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Plantar fasciitis or plantar heel pain is the most common foot pain condition treated by healthcare providers. 28 It has been estimated that plantar fasciitis occurs in approximately 2 million Americans annually 10 and affects as much as 10% of the general population over the course of a lifetime. 29 In fact, some authors have reported that plantar fasciitis accounts for between 8% and 15% of foot complaints in nonathletic and athletic populations. 31,37 Plantar heel pain has a negative impact on foot-specific and general health-related quality of life, 20 and shows distinct patterns of disability on different functional domains. 30 To date, there is evidence that this condition may not be characterized by inflammation but, rather, by noninflammatory degenerative changes in the plantar fascia. 21 These findings suggest that this painful T T OBJECTIVE:To investigate the effects of trigger point (TrP) manual therapy combined with a self-stretching program for the management of patients with plantar heel pain. T T BACKGROUND:Previous studies have reported that stretching of the calf musculature and the plantar fascia are effective management strategies for plantar heel pain. However, it is not known if the inclusion of soft tissue therapy can further improve the outcomes in this population. T T METHODS:Sixty patients, 15 men and 45 women (mean  SD age, 44  10 years) with a clinical diagnosis of plantar heel pain were randomly divided into 2 groups: a self-stretching (Str) group who received a stretching protocol, and a self-stretching and soft tissue TrP manual therapy (Str-ST) group who received TrP manual interventions (TrP pressure release and neuromuscular approach) in addition to the same self-stretching protocol. The primary outcomes were physical function and bodily pain domains of the quality of life SF-36 questionnaire. Additionally, pressure pain thresholds (PPT) were assessed over the affected gastrocnemii and soleus muscles, and over the calcaneus, by an assessor blinded to the treatment allocation. Outcomes of interest were captured at baseline and at a 1-month follow-up (end of treatment period). Mixed-model ANOVAs were used to examine the effects of the interventions on each outcome, with group as the between-subjects variable and time as the within-subjects variable. The primary analysis was the group-by-time interaction. T T RESULTS:The 2 × 2 mixed-model analysis of variance (ANOVA) revealed a significant groupby-time interaction for the main outcomes of the study: physical function (P = .001) and bodily pain (P = .005); patients receiving a combination of self-stretching and TrP tissue intervention experienced a greater improvement in physical function and a greater reduction in pain, as compared to those receiving the self-stretching protocol. The mixed ANOVA also revealed significant group-by-time interactions for changes in PPT over the gastrocnemii and soleus muscles, and the calcaneus (all P<.001). Patients receiving a combination of self-stretching and TrP tissue intervention showed a gre...

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The results suggest that the addition of mechanical cervical traction to a multimodal treatment program of manual therapy and exercise yields no significant additional benefit to pain, function, or disability in patients with cervical radiculopathy.

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