Comparative Effectiveness of Gua Sha, Cryostretch, and Positional Release Technique on Tenderness and Function in Subjects with Plantar Fasciitis: ...
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JADHAV: GUA SHA, CRYOSTRETCH, PRT ON PLANTAR FASCIITIS
R E S E A R C H
Comparative Effectiveness
of Gua Sha, Cryostretch, and
Positional Release Technique
on Tenderness and Function in
Subjects with Plantar Fasciitis:
a Randomized Clinical Trial
Aditi Jadhav, MPT, Peeyoosha Gurudut, MPT, PhD (Candidate)
Department of Orthopaedic Physiotherapy, KAHER’s Institute of Physiotherapy,
KLE Academy of Higher Education & Research, Karnataka, India
https://doi.org/10.3822/ijtmb.v16i1.749
Background: Plantar fasciitis (PF) Pain Rating Scale, Foot Function Index,
can be treated effectively with manual and pressure algometer, respectively,
techniques like cryostretch (CS) and the on day 1 (pre-intervention) and day 7
positional release technique (PRT). Al- (post-intervention).
though Gua Sha (GS) has been suggested Resul ts: Between- group analyses
in the literature for PF, its efficacy has not showed that group GS was more effective
been studied in the research. than CS and PRT for pain (p=.0001), group
Objective: To determine and compare CS was more effective than GS and PRT
the effectiveness of GS, CS, and PRT in for foot function (p=.0001) whereas group
subjects with PF in terms of pain intensity, PRT was more effective than GS and CS for
pain pressure threshold, and foot function. pain pressure threshold (p=.0001).
Methods/Design: Thirty-six patients with Conclusion: Although all three groups
PF (n=36) were randomly allocated to three showed improvement, Gua Sha was supe-
study groups (12 in each group)—group rior in terms of reducing pain, cryostretch
GS, group CS, and group PRT, respectively. for improving foot functions, and PRT for re-
Settings: A randomized clinical trial was ducing tenderness. The interventions used
conducted at physiotherapy OPD in a ter- in this study are cost-effective and have
tiary health center. proved to be simple and safe techniques.
Participants: Subjects of all genders
with plantar fasciitis of the age group KEYWORDS: plantar fasciitis; cold thera-
20-60 years. Thirty-six subjects with plan- py; stretching; manual therapy; alternative
tar fasciitis out of whom 12 were males therapies; soft tissue; manipulation
and 24 females. There were no dropouts
in this study.
Intervention: The interventions included INTRODUCTION
the Gua Sha technique (1 session), the
cryostretch technique with a frozen tennis Heel pain is one of the common foot
ball (3 sessions), and the positional release disorders in which there is extreme dis-
technique (7 sessions), along with com- comfort weight-bearing on the heel
mon exercises for all three groups. because of the inflammation of the thick
Outcome Measures: Pain intensity, fascia at the sole of the foot. It may be
foot functions, and pain pressure thresh- due to either inflammatory or mechanical
old were assessed using the Numerical causes.(1) Plantar fasciitis (PF) is a serious
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International Journal of Therapeutic Massage and Bodywork—Volume 16, Number 1, March 2023
JADHAV: GUA SHA, CRYOSTRETCH, PRT ON PLANTAR FASCIITIS
public health issue since it is the common keeping the muscle in a shortened posi-
source of heel pain in outpatient depart- tion to promote relaxation of muscle in
ment settings. Heel pain affects 10% of contrast to placing the muscle in a length-
the population at some point in their lives, ened or stretched position. PRT as defined
where 83 percent of these patients are ac- by Wynn et al. is an indirect myofascial
tive adults who fall under the age group of technique that aims at the neurologic
25 to 65 years.(2) component of the neuro-vascular myofas-
The plantar fascia when released has cial somatic dysfunction. PRT is an indirect
been suggested to be of benefit to patients approach with respect to tissue resistance
with symptoms of PF. Various other phys- that includes the use of positioning of the
iotherapy treatment interventions have body, utilization of tender points to find the
been recommended in the past which problem and monitoring the therapeutic
include rest, taping, cryotherapy, orthotic intervention.(15) In previous studies, PRT has
modifications, silicon heel cups, myofascial shown a significant decrease in pain and
release,(3,4) manual stretching,(5) and advice improvement in functional ability in PF
for footwear modifications. Manual therapy patients but has not been compared with
is administered in the treatment of PF the other two treatment approaches.(16)
comprising techniques such as soft tissue Further, all three manual therapy in-
mobilizations, deep massage of the tis- terventions work on the basis of different
sue, myofascial release, and the positional theories/principles. Hence, this study hy-
release technique (PRT). pothesized that the three techniques, viz.
Gua Sha is a Chinese method of Gua Sha, cryostretch (using a frozen tennis
instrument-assisted unidirectional “press- ball), and positional release techniques, will
stroking” of a painful area that intentionally not be equally effective in the manage-
creates transitory therapeutic petechiae. ment of PF.
These therapeutic petechiae are a result
of the eruption of blood into the subcutis
and fade within two to five days.(6) The METHODS
effects of the Gua Sha technique on mus-
culoskeletal conditions like chronic neck The study was approved by the Institu-
pain,(7) low back pain,(8) cervical spondy- tional Research and Ethical Committee with
losis,(9) and lumbar disc herniation(10) have approval number KIPT/SI No.709/07.08.2020.
shown better response to pain and func- The trial is prospectively registered under
tions. A systematic review using Gua Sha the clinical trial registry of India with trial
to treat musculoskeletal pain concluded number CTRI/2020/10/028591. Written con-
insufficient evidence about its effective- sent from the subjects was acquired prior
ness.(11) To the best of our knowledge and to the commencement of the study.
a literature search conducted, there are no Thirty-six subjects with plantar fasciitis
studies done to evaluate the effects of Gua were randomly allocated to one of the
Sha on PF subjects. three treatment groups with 12 subjects
Cryostretch is a treatment method that (12 × 3) in each group. The sample size was
includes a combination of cryotherapy and calculated using the formula where the
stretching which is given for releasing soft alpha value was considered as 1.96 at a 5%
tissues.(12) Myofascial release (MFR) with significance level, the beta value was 1.2816
the help of a tennis ball to the plantar as- at 90% power, the standard deviation was 3,
pect of the foot is widely used to increase and the effect size was set at 4, referring to
flexibility and range of motion further the previous studies.(11,13) Allocation to the
along the posterior muscles.(13) One form groups was done using the lottery method
of cryostretch technique is given using a where participants picked the chits with
frozen tennis ball which helps to release the group names written on them. The
the spasm and increase the muscle/fascia three treatment groups were Gua Sha,
length. The review of literature exhibits Cryostretch, and PRT groups. The inclusion
lacuna in evidence of the application of criteria of the study were subjects clinically
the cryostretch technique to confirm its diagnosed with any one of the following
effectiveness in plantar fasciitis. criteria for plantar fasciitis: the painful first
Positional release technique (PRT), for- step in the morning, calcaneal soreness
merly known as strain-counterstrain, is an on palpation, pain on palpation along the
osteopathic manual therapy technique proximal plantar fascia,(17) age between
that aims to improve muscle flexibility by 20 and 60 years, and subjects willing to
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International Journal of Therapeutic Massage and Bodywork—Volume 16, Number 1, March 2023
JADHAV: GUA SHA, CRYOSTRETCH, PRT ON PLANTAR FASCIITIS
participate in our study. The participants 3 sets), curb/stair stretch (15 sec, 3 sets),
were excluded if they had a recent history seated plantar fascia stretch (15 sec, 3 sets),
of fracture or surgery in and around the cross-friction massage above the plantar
ankle joint; congenital deformity of the fascia (3–5 min), toe curls (10–20 reps), and
foot; open wounds, infections; malignancy; heel raises (15 reps, 5-sec holds, 2 sets).
sensory impairment, or skin hypersensitiv- The materials required for the following
ity. All the subjects completed the study exercises were: a chair, stairs/curb, and a
intervention with no loss to follow-up towel. The standing calf stretch and curb/
(Figure 1). stairs stretch focused on the gastrocne-
mius and soleus muscles stretching. The
Intervention plantar fascia stretches and cross-friction
massage above the plantar fascia are
The interventions were carried out by beneficial for walking to help stretch and
a qualified physiotherapist who had ad- warm up the fascia before the first steps
ditional certification in the application of of the day. The exercises were performed
instrument-assisted soft tissue manipula- by the patients sitting on a chair. The toe
tion techniques with jade stone, as well as curls and heel raises are strengthening
in positional release therapy. exercises focused on the foot’s intrinsic
The common intervention comprised of muscles. Both of these exercises were
exercises prescribed for targeting the ankle performed in a standing position with the
and foot: standing calf stretch (15–30 sec, subject’s hands resting on a chair. The toe
Figure 1. CONSORT flow diagram.
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International Journal of Therapeutic Massage and Bodywork—Volume 16, Number 1, March 2023
JADHAV: GUA SHA, CRYOSTRETCH, PRT ON PLANTAR FASCIITIS
curls were performed with the help of a ceramic Chinese soup spoon or a blunt,
towel, and for the heel raises, the subjects well-worn coin. Today practitioners com-
were asked to raise their heels off the floor monly use jade or rose quartz or both.
while keeping their knees straight. The However, considering the cost-effective-
subjects performed these exercises twice ness of jade stone which has similar effects
a day, once in presence of the therapist as that of rose quartz, in addition to the
in the OPD and the second time at home training involved in the application of jade
(Figure 2).(18) stone by the therapist involved in the in-
Group GS received the Gua Sha technique tervention, the jade stone was chosen for
along with exercises included in the com- the application of Gua Sha. The subjects
mon intervention. This technique was were treated in a prone lying position
performed using a jade stone and a skin where the therapist was standing near
lubricant to decrease f riction. Gua Sha the affected foot of the subject. There was
technique was anciently done using a sequential press unidirectional stroking
Figure 2. Common exercises (A-standing calf stretch, B-curb/stair stretch, C-seated plantar fascia stretch,
D-cross-friction massage above the plantar fascia, E-toe curls, F-heel raises).
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International Journal of Therapeutic Massage and Bodywork—Volume 16, Number 1, March 2023
JADHAV: GUA SHA, CRYOSTRETCH, PRT ON PLANTAR FASCIITIS
along the orientation of the fascia f rom and then slight mechanical pressure was
heel to toe direction, followed by areas in- put on the tender point with one finger-
cluding tendon Achilles, calf muscle bulk, tip to determine the tenderness. The foot
and origin of gastrocnemius with 3 min was then positioned into complete plantar
of stroking per area.(19,20) This technique flexion and gently fine-tuned by rotation
was administered only once, on the first until there was a reduction in tender point
day of the intervention, because the rec- by at least 70%, and this position was held
ommended dosage is 1 session per seven for 90 sec with 3 repetitions.(21) The subjects
days considering the petechial rashes that received this treatment for 7 consecutive
result due to the technique. The remain- sessions over a period of seven days, along
ing six days were continued only with the with the exercises (Figure 5).
exercises (Figure 3).
Group CS received the cryostretch tech- Outcome Measures
nique along with the exercises mentioned
above in the section on common interven- Outcome measures included in the
tion. This technique was performed using a study were pain intensity using a Numeri-
frozen tennis ball. The subjects were sitting cal Pain Rating Scale (NPRS), foot functions
seated on a chair where one foot was on using Foot Function Index (FFI), and pain
the frozen tennis ball and the other was flat pressure threshold using a pressure al-
on the floor. The subjects were then asked gometer. The demographic data of each
to roll the frozen ball under the arch of their subject were documented along with the
foot extending from the heel to the meta- initial assessment of the outcome mea-
tarsal heads concentrating on the medial sures prior to the intervention (baseline)
arch for 2 min (30 reps).(13) The subjects and post-intervention (Day 7). The duration
were instructed to apply as much pressure of the intervention was one week.
as they could, pushing into discomfort but The NPRS was used to measure pain in-
not pain, as greater pressures have shown tensity. The subjects were asked to indicate
to have better benefits on flexibility. This the numeric value on an 11-point numerical
technique was administered on alternate scale (horizontal bar or line format) ac-
days (the 1st, 3rd, and 5th day of the week) cording to their current pain over the past
along with the exercises (Figure 4). 24 hours where 0 was considered as “No
Group PRT received positional release Pain” and 10 was considered as “worst
technique along with exercises. The sub- Pain’ possible. The NPRS is a valid scale to
jects were made to lie in a supine position measure pain intensity and the reliability
with the affected limb out of the plinth of this scale is 0.90.(22)
(a) (b)
Figure 3. (a) Gua Sha for plantar fascia with jade stone; (b) Gua Sha for tendoachilles, calf and gastrocnemius
muscle origins.
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International Journal of Therapeutic Massage and Bodywork—Volume 16, Number 1, March 2023
JADHAV: GUA SHA, CRYOSTRETCH, PRT ON PLANTAR FASCIITIS
Figure 4. Cryostretch technique.
which best describes their foot functional
ability over the previous week. The FFI is
a valid and reliable tool for patients with
non-traumatic foot or ankle problems.
Test/retest reliability of the FFI total and
sub-scale scores ranged from 0.87 to 0.69,
whereas the internal consistency ranges
from 0.96 to 0.73.(23)
The pain pressure threshold was assessed
using a pressure algometer (Baseline brand;
White Plains, NY) which is a hand-held in-
strument where the pressure threshold at
which the patient feels the pain is calibrated
in kg/cm2 with a range of 10 kg and 0.1 kg
divisions. The subjects were asked to point
to the location of the worst pain on the foot
to identify the maximum tender spot (TS).
The subject was asked to confirm pain or
discomfort at the point. The indicated site
was then palpated by the examiners to
identify the correct TS which was marked
with a marker. The tip of the algometer was
kept over the marked area of maximum
tenderness, perpendicular to the involved
Figure 5. Positional release technique.
muscle/fascia. The pressure was progres-
sively increased and the readings at which
the subject felt pain were recorded.(24)
Foot Function Index (FFI) is a self-
administered index consisting of 23 Statistical Analysis
items divided into three sub-scales: pain
subscale, disability subscale, and activity Statistical analysis for the present study
limitation subscale. The subject was asked was done using SPSS version 23.0 (IBM
to score each question on a scale f rom SPSS Statistics, Armonk, NY, USA) to verify
0 (no pain or difficulty) to 10 (worst pain the results obtained. Data were summa-
imaginable or so difficult it requires help), rized as mean ± standard deviation for
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International Journal of Therapeutic Massage and Bodywork—Volume 16, Number 1, March 2023
JADHAV: GUA SHA, CRYOSTRETCH, PRT ON PLANTAR FASCIITIS continuous variables, whereas the cat- Assessment of pain intensity demon- egorical variables were represented as a strated a statistically significant reduction percentage. A comparison of the difference in pain on Day 7 post-intervention in all between the three groups was done using three groups at pre- to post-intervention a one-way analysis of variance (ANOVA) (p
JADHAV: GUA SHA, CRYOSTRETCH, PRT ON PLANTAR FASCIITIS 33.66 for pressure pain threshold for GS, CS, Studies have reported a decrease in pain and PRT groups. respectively. intensity with the help of GS in the chronic Further, in comparison of the three neck pain population, low back pain, mus- groups for the mean difference (GS, CS, culoskeletal pain, breast engorgement, and PRT), group GS was better than group cervical spondylosis, and f ibromyalgia CS (p
JADHAV: GUA SHA, CRYOSTRETCH, PRT ON PLANTAR FASCIITIS
decreasing the inflammation around the The PRT group demonstrated that
plantar fascia. Cryotherapy reduces local trigger point sensitivity decreased post-
hyperthermia, induces vasoconstriction, intervention. Our study results agreed
and lowers microcirculation. The erup- with another study where PRT was used
tion of blood into the surrounding tissues in decreasing tender points by increas-
decreases local inflammation, and edema ing pressure pain thresholds of trigger
production is also reduced, along with a points in the upper trapezius muscle with
decrease in motor as well as sensory nerve mechanical neck pain patients. (31) The
conduction.(27) Stretching improves blood application of PRT causes a decrease in
circulation which brings nutrients to cells tissue tenderness by changing nociceptor
and there is the removal of waste products. activity in the soft tissues. The increase in
The rise in the blood flow causes the open- pain pressure threshold is associated with
ing of the connective tissues, which helps a reduction in the susceptibility of the tis-
alleviate pain.(28) sue. Based on previous literature and our
Previous studies have found that the current findings, PRT interventions have
increase in PPT following stretching with the ability to relieve tenderness and local
a tennis ball in the ipsilateral and contra- pain caused by myofascial trigger points.(32)
lateral plantar flexors may be because of However, there were a few limitations
the mechanical pressure that rolling ten- to our study such as the lack of a control
nis balls exert on mechanoreceptors and group, the short duration of the interven-
proprioceptors.(29) Mechanical stress like tion, and no long-term follow-up to assess
massage, which removes trigger points the continuity of practice that needs to be
from muscle tissue, leads to increased PPT. considered in future studies. Also, there
The application of mechanical pressure are more chances of a higher number of
applied on trigger points averts unwanted patient/therapist interactions in the CS and
firing of muscle spindles from the trigger PRT intervention groups than the GS group
point, decreases muscle spasms, and helps due to a greater number of treatment
to decrease the pain.(30) sessions in a week which may influence
In the current study, there was a signifi- pain perception. A follow-up period can
cant difference in the PRT group in terms be used to see the long-term effects of all
of pain intensity and functional disability three techniques. More standard outcome
on Day 7 post-intervention. The factors measures, like ultrasonography at pre and
that helped in pain reduction may be ex- post-intervention comparison, can be used
plained due to the reduction in the intra for a better understanding of the results.
and extrafusal fiber difference and reset
of the inappropriate proprioceptive activ-
ity. PRT uses static ischemic compression, CONCLUSION
a position of comfort, and fine-tuning on
reflexogenic trigger points to resolve the The present study concluded that all
associated dysfunction.(15) three groups—Gua Sha, cryostretch, and
Positional release therapy is a technique positional release techniques—demon-
suggested to improve muscle flexibility strated significant improvement in terms
by keeping the muscle in a shortened po- of reducing pain intensity and foot func-
sition, which inhibits muscle relaxation, tion score, and increasing pain pressure
rather than keeping the muscle in a threshold on Day 7 post-intervention.
lengthened or stretched condition. The uti- Further, the Gua Sha intervention was
lization of body positioning, tender points more effective than the cryostretch and
to find the problem, and monitoring of the positional release technique for pain; the
intervention are some of the PRT indirect cryostretch technique was more effec-
approaches regarding tissue resistance. tive for foot function scoring; whereas the
The excitability of the myotatic reflex arc positional release technique was more
might lead to restriction in the movement, effective for pain pressure threshold. To
which is caused by excessive gamma gain. the best of our knowledge, our study is
By keeping the patient’s muscle in the the first to evaluate the effectiveness of
placement of ease for a small period of the Gua Sha technique on plantar fasciitis
time, there is a decrease in gamma gain; patients. Level II evidence is created by
thereby allowing the excited reflex arc to this study where three different manual
return back to its original state and in- therapies have been compared. Further,
crease the range of motion.(16) the interventions used in this study are
21
International Journal of Therapeutic Massage and Bodywork—Volume 16, Number 1, March 2023JADHAV: GUA SHA, CRYOSTRETCH, PRT ON PLANTAR FASCIITIS
cost-effective and have proved to be simple 9. Ma H, Li SZ, Zheng HM: Clinical observation gua sha
and safe techniques. plus herbal injection with 83 cases of cervical spon-
dylosis. Zhengjiu Lingchuang Zazhi. 2003;19:27–28.
10. Wang ZG, Tao Y, Wu NT. The effect of coin scrap-
ACKNOWLEDGMENTS ing therapy for the treatment of lumbar disc
herniation. Zhongguo Zhongyi Gushangke Zazhi.
We are thankful to all the subjects for 2004;12:7–10.
their cooperation. We would also like to 11. Lee M, Choi TY, Kim JI, Choi SM. Using Guasha to
thank our statistician, Dr. Manjunath Javali, treat musculoskeletal pain: a systematic review
for helping us with the statistical analysis of controlled clinical trials. Chinese Med. 2010;5(1):
of this study. 1–5
12. Yadav M, Attrey P, Kashyap P. Comparative study
between cryostretch and light concentric exercise
CONFLICT OF INTEREST NOTIFICATION on delayed onset muscle soreness. Indian J Phys
Educ Sports Appl Sci. 2016;44975451.
The authors declare there are no con- 13. Grieve R, Goodwin F, Alfaki M, Bourton AJ, Jeffries
flicts of interest. C, Scott H. The immediate effect of bilateral self-
myofascial release on the plantar surface of the
feet on hamstring and lumbar spine flexibility: a
COPYRIGHT pilot randomised controlled trial. J Bodywk Move
Ther. 2015;19(3):544–52.
Published under the CreativeCommons 14. Wynne MM, Burns JM, Eland DC, Conatser RR,
Attribution-NonCommercial-NoDerivs Howell JN. Effect of counterstrain on stretch re-
3.0 License. flexes, Hoffman reflexes, and clinical outcomes in
subjects with plantar fasciitis. J Osteopath Med.
2006 Sep 1;106(9):547–556.
REFERENCES 15. D’Ambriogo K, Roth G. Text Book of Positional
Release Therapy, Assessment and Treatment of
1. Borland A, Martin CH, Locke J. Nurses’ understand- Musculoskeletal Dysfunction, 2nd ed. Philadelphia:
ings of suitable footwear for older people. Int J Mosby; 2002. p.268-282
Healthcare Qual Assur. 2013;26(7):633. Available 16. Unver B, Erdem E, Akbas E. Effects of short-foot
f rom: https: //www.researchgate.net/publica- exercises on foot posture, pain, disability, and
tion/257012954_Nurses’_understandings_of_ plantar pressure in pesplanus. J Sport Rehabil.
suitable_footwear_for_older_people 2019;29(4):436–440.
2. Scher D, Belmont P, Owens B. The epidemiology of 17. Hoebeke RE. Diagnosing plantar fasciitis. J Nurs
plantar fasciitis. Lower Extremity Rev. 2010;12(1):60 Pract. 2008;4(1):66–67.
3. Ajimsha MS, Binsu D, Chithra S. Effectiveness of 18. Roxas M. Plantar fasciitis: diagnosis and thera-
myofascial release in the management of plantar peutic considerations. Altern Med Rev. 2005;10(2):
heel pain: a randomized controlled trial. The Foot. 83–93.
2014;24(2):66–71. 19. Nielsen A. Gua sha: a Traditional Technique for
4. Kuhar S, Subhash K, Chitra J. Effectiveness of myo- Modern Practice, 2nd. ed. [e-book]. Amsterdam:
fascial release in treatment of plantar fasciitis: A Elsevier Health Sciences; 2014.
RCT. Indian J Physiother Occup Ther. 2007;1(3):3–9. 20. Smith T. Plantar Fasciitis & Gua Sha [video]. Arroyo
5. Orchard J. Plantar fasciitis. BMJ. 2012;345(1): Grande Health & Wellness [Internet]. 2012. [cited
6603–6603. 20 November 2019]. Available from: https://youtu.
6. Lauche R, Wübbeling K, Lüdtke R, Cramer H, Choi be/1YH3EbGANi4
KE, Rampp T, et al. Randomized controlled pilot 21. Am H, Kage Vijay B, Basavaraj C. Comparison of
study: pain intensity and pressure pain thresholds myofascial release and positional release therapy in
in patients with neck and low back pain before and plantar fasciitis—a clinical trial. Physiother Occup
after traditional East Asian” gua sha” therapy. Am Ther. 2010;4(4):8
J Chinese Med. 2012;40(05):905–917. 22. Krebs EE, Carey TS, Weinberger M. Accuracy of
7. Braun M, Schwickert M, Nielsen A, Brunnhuber S, the pain numeric rating scale as a screening test
Dobos G, Musial F, et al. Effectiveness of traditional in primary care. J Gen Intern Med. 2007;22(10):
Chinese “gua sha” therapy in patients with chronic 1453–1458.
neck pain: a randomized controlled trial. Pain Med. 23. SooHoo NF, Samimi DB, Vyas RM, Botzler T. Evalu-
2011;12(3):362–369. ation of the validity of the Foot Function Index
8. Puttaswamaiah R, Chandran P. Degenerative in measuring outcomes in patients with foot
plantar fasciitis: a review of current concepts. The and ankle disorders. Foot Ankle Int. 2006;27(1):
Foot. 2007;17(1):3–9. 38–42.
22
International Journal of Therapeutic Massage and Bodywork—Volume 16, Number 1, March 2023JADHAV: GUA SHA, CRYOSTRETCH, PRT ON PLANTAR FASCIITIS
24. Imamura M, Fischer AA, Imamura ST, Kaziyama HS, 30. Kostopoulos D, Nelson J, Arthur J, Ingber RS, Larkin
Carvalho AE, Salomao O. Treatment of myofascial RW. Reduction of spontaneous electrical activity
pain components in plantar fasciitis speeds up and pain perception of trigger points in the upper
recovery: documentation by algometry. J Muscu- trapezius muscle through trigger point compres-
loskel Pain. 1998;6(1):91–110. sion and passive stretching. J Muscoskelet Pain.
25. Nielsen A, Knoblauch NT, Dobos GJ, Michalsen A, 2008;16(4):266–278.
Kaptchuk TJ. The effect of Gua Sha treatment on 31. AL-Shawabka SA, Shenouda MM, Balbaa AA. Posi-
the microcirculation of surface tissue: a pilot study tional release technique versus manual pressure
in healthy subjects. Explore. 2007;3(5):456–466. release on the upper trapezius muscle in patients
26. Nascimento C, Branco L. Role of the peripheral with myofascial pain dysfunction syndrome. Bull
hemeoxygenase–carbon monoxide pathway on Fac Phys Ther. 2013;18(1):55–63.
the nociceptive response of rats to the formalin 32. Weiselfish S. Manual Therapy for the Orthopedic
test: Evidence for a cGMP signaling pathway. Eur and Neurologic Patient Emphasizing Strain and
J Pharmacol. 2007;556(1-3):55–61. Counterstrain Technique. Hartford, CT: Regional
27. Block, J. Cold and compression in the manage- Physical Therapy (self-published); 1993.
ment of musculoskeletal injuries and orthopedic
operative procedures: a narrative review. J Sports
Med. 2010;1:105–113.
28. Mohamed, H. Effectiveness of Achilles tendon Corresponding author: Dr. Peeyoosha
stretching for the treatment of chronic plantar Gurudut, MPT, PhD, Department of Ortho-
fasciitis. Egypt Orthopaed J. 2015;50(4):215. paedic Physiotherapy, KAHER’s Institute
29. Aboodarda SJ, Spence AJ, Button DC. Pain pres- of Physiotherapy, KLE Academy of Higher
sure threshold of a muscle tender spot increases Education & Research, Belagavi -590010,
following local and non-local rolling massage. BMC State: Karnataka, India
Musculoskelet Disord. 2015;16(1):1. E-mail: peeoo123@yahoo.com
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