Comparative Effects of Self Myofascial Release Technique and Direct Myofascial Release Technique in Chronic Plantar Fasciitis
Abstract
Background: Chronic plantar fasciitis can cause heel pain, functional limitation, and restricted movement. Myofascial release is used in physiotherapy, but evidence comparing self-myofascial release (SMR) with therapist-administered direct myofascial release (DMFR) remains limited. Objective: To compare the effects of SMR and DMFR, combined with conventional physiotherapy, on pain, foot function, and range of motion in chronic plantar fasciitis. Methodology: This randomized clinical trial included 24 participants with chronic plantar fasciitis recruited from two outpatient clinics in Faisalabad. Participants were randomly allocated to SMR (n=12) or DMFR (n=12). Both groups received ultrasound and stretching exercises for 4 weeks, three sessions per week, with the assigned technique. Pain and foot function were assessed using the Numerical Pain Rating Scale (NPRS) and Foot Function Index (FFI). Dorsiflexion, plantarflexion, inversion, and eversion were measured using goniometry. Wilcoxon signed-rank and Mann-Whitney U tests were used for within- and between-group comparisons. Results: Both groups showed improvement in all outcomes. NPRS decreased from 5.25±0.75 to 3.41±0.66 in the SMR group (p=0.002) and from 5.25±0.75 to 2.25±0.62 in the DMFR group (p=0.001). FFI decreased from 70.91±4.83 to 39.25±6.95 and from 77.25±5.17 to 25.00±6.29, respectively (both p=0.002). DMFR had significantly lower post-treatment NPRS and FFI scores and higher dorsiflexion and plantarflexion than SMR (p≤0.047). No post-treatment differences were found for inversion or eversion. Conclusion: Both SMR and DMFR, when combined with conventional physiotherapy, improved pain, foot function, and ankle and foot range of motion after 4 weeks. DMFR was associated with better post-treatment pain, functional, dorsiflexion, and plantarflexion outcomes, although baseline differences in FFI and eversion warrant cautious interpretation. Larger trials with baseline-adjusted analyses and longer follow-up are needed.