MANUSCRIPT

TITLE: COMPARISION OF MYOFASCIAL RELEASE VERSUS

STRECHING IN DECREASING PAIN & IMPROVING RANGE OF

MOTION IN PATIENT SUFFERING FROM PLANTER FASCITIS.

AUTHOR: GAURAV GULERIA

MPT IIND YEAR ( Orthopeadics)

Ras Bihari Bose Subharti University In Shahpur Santore ,Dehradun,Uttrakhand

ABSTRACT

Purpose of study: to compare the effectiveness of myofascial release and stretching with ultrasonic

on plantar fasitis.

Materials and Methods: 30 subjects with the clinical diagnosis of plantar fasciitis were randomly
allocated to two study groups. Group A received therapeutic ultrasound(Frequency: 7mintute per
session Mode-pulsed mode-4:1, Intensity-1.2)and stretching and group B received therapeutic
ultrasound(1 MHz, 1 Watt/cm2,pulsed mode 1:4,5 minutes) with myofascial release for 15 minutes for
15 consecutive days. The outcome was assessed in terms of VAS and ROM in different ankle
movement prior to the treatment,than every 8th day and last 15th day than according to follow up.

Results: In this study i found that there was relief in both the scale in the group but there was no
significant change between the two groups in VAS and ROM for all the movements at end of the
treatment.

Conclusion: it is concluded that both the techniques

Keywords: plantar fascia, plantar fasciitis, ultransonic therapy have same effect on plantar fasciitis
but myofascial release was slight better than stretching., stretching; myofascial release, visual
analogue scale (VAS), goniometer, range of motion.

INTRODUCTION

Plantar fasciitis is the most common cause of inferior heel pain. The word ‘fasciitis’ assumes
inflammation is an inherent component of this condition.

It is typically precipitated by biomechanical stress.

Plantar fascia is plantar aponeurosis, lies superficial to the muscles of the plantar surface of
the foot. Plantar fascia has a thick central part which covers the central muscle of the 1st
layer, flexor digitorum brevis and is immediately deep to the superficial fascia of the plantar
surface. It acts as a truss, maintaining the medial longitudinal arch of the foot, and assists
during the gait cycle and facilitates shock absorption during weight bearing activities. Plantar
fasciitis has been reported across a wide sample of the community. In the non athletic
population, it is most frequently seen in weight bearing occupations.65% of non sports
demographics are over weight, with unilateral involvement most common in 70% of cases.
Second major distribution of plantar fasciitis is in the athletic population, 10% of all running
athletes. Basket ball, tennis, football, long distance runner and dance have all noted high
frequency of plantar fasciitis.1

The classic presentation of plantar fascia is pain on the sole of foot at the inferior region of
the heel. Patient report the pain to be particularly bad with the first step taken on rising in the
morning or after an extended refrain from weight bearing activity. After few steps and
through the course of the day, the heel pain diminishes, but returns if intense or prolonged
weight bearing activity is undertaken. Initial reports of heel pain may be diffuse or migratory;
with time it usually focuses around the area of the medial calcaneal tuberosity. Generally,
pain is most significant when weight bearing activities are involved.2

Various physiotherapy treatment protocols have been advocated in the past such as rest,
taping, orthosis- night splint, Silicon heel cups, stretching and myofascial release.
Electrotherapy modalities in the form of ultrasound, phonophoresis, laser, microwave
diathermy, iontophoresis, cryotherapy, contrast bath have been given in past.13 Myofascial
release has been one of the physical therapy treatments given in the chronic conditions that
causes tightness and restriction in soft tissues (e.g.:- fibromyalgia and post polio
syndrome),asymmetrical muscle weakness due to peripheral neuropathy and in inflexible rib
cage due to chronic respiratory disease and also in plantar fasciitis.

Myofascial release is a soft tissue mobilization technique. If the condition is treated in the
acute stage, then symptoms will be aggravated. If treated in the chronic stage, the symptoms
will alleviate. Myofascial release techniques stem from the foundation that fascia, a
connective tissue found throughout the body, reorganizes itself in response to physical stress
and thickness along the lines of tension.3 By myofascial release there is a change in the
viscosity of the ground substance to a more fluid state which eliminates the fascia’s excessive
pressure on the pain sensitive structure and restores proper alignment.4 Hence this technique
is proposed to act as a catalyst in the resolution of plantar fasciitis.

The present study was undertaken with the intention to find out the effectiveness of
myofascial release in plantar fasciitis, in conjunction with conventional treatment and to
compare the effectiveness of MFR over conventional treatment.

Check for the Windlass Test5 is an appropriate special test for impairment of the fascia and
ligaments of the foot. With the patient sitting, the examiner stabilizes the ankle in neutral
with one hand and then, with the other hand, extends the first metatarsophalangeal joint while
allowing the interphalangeal joint to flex. Passive extension of the first metatarsophalangeal
joint is continued until end range or until the patient’s pain is reproduced. Reproduction of
pain indicates a positive test for plantar fascia impairment.
Ultrasonic Therapy- benefits to ultrasound:-Speeding up of the healing process from the
increase in blood flow in the treated area, Decrease in pain from the reduction of swelling and
edema, break up scar tissue and adhesions, increase soft tissue extensibility prior to stretching
and exercise.
Stretching is a form of physical exercise in which a specific muscle or tendon (or muscle
group) is deliberately flexed or stretched to improve the muscle's felt elasticity and achieve
comfortable muscle tone. The result –increase muscle control, flexibility and range of
motion.
Stretching planter fasciitis- Heel-Cord Stretching, Ankle Dorsiflexion. Foot Inversion and
Eversion, Self stretching.

METHODOLOGY

The study was carried out in patients referred to Physiotherapy department of Avantika
Hospital and sneh shakti clinic in ghaziabad, For treatment of plantar fasciitis. It was a
randomized controlled trial study. Consent to carry out the study was granted by the
Institutional ethical clearance committee. Both male and female (30 subjects) individuals
suffering with heel pain and clinically diagnosed plantar fasciitis since 6 weeks referred to
physiotherapy department and willing to take treatment for 15 successive days, were enrolled
for that study.

INCLUSION CRITERIA

 Male and female both.

 Age- 20-60years
 Clinically diagnosed cases of plantar fasciitis not less than 3-6 weeks.
 Those who were willing to precipitate in the study and willing to take treatment for 15
successive days.
 Heel pain felt maximally over plantar aspect of heel
 Pain in the heel on the first step in the morning
 No history of rest pain in heel

EXCLUSION CRITERIA

 Subjects with clinical disorder where therapeutic ultrasound is contraindicated such as

infective conditions of foot, tumor, calcaneal fracture, metal implant around ankle.
 Subjects with clinical disorder where myofascial release is contraindicated as
dermatitis.
 Subjects with impaired circulation to lower extremities
 Subjects with referred pain due to sciatica and other neurological disorders.
 Subject with impaired foot deformities.
 Corticosteroids injection in heel preceding 3 months.

METHOD

Ultrasonic therapy is used for healing purpose of inflamed fascia.

Frequency: 7mintute per session
Mode-pulsed mode-4:1
Intensity-1.2
2weeks treatment
 MFR is a soft tissue mobilization technique.The patient is asked to lie prone
on a couch with his feet out of the couch. He is given a pillow under his feet for
support and patient comfort. The area of treatment is cleaned and dried properly. The
therapist evaluates the area of pain. Sustained gentle pressure in the line with the
fibers of plantar fascia from calcaneum towards the toes, using the thumb, is given.
This pressure is held for 90 seconds.

Frequency: 15 minutes per session

1 minute of rest interval
2 weeks treatment.

Stretching is given specific to plantar fascia. The patient is asked to lie supine
and made comfortable. The therapist supports the patient’s ankle with his one hand.
With the other hand he gives stretch to the plantar fascia. The foot is kept in neutral
position. The therapist places his fingers on the patient’s toes and extends them till the
patient feels the stretch on the plantar fascia. The stretch is checked by palpating
tension over plantar fascia.

Frequency: 30 seconds hold time

6 repititions
15 seconds rest time between each stretch
2 weeks
Frequency: one session everyday for 2weeks

Group I: 15 subjects in this group will be given ultrasonic therapy (7min)+

stretching will be given for plantar fascia. Sustained stretching will be given for the
duration of 30 seconds with 6 repetitions and 15 seconds rest period will be given
between each repetition. Treatment will be given for one session per day and the total
treatment period will be for 2 weeks. We will advice for home exercises.

Group II: 15 Subjects in this group will be given ultrasonic therapy (7min)+
myofascial release technique by using thumb for 15 minutes. Treatment will be given
for one session per day and the total treatment period will be for 2 weeks. We will
advice for home exercises.

 We will measure the pain rate by Visual analogue scale for pain and foot fuction
scale prior to the treatment,than every 5 th day and last 15th day than according to
follow up.
RESULTS

Mean and standard deviation for pain relief with VAS was calculated and compared for
subjects of group A and group B on different days in table 1(a ) and t-test (1 st-0.58, 8th-0.72,
15th- 1.41) and significance 2-tailed (1st-0.56, 8th-0.47, 15th-0.16) were calculated and
compared on different days in table 1(b) by independent sample of t-test. There was no
significant difference between the groups, however group B was slight better than group A.
no difference may be due to sampling error.
Mean and standard deviation for range of motion measured in terms of goniometry were
calculated and compared for different ankle movement that were dorsiflexion in table 2 (a),
plantar flexion in table 3 (a), inversion in table 4 (a) and eversion in table 5 (a) between two
groups and t-test and significance for dorsiflexion (1 st - -0.70/0.94, 8th-0.23/0.81, 15th-
0.29/0.77) in table 2(b), plantarflexion (1 st- -1.31/0.20, 8th- -1.40/0.17, 15th- -1.02/0.31) in
table 3(b), inversion (1st- 0.85/0.40, 8th- 1.62/0.11, 15th -1.37/0.18) in table 4(b) and eversion
(1st- -1.01/0.32, 8th- -1.12/0.27, 15th- 1.18/0.24) in table 5(b) by independent sample of t-test
on different days. There were no such significant difference between the groups, but group B
had shown slight better improvement in range than group A.

DISCUSSION

Plantar fasciitis is one of the conditions, which can be treated by a wide variety of
physiotherapy methods. It is still difficult to formulate all proof guidelines for the
management of plantar fasciitis. Various methods of treatment exist with own claims of
success without any attempts of comparing the maximal effective methods. The objective of
this study was to find out the effectiveness of myofascial release and stretching in treatment
of plantar fasciitis.

In the present study, age group participated was between 20 to 60 years. The majority of
patients afflicted with plantar fasciitis are 40 to 60 years of age46, although the range has been
reported to be 8 to 80 years of age. It has been reported that subcalcaneal pain is a common
orthopaedic problem that generally occurs in person 30 to 70 years of age. Body mass index
of the subjects has been assessed for both groups and mean BMI was found which were 24.22
kgs/mt2 for A group and 26.36kgs/mt2 for Bl group. According to WHO standard
ideal BMI is in range of 18.5 – 24.9.47 One of the risk factor for plantar fasciitis is sudden
gain in body weight or obesity, few subjects were obese which was the one of main cause of
planter fascittis.

Analysis of pain relief was done by subjective VAS by statistical mean. Mean and standard
deviation of pain in terms of VAS was done and found that the average of VAS score for A
group on 1st day was 8.13±0.99 and on 8th day was 6.60±1.45 and on 15th day was
4.53±1.30. The average VAS score for B group on 1st day was 7.93±0.88 and on 8th day was
6.26±1.03 and on 15th day was 4.00±0.65. The t value for VAS on 1st day for both groups
was 0.58 and on 8th day was 0.72 and on 15th day was 1.41. The significance (2-tailed) for 1st
day was 0.56, for 8th day was 0.47 and for 15th day was 0.17 which showed a statistical
significant difference between 1st, 8th and 15th day score which says that there is no as such
significance difference..

Analysis of range of motion for different movement (i,e dorsiflexion, planter flexion,
inversion and eversion) was done by goniometry by statistical mean. Mean and standard
deviation of range of motion in term of goniometry was done and found that the average of
goniometry score for dorsiflexion for group A on 1st day was 13.86±2.77, on 8th day was
15.86±2.58 and on 15th day was 17.26±2.15 and for group B on 1st day was 13.93±2.77, on 8th
day was 15.66±2.05 and on 15th day was 17.06±1.57. For planterflexion for group A on 1st
day was 39.87±3.39, on 8th day was 42.13±3.15 and on 15th day was 44.80±2.93 and for
group B on 1st day was 41.40±2.99, on 8th day was 43.60±2.53 and on 15th day was
45.73±1.98. for inversion for group A on 1st day was 30.20±2.11, on 8th day was 32.00±1.69
and on 15th day was 32.47±1.45 and for group B on 1st day was 29.67±1.17, on 8th day was
31.13±1.18 and on 15th day was 32.47±1.18. for eversion for group A on 1st day was
16.13±3.18, on 8th day was 17.73±2.91 and on 15th day was 20.20±2.75 and for group B on 1st
day was 17.13±2.13, on 8th day was 18.73±1.83 and on 15th day was 21.20±1.78. .

The t value for range of motion for dorsiflexion on 1st day for both groups was -0.07 and on
8th day was 0.23 and on 15th day was 0.29. The significance (2-tailed) for 1st day was 0.94,
for 8th day was 0.81 and for 15th day was 0.77 which showed a statistical significant
difference between 1st, 8th and 15th day score which says that there is no as such significance
difference. . The t value for planterflexion on 1st day for both groups was -1.31 and on 8th
day was -1.40 and on 15th day was -1.02. The significance (2-tailed) for 1st day was 0.20, for
8th day was 0.17 and for 15th day was 0.31 which showed a statistical significant difference
between 1st, 8th and 15th day score which says that there is no significance difference. . The t
value for inversion on 1st day for both groups was 0.85 and on 8th day was 1.62 and on 15th
day was 1.37. The significance (2-tailed) for 1st day was 0.40, for 8th day was 0.11 and for 15th
day was 0.18 which showed a statistical significant difference between 1st, 8th and 15th day
score which says that there is no significance difference. . The t value for eversion on 1st day
for both groups was -1.01 and on 8th day was -1.12 and on 15th day was -1.18. The
significance (2-tailed) for 1st day was 0.32, for 8th day was 0.27 and for 15th day was 0.24
which showed a statistical significant difference between 1st, 8th and 15th day score whish says
that there is no significance difference.

In this study both groups received therapeutic ultrasound as a part of conventional treatment
for plantar fasciitis. According to a study performed by Hana Hronkova in 200092 in which
the group which received ultrasound for plantar fasciitis showed significant reduction in pain.

In contrast, study done by Crawford F, et al in 1996 therapeutic ultrasound was given to

patients with heel pain and found no evidence to support the effectiveness of therapeutic
ultrasound.48 for therapeutic ultrasound the dosage used in this study was chosen from
evidence available. Pulsed ultrasound was used as its preferred for soft tissue repair as
affirmed by Young49 and 1 MHz was chosen as it is capable of reaching to deeper layer. Pain
relief could have occurred due to the non thermal effects of pulsed ultrasound in the form of
stimulation of histamine release from mast cells and factors from macrophages that
accelerated the normal resolution of inflammation as suggested by young and
Dyson50 Although the results are contradictory to a review carried out by Robert and Baker of
35 randomized controlled trials looking at evidence of the biophysical effects of ultrasound
out of which only 2 trials were found to be more effective than placebo ultrasound and ten of
the 35 trials studied were judged to be robust513

Group B showed slight improvement in terms of both pain relief and range of motion than
stretching for group A. This can be attributed to myofascial release which B group received
in addition to conventional treatment. Myofascial release refers to soft tissue manipulation
techniques. Stretching had also show a good result approximately equal to myofascial release

Myofascial release therapy uses hands on manipulation of the whole body to promote healing
and relieving pain. Injuries, stress, trauma and poor postures can cause restriction to fascia.
The goal of myofascial release is to release is to release fascia restriction and restore its
tissue. This technique is used to ease pressure in the fibrous bands of the connective tissue, or
fascia. Gentle and sustained stretching of myofascial release is believed to free adhesions and
softens and lengthens the fascia. By freeing up fascia that may be impending blood vessels or
nerves, myofascial release is also said to enhance the body’s innate restorative powers by
improving circulation and nervous system transmission. Some practitioners contend that the
method also release pent-up emotions that may be contributing to pain and stress in the body.
Myofascial release works on a broader swath of muscles and connective tissue.
The movement has been likened to kneading a piece of taffy- a gentle stretching that
gradually softens, lengthens, and realigns the fascia. Direct myofascial release method works
directly on the restricted fascia. MFR seeks for changes in the myofascial structures by
stretching, elongation of fascia or mobilizing adhesive tissues.
Study done by Shirat Ling, DO, 1999, concluded that direct myofascial release is a highly
effective technique for plantar fasciitis patients who need to recover quickly. All the
treatment methods are equally beneficial in the treatment of plantar fasciitis. It can be
concluded that myofascial release is an effective therapeutic option in the treatment of plantar
fasciitis. Hence the sample size studied, further research can be done with a larger sample
using the same protocol.
Stretching is a form of physical exercise in which a specific muscle or tendon (or muscle
group) is deliberately flexed or stretched in order to improve the muscle's felt elasticity and
achieve comfortable muscle tone. The result is a feeling of increased muscle control,
flexibility and range of motion. Static stretching is a type of stretch whereby a person
stretches the muscle until a gentle tension is felt and then holds the stretch for thirty seconds
without any movement.
A study performed by Magid and Law demonstrated that the origin of passive muscle tension
(which occurs during stretching) is actually within the myofibrils, not extracellularly as had
previously been supposed.
Due to neurological safeguards against injury, it is normally impossible for adults to stretch
most muscle groups to their fullest length without training due to the activation of muscle
antagonists as the muscle reaches its normal range of motion.
 If people stretch daily, they will increase their flexibility, elasticity, range of motion, and
production of synovial fluid. Stretching improves balance, physical performance, and blood
circulation.

Muscle pain is caused by tissue damages and excessive blood accumulation. This can be
prevented if one stretches on a regular basis.

CLINICAL IMPLICATIONS

This study deal with the comparison of two very useful techniques that are stretching and
myofascial release with ultrasonic therapy in plantar fasciitis which is a very common
problem in today’s day to day life after 19-20 years of age in all genders. Few commonest
reasons for this is obesity, standing or running jobs, regular high heel wearing etc. Obesity is
one of the reasons which can cause plantar fasciitis in age group below 19 also due to
excessive load on plantar fascia. These two therapies stretching and myofascial release are
used to decrease pain and improve range of motion in the patients. Stretching is used to
stretch the effected contracted plantar fascia to increase its flexibility and strengthen it. On
the other hand myofascial release is also use to strengthen the muscle and increase flexibility
which in turn decrease the pain and improves the range of motion. Ultrasound therapy is used
with both the methods which is used to decrease inflammation and decrease pain. Both the
technique approximately same results with improved range and decreased pain. Myofascial
release show slight better effect then stretching .

FUTURE RESEARCH
Effects of myofascial released with home exercises should be explored further.
Effects of myofasical release with physical therapy machines should be encouraged
Study can be done with more number of subjects so that result can be more accurate.
For a accurate study subjects can be taken from same field like only dancers, soldiers, runners
etc.
CONCLUSION

On the basis of present study, it can be concluded that conservative treatment approach like
physiotherapy in the treatment of plantar fasciitis, is beneficial. Although both the stretching and
myofascial release have found to be equally effective in alleviation of symptoms and associated
disability in plantar fasciitis. However the subjects treated with myofascial release showed a slight
benefit in terms of reduction of pain on VAS and range of motion than stretching but significance
difference was not such. Hence it can be concluded that myofascial release and stretching both are an
effective therapeutic option in the treatment of plantar fasciitis
Acknowledgement

The present dissertation entitled “COMPARISION OF MYOFASCIAL RELEASE VERSUS

STRECHING IN DECREASING PAIN & IMPROVING RANGE OF MOTION IN PATIENT

SUFFERING FROM PLANTER FASCITIS” was conducted under the guidance of Dr. Deepali

Pal , Ras Bihari Bose Subharti University. No amount of words can express my sense of gratitude

and measure the debt I owe to my guide who gave me inspiration, valuable comments and suggestions

during the course of study and preparation of manuscript.

I also wish to thank the entire staff, Physiotherapy department, Ras Bihari Bose University, Dehradun,

Uttrakhand who guided me in every step.

Date: Signature of the Candidate

Place:

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Important tables and graphs

VAS SCALE FOR GROUP A VAS SCALE FOR GROUP B

 Age/sex Pre 8th 15th pr 8th 15th
Age/sex
day day e da day
1. 27/f 9 8 5 y
1. 29/F 7 5 4
2. 31/m 10 9 7 9 7 4
2. 42/F
3. 35/f 8 6 4
3. 19/M 9 8 5
4. 40/M 8 5 4
4. 56/F 9 7 4
5. 32/ M 8 8 6
5. 52/M 7 5 3
6. 26/F 8 7 5
7 5 3 6. 20/F 9 7 4
7. 30/M
10 9 7 7. 29/F 8 7 4
8. 52/M
9. 27/M 7 5 4 8. 45/F 7 5 3
10. 39/M 8 6 3 9. 37/M 9 7 4
10. 59/M 7 5 4
11. 33/M 7 5 4 11. 60/M 7 5 3
12. 49/M 7 5 3 12. 22/F 8 7 4
13. 36/M 8 7 5 13. 42/M 7 6 5
14. 45/F 8 7 4 14. 27/F 8 7 4
15. 42/M 9 7 4 8 6 5
15. 23/F

Group N Mean Std. Deviation

VASPre A 15 8.1333 .99043

B 15 7.9333 .88372

VAS8thDay A 15 6.6000 1.45406

B 15 6.2667 1.03280

VAS15thDay A 15 4.5333 1.30201

B 15 4.0000 .65465

Table 1(a): mean and standard deviation of VAS for subjects of group A

and group B on different days.

 t Sig. (2-tailed) Mean Difference

VASPre Equal variances assumed .584 .564 .20000

Equal variances not assumed .584 .564 .20000

VAS8thDay Equal variances assumed .724 .475 .33333

Equal variances not assumed .724 .476 .33333

VAS15thDay Equal variances assumed 1.417 .167 .53333

Equal variances not assumed 1.417 .171 .53333

Table:1(b) t value and sig (2-tailed) value for VAS for group A and B
on different days

5
pre
8th day
4
15th day
3

0
group A (m) group B (M)

Figure 1: Comparison of mean values of the subjects of group A and group B on different
days for VAS for pain scale.

ROM FOR DORSIFLEXION Of GROUP A

Normal range- 15 to 20 degree ROM FOR DORSIFLEXION OF GROUP B
 Age/sex Pre 8th 15th
Age/sex pre 8th 15th
day day
day day
1. 27/f 11° 15° 16°
1. 29/F 15° 17° 19°
2. 42/F 10° 12° 13°
2. 31/m 9° 10° 12°
3. 19/M 14° 16° 18°
3. 35/f 15° 17° 18°
4. 56/F 9° 12° 17°
4. 40/M 18° 20° 20°
5. 52/M 16° 17° 19°
5. 32/ M 11° 12° 14°
12° 16° 17° 6. 20/F 14° 17° 17°
6. 26/F
7. 30/M 16° 17° 19° 7. 29/F 10° 12° 15°
8. 52/M 15° 18° 18° 8. 45/F 17° 18° 18°
9. 27/M 18° 18° 20 9. 37/M 13° 16° 17°
10. 39/F 16° 18° 18° 10. 59/M 15° 15° 17°
11. 60/M 16° 17° 19°
11. 33/M 16° 17° 19° 12. 22/F 16° 17° 17°
12. 49/M 13° 14° 17° 13. 42/M 14° 15° 16°
13. 36/M 11° 14° 16° 14. 27/F 14° 17° 17°
14. 45/F 12° 15° 17° 15. 23/F 16° 17° 17°
15. 42/M 15° 17° 18°

Group N Mean Std. Deviation

ROMDFPre A 15 13.8667 2.77403

B 15 13.9333 2.46306

ROMDF8thDay A 15 15.8667 2.58752

B 15 15.6667 2.05866

ROMDF15thDay A 15 17.2667 2.15362

B 15 17.0667 1.57963

Table 2(a): Mean and standard deviation of dorsiflexion for subjects

of group A and group B on different days.

T df Sig. (2-tailed)

ROMDFPre Equal variances assumed -.070 28 .945

Equal variances not assumed -.070 27.613 .945

ROMDF8thDay Equal variances assumed .234 28 .816

Equal variances not assumed .234 26.654 .817

ROMDF15thDay Equal variances assumed .290 28 .774

Equal variances not assumed .290 25.682 .774

 Table: (b) t value and sig (2-tailed) value for range of motion for
dorsiflexion flexion of group A and B

20

18

16

14

12
Series 1
10
Series 2
8 Series 3

0
Group A (M) Group B (M)

Figure 2: Comparison of mean values of the subjects of group A and group B on different
days for range of motion in dorsiflexion.

ROM FOR PLANTERFLEXION OF GROUP A ROM FOR PLANTERFLEXION OF GROUP B

Normal range- 45-50 degree

Age/sex Pre 8th 15th

day day
1. 27/f 35° 39° 42°

2. 31/m 30° 33° 36°

3. 35/f 40° 42° 46°
4. 40/M 42° 44° 47°
5. 32/ M 42° 44° 45°
6. 26/F 39° 40° 44°
7. 30/M 40° 42° 46°
8. 52/M 41° 43° 46°
 Age/sex pre 8th 15th
day day
1. 29/F 40° 41° 45°
2. 42/F 39° 42° 44°
3. 19/M 42° 42° 45°
9. 27/M 42° 45° 47° 4. 56/F 34° 39° 42°
10. 39/F 41° 41° 43° 5. 52/M 45° 46° 48°
6. 20/F 41° 45° 47°
11. 33/M 44° 45° 48° 7. 29/F 40° 44 47
12. 49/M 42° 45° 46° 8. 45/F 45° 47° 48°
13. 36/M 39° 41° 44° 9. 37/M 40° 42° 45°
14. 45/F 41° 44° 47° 10. 59/M 44° 47° 48°
15. 42/M 40° 44° 45° 11. 60/M 41° 44° 46°
12. 22/F 45° 45° 47°
13. 42/M 39° 41° 42°
14. 27/F 44° 47° 47°
15. 23/F 42° 42° 45°

Group N Mean Std. Deviation

ROMPFPre 1 15 39.87 3.399

2 15 41.40 2.995

ROMPF8thDay 1 15 42.13 3.159

2 15 43.60 2.530

ROMPF15thDay 1 15 44.80 2.933

2 15 45.73 1.981

Table 3(a): Mean and standard deviation of plantarflexion for subjects of group A and group
B on different days.
 t Df Sig. (2-tailed)

ROMPFPr Equal variances assumed -1.311 28 .201

e
Equal variances not
-1.311 27.564 .201
assumed

ROMPF8t Equal variances assumed -1.403 28 .171

hDay Equal variances not
-1.403 26.723 .172
assumed

ROMPF15 Equal variances assumed -1.021 28 .316

thDay
Equal variances not
-1.021 24.574 .317
assumed

Table: 3(b) t value and sig (2-tailed) value for range of motion for plantarflexion of group A
and B on different days.

48

46

44

pre
42
8th day
15th day
40

38

36
group A(M) group b(M)

Figure 3: Comparison of mean values of the subjects of group A and group B on different
days for range of motion in plantar flexion.
ROM FOR INVERSION OF GROUP A ROM FOR INVERSION OF GROUP B
Normal range- 30-35 degree

Age/sex Pre 8th 15th Age/sex pre 8th 15th

day day day day
1. 27/f 28° 30° 31° 1. 29/F 31° 33° 33°
2. 42/F 28° 30° 31°
2. 31/m 27° 30° 31° 3. 19/M 27° 29° 30°
3. 35/f 32° 34° 34° 4. 56/F 30° 31° 33°
4. 40/M 30° 32° 35° 5. 52/M 31° 32° 34°
5. 32/ M 33° 34° 34° 6. 20/F 29° 30° 31°
6. 26/F 34° 34° 35° 30° 31° 33°
7. 29/F
7. 30/M 31° 33° 33°
8. 45/F 30° 32° 33°
8. 52/M 30° 32° 33°
9. 37/M 29° 30° 32°
9. 27/M 33° 35° 35°
30° 32° 33° 10. 59/M 31° 32° 34°
10. 39/F
11. 60/M 30° 32° 32°
11. 33/M 29° 30° 32° 12. 22/F 30° 31° 33°
12. 49/M 29° 31° 32° 13. 42/M 29° 31° 32°
13. 36/M 28° 31° 34° 14. 27/F 31° 33° 34°
14. 45/F 31° 32° 34° 15. 23/F 29° 30° 32°
15. 42/M 28° 30° 31°

Group N Mean Std. Deviation

ROMINPre 1 15 30.20 2.111

2 15 29.67 1.175

ROMIN8thDay 1 15 32.00 1.690

2 15 31.13 1.187

ROMIN15thDay 1 15 33.13 1.457

2 15 32.47 1.187

Table 4(a): Mean and standard deviation of inversion for subjects of group A and group B on
different days.
 t Df Sig. (2-tailed)

ROMINPre Equal variances assumed .855 28 .400

Equal variances not

.855 21.915 .402
assumed

ROMIN8thDay Equal variances assumed 1.625 28 .115

Equal variances not

1.625 25.110 .117
assumed

ROMIN15thDay Equal variances assumed 1.374 28 .180

Equal variances not

1.374 26.901 .181
assumed

Table: 4(b) t value and sig (2-tailed) value for range of motion for inversion of group A and B
on different days.
 34

33

32

31
pre
8th day
30
15th day

29

28

27
group A (M) group B(M)

Figure 4: Comparison of mean values of the subjects of group A and group B on different
days for range of motion in inversion

ROM FOR EVERSION OF GROUP A ROM FOR EVERSION OF GROUP B

Normal range- 20-25 degree

Age/sex pre 8th 15th

Age/sex Pre 8th 15th day day
day day
1. 29/F 19° 19° 22°
1. 27/f 15° 16° 20°
2. 42/F 15° 17° 20°
2. 31/m 11° 12° 14° 3. 19/M 14° 17° 19°
3. 35/f 13° 15° 19° 4. 56/F 19° 21° 23°
4. 40/M 17° 19° 22° 5. 52/M 18° 20° 22°
5. 32/ M 11° 13° 17° 6. 20/F 15° 17° 19°
6. 26/F 14° 17° 20° 7. 29/F 17° 20° 23°
7. 30/M 18° 19° 22° 8. 45/F 20° 21° 23°
8. 52/M 15° 17° 18° 18° 19° 21°
9. 37/M
9. 27/M 19° 20° 23°
10. 59/M 19° 20° 22°
10. 39/F 19° 20° 22°
11. 60/M 15° 17° 21°
11. 33/M 20° 21° 23° 12. 22/F 20° 21° 23°
12. 49/M 19° 20° 23° 13. 42/M 14° 15° 17°
13. 36/M 14° 16° 17° 14. 27/F 18° 19° 22°
14. 45/F 21° 22° 23° 15. 23/F 16° 18° 21°
15. 42/M 16° 19° 20°
 Group N Mean Std. Deviation

ROMEVPre 1 15 16.13 3.182

2 15 17.13 2.134

ROMEV8thDay 1 15 17.73 2.915

2 15 18.73 1.831

ROMEV15thDay 1 15 20.20 2.757

2 15 21.20 1.781

Table 5(a): Mean and standard deviation of eversion for subjects of group A and group B on
different days.

t df Sig. (2-tailed)

ROMEVPre Equal variances assumed

-1.011 28 .321

Equal variances not assumed -1.011 24.473 .322

ROMEV8thDay Equal variances assumed

-1.125 28 .270

Equal variances not assumed -1.125 23.561 .272

ROMEV15thDay Equal variances assumed

-1.180 28 .248

Equal variances not assumed -1.180 23.951 .250

Table: 5(b) t value and sig (2-tailed) value for range of motion for eversion of group A and B
on different days.
 25

20

15
pre
8th day
10 15th day

0
Group A (M) Group B (M)

Figure 5: Comparison of mean values of the subjects of group A and group B on different
days for range of motion in eversion

CERTIFICATE

This is to certify that work embodied in this dissertation entitled

COMPARISION OF MY0FASCIAL RELEASE VERSUS STRECHING IN

DECREASING PAIN & IMPROVING RANGE OF MOTION IN PATIENT

SUFFERING FROM PLANTER FASCITIS has been carried out by

GAURAV GULERIA in RAS BIHARI BOSE SUBHARTI UNIVERSITY,

DEHRADUN,UTTRAKHAND,MPT II YEAR (ORTHOPEDICS) under my

supervision and guidance.

To the best of my knowledge no part of this dissertation has been

submitted for any other degree.

The candidate has put up the required attendance as per the ordinance of

the RAS BIHARI BOSE SUBHARTI UNIVERSITY, DEHRADUN, UTTRAKHAND.

Date:

Place: Signature and Seal of the Guide

(Dr. deepali pal)

MPT (ortho)
Physiotherapy Department