1/USTA_Import/USTA/dps/doc_437_269.pdf


    If you would like a site that gives a good overview of programs for tennis fitness, check out
    Sports Fitness Advisor, Tennis Training Section http://www.sport-fitness-advisor.com/tennis-training.html
     
    #2
  3. bharat

    bharat Rookie

    Joined:
    Nov 5, 2009
    Messages:
    140
    Location:
    WI
    thanks Charlie!

    I will start with the mini workouts and then get into some more strength training.
     
    #3
  4. gilly2571

    gilly2571 Guest

    Sounds like a really good approach as some have already stated. The shots were a temporary fix for me. It was the custom orthotics that really made the difference as far as permanent relief. They feel odd when first wearing them but if you use them in ALL of your footwear it will help, or at least it did for me. Only drawback is the outrageous cost of $300. Worth it if you want to keep playing though.

    Good luck!
     
    #4
  5. sureshs

    sureshs Bionic Poster

    Joined:
    Oct 1, 2005
    Messages:
    35,086
    Do you know what caused the PF? I have hereditary flat feet and some pain once in a while so I want to know how to avoid it.
     
    #5
  6. Chas Tennis

    Chas Tennis Hall of Fame

    Joined:
    Feb 17, 2011
    Messages:
    4,283
    Location:
    Baltimore, MD
    I had PF for about a year. As I continued to play tennis it kept getting worse. I stopped for 3 months. My feet - after no tennis for 3 months - did not feel perfect but the slight residual PF feeling went away. In retrospect, I probably should have waited longer to be safe. I stretched my calves and had gotten non-prescription arch support inserts.

    A friend of mine took off from tennis for a year to shake his PF. It worked. Another much younger friend, 30, has continued to play volleyball with PF for years! Last I heard it was not improving.

    I am very uncertain on needed healing times but 2-6 months away from any damaging stress is my best guess for tendons and ligaments. ?

    I have never had a cortisone shot. The cortisone shot is often effective in masking pain. But I'm very uncertain - again - about the effectiveness of cortisone for healing or even if it helps healing at all.

    You have been off tennis for 6 weeks. Consider taking some more weeks off and on returning let any pain guide you.
     
    #6
  7. bharat

    bharat Rookie

    Joined:
    Nov 5, 2009
    Messages:
    140
    Location:
    WI
    Yes I did get those custom orthotics, although I must say I cannot tell any difference since i started using them, except that i paid 500 for them!! Oh, come to think of it, it took away the blisters i was getting with the orthotics the doc customized for me(adding those pads where needed).
     
    #7
  8. bharat

    bharat Rookie

    Joined:
    Nov 5, 2009
    Messages:
    140
    Location:
    WI
    So my PF story starts about 3 yrs ago when I started noticing the pain, went one doc who immediately gave me a cortisone shot right there (I had no idea what it was and i knew nothing about other ways of treating it)
    He said nothing about stretching or orthotics or anything!!

    Anyway, as expected the pain came back with a month. So next I went to my current doc who gave some anti-inflammation meds and jerry-rigged a pair or orthotics for me. Within a week, I was back to normal and the pain had gone away.

    Unfortunately, about 6 months ago, it came back but it kind of felt diff, it was sharp pain to the inner side of right heel, came up suddenly within a few days. I had been using the same shoes for about 3 months and they had plenty of wear in them. I changed my shoes immediately and hoped it would go away but that didnt happen.

    So now, after trying out diff orthotics, taking time off, htp inserts, icing, stretching, tried diff shoes and few weeks back we came to the difficult decision that cortisone is the logical next step. My doc said there is a nerve going down the calf to the foot right where I feel the pin pointed pain, that got caught in the inflamed area and is refusing to heal.

    Now, I dont feel any pain in the heel, although I have been off my feet most of the last 3 to 4 weeks. Hope this will be the last time I feel this horrible nagging pain. Sorry for the long post, hope this helps u avoid PF.

    I tell everyone I play with now, pre and post match stretching is the only way u can keep your body safe
     
    #8
  9. sureshs

    sureshs Bionic Poster

    Joined:
    Oct 1, 2005
    Messages:
    35,086
    My symptoms are these:

    Happens mainly on workdays when I show up for play after a day full of walking to meetings and here and there. Does not seem that much on weekends.

    At first, there is no pain. Then, pain starts after I have run to a few balls.

    Sometimes it just goes away after 10 minutes.

    It never happens in doubles, so it must be related to some movement in singles.

    Is this PF? I stretch before playing, but what can I do for the foot? How to stretch it?
     
    #9
  10. charliefedererer

    charliefedererer Legend

    Joined:
    Feb 13, 2009
    Messages:
    5,639
    These are plantar fasciitis exercises:

    [​IMG]
    - http://www.summitmedicalgroup.com/library/sports_health/plantar_fasciitis_exercises/

    Do you wear orthotics or supportive insoles like Superfeet Orange or Green?

    Most with flat feet can have the sole pushed upward by the orthotic/insert so that functionally they no longer have flat feet:

    [​IMG]
     
    Last edited: Apr 10, 2012
    #10
  11. Chas Tennis

    Chas Tennis Hall of Fame

    Joined:
    Feb 17, 2011
    Messages:
    4,283
    Location:
    Baltimore, MD
    Where exactly is the pain?

    PF is often localized. Where exactly is your pain? Also, it often gives characteristic pain in the morning on first getting out of bed.

    An informative site is Heelspurs.com

    http://heelspurs.com/_intro.html

    [​IMG]
    [​IMG]
     
    Last edited: Apr 10, 2012
    #11
  12. Chas Tennis

    Chas Tennis Hall of Fame

    Joined:
    Feb 17, 2011
    Messages:
    4,283
    Location:
    Baltimore, MD
    Reply in earlier PF thread.

    Here are some of my opinions on PF and its cause.

    An informative site is Heelspurs.com http://heelspurs.com/_intro.html

    From earlier thread -

    http://tt.tennis-warehouse.com/showthread.php?t=371446&page=2 Relpy #38

    "Some Considerations on Plantar Fasciitis
    I had plantar fasciitis and tried to play with it. It slowly got worse over about a year. I did not see a doctor. I read that tendons and similar tissues take 3-6 months to heal. I finally took off from tennis for 3 months. The PF went away. A friend of mine had a similar experience and took off for a year.

    Along the way, I read about many of the other subjects mentioned in this thread.

    I tend to read and then make up a story that makes sense to me. I have been very wrong before so check out any of my opinions independently. ……..one mistake could be a show stopper……..

    The term “plantar fascia” as used here means all muscles, tendons, fascia, etc, on the bottom of the foot – This structure has not been clearly defined in what I have read.

    As discussed on the websites one main cause of plantar fasciitis is tight & short calf muscles. The calves connect to the heel through the Achilles and the heel connects to the plantar fascia - all in one chain. There are two calf muscles, the gastrocnemius and the soleus. Both the gastrocnemius and soleus connect through the same tendon to the heel, the Achilles (also another potential injury spot if the calves are tight).

    Bent Knee or Straight Knee? An important point is that the gastrocnemius connects to the bone above the knee. When the knee is semi-straight the gastrocnemius contributes a lot of force but as soon as the knee is bent a little the gastrocnemius becomes slack and contributes much less force. The soleus is connected below the knee and can apply force through the heel whether the knee is straight or bent. Only the soleus works when seated.

    During Tennis Gastrocnemius or Soleus? During tennis which of the two calf muscles is causing the most strain on the Achilles and plantar fascia? I don’t know and have not seen it discussed. On one hand maybe some very stressful straight-leg move such as changing direction while coming down might be the most damaging. ? On the other hand it seems that tennis is being played mostly with a bent knee. Therefore it seems reasonable that the soleus might be the muscle most often causing too much strain on the plantar fascia. ?

    Life Style. Most people spend a great deal of time with the calf in a much shortened state: sitting at the computer with bent knees and pointed toes (pointed toes = short calf muscles), watching TV with pointed toes, sleeping with pointed toes, etc. Sitting around, sleeping, etc. for 120 hours a week and then playing tennis for 8 hours a week sets up the problem. If the calves have become too short or tight during tennis they overstretch the plantar fascia and put excess strain on it.

    Strengthening Exercises. Exercise both calf muscles with straight leg calf raises. Exercise only the soleus with seated calf raises.

    General Stretching. 1) I have read that you should warm up the muscle before stretching. That is easy to do for calves, run a little or do calf raises on steps. 2) Also, that you should not stretch when injured……….this is problematic for most tennis players because they don’t want to quit………..?

    Calf stretching – There are straight knee stretches for both gastrocnemius and soleus. There are bent knee stretches for just the soleus. My favorite bent knee soleus stretch is - while seated - to place a thick telephone book under the front of my foot, heel off the floor, cross the other leg over for a little added weight and do a gentle stretch. After a warm up, this stretch is easy to do while watching TV.

    If you only do straight knee stretches and the gastrocnemius is tight does the soleus get a useful stretch?

    Night Issues- You play tennis and afterward the PF hurts more or less. You go to bed and point your toes for some hours. During sleep healing occurs. The calves and plantar fascia are in a shortened state. You wake up and get out of bed, ouch! I speculate that your tight calves are tearing up some of the new healing of a short plantar fascia. ?? Help, Doc. (Mine would hurt for a minute or two just in front of my heel.) Night splints stretch both your calf and the plantar fascia so that any healing is done with the plantar .. more elongated."
     
    Last edited: Apr 10, 2012
    #12
  13. sixftlion

    sixftlion Rookie

    Joined:
    Jun 28, 2006
    Messages:
    262
    Location:
    Venice, CA, US
    I've been away from the forum for a while... Bharat, just recently I wrote two articles about importance of strengthening your feet muscles. I think you would benefit from the exercises tremendously, and eventually get rid of your orthotics and play without pain. Check them out here:

    Part 1:
    http://www.tennisfitnesslove.com/2012/01/fit-and-healthy-feet-for-better-tennis-and-less-injuries/


    Part 2:
    http://www.tennisfitnesslove.com/2012/03/flexible-hip-flexors-and-healthy-feet-will-improve-your-tennis-fitness/

    With strong feet, you can do any of those routines that CharlieFedererer outlined for you and you will do great.

    Suzanna
     
    #13
  14. sureshs

    sureshs Bionic Poster

    Joined:
    Oct 1, 2005
    Messages:
    35,086
    Thanks Charlie and Chas.

    I think it is the calf muscle shortening issue that you mentioned. I sit with my knees bent for hours during the day. That explains why I get the pain on working days (after work).

    I don't have any pain in the morning or night and the pain stops with more playing or when I stop playing. Never any pain during normal activities, only during stop-and-go running during singles.

    The pain is on the sides of the feet, not in the areas shown in the figure. As if the side edges of my feet are not being supported properly and I need some strapping there.
     
    Last edited: Apr 11, 2012
    #14
  15. Chas Tennis

    Chas Tennis Hall of Fame

    Joined:
    Feb 17, 2011
    Messages:
    4,283
    Location:
    Baltimore, MD
    Suresh, Feet are very complex and you could have tight calves but the calves might not be related your foot pain. ? My opinions listed above seemed to fit my case of plantar fasciitis. I'm sure that there is a long list of other possibilities for your issue. Reason enough to see a Dr.
     
    Last edited: Apr 13, 2012
    #15
  16. bharat

    bharat Rookie

    Joined:
    Nov 5, 2009
    Messages:
    140
    Location:
    WI
    I think the trademark symptom for PF is pain in the morning, since you dont have that, I dont think its PF in your case.

    Have you tried icing and stretching after u play?
     
    #16
  17. bharat

    bharat Rookie

    Joined:
    Nov 5, 2009
    Messages:
    140
    Location:
    WI
    thanks Suzanna! I will check out those posts.
     
    #17
  18. sureshs

    sureshs Bionic Poster

    Joined:
    Oct 1, 2005
    Messages:
    35,086
    I stretch before. Not after. I need to add it.

    But this pain I have is around the outside edges of the feet. Sometimes I will supinate my feet to make them vertical, and press down with the outside edge of the shoe, if you can visualize it. The shoe is on its side and being pressed down. That "massage" on the feet edge feels good and relieves the pain a little.
     
    #18
  19. sureshs

    sureshs Bionic Poster

    Joined:
    Oct 1, 2005
    Messages:
    35,086
    OK plenty of answers when googling "foot outside edge pain"! Wonder why it did not occur to me to do it before this.

    Peroneal tendonitis.

    Causes include calf muscle shortening (as mentioned on this thread) and improper shoes (I noticed that the pain was much less when I switched to a new pair).

    Cure is stretching, foam rolling, and proper shoes.
     
    #19
  20. Chas Tennis

    Chas Tennis Hall of Fame

    Joined:
    Feb 17, 2011
    Messages:
    4,283
    Location:
    Baltimore, MD
    I'd first research the specific problems associated with overuse and flat feet?

    With some posture issues muscles in you hip area or upper body can cause problems in the knees and feet.

    I would see a specialist especially since you have flat feet.
     
    #20
  21. bharat

    bharat Rookie

    Joined:
    Nov 5, 2009
    Messages:
    140
    Location:
    WI
    Actually there is no study showing that stretching before is helpful, on the other hand there are plenty showing stretching after is key to avoid injuries.
    If you only do one, it should be post match.
     
    #21
  22. paulfreda

    paulfreda Hall of Fame

    Joined:
    Oct 3, 2004
    Messages:
    1,612
    Location:
    Bangkok, Thailand
    My cure ....
    I bought tennis shoes 2 sizes larger than normal and in the wide 2E size so there was plenty of room to put 2-3 layers of Dr Scholl's gel pads inside.
    My PF disappeared for good.
    Only issue was getting used to these large things on my feet and that turned out to be mostly my fears of falling down. Was not a problem in the long run.

    Hope that helps you.
     
    #22
  23. charliefedererer

    charliefedererer Legend

    Joined:
    Feb 13, 2009
    Messages:
    5,639
    I'm glad that this solution seemed to help you, and it was good of you to post this to potentially help others.

    I thought I would just note a bit of caution however.

    It would take some experimentation to find the right "fit" with your approach and risk a turned ankle from losing the tight fit and support provided in most tennis shoes.
     
    #23
  24. Frank Silbermann

    Frank Silbermann Professional

    Joined:
    Feb 24, 2004
    Messages:
    1,063
    I guy I used to play, in his late 70s, came down with PF a little over a year ago. He hasn't played over six months, has been to doctors, says he's tried everything, still suffers even when walking (he stands a lot in his job). No help there.

    I started developing it six months ago. It would be sore after playing, then sore also the next day, then every day. I bought HTP Heel Seats to wear all the time and especially while playing, and there was an immediate improvement. That allowed me to start doing some stretches and it gradually went away completely. I started jogging a month ago, and I still wear the inserts for that, usually. But my older friend says he tried them and they did nothing for him.
     
    #24

Share This Page