Comparative Effectiveness of Muscle Energy Technique and Trigger Point Release in Plantar Fasciitis

Effectiveness of Muscle Energy Technique and Trigger Point Release in Plantar Fasciitis: A Comparative Study

Plantar Fasciitis (PF) causes heel pain in patients who have prolonged weight-bearing commonly, and it affects their ability to manage their routine work. By different physical therapy approaches like muscle energy technique (MET) and trigger point release, their pain and foot function would, might improve that would increase their work efficiency. This study aim towards better treatment option in treating PF. Therefore, the objective of this study was to compare the treatment effectiveness of MET and triggers point release in PF. A single blinded, randomized clinical design was conducted. Thirty patients was randomly allocated into two groups. One group received muscle energy technique and the other receive trigger point release, while both groups performed self-stretching exercises as a home plan. Their pain and foot function serve as outcome measure. Treatment was given for 4 weeks, 3 sessions per week.

Post-isometric relaxation was given as the form of MET. It was applied to gastrocnemius and soleus with patient supine and foot extended, knee was flexed for soleus and extended for gastrocnemius muscle. The patient ankle was dorsiflexed by the therapist until the point of discomfort or resistance, and the patient was instructed to exert pressure using 20% force for 5-7 seconds toward plantar flexion. Relaxation was given for 5 seconds and the therapist passively dorsiflex the ankle to a new barrier. Gastrocnemius and soleus both received a single set of 5 repetitions separately. Treatment was given for 4 weeks, 3 sessions per week.

Trigger points of gastrocnemius muscle was released. The patient in prone lying with legs extended and the therapist in walk standing position, applied vertical downward pressure toward the trigger points for 90 seconds with the therapist's thumb. Three repetitions was given with 30 seconds relaxation time. After that, 3 longitudinal strokes in caudal to cranial direction was given by the therapist's thumb over the taut band. Treatment was provided for 4 weeks, 3 sessions per week.

Muscle energy technique (MET) is an active manipulative technique that requires patient active muscle contraction of a respective muscle from a specific position in a specific direction with 10-20 percent force exerted by the patient which is resisted by the therapist in an attempt to relax and lengthen the muscle.

In trigger point release, a vertical downward pressure toward the trigger point for 90 seconds is applied with the therapist's thumb. Three repetitions needed to be done with 30 seconds relaxation time. After that, 3 longitudinal strokes in caudal to cranial direction are given by therapist's thumb over the taut band.

Self-stretching will be done 5 times twice a day with 20 seconds of intermittent stretch and 20 seconds relaxation time.

Numeric Pain Rating Scale (NPRS) was the primary outcome measure. NPRS is a subjective pain rating scale that has 11 points from 0-10. "0" stands for no pain, "1-3" score indicate mild pain, "4-6" shows moderate pain and "7-10 score depicts most severe pain ever in the last 24 hours as explained or narrated by patient. It is administered via paper and pencil; it doesn't require any cost to have this scale or to score it. It doesn't require any special skills to score this scale. Furthermore, it can be used for age group 18-65 by taking time of less than three minutes to score their pain.

Foot function index (FFI) was the secondary outcome measure of this study. FFI measures pain and foot dysfunction due to non-traumatic injury. It is a questionnaire that only requires a paper and pencil and requires less time to score. It is 23 item questionnaire having three subscales but due to repetitive null answers to six questions, it has been modified into 17 questions. Its scoring is based on visual analogue scale having score range from 0-10, with "0" depicting no pain and "10" showing worst pain. This questionnaire was filled by the patient based on his/her pain or activity limitation due to pathology in the past week. Pain, disability and activity limitation are the three subscales of FFI.

Inclusion Criteria: Having unilateral plantar heel pain on weight-bearing Age 25-45 Pain aggravated by walking few steps in the morning Having at least one identifiable trigger point in calf Exclusion Criteria: Bilateral heel pain History of leg and foot tumor Lower limb fracture Lower limb injury, Achilles tendentious Ankle arthritis, Surgery or any vascular disease