Efficacy Of Self Myofascial Release Technique On Pain And Function In Patients With Plantar Fasciitis

INTRODUCTION

Plantar fasciitis (PF) is the most commonly reported cause of inferior heel pain. It has been estimated that it affects as much as 10% of the general population over the course of a lifetime. In fact, some authors have reported that PF accounts for between 8% and 15% of foot complaints in nonathletic and athletic populations. (1) It is estimated that 1 in 10 people will develop plantar fasciitis during their lifetime. (1)(4) It is more common in middle-aged obese females and young male athletes have a higher incidence in the athletic population. Heel spurs have commonly been implicated as a risk factor for PF. PF is usually unilateral, but up to 30% of cases have a bilateral presentation. The tightness of Achilles tendon is found in almost 80% of cases. The typical resolution time of plantar fasciitis is anywhere from 6 to 18 months and sometimes longer, which can lead to dissatisfaction of patient and physician. Most experts agree that early recognition and management of PF leads to the short course of treatment and a greater chance of success with conservative therapies. (2)

Numerous interventions have been described for treatment of PF, which include: rest, heat, ice pack, non-steroidal anti-inflammatory drugs (NSAIDS), heel pads, magnetic insole, night splints, walking cast, taping, plantar and Achilles stretching, ultrasound, steroid injection, extracorporeal shock wave therapy, platelet-rich plasma injection, pulsed radiofrequency electromagnetic field therapy, and surgery. (2) Of these, the tissue-specific plantar fascia and calf stretching is more effective than low dose shock wave therapy in the acute phase of PF. And about local injections of steroids, there is no gold standard regarding the types and doses of local injection of corticosteroids. (2)(5)

Myofascial release (MFR) is the application of a low load, long duration stretch to the myofascial complex, intended to restore optimal length, decrease pain, and improve function. It has been hypothesized that fascial restrictions in one part of the body cause undue tension in other parts of the body due to fascial continuity. This may result in stress on any structures that are enveloped, divided, or supported by fascia. (1) Self-myofascial release (SMFR) is a technique performed by the individual themselves rather than by a clinician, typically using a tool. (3) Myofascial practitioners believe that by restoring the length and health of the restricted connective tissue, pressure can be relieved on pain sensitive structures such as nerves and blood vessels. The objective of the study is to evaluate the efficacy of self-myofascial release on pain and function for the management of PF in comparison with a control group receiving static stretching.

RESEARCH QUESTION

Is self-myofascial release technique effective in improving pain and function in patients with plantar fasciitis?

HYPOTHESIS

• Null hypothesis

Self-myofascial release is not effective than static stretching in improving pain and foot function.

• Alternative hypothesis

-Self-myofascial release improves pain and foot function.

-Self-myofascial release technique is better than static stretching.

• Self-myofascial release, as well as static stretching, improves pain and foot function.

AIM

1.      To check the efficacy of self-myofascial release technique in improving pain and function in patients with plantar fasciitis.

OBJECTIVES

1. To see the effect of the self-myofascial release on pain and function in patients with plantar fasciitis.

2. To see the effect of static stretching in improving pain and function in patients with plantar fasciitis.

3.  To compare the effects of two groups.

STUDY DESIGN: Pre-test, post-test 2 group comparative study.

STUDY POPULATIONS-  Plantar fasciitis patients

SAMPLE SIZE- 18 in each group

SAMPLE SIZE CALCULATION-

Formula

SAMPLING TECHNIQUE- convenient sampling

Inclusion criteria-

1.      APTA guidelines -

â        Plantar medial heel pain

â        Heel pain precipitated by a recent increase in weight-bearing activity

â         Pain with palpation of the proximal insertion of the plantar  fascia

â        Positive windlass test

â         Negative tarsal tunnel test

 

2.      age group- 20-50 years

3.      VAS score between= ≥4

4.      duration of condition <6 months

Exclusion criteria-

1.      Recent lower limb injuries.

2.      Patients with RA

3.      Pregnancy

4.      Calcaneal stress fracture

OUTCOME MEASURES

â—       Foot Function Index

â—       Pressure pain threshold

All the outcome measures will be measured by a blinded assessor pre-intervention and post-intervention (after 5 days).

STUDY INSTRUMENT-

·    Algometer

 PROCEDURE:

Patients will be selected as per the inclusion criteria and will be informed about the study procedure and a written consent will be taken.

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Subjects will be allocated into two groups using computerized randomization.

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Baseline assessment will be taken along with the pain pressure threshold by a blinded assessor with foot function index scale to be filled by the patient.

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Treatment will be given to both groups of 5 sessions. and post-treatment assessment will be taken by the blinded assessor, with foot function index scale to be filled by the patient.

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Data analysis