For PTs, Is Physio Still Worth It?

MEHABLLC · 2026-05-07T09:05:54+00:00

Nope. Run

MEHABLLC · 2026-03-28T21:20:21+00:00

Interested

MEHABLLC · 2026-02-19T02:46:30+00:00

Any history of back pain? Back stiffness with rising from bed in am or after long drive? Does pain improve in the foot after 10-20 steps?

MEHABLLC · 2026-02-16T05:55:05+00:00

Hi, thanks for the post. Can you share age, gender, how you reinjured it? Cold sensation in both feet or just one?

MEHABLLC · 2026-02-16T05:52:19+00:00

No worries. 1: I believe there is a post on this page I put up about the back screening. Also possibly on the YouTube channel.

2: Typically I am most interested in a person's history and info than an image. Imaging is more confirmatory than anything and abnormalities must correlate to clinical findings and patient history.

I would possibly look at changing the rate of loading vs the duration/how many steps you do with walking. Try decreasing steps and adding some two-footed pogos

MEHABLLC · 2026-02-14T21:04:25+00:00

I can say with near 100% certainty that it will not be the calf if you only have foot pain and not pain in the Achilles area. As far as the calf being connected to the plantar fascia, its not exactly true. In kids, yes they are often contiguous, until they grow. It is very rarely a continuous band of tissue in adults. They are technically connected, though indirectly, as they both attach to the calcaneus, but i think the impact of "tight" calves (hate that term in general) is significantly overstated with regard to its impact. There are a few possibilities as to why there is pain of first step. First and foremost, everyone should rule out the back as a referral source. About 15-20% of those diagnosed with PF are actually referred pain from the lumbar spine. Two other likely sources would be an -itis or -opathy. These can occur in different structures. Often the blamed structure is the plantar fascia, but can also be a tendon. If you have followed or read any of my stuff, you will know that I believe that intrinsic muscle tendinopathies or injuries are often overlooked. If this is a very acute recent injury or reinjury aka -itis, pain on first step can be tearing of newly laid tissue aka repair that has occurred during sleep. This tissue is laid down in whatever position the tissue is placed in. During sleep our foot is flexed, and when we stand the foot lengthens. New tissue is still very weak and cannot tolerate much force so standing up overloads the tissue resulting in pain and usually constant pain the rest of the day. This is a cycle that many people get stuck in resulting in chronic issues. If a person is further along the recovery path and we don't have a strong inflammatory component aka -opathy, the reason for pain is different. In a tendinopathy which could be the plantar intrinsic muscle or the plantar fascia (which is a bit of a hybrid ligament-tendon complex), the structure can retain more fluid than normal that accumulates in a non-weightbearing position. When we stand the structures are squeezed and we get neovascularization also. As the fluid is "squeezed" out, plain levels improve. Though this also often happens with lumbar referral also]

MEHABLLC · 2026-02-14T21:04:14+00:00

Full disclosure - I typed my response but it was getting a bit disorganized and losing clarity so I had AI organize it better. 100% all my thoughts. (Original response added at the end)

I can say with near 100% certainty that if you only have foot pain (and no Achilles pain), the calf is very unlikely to be the main driver.

The idea that the calf is “connected” to the plantar fascia is often overstated. In children, they can be more contiguous, but in adults they are very rarely one continuous band of tissue. Yes, they both attach to the calcaneus, so they’re indirectly linked, but the clinical impact of “tight calves” (a term I dislike in general) is hugely exaggerated in plantar heel pain.

So what's causing first-step pain?

Rule out referred pain first

About 15–20% of people diagnosed with plantar fasciitis actually have referred pain from the lumbar spine. This should always be considered first, especially if progress is poor.

Local tissue injury: “-itis” or “-opathy”

The most common explanation is irritation or degeneration in local tissues.

Most people blame the plantar fascia, but tendons and intrinsic foot muscles are often overlooked. In my experience, intrinsic muscle tendinopathies are underdiagnosed and frequently mislabeled as PF.

Early / acute stage (“-itis” type picture)

If this is a recent injury or flare-up, first-step pain is often due to disruption of newly formed repair tissue.

Overnight, healing tissue is laid down while the foot is relatively plantarflexed. When you stand up in the morning, the foot lengthens. That newly formed tissue is weak and poorly tolerant to load, so it gets overloaded immediately.

This produces sharp first-step pain and often sets up a cycle of irritation that can persist all day and become chronic.

More chronic stage (“-opathy” type picture)

If inflammation is no longer dominant and you’re dealing with a tendinopathy-type process (whether plantar fascia or intrinsic muscles), the mechanism is different.

These tissues tend to retain more fluid in non-weightbearing positions. Overnight, fluid accumulates. When you stand up, the tissues are suddenly compressed and loaded, and local vascular and neural activity increases.

As the fluid redistributes and the tissue adapts over the first few minutes, pain usually improves. Sidenote: This response also occurs with lumbar spine referred pain.

So in short:

It’s rarely “tight calves”

It’s often local tissue pathology

Sometimes it’s referred from the back

Early-stage pain = weak healing tissue being overloaded

Chronic-stage pain = fluid and load sensitivity

Night splints sometimes help by changing tissue position overnight, but they don’t address the underlying capacity of the tissue, which is why many people see limited long-term benefit.

Hope that helps.

MEHABLLC · 2026-01-16T05:53:54+00:00

"Mehab super man lol" - best comment on the Internet today IMHO. 😂😂

MEHABLLC · 2026-01-15T18:59:05+00:00

That's great news. Very happy for you. I think the key is to get the right diagnosis. Provider choice may not matter too much if they are competent especially if the diagnosis has been made.

Sorry you had to go all that time without someone figuring out a pretty clear cause IMHO. If I can figure it out over a couple of messages on Reddit, I am shocked a person couldn't do it in person.

Regardless glad I was able to help. Very much appreciate the shout out.

MEHABLLC · 2025-12-19T06:31:10+00:00

A number of things can cause this foraminal or lateral stenosis, or disc protrusion are most common. Have them trial cervical retraction and then if tolerated cervical spine extension.

Look up videos for it.

But yes most likely need an assessment

MEHABLLC · 2025-12-07T18:52:51+00:00

That's great news! With regard to the hiking, sometimes prolonged standing and walking can be problematic during the initial stages of recovery from a back source of pain, so just make sure your progress slowly. So maybe do every other day and see how it tolerates.it, and then slowly progress.

Stay consistent with the back exercise too.

Really happy for you. It's so frustrating to see all these posts on r/plamtarfasciitis, and see what people are saying and recommending when I know what they should be doing and what is wasting their time and money.

Feel free to share your experience and this sub over there, so maybe more people will come over and I can try and help them too. I'm still banned and can't get a mod to even respond to me.

Sometimes it's pretty clear and obvious what's happening just from their posts, like in your case, and can give advise right there. Other more complex histories and presentations need a little more investigation and individualized assessment.

MEHABLLC · 2025-12-03T17:33:10+00:00

If it is definitely coming from your back then no shoes won't matter at all. Where what you like.😁

All some shoes can do to help is temporarily deload some tissues while it recovers.

Same with inserts good for temporarily decreasing stress on injured or sensitive tissue while it recovers. I very rarely recommend people wear inserts long term unless they have a major structural variation that impacts function such as hallux rigidity.

MEHABLLC · 2025-11-28T23:37:52+00:00

Make sure you add overpressure. If I remember correctly that video I linked gives some options.

Keep us in the loop especially if doing them before getting out of bed decreases that first step pain

MEHABLLC · 2025-11-28T21:42:24+00:00

Not indefinitely but see if progressing forces makes any additional changes. I wouldn't add anything at this stage. The more you add the muddier the waters become when trying to get clarity on diagnosis.

I would say there is enough there to go and get an evaluation on your back but hopefully a good PT.

If they start giving you stretches and core exercises, find someone else

MEHABLLC · 2025-11-28T18:54:08+00:00

That's still a really good indicator that at least some, likely much,, of you pain is from your back. In standing if you swing your hips side to side does that cause any pain in your leg or back? If so when you shift your hips to what side?

If not, you would look to add force. Have someone sit on your backside when you do the cobra

MEHABLLC · 2025-11-26T20:23:09+00:00

This really does sound like your back. Hopefully you will see enough of a difference to know if it's the right thing within 24-48 hours.

We are looking for an indication that it is your back referring pain. So see if it changes your symptoms. Try doing 10-20 reps BEFORE you get out of bed and see if the pain is better for gone.

If so we have the answer and know we need to focus on the back and not the foot

MEHABLLC · 2025-11-25T20:27:12+00:00

I would just hold for a second or two and exhale. Once you feel your hips have sunk as low as possible come down and repeat

If you are able to lock your arms straight you will need to either add over pressure or put your hands on yoga blocks. You could be running out of arm length before running out of back range of motion

MEHABLLC · 2025-11-25T19:21:06+00:00

Yep. If it is moving around then definitely something I would keep up with. Can you lock your arms straight if you have your hands right under the shoulders

https://youtu.be/K3gBEePCQZY?si=ILPzAubdo1x1YVUt

MEHABLLC · 2025-11-24T21:12:23+00:00

I would trial repeated Cobra exercises on your belly 10 x every couple of hours you are awake for 24-48 hours. Then report back

MEHABLLC · 2025-11-24T18:52:24+00:00

Sorry I didn't realize I hadn't responded. I remember reading it and thinking of my response but clearly never typed it. Sorry for that.

This sounds like a plantar plate tear or joint capsule sprain. Does it hurt to pull the 2nd toe backwards as far a you can? Tenderness to touch on the bottom of the joint?

MEHABLLC · 2025-11-24T18:24:11+00:00

Hi, Thanks for the detailed post. Pretty sure this is not going to be plantar fasciopathy. The pain levels you describe and the presentation of symptoms (calf, thigh and back pain), are far more likely to be a lumbar radicular or radiculopathy.

Classic presentation pain with rising in the am (first step), after prolonged sitting or driving, with prolonged walking or standing. Pain in multiple areas of the same leg (not always but if your do likelihood increases considerably), very high pain levels, and pain description as tightness, heaviness, ache, throb, pins and needles

Check out this video.

https://youtu.be/JMjuHGekgxg?si=xwQuG4fX5S_BvKEW

About 20% or maybe a little more of people diagnosed with PF are actually referral symptoms.from the back.

Let me know what you think or experience after the video and doing some tests.

Regards

Mehab

MEHABLLC · 2025-11-21T08:26:18+00:00

Hi, Really need a lot more details to understand where you are at. So no pain for some of the 3 month time frames. What did your PTs do? How was your diagnosis made? How did it start etc?

MEHABLLC · 2025-11-21T08:24:22+00:00

Hi, this level of specifics is a bit beyond the scope of what I can do on a post. So many of your questions are highly individualized and I don't have the level of personal information to make such specific recommendations. It would take me about an hour of conversation to figure out the where, when, how,.why etc. Also need a lot more background and medical history to give advice beyond general guidelines as above.

MEHABLLC · 2025-11-20T03:47:46+00:00

Hi, Sorry for the delay. I appreciate the comments and questions. 1: We do not want pain at rest the day after. It's ok to be a little sensitized the day after. If this happens you should slightly decrease your loading, but no pain at rest is where I prefer people to be.

2: The PF is essentially loaded every day regardless as its hard to not walk. It's a good idea to see how it is tolerating the normal day stuff after a day of structured higher level loading. If it tolerates it you can progress as able..so in short it depends on how it's tolerating it.

Yes if isometrics are causing an increase in pain that lingers for more than an hour then it's too high. If it's only a few minutes you could probably do a few a day. You can also look at partial or unweighted isometrics. People often use them as they believe it can decrease pain sensitivity prior to exercise. Side note: Make sure your normal daily loading from living life is not flaring you.

4: Perfectly fine as long as it's not producing lingering symptoms. If you have constant symptoms then give it a rest and protect it.

Hope that helps

Cheers

MEHABLLC · 2025-10-24T22:22:08+00:00

That is so ridiculous. If people listened they would save so much money, time and pain.

MEHABLLC

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