The Effect Of Myofascial Release Versus Foam Roller On Decreasing Pain And Improving Dorsiflexion Range Of Motion Of Ankle Joint In Patients With Plantar Fascitis -A Randomized Control Trial

INTRODUCTION & BACKGROUND Plantar fasciitis, is also known as plantar heel pain and it is a soreness, which affects the bottom of the foot1. The most typical cause of pain in the inferior heel is plantar fasciitis. Fasciitis implies inflammation which is a fundamental aspect of this illness. Which is due to biomechanical stress.When plantar fasciitis develops, the pain is frequently severe and, in 70% of cases, unilateral. Putting weight on the heel after extended periods of rest exacerbates heel discomfort in those who are affected. People with plantar fasciitis frequently say that the first few steps after getting out of bed or during extended periods of sitting are when their

pains are the worst

Symptoms often get better as you keep walking. Numbness, tingling, swelling, or radiating pain are typical symptoms. Normally, there are no fevers or sweats at night. A review suggested that it be renamed "Plantar Fasciosis," "Painful Heel Syndrome," "Runner’s Heel," "Tennis Heel," as inflammation either plays a minor or non-existent function.The foot often assumes a plantar flexed position at night, and when a patient gets out of bed in the morning, the foot assumes a dorsiflexed position when walking. In bed, the plantar fascia gradually contracts, and the initial stretching that comes with waking up early in the morning is probably what causes the initial soreness.

Plantar fasciitis is most common in adults between the ages of 40 and 60, with no preference for either gender. A soft tissue mobilization treatment called myofascial release (MFR) is utilized for long-term disorders which cause tightness and constriction in soft tissues. By changing the ground substance’s viscosity to a more fluid state, myofascial release therapy relieves the fascia’s excessive pressure on the pain- sensitive structure and returns the body to its natural alignment. So, it is suggested that this method serve as a catalyst in the resolution of plantar fasciitis. The goal of the direct MFR approach is to increase soft tissue mobility by using gradual fingers, thumbs, forearms, or elbows to apply regulated mechanical stress directly into a limitation. The amount of pressure is progressively increased or applied repeatedly until the tissue’s mobility is perceived to improve

Roller massagers are held in the hands, which are made of plastic, while foam rollers are cylinders made of foam in varying densities and textures. Similar to conventional myofascial release, these tools use pressure that is applied by the patient either externally or with their own body weight. Foam roller has been the subject of recent and ongoing research. Foam roller has also been demonstrated to possibly lessen stiffness and the pain brought on by delayed onset muscle soreness. Foam roller is well-respected in the fields of rehabilitation and strength and conditioning for promoting healing and extending joint range of motion. Few studies have been published that have found that chronic foam roller technique increases range of motion measures. Foam rollers and roller massagers are often employed tools to promote myofascial mobility. In order to exert pressure on the soft tissues while rolling with a foam roller, the clients employ their body weight.

AIMS AND OBJECTIVE AIM: To find out the effectiveness of myofascial release and foam roller on decreasing pain and improving dorsiflexion range of motion of ankle joint in patients with plantar fasciitis. OBJECTIVES: PRIMARY OBJECTIVE - To compare the efficacy of myofascial release and foam roller in patients with plantar fasciitis. SECONDARY OBJECTIVE - To evaluate the pain and range of motion by using myofascial release in patients with plantar fasciitis. Evaluating the myofascial release and foam roller effectively reduces pain. To assess the myofascial release and foam roller are effective in improving ankle function.

Selection criteria

Inclusion Criteria: ï‚· Age group above 18 years ï‚· Both males and females. ï‚· Both unilateral and bilateral limb involvement ï‚· Subjects having sharp acute pain on the first step in the morning ï‚· Patients who are having the history of prolonged standing

Exclusion criteria ï‚· Subjects with calcaneal spur , ï‚· Subjects with systemic disorders, ï‚· Subjects with neurological disorder/ musculoskeletal disorders, ï‚· Fractures in and around ankle joint, ï‚· Subjects who have undergone prior orthopaedic surgery,

METHODOLOGY

Experimental group: This group will undergo myofascial release with conventional therapy (stretching, towel curl, heel raise, contrast bath are the standard protocol of myofascial release) In stage 1: myofascial release 20 repetitions will be given. The ankle will be dorsiflexed during the application. Myofascial release will be applied with the dorsal part of the hand and pressure will be given over the superficial layer by sliding towards the calcaneus from the affected area. Stage 2: is done for deep tissue release. The patient will be in prone lying with the knees flexed position and ankle is kept in normal position. The therapist holds the anterior part of the ankle by hand and with another forearm applies the myofascial technique and gives pressure over the affected side of plantar aponeurosis. Stage 3: for Achilles tendon were a small roll will be placed under the ankle, or the foot is off the bed so that the foot and ankle are in forced plantar flexion. The superior hand will be placed over the superior aspect of the Achilles tendon. Then the tissue will be forced perpendicular to the tibia. Then the superior aspect and inferior aspect of the tendon are compressed together bringing the two ends of the tendon closed together and the compressive force was maintained. Stage 4: is done for the gastrocnemius muscle where the patient is in prone lying position. The therapist used both hands in a cross-hand pattern and apply Myofascial release over the gastrocnemius muscle The Range of motion, VAS, and FFI these outcome measures that will be used and will be assessed pre and post-intervention. Control group: This group will undergo foam roller along with conventional therapy (stretching, towel curl, heel raise, contrast bath are the standard protocol of myofascial release) Participants will be instructed to be in a standing position. A foam roller will be given to roll under the affected sole starting from behind the head of metatarsals towards the heel focusing on the medial arch for 2 minutes. They will be asked to exert maximum pressure, till a point of discomfort but not pain. It will be given for 4 weeks. The outcome measures will be assessed pre and post-intervention.