Study: Effective strength training program for the treatment of plantar fasciitis

Veröffentlicht:

Von:

Referenz Rathleff MS, Mølgaard CM, Fredberg U, et al. Krafttraining mit hoher Belastung verbessert das Ergebnis bei Patienten mit Plantarfasziitis: Eine randomisierte kontrollierte Studie mit 12-monatiger Nachbeobachtung. Scand J Med Sci Sports. 21. August 2014. Epub vor dem Druck. Design Eine randomisierte Studie zum Vergleich von 2 Behandlungen für Plantarfasziitis (PF) Teilnehmer An dieser Studie nahmen 48 Patienten mit durch Ultraschall verifizierter PF teil. Studienintervention Diese Studie verglich die Wirksamkeit von Schuheinlagen und täglichem Plantarfaszien-spezifischem Dehnen („Stretch“-Gruppe = 24 Teilnehmer) mit Schuheinlagen und progressivem Krafttraining mit hoher Belastung („Kraft“-Gruppe = 24 Teilnehmer), die jeden zweiten Tag durchgeführt wurden. Dieses Krafttraining …
Reference Rathleff MS, Mølgaard CM, Fredberg u, et al. Strength training with high stress improves the result in patients with plantar fasciitis: a randomized controlled study with a 12-month follow-up. Scand J med sci sports. August 21, 2014. Epub before printing. Design A randomized study for comparison of 2 treatments for plantar fasciitis (PF) Participants in this study took part in 48 patients with PF verified by ultrasound. Study intervention This study compared the effectiveness of shoe insoles and daily plantar fascia-specific stretching ("stretch" group = 24 participants) with shoe insoles and progressive strength training with high load ("Kraft" group = 24 participants) that were carried out every other day. This strength training ... (Symbolbild/natur.wiki)

Reference

Rathleff MS, Mølgaard CM, Fredberg u, et al. Strength training with high stress improves the result in patients with plantar fasciitis: a randomized controlled study with a 12-month follow-up. Scand J med sci Sports. 21. August 2014. Epub before printing.

Design

A randomized study for comparing 2 treatments for Plantar fasciitis (PF)

participant

In this study, 48 patients took part with Pfel verified by ultrasound.

Study intervention

This study compares the effectiveness of shoe inserts and daily plantar fascia-specific stretching ("stretch" group = 24 participants) with shoe insoles and progressive strength training with high load ("Kraft" group = 24 participants) that were carried out every other day. This strength training with high load consisted of one -sided heel lifting with a towel introduced under the toes.

target parameter

The primary end point was the foot function index (FFI), measured after 1, 3, 6 and 12 months. The FFI was developed to measure the influence of foot pathology on the function of pain, disability and activity restriction. This assessment is a self -managed index and consists of 23 items that are divided into 3 subscales.

important knowledge

The simple progressive exercise protocol (power group) led to a superior self -reported result compared to the traditional plantar -specific stretching (stretching group) after 3 months. This technology can lead to faster pain relief and functional improvement. At the primary end point of 3 months, the force group had a 29-point FFI lower (95 % confidence interval: 6-52, p =. 016) compared to the extension group. There was no significant difference in the later follow -up examinations.

practice implications

pf is one of the most common causes of foot pain, which leads to more than one million visits to the doctor per year. 2 The typical age of illness is between 40 and 60 years in the general population and disciples among runners. Over 10 % of the population will have pain at some point, which are due to PF, 3 and most doctors will encounter the problem in their practice.
The cause of PF is most likely multifactorial. The proposed risk factors include bad footwear, exaggeration, pes planus (flat feet), high foot vaults, shortened Achilles tendons and tense calf muscles. 4.5 Overweight, long standing or repeated jumping can also play a role. Heel spur can coexist with PF, but it is unclear whether you play a causal role or whether you result from PFL. In the case of runners, the incidence tends to indicate that PFs could be caused by repeated microtraumas. 6 This accumulation of microtrauma can weaken both the collagen and non-collage matrix and the vascular system of the tissue, which leads to chronic tendinopathy or tendinitis.
cortisone injections have been standard therapy in the past, but with these new thoughts on etiology and the structural changes in plantar fasciitis, these injections should be used more prudently.
Pf typically occurs as an isolated problem that normally occurs on the calcaneous origin of the plantar fascia. Biopsy samples of this pearl white tissue show a variety of pathological changes. These range from degrover changes to fibroblastic proliferation that occur with or without signs of chronic inflammation. Our treatment schemes should therefore be re -evaluated to reflect this, and could include stretching, exercises and strengthening instead of serial cortisone injections.
The treatments generally include a long list of modalities, and despite the frequency of PF, there are only limited data that indicate that treatment is more effective than another. Initial treatments generally included calm, ice cream, orthoses, weight loss in obese, non-steroidal anti-inflammatory drugs (NSAIDs), night rails and glucocorticoid injections.
calm and icing can provide some relief, especially if movement seems to be the aggravating factor. My practice usually sees a large number of runners and triathletes. I generally transfer you to a physiotherapist for a gait analysis to see if an inappropriate biomechanics could worsen the PF. This usually includes an assessment of shoes and sometimes custom -made or pre -made deposits, especially with symptomatic flat feet. The proof that orthoses help with pain relief is not conclusive.
A 2 to 3-week attempt with NSAIDS makes sense to reduce acute pain and swelling. 10 The use of foot rails for the night has proven to be sensible and inexpensive. 11 Exercises can help, although the benefit is limited. Stretching, in particular tissue -specific, is a simple homemade therapy and can offer long -term advantages in reducing pain and functional restrictions.
The current study that compares plantar-specific strength training with plantar-specific stretching, suggests a new modality for the treatment of PF. There are numerous studies that examine the use of daily eccentric isocinetic strengthening exercises for the treatment of other chronic tendinopathies such as Achilles tendonitis and patella syndrome. This study extrapolated by them in order to advocate a similar rehabilitation approach for PF, and shows a greater improvement in the dissolution of the symptoms compared to the sole stretching after 3 months. This approach deals with the non-inflammatory changes that take place in the fascia, strengthens and normalizes the fascia and tendon structure and increases collagen synthesis. Cortisone injections have been standard therapy in the past, but with these new considerations on etiology and the structural changes in PF, these injections should be used more prudently. If non-invasive therapies do not relieve and the pain and disabilities remain, a glucocorticoid injection can be advisable and has proven to be effective.
Unfortunately, this study does not provide us with healing for PF, but it offers a new and non-invasive method for pain relief. The treatment of non -inflammatory, degenerative, structural changes with these exercises and stretches and the simultaneous treatment of the inflammatory changes offers a multifactorial approach that benefits most patients.

  1. Budiman-MAK E, Conrad KJ, Roach Ke. The foot function index: a measure of foot pain and disability. j Clin epidemiol. 1991; 44 (6): 561-570.
  2. puzzle DL, Schappert SM. Volume of outpatient care visits and care patterns for patients with diagnosed plantar fasciitis: a national study by doctors. Foot ankle int. 2004; 25 (5): 303-310.
  3. Demaio M, Paine R, Mangine R, Drez D Jr. Plantar fasciitis. Orthopedics. 1993; 16 (10): 1153-1163.
  4. Rome K. Anthropometric and biomechanical risk factors in the development of plantern heel pain - a literature overview. Phys Ther Rev. 1997; 2 (3): 123-134.
  5. Messier SP, Pittala Ka. Etiological factors in connection with selected running injuries. med sci Sport Exerc. 1988; 20 (5): 501-505.
  6. Taunton Je, Ryan MB, Clement DB, et al. A retrospective case control analysis of running injuries from 2002. br j Sports med. 2002; 36 (2): 95-101.
  7. Fredberg u, Stengaard-Pedersen K. Chronic tendinopathy tissue pathology, pain mechanisms and etiology with special focus on inflammation. scand J med sci sports. 2008: 18 (1): 3-15.
  8. lemont h, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. j am Podiatr Med Assoc. 2003; 93 (3): 234-237.
  9. Hawke F, Burns J, Radford yes, you toit V. Tailor -made foot orthoses for the treatment of foot pain. Cochrane Database Syst Rev. July 16, 2008; (3): CD006801.
  10. Donley BG, Moore T, Sferra J, Gozdanovic J, Smith R. The effectiveness of oral non -steroidal anti -inflammatory medication (NSAID) in the treatment of plantar fasciitis: a randomized, prospective, placebo -controlled study. foot ankle int. 2007; 28 (1): 20-23.
  11. Wapner Kl, Sharkey Pf. The use of night rails for the treatment of stubborn plantar fasciitis. ankle. 1991; 12 (3): 135-137.
  12. DIGIOVANNI BF, Nawoczenski da, Malay dp, et al. Plantar fascia -specific stretching exercises improve the results in patients with chronic plantar fasciitis. A prospective clinical study with two years of follow -up. J bone joint surgery on. 2006; 88 (8): 1775-1781.
  13. camel M, Kotob H. High -frequency ultrasound findings in plantar fasciitis and assessment of local steroid injection. j rheumatol. 2000; 27 (9): 2139-2141.