Is stress on the plantar plate ligament bad for runners? Well, that is what we’re talking about today on the Doc On The Run Podcast.
I was just on a call with an injured runner who has been healing from a plantar plate sprain. If you have had one of these, you know they’re problematic. The thing was, is that he asked me a question that really made me stop and think.
What he asked was, “Is stress good or bad for the plantar plate ligament?”
Well, given that he had an injury to the plantar plate ligament, my reflexive answer was, all stress is bad. And what I was thinking is that physiological stress, emotional stress, biomechanical stress, all of those things are known to delay healing of injuries, including things like a sprain or a tear of the plantar plate ligament. But no sooner had those words come out of my mouth, that I realized that I was wrong, it was untrue.
Here is the thing, as a runner who is considering the stresses applied to a healing plantar plate ligament, it is all about timing and your specific goals. It is not just about the injury. I always talk to doctors and runners who I am talking to about their specific running goals.
Everything is about timing. The amount of time you have to take off is related to your goals, not just the injury. It is not related to a grading scale. It is related to whether or not you can complete your event or resume training when you need to and there is a way that this applies to the stresses applied to this ligament as well.
If you think about this, the way that we train as athletes is all related to a thing called physical stress theory. And this has been the foundation of exercise prescriptions for years and years, decades. It is really a simple idea. What it means is that you have specific adaptations in tissues because of imposed demands on those tissues.
If you do biceps curls, if you lift weights and you exercise your biceps, that puts a demand on the muscle that forces it to grow. That is true of all tissues that respond to forces that way. Tendons, ligaments, bones, they all get stronger.
If you lift weights and you do resistance training, your bones will respond, and they will start to get thicker and stronger as a consequence of that injury. This is true of tendons and ligaments too. When you have an injury to something like the plantar plate ligament and you sit still, you can get healing of that, but it is not organized. But when you load a tendon or a ligament and you stretch it, the cells that repair the collagen lay down collagen in a direction that resists that motion and reinforces the strength of the ligament. It is more organized, it is stronger, and it is better for you as a runner. So, those adaptations are related to timing.
You have to really think about this in the mechanical properties, the physiologic stressors that happen to you in terms of the timing of the injury. Now before the injury, if you are doing things that gently stress and apply forces to the plantar plate ligament, in theory, it should, over time, get stronger and reduce your risk of getting a plantar plate sprain.
Immediately after the injury, well, now you’re in the acute injury phase. You have swelling, you have bleeding, you have bruising, you have pain because the ligament is ripped. If you rip half of the ligament, it stands to reason that this other half is still attached, well, it is going to be weaker. So, in the acute phase, where you have weaker tissue that has just been damaged, it is not structurally intact the same way, and because of all the stuff that happens with the pain receptors around the injury, you won’t feel it as much.
This is one of the reasons it is so important to stop running when you have an ankle sprain. Your proprioception decreases, the ability to tell the position of your foot underneath you decreases, and you are more likely to sprain it again worse right after that. And I think that there’s something that applies in the same way here to plantar plate ligaments. You are not able to feel what it is doing as much right during that acute injury phase, which could go on for a week or two.
The next phase is called the proliferative phase. It is where you have collagen healing and during that phase, it is really important that you let it solidify and start to heal and repair itself and get that tear to start filling in with some new collagen.
Then during the remodeling phase, that is where it is most important to be applying stresses to it gradually and systematically because that is where the disorganized collagen that is sort of a web in all different directions, starts getting removed and repaired to become more linear in the same orientation that the original fibers of the plantar plate were laid down before it was injured.
So, you have really got to think about when it is and how important the healing is related to your running goals, to really consider about what to do in terms of applying or preventing stresses applied to the plantar plate ligament when you have a sprain and you are a runner who wants to get back to running.
If you think you have a plantar plate injury and you have not checked it out yet, you might want to check out the Plantar Plate Masterclass. It is where I go into a deep dive about all of the specific strategies that I teach to runners who have these injuries and want to get back to running. It is also the exact same strategies I teach to physicians at medical conferences.
Last week, I was lecturing at the International Foot and Ankle Foundation meeting at the Swedish Medical Center, and I was teaching these same strategies to them. So, if it will help them understand how to help you get better, it ought to help you too. You can get it for free at www.docontherun.com/plantarplatemasterclass. Go check it out, and I’ll see you in the training.
