Ankle

Use Trigger Point Manual Therapy for Plantar Heel Pain…It Works!!!

By: Joseph Brence, DPT

An article in this months JOSPT highlighted the effective short-term outcomes of individuals with plantar heel pain through the use of stretching and manual trigger point(TrP) treatments.  The authors found a reduction in pain pressure thresholds as well as improved outcomes on the SF-36. 

When treating plantarfasciitis/plantar heel pain, it is important to remember that recent literature has classifed it not as an inflammatory disorder, but instead a noninflammatory degeneration of the plantar fascia. 

The authors techniques for stretching included a runners stretch and a self-plantarfascia stretch through extension of the 1st MTP.  The manual techniques began through the assessment of trigger points in the gastrocnemius musculature.  The authors looked for a palpable taut band, presence of hypersensative taut band, local twitch or reproduction of referred pain.  There were 2 methods used in this release:

  1. Pressure was applied to the gastrocnemius until the clinician perceived tissue resistance.  The pressure was maintained until the clinician felt a release of the taut band.  This process occured generally 3 times for 90 seconds each.
  2. A neuromuscular technique or longitudinal stroke was applied over the gastrocnemius. With the patient prone, the thumb of the therapist was placed over the taut band and 3 strokes were made from the ankle upwards toward the knee. These were applied slowly and resistance did not increase pain. 

Active TrPs were located in all individuals in this study who had complaints of plantar heel pain and upon stretching and manual interventions, pain was significantly reduced which demonstrates a possible relationship between active TrPs and heel pain. 

Renan-Ordine R, Alburquerque-Sendin F, Rodrigues de Souza DP, et al. Effectiveness of Myofascial Trigger Point Manual Therapy Combined with a Self-Stretching Protocol for Plantar Heel Pain: A Randomized Controlled Trial. JOSPT. 2011; 41: 43-51.

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