Home > Foot/Ankle Injury > Myofascial Release Therapy is Effective in Treating Heel Pain (Plantar Fasciitis)

Myofascial Release Therapy is Effective in Treating Heel Pain (Plantar Fasciitis)

Renan-Ordine R, Alburquerque-Sendin F, de Souza DP, Cleland JA, Fernandez-de-Las-Penas C.  Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: a randomized controlled trial.  J Orthop Sports Phys Ther. 2011 Feb;41(2):43-50. Epub 2011 Jan 31.

http://www.ncbi.nlm.nih.gov/pubmed/21285525

Note: The following article provides Level I evidence that use of myofascial release techniques in combination with static stretching is more effective than isolated static stretching in treating plantar fasciitis.

Rationale and Purpose:  Plantar fasciitis or heel pain is the most common foot pain conditions and can have debilitating consequences, especially for athletes performing repetitive jumping, landing and running.  Research indicates that inflammation does not characterize this condition, but rather noninflammatory degenerative changes in the plantar fascia are most characteristic.  The lack of inflammation associated with this condition suggests that interventions exclusively targeting inflammation may not be effective at decreasing pain/symptoms and restoring normal function.

There is moderate evidence that stretching of the gastrocnemius and plantar fascia can successfully improve symptoms and function in those with plantar fasciitis/heel pain.  However, this literature is mixed and the magnitude of improvement using isolated static stretching has been questioned.

The presence of myofascial/muscle trigger points in the gastrocnemius has been suggested to be a factor associated with plantar fasciitis/heel pain.  Thus, incorporating myofascial release techniques prior to static stretching may provide greater benefits than isolated static stretching.

Overview of Research Methods:  60 subjects were randomly assigned to the Isolated Stretching group or the Myofascial Release + Stretching group.  Subjects were all clinically diagnosed with unilateral plantar fasciitis/heel pain using a standard set of inclusion/exclusion criteria.

Dependent Variables: Multiple outcome measures related to physical function / body pain (SF-36) were measured as well as pressure pain threshold.  All measures were taken before and after the interventions.

Intervention Protocol: All participants attended 4 treatment sessions each week for a total of 4 weeks (16 total treatment sessions).  The Isolated Stretching group performed standing wall stretches for the gastrocnemius (knee straight), soleus (knee flexed), and plantar fascia self-stretching.  Each stretch was held for 20-seconds, followed 20 seconds rest for a total of 3 minutes (total stretching protocol lasted 9 minutes).  This was repeated 2 times per day.  The Myofascial Release + Stretching  group were examined for presence of active trigger points in the gastrocnemius (all subjects were found to have active trigger points upon inspection).  Prior to static stretching, manual pressure was applied over trigger point areas by the clinician.  The pressure was maintained until noting a release of the taut band, then pressure was increased and the process repeated for 90-seconds (usually 3 repetitions).  After trigger point release the clinician applied a longitudinal stroke over the gastrocnemius starting from the ankle to the knee.  Strokes were applied with moderate pressure, but were not painful.  The subjects then performed the identical static stretching protocol as performed by the isolated stretching group.

Key Findings:  Both the isolated stretching and myofascial release + stretching group demonstrated improved function and decreased pressure pain threshold.  However, the magnitude of improvement in the myofascial release + stetching group was significantly greater than the isolated stretching group.  The greater magnitude of improvement in the myofascial release + stretching group was considered to be clinically meaningful.

Clinical Implications:  These findings provide Level I evidence that an integrated program consisting of myofascial release followed by static stretching is superior to isolated stretching for improving function and decreasing pain threshold in those with plantar fasciitis/heel pain.  Based on these findings the incorporation of myofascial release techniques before static stretching is recommended in treating those with plantar fasciitis/heel pain.

It should be noted that the current study only looked at the short term effects and no long term follow up was performed.

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Categories: Foot/Ankle Injury
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