ASTYM® TREATMENT AS AN ADJUNCT TO STANDARD PHYSICAL THERAPY - PowerPoint Presentation

ASTYM® TREATMENT AS AN ADJUNCT TO STANDARD PHYSICAL THERAPY CARE FOR CHRONIC HEEL PAIN: A MULTIPLE PATIENT CASE REPORTShannon Hay, DPT, Mallory Mountz, DPT, Monika Thelen, DPTBenchmark Rehab Partners, Ooltewah, TN Background/PurposePlantar heel pain is the most common diagnosis for foot & ankle pain, and approximately 1 in 10 individuals will experience plantar heel pain during the course of their life. Current research suggests that the underlying pathology behind chronic plantar heel pain is the result of a degenerative process, as opposed to inflammation, which has significant implications for its treatment. The use of Astym® therapy has been shown to promote cell regeneration and decrease presence of scar tissue resulting in improved ROM, decreased pain, and improved function in several tendinopathies and chronic soft tissue injuries. Currently, there is limited evidence for the effectiveness of Astym therapy as an adjunct to standard physical therapist services in the treatment of plantar heel pain. The purpose of this case report is to describe the outcome of three patients treated with the Astym soft tissue approach including exercise and stretching for plantar heel pain. Methods Three patients with a referral for heel pain completed a numeric pain rating scale and a Lower Extremity Functional Scale (LEFS) which were administered at baseline and conclusion of care. Each patient was treated with Astym therapy using the lower extremity protocol 2 times a week over a span of 4-6 weeks. Astym treatment was used in conjunction with standard physical therapist services including manual therapy, therapeutic exercise, and education in a home program. References 1. Cleland J a, Abbott JH, Kidd MO, et al. Manual physical therapy and exercise versus electrophysical agents and exercise in the management of plantar heel pain: a multicenter randomized clinical trial. J Orthop Sports Phys Ther. 2009;39(8):573-585. doi:10.2519/jospt.2009.3036. 2. Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc.2003;93:234-237. 3. Davidson CJ, Ganion LR, Gehlsen GM, Verhoestra B, Roepke JE, Sevier TL. 1997. Rat tendon morphologic and functional changes resulting from soft tissue mobilization. Medicine and Science in Sports and Exercise 29(3):313–319 DOI 10.1097/00005768-199703000-00005. 4. Gehlsen GM, Ganion LR, Helfst R. 1999. Fibroblast responses to variation in soft tissue mobilization pressure. Medicine and Science in Sports and Exercise 31(4):531–535 DOI 10.1097/00005768-199904000-00006. 5. Slaven, EJ. The role of Astym® treatment in the management of lateral epicondylosis: A single case research design. Orthopaedic Physical Therapy Practice 2014; 26(1): 44-8. 6. Tyler A, Slaven E. The Role of the Astym® Process in the Management of Osteoarthritis of the Knee: A Single-Subject Research Design. Journal of Student Physical Therapy Research. 2013;6(2):1-10. 7. McCormack JR. The management of mid-portion Achilles tendinopathy with Astym® treatment and eccentric exercise: a case report. The International Journal of Sports Physical Therapy. 2012; 7(6):672-677. 8. McCormack JR. The management of bilateral high hamstring tendinopathy with ASTYM® treatment and eccentric exercise: a case report. Journal of Manual and Manipulative Therapy. 2012; 20(3):142-146. 9. Slaven EJ, Mathers J. Management of chronic ankle pain using joint mobilization and Astym® treatment: a case report. Journal of Manual and Manipulative Therapy. 2011;19(2):108-112. Results Patients were treated for an average of 10 visits (SD, 2.6) over an average of 55 days (SD, 34.2). All three patients reported lower pain from an average of 5.7 (SD, 1.5) to 2.3 (SD, 0.6). In addition, each patient had an improved LEFS score averaging 58.3 (SD,4) at baseline and increasing to 64.7 (SD, 0.6) at conclusion of care. Conclusions This study suggests Astym therapy is an effective treatment approach when combined with standard physical therapist services when treating patients with chronic plantar heel pain. Case Reports Patient 1: Insidious onset of right heel pain located locally along the plantar surface of his calcaneus. Pain was aggravated with prolonged walking and eased with using medicated gel and wearing his orthotics. Pt was treated 2x/week for 4 weeks for a total of 8 visits. At conclusion of care, there were improvements in pain level, LEFS score, plantarflexion strength, and muscle extensibility of the gastrocnemius and soleus complex. Patient 2: Insidious onset of bilateral heel pain located on the plantar surface of the calcaneus and occasional sharp pain along the medial and lateral aspects of his foot. Pain was worse in the morning and following prolonged standing and walking; relief with rest. Pt was treated 2x/week for 6 weeks for a total of 13 visits. At conclusion of care, there were improvements in pain level, LEFS score, bilateral ankle dorsiflexion ROM, muscle extensibility of the gastrocnemius and soleus complex, and tenderness to palpation at the plantar calcaneus.Patient 3: Insidious onset of right heel pain that began in the plantar heel and progressively worsened to include the Achilles tendon. Pain was aggravated with walking and relieved with rest and use of an anti-inflammatory gel. Pt was treated 2x/week for 5 weeks for a total of 9 visits. At conclusion of care there were improvements in pain level, LEFS score, ankle ROM, plantarflexion strength, and muscle extensibility of the gastrocnemius and soleus complex. Patient 1 Patient 2 Patient 3Age655326SexMaleMaleFemaleSymptom duration3 months18 months3 months