Effectiveness of Myofascial Trigger Point Manual Therapy Combined With a Self-Stretching Protocol for the Management of Plantar Heel Pain: A Randomized Controlled Trial

Abstract

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...

Combination of Hip Strengthening and Manipulative Therapy for the Treatment of Plantar Fasciitis: A Case Report

“…Saban et al 6 used a combination of gastrocnemius myofascial release, neural mobilization, and self-stretching exercises, reporting a reduction of 38% on a visual analog pain scale. Renan-Ordine et al 7 have also reported a reduction in plantar pain resulting from a combination of manual therapy and self-stretching. Finally, Looney et al 20 observed a 53% improvement in pain intensity in patients who used an instrument for soft tissue mobilization and also stretched at home.…”

“…Prescribed treatments have generally required a greater number of sessions per week, with previous studies reporting treatment regimens of 3 weekly sessions over a period of 3 weeks 5 or 4 weekly sessions over 4 weeks. 7 The ability to offer different treatment options is important to suit different patient requirements and to fit around patients who have limited time available for treatment. Hip strengthening is a simple and quick treatment, which should be incorporated into clinical treatment routines using MT to maximize the results of the intervention and improve outcomes in the patient.…”

“…Manipulative therapy (MT) has been used as a treatment option for PF in several previous studies, [5][6][7][8][9][10][11] and randomized clinical trials have recommended MT for improving the pain and function in PF patients. 7,8 The techniques for PF treatment include passive joint manipulation of the ankle and foot; myofascial maneuvers of the gastrocnemius, soleus muscles, and plantar fascia; neural mobilization of the tibial nerve; and stretching of the plantar fascia and triceps surae.…”

“…7,8 The techniques for PF treatment include passive joint manipulation of the ankle and foot; myofascial maneuvers of the gastrocnemius, soleus muscles, and plantar fascia; neural mobilization of the tibial nerve; and stretching of the plantar fascia and triceps surae. 1 A recent study reported that strengthening the hip abductors and external rotators is effective for reducing pain in fasciitis.…”

Static, dynamic balance and functional performance in subjects with and without plantar fasciitis

“…It is a major orthopedic injury that affects about 10% of the world's population at least once in life (2,3). PF is characterized by a non-in lammatory degeneration and pain under the heel and along the medial side of the plantar fascia (3,4). It occurs as a result of repetitive microtrauma at the origin of the medial tuberosity of the calcaneus (5,6).…”