COMPARISON OF STRUCTURAL DIAGNOSIS AND MANAGEMENT (SDM) APPROACH AND MYOFASCIAL RELEASE FOR IMPROVING PLANTER HEEL PAIN, ANKLE ROM AND DISABILITY

S. Akter¹, M.S. Hossain¹, KMA. Hossain^1,2, Z. Uddin³, M.A. Hossain⁴, F. Alom⁵, M.F. Kabir², L.M. Walton⁶, V. Raigangar⁷

¹Institute of Advanced Mechanical Correction Therapy, Dhaka, Bangladesh, ²Jashore University of Science and Technology, Jashore, Bangladesh, ³School of Rehabilitation Science, McMaster University, Ontario, Canada, ⁴Bangladesh Health Professions Institute, CRP, Dhaka, Bangladesh, ⁵National Institute of Traumatology & Orthopedic Rehabilitation-NITOR, Dhaka, Bangladesh, ⁶University of Scranton, Department of Physical Therapy, Panuska College of Professional Studies, Pennsylvania, United States, ⁷College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates

Background: Plantar heel pain is a most prevalent and is a disabling condition of the lower limbs, manifested by pain in one or both feet. SDM is a newly designed hypothetical concept which can use with Myofascial release (MFR) to reduce plantar pain.

Purpose: This study aims to compare the effects of the Structural Diagnosis and Management (SDM) approach over Myofascial Release (MFR) on the gastrocnemius, soleus, and plantar fascia in patients with plantar heel pain.

Methods: This is a assessor-blinded randomized clinical trial study. Sixty-four (n = 64) subjects, aged 30–60 years, with a diagnosis of plantar heel pain, plantar fasciitis, or calcaneal spur by a physician, and according to ICD-10, were selected by hospital-based randomization . Participants were equally assigned to the MFR (n = 32) and SDM (n = 32) groups by concealed allocation. The control group received MFR (three tissue-specific stretching techniques) and the experimental group received 2 tissue-specific interventions utilizing the Structural Diagnosis and Management (SDM) concept for 12 sessions over a 4-week period. In addition, both groups received strengthening exercises and other conventional treatments. Pain, activity limitations, and disability were assessed as primary outcomes utilizing the foot function index (FFI) and range of motion (ROM) of the ankle dorsiflexors and plantar flexors were measured with a universal goniometer. Secondary outcomes were measured using the Foot Ankle Disability Index (FADI) and a 10-point manual muscle testing process for the ankle dorsiflexors and plantar flexors.

Results: Both the MFR and SDM groups exhibited significant improvements from baseline in all outcome variables, including: pain, activity level, disability, range of motion, and function after the 12-week intervention period (p<.05). The SDM group showed more significant improvements than MFR for FFI pain (p =.001), FFI activity (p =.009), FFI (p =.001), and FADI (p =.002).

Conclusions: MFR and SDM approaches are both effective to reduce pain, improve function, ankle range of motion, and reduce disability in plantar heel pain. However, the SDM approach is significantly superior (for reducing pain, improving function, and reducing disability (p<.05).

Implications: The result of the study will help to understand the effect of the Structural Diagnosis and Management (SDM) approach and Myofascial Release (MFR) for improving plantar heel pain, ankle range of motion, and disability during clinical practice. Besides, this will encourage the physiotherapist to use protocol-based treatment.

Funding acknowledgements: The trial is a self-funded study by the first author.

Keywords:
Plantar heel pain
Structural Diagnosis and Management
Myofascial Release

Topics:
Musculoskeletal: lower limb

Did this work require ethics approval? Yes

Institution: Bangladesh Health Professions Institute (BHPI)

Committee: Institutional Review Board (IRB) of BHPI, Clinical Trial Registry India (CTRI)

Ethics number: CTRI/2020/05/025151