THE EFFECT OF MYOFASCIAL RELEASE TECHNIQUE AND
STRETCHING VERSUS MYOFASCIAL RELEASE TECHNIQUE
AND TAPING IN PATIENTS WITH CHRONIC PLANTAR
FASCIITIS.
- A COMPARATIVE STUDY.
By
SHARVARI SHAHANE.
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Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Karnataka,
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Bangalore, in partial fulfillment of the requirements for the degree of
MASTER OF PHYSIOTHERAPY
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In
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MUSCULOSKELETAL DISORDERS AND SPORTS PHYSIOTHERAPY
Under the guidance of
PRADEEP. K REDDY (M.P.T.)
KEMPEGOWDA INSTITUTE OF PHYSIOTHERAPY
K.R. ROAD, V. V. PURAM, BANGALORE.
2011-2013
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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,
BANGALORE
DECLARATION BY THE CANDIDATE
I hereby declare that this thesis entitled “THE EFFECT OF MYOFASCIAL
RELEASE TECHNIQUE AND STRETCHING VERSUS MYOFASCIAL
RELEASE TECHNIQUE AND TAPING IN PATIENTS WITH CHRONIC
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PLANTAR FASCIITIS - A COMPARATIVE STUDY” is a bonafide and genuine
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research work carried out by me under the guidance of PRADEEP. K REDDY, Lecturer,
Kempegowda Institute of Physiotherapy, Bangalore.
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Date: Signature of the Candidate
Place: Bangalore Name: SHARVARI SHAHANE
II
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,
BANGALORE
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled “THE EFFECT OF
MYOFASCIAL RELEASE TECHNIQUE AND STRETCHING
VERSUS MYOFASCIAL RELEASE TECHNIQUE AND TAPING IN
PATIENTS WITH CHRONIC
W PLANTAR FASCIITIS - A
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COMPARATIVE STUDY” is a bonafide research work done by SHARVARI
SHAHANE, in partial fulfillment of the requirement for the degree of MASTER OF
EV
PHYSIOTHERAPY.
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Date: Signature of the Guide
Place: Bangalore PRADEEP. K REDDY M.P.T.
Lecturer
Kempegowda Institute of Physiotherapy,
Bangalore.
III
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE
CERTIFICATE BY THE CO-GUIDE
This is to certify that the dissertation entitled “THE EFFECT OF
MYOFASCIAL RELEASE TECHNIQUE AND STRETCHING
VERSUS MYOFASCIAL RELEASE TECHNIQUE AND TAPING IN
PATIENTS WITH CHRONIC
W PLANTAR FASCIITIS - A
IE
COMPARATIVE STUDY” is a bonafide research work done by SHARVARI
SHAHANE, in partial fulfillment of the requirement for the degree of MASTER OF
EV
PHYSIOTHERAPY.
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Date: Signature of the Co-Guide
Place: Bangalore DR. VINOD KUMAR A.C.
M.B.B.S., M.S. (ORTHO)
Associate Professor,
Department Of Orhtopaedics
KIMS & RC
IV
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE
ENDORSEMENT BY THE PRINCIPAL / HEAD OF THE
INSTITUTION
This is to certify that the dissertation entitled “THE EFFECT OF
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MYOFASCIAL RELEASE TECHNIQUE AND STRETCHING
VERSUS MYOFASCIAL RELEASE TECHNIQUE AND TAPING IN
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PATIENTS WITH CHRONIC PLANTAR FASCIITIS - A
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COMPARATIVE STUDY” is a bonafide research work done by SHARVARI
SHAHANE, under the guidance of PRADEEP. K REDDY, M.P.T., Lecturer,
Kempegowda Institute of Physiotherapy, KIMS, Bangalore.
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Date: Signature of the Principal
Place: Bangalore PROF. BALASARAVANAN (M.P.T)
Professor and Principal
Kempegowda Institute of Physiotherapy,
Bangalore.
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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE
COPYRIGHT
DECLARATION BY THE CANDIDATE
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I hereby declare that the Rajiv Gandhi University of Health Sciences, Bangalore,
Karnataka shall have the rights to preserve, use and disseminate this dissertation /
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thesis in print or electronic format for academic / research purposes.
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Date: Signature of the candidate
Place: Bangalore SHARVARI SHAHANE
Post graduate student,
Kempegowda Institute of Physiotherapy,
Bangalore.
© Rajiv Gandhi University of Health Sciences, Karnataka
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ACKNOWLEDGEMENT
I acknowledge with gratitude and devotion to God, for his unending blessings
which made this study a reality.
I gratefully thank Prof. BALASARVANAN, Principal, Kempegowda institute
of physiotherapy, for his constructive criticism and guidance throughout the study.
I wish to acknowledge with deep sense of gratitude and thanks to Lecturer
PRADEEP. K REDDY M.P.T., Kempegowda Institute of Physiotherapy, for his guidance
and encouragement throughout the study.
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I extend my thanks to DR. VINOD KUMAR, Associated Professor, Department
of Orthopedics, Kempegowda Institute of Medical Sciences, Bangalore for timely and
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valuable help.
I extend my gratitude to all faculty members, Kempegowda Institute of
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Physiotherapy for their constant support, encouragement and also their valuable
suggestions which strengthens me along the process of study.
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I would like to thank all my colleagues and friends who have helped each in their
own special way to complete this study.
My sincere thanks to all my family members for their moral support and faith in
my ability.
Last but not the least with gratitude and devotion to God, for his unending
blessings which made this study a reality.
Date: Signature of Candidate
Place: Bangalore SHARVARI SHAHANE
VII
List of abbreviations used
MFR myofascial release
PF plantar fasciitis
VAS visual analogue scale
FFI foot functional index
ROM range of motion
Et al and others
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SD standard deviation IE
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THE EFFECT OF MYOFASCIAL RELEASE TECHNIQUE AND
STRETCHING VERSUS MYOFASCIAL RELEASE TECHNIQUE
AND TAPING IN PATIENTS WITH CHRONIC PLANTAR
FASCIITIS - A COMPARATIVE STUDY
ABSTRACT
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BACKGROUND AND OBJECTIVES:-
Plantar fasciitis is a most common cause of inferior heel pain. The pain and discomfort
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associated with this condition have a dramatic impact on physical mobility and function.
This study was done to assess the effectiveness of MFR and stretching versus MFR and
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taping in patients suffering from chronic plantar fasciitis.
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METHODS:-
All the subjects were clinically diagnosed by orthopaedician with chronic plantar fasciitis
were screened after finding their suitability as per the inclusion and exclusion criteria and
were requested to participate in the study. Participants in the study were briefed about the
nature of the study and their intervention. After briefing them about the study, their
informed written consent was taken. 60 plantar fasciitis patients were randomly divided
into two groups with n= 30 each group, Group 1- received MFR and stretching, where
Group 2- received MFR and taping. The treatment was given one session per day, 5 days
a week. The total treatment duration was for 2 weeks.
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OUTCOME MEASURES:-
The patients were evaluated at the beginning of the intervention program, and again at the
beginning of treatment of day 5 and day 10. All the patients were requested to come for a
follow up measurement after 1 week of treatment program. All the patients were assessed
for pain and foot function by taking their VAS and FFI.
RESULTS:-
Group 1 which received myofascial release technique and stretching showed great
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improvements from baseline to week 1after on pain intensity and foot function assessed
using VAS and FFI respectively. Group 2 showed improvements from baseline to day 10
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but there was mild increase in pain levels and decreased foot function in measurements in
1 week after. After analysis group 1 showed significance with P = 0.001.
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CONCLUSION:-
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Myofascial release technique and stretching, myofascial release technique and taping
both showed effectiveness in reducing the pain intensity and increasing the foot function
but myofascial release technique and stretching showed superior hand over myofascial
release technique and taping.
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KEY WORDS:-
Chronic plantar fasciitis, myofascial release, stretching technique, taping technique, pain
intensity, foot function, visual analogue scale, foot function index.
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Table of contents
No. Contents Pg No.
1. INTRODUCTION 1
2. AIMS AND OBJECTIVES 12
3. HYPOTHESIS 13
4. REVIEW OF LITERATURE 14
5. MATERIALS AND METHODS
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6. RESULTS 33
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7. DISCUSSION 45
8. CONCLUSION 49
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9. SUMMARY 51
10. REFERENCES 53
11. ANNEXURE 59
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List of tables
Table
Sr No. Contents Pg No.
No.
1. 1. Sex distribution of subjects according to age groups. 36
2. 2. Assessment of pain intensity using VAS for group 1. 37
3. 3.
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Assessment of foot function using FFI for group 1. 38
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4 4. Assessment of pain intensity using VAS for group 2. 39
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5. 5. Assessment of foot function using FFI for group 2. 40
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6. 6. Comparison of VAS scores in group 1 and group 2. 41
Comparison of foot function index scores in group1 and
7. 7. 42
group 2.
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List of figures
Fig
Contents Pg No.
No.
1. Materials used 25
2. Therapist performing myofascial release technique 29
3. Therapist performing stretching 31
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4. Therapist giving taping 31
Graphical representation of sex distribution of subjects according to age
5. 36
groups.
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Graphical representation of Assessment of pain intensity using VAS for
6. 37
group 1.
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Graphical representation of Assessment of foot function using FFI for
7. 38
group 1.
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Graphical representation of Assessment of pain intensity using VAS for
8. 39
group 2.
Graphical representation of Assessment of foot function using FFI for
9. 40
group 2.
Graphical representation of Comparison of VAS scores in group 1 and
10. 41
group 2.
Graphical representation of Comparison of foot function index scores in
11. 42
group 1 and group 2.
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INTRODUCTION
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1
Introduction
Plantar fasciitis is another word for the deep fascia of the foot pad. It is also referred to as
plantar heel pain syndrome, heel spur syndrome or painful heel syndrome. Plantar
fasciitis by definition is the inflammation of the plantar fascia. Frequent injury or load to
the plantar fascia can cause micro cracks or tears which can eventually lead to an
inflammation and degeneration of the connective tissue in the fascia. [1] The injury itself
is an enthesopathy (an abnormality or injury at the side of attachment of ligament or
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tendon to the bone) of the origin of plantar fascia at the medial tubercle of the calcanea.
This type of injury occurs due to excess friction or traction often characterized by pain on
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first steps in the morning. Plantar fasciitis is generally believed to be due to repetitive
partial tearing at this enthesis with associated chronic inflammation. [2]
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Plantar fasciitis affects adult population. Approximately 10% of patients with plantar
fasciitis have development of persistent and often disabling symptoms. [3] Plantar fasciitis
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is a most common cause of inferior heel pain. The pain and discomfort associated with
this condition have a dramatic impact on physical mobility. The etiology of this condition
is not clearly understood and is probably multifunctional in nature. Obesity, occupation
related activity, anatomical variation, poor biomechanics, over exertion and improper
foot wear are contributing factors. [4] The most common cause of injury is overuse such
as running, prolong standing, etc. which allow for repetitive micro trauma to the fascia. [5]
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Plantar fascia is considered a rose injury and as such, the patient’s history will typically
reveal some combination of either extrinsic or intrinsic factors that contributed to the
development of the injury. Extrinsic factors suggested in the literature include training
errors, training on unyielding surfaces and improper or excessively worn footwear. [6]
The classic presentation of plantar fascia is pain on the sole of the foot at the inferior
region of the heel. Patient reports of pain to be particularly bad with the first steps taken
in the morning or after extended refrain from weight bearing activity but the pain will
subside slowly during the next 30-45 minutes. [7] If the patients have a long commute to
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work, they can also report that their heels were not painful during the commute but the
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pain commenced immediately as they attempted to weight bear again on the involved
extremity. Once at work, depending on whether the patient’s job requires sitting or
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standing for extended periods of time, they might be able to undertake various activities
for 3-4 hours before the onset of their heel pain. The duration of activity before the onset
of heel pain can serve as an excellent indicator of the degree of irritability in the involved
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tissue. [8]
The location of the pain in the heel region can be varied with patients often reporting pain
over medial, lateral and lower posterior aspect of the calcaneus and the inferior heel
region. On occasion the patient may also complain of pain over the central band of the
plantar fascia in the region of the medial longitudinal arch.
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