Graston Technique for Plantar Fasciitis

Plantar fasciitis is the most common cause of heel pain. Caused by inflammation of the tissue that runs along the bottom of the foot and connects the heel to the toes, plantar fasciitis can become chronic and be painful enough to interfere with normal activities. The Graston Technique® is one option for treating chronic plantar fasciitis and restoring function.

History

• The Graston Technique® was thought of by an athlete who was frustrated by his slow recovery after a soft-tissue injury. Since he had a background in machining, he wondered if metal instruments could be used to help restore range of motion to injured tissues. Research on the technique began in Indiana in 1994, and the parent company began training clinicians to use the technique in 1999. Now there are nearly 6000 clinicians who use the Graston Technique® as part of their rehabilitation programs, and the technique is a part of the curriculum at 29 colleges/universities (see Resources sections to locate practitioners).

Features

• The fascia is made of layers of connective tissue that surround muscles, ligaments, tendons and other body parts. Chronic soft tissue injuries such as plantar fasciitis often include scar tissue and/or adhesions that can make the fascia "stiff" and limit range of motion. Many treatments for plantar fasciitis involve stretching the muscles, tendons and fascia of the calf and the foot.

  The Graston Technique® is a method of stretching those tissues involved in plantar fasciitis in order to reduce pain and improve range of motion. The technique uses patented stainless steel instruments, which the clinician moves over the affected areas in a prescribed way. Each instrument is shaped and weighted for a specific body area. For treating plantar fasciitis, the instruments are used along the gastrocnemius muscle (the large muscle in the calf), the first metatarsophalangeal joint (where the big toe connects to the foot) and the medial calcaneal tuberosity (the bulge in the heel bone on the arch-side of the foot).

  During Graston Technique® treatments, the clinician firmly presses the stainless steel instrument into the affected area, and steadily moves the instrument across the area. While moving the instrument across the skin, the clinician can feel "bumpy" areas where scar tissue or adhesions are. The gentle pulling of the instrument across the tissue is designed to break up the adhesions or scar tissue, freeing the tissue for increased range of motion. The patient is not limited in his or her activities while undergoing treatment with the Graston Technique. The clinician will have the patient do a brief warm-up before the treatment, and stretch and apply ice afterward. Patients usually have treatments twice a week for four to five weeks.

Alternatives

• Methods for decreasing pain and increasing range of motion in plantar fasciitis sufferers include ice massage, use of anti-inflammatory medications, stretching and strengthening exercises, use of night splints, ultrasound or galvanic therapy, and extracorporeal shock wave therapy. Your physician or physical therapist can help you to decide which combination of therapies is right for you. In rare cases, surgery is required to treat plantar fasciitis.

Prevention/Solution

• Since plantar fasciitis is often brought on by over-use, it is important to pay attention to activities that cause or increase heel pain. Standing, walking, running and jumping are all activities that can strain the plantar fascia. Keeping a pain journal can help you to tell which activities are contributing to your heel pain, so you can reduce or eliminate certain activities.

  Since people who are overweight are more prone to developing plantar fasciitis, weight loss can help when it is appropriate. Since pregnant women are more prone to plantar fasciitis, they should take extra care to wear shoes with good arch support. Runners also need to take special care to wear the proper shoes; see Resources section for advice on selecting shoes. Runners should be sure to use regular gentle stretches that target the muscles in the backs of the legs; this can help to prevent plantar fasciitis.

Considerations

• There are a variety of methods available for treating plantar fasciitis. Most methods are used in a combination with other methods. Your physician or physical therapist can help you decide which combination will work best for you.

  Possible side effects of the Graston Technique® include discomfort, swelling and bruising, and are usually mild.