may be experiencing plantar fasciitis, be sure that you refer them to a physician for a diagnosis. Choose your words wisely when discussing the potential situation and always stay within your scope of practice. Be careful about saying anything that can be misconstrued as medical advice: refer them to someone qualified to make that call. Trigger point therapy If you are trained in trigger point therapy, this can also be a very effective method for treating plantar fasciitis when applied to the muscles of the calf discussed above. It can be even more effective when combined with passive stretching during a massage therapy session and can greatly increase the beneficial effects of stretching. A study published in the Journal of Orthopedic and Sports Physical Therapy in 2011 “reported that trigger point manual therapy can also potentially provide ‘superior short-term outcomes’ when compared to stretching alone. This particular study involved 60 patients with diagnosed plantar heel pain and those who received trigger point therapy indicated experiencing a greater reduction of pain and improvement in function than those assigned to the stretching-only group” (DeBusk, 2018). Releasing the calf muscles first with trigger point therapy or tissue massage can allow for better stretching in those muscles as well as the plantar fascia itself. However, you should proceed with caution when applying trigger point therapy to a client with an acute case of plantar fasciitis. As with deep-tissue massage, trigger point therapy applied to the calf muscles can also cause cramping in the sole of the foot. If this happens, follow the Stretching, as a method for treating plantar fasciitis, is commonly applied during physical therapy sessions and may be suggested to patients as a way to self-treat at home. Passive stretching (in which the client does not actively participate) can also be very effective as part of a massage therapy treatment. After the soft tissues of the lower leg, ankle, and sole of the foot have been adequately warmed up and worked with the tools discussed above, stretching can be applied with caution during acute episodes. If your client is currently experiencing a lot of pain from acute inflammation, use gentle stretching with the intention of slowly lengthening the affected tissues. In this case, the goal is less about creating more flexibility and more about allowing some small amount of release to take place. As the saying goes, slow and steady wins the race. Be careful about pushing already inflamed tissue too far; invite feedback from your client about his or her comfort level while performing passive stretches. Our goal is to aid in the reduction of inflammation, not to add to it. Light massage Depending on the severity of the acute inflammation and the comfort level of your client, light massage may be applied directly to the plantar fascia. Remember that the common point of tenderness with plantar fasciitis is at the front and central edge of the heel mound on the sole of the foot. The plantar fascia is thickest in this area. Digging too deeply in this area during episodes of acute inflammation can cause more pain and inflammation and should be avoided until the condition has improved (see below for applications for chronic plantar fasciitis). However, light effleurage and gentle cross-fiber friction to the whole of the plantar fascia can provide some release and relief. Light massage can also be combined with gentle, passive stretching if either deep tissue massage or trigger point therapy is too much for your client to tolerate in a session. It may be useful to communicate to your client that you are not likely to solve the inflammation problem in one massage therapy session, and that lighter work applied over a few subsequent sessions may be a more effective course of treatment for long-term relief. guidelines above. Passive stretching
activity, an event, or a certain pair of shoes. On the other hand, clients who are new to the experience may not have enough of a history behind them to be able to identify any patterns. Clients who are completely new to plantar fasciitis may not even know what they are dealing with; therefore, you must be careful with what information or advice you give them. If your client has not been formally diagnosed, but you suspect they Acute plantar fasciitis An acute episode of plantar fasciitis is one in which your client experiences frequent and excessive pain, indicating that the plantar fascia is very inflamed. As with any active inflammation, it is wise to proceed with caution: Bodywork can sometimes temporarily increase inflammation as part of the healing process. Clients who have minimal experience with bodywork may think that massage has made their condition worse; they may come to doubt your skills or the efficacy of massage therapy in general. In those situations, clear communication about their expectations and your treatment decisions is paramount. If the situation based on your professional assessment calls for you to give the plantar fascia only light work or to leave it alone completely, your planned course of action should be spelled out for your client. Let your client know why you are either working lightly with (or avoiding) the area, and why this is in his or her best interest. Not all inflammation benefits from hands-on work, depending on at what point the tissues are in the inflammatory process. Plantar fasciitis is a prime example of this. Sometimes, working the area too aggressively—or working on it at all—can do more harm than good, making it more painful than when your client came in. Let your experience guide you. If you are relatively new to massage therapy and have not yet seen many cases of plantar fasciitis, confer with more experienced practitioners or teachers about their experiences and ask for their advice. Listed below are some techniques to use in cases of acute plantar fasciitis. As we learned previously in this course, the problem is not always limited to the plantar fascia itself. Addressing the other participating structures as your primary focus may be the best course of action in some acute cases of plantar fasciitis. Even with little or no attention paid to the plantar fascia, we may be able to reduce the client’s symptoms and start to improve the health of structures causing the problem. Deep tissue massage Applying deep tissue massage to the muscles of the calf can be an effective treatment, especially if decreased dorsiflexion in the ankle (as described above) is contributing to the problem. Due to its size, primary function, and attachment to the Achilles tendon, the gastrocnemius is usually the biggest contributor; however, the soleus and the peroneus longus, the most superficial of the peroneal muscles, can also play a part in inhibiting dorsiflexion. The gastrocnemius is the easiest to access: It is the most superficial and the densest muscle of the group. Therefore, it may be necessary to work through the gastrocnemius to get to the soleus in some respects, hence the need for tissue massage. The lateral edges of the soleus may be palpable adjacent to the gastrocnemius, but the belly of the muscle is deep to the belly of the gastrocnemius. For the most effective therapeutic application, work from the outside in. A word of caution: Deep tissue to the gastrocnemius can cause cramping in the sole of the foot. If this occurs, stop the deep tissue work and apply gentle compressions to the gastrocnemius until the cramp subsides. Another effective tool to relieve the cramp can be to ask the client to press the sole of the foot into your palm to simulate standing, which can effectively release the cramp. If neither of those is effective, you can ask the client to place the cramping foot onto the floor and put weight on it, which often relieves the cramp immediately. When the cramp subsides, ease back into the deep tissue work if there is no evidence of further cramping. If the cramping continues to happen, stop the work that is causing it and continue on with the rest of the massage.
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Book Code: MTX1324B
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