Research Article

Effects of Hamstring Flossing on Balance and Foot Function in Female Patients with Plantar Fasciopathy: A Randomized Controlled Study

Abstract

Introduction: A relationship between hamstring tightness and plantar fasciopathy (PF) has been reported. Hamstring flossing has been reported to improve hamstring flexibility; however, its effects on balance and foot function in patients with PF have not been investigated. This study aimed to compare the efficacy of a conventional physical therapy treatment protocol combined with hamstring flossing versus a conventional physical therapy treatment protocol alone on balance and foot function in patients with PF.
Materials and Methods: Thirty patients with PF were randomly assigned to two groups: The study group (A) received hamstring flossing in addition to the conventional physical therapy treatment protocol, whereas patients in the control group (B) received only the conventional physical therapy treatment protocol. Foot function was evaluated using the foot function index (FFI), and the Biodex balance system (BBS) was used to assess the overall stability index (OSI). Outcomes were evaluated at baseline and three weeks after the intervention. The groups were compared using a two-way mixed-design multivariate analysis of variance (MANOVA).
Results: The post-test mean values of the FFI score and OSI were significantly higher than the pre-test values in both the flossing and control groups (P=0.001). No significant intergroup differences were observed for either variable post-treatment (P>0.05).
Conclusion: The combination of conventional treatment for PF and hamstring flossing provided no additive benefit compared to conventional treatment alone in patients with PF.

Salehi S, Shadmehr A, Olyaee G, Bashardoust Tajali S, Mir S M. Effectiveness of dry needling for the management of plantar fasciitis: A review study. Journal of Modern Rehabilitatio. 2019; 13(1):1-10. [DOI:10.32598/jmr.13.1.1]

Rhim HC, Kwon J, Park J, Borg-Stein J, Tenforde AS. A systematic review of systematic reviews on the epidemiology, evaluation, and treatment of plantar fasciitis. Life. 2021; 11(12):1287. [DOI:10.3390/life11121287] [PMID]

Palomo-López P, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, Rodríguez-Sanz D, Calvo-Lobo C, López-López D. Impact of plantar fasciitis on the quality of life of male and female patients according to the foot health status questionnaire. Journal of Pain Research. 2018; 11:875-80. [DOI:10.2147/JPR.S159918] [PMID]

Iglesias M, Sperone E, Macklin Vadell A, Bigatti A. Plantar fasciitis: Analysis of therapeutic options. Revista de la Asociación Argentina de Ortopedia y Traumatologia. 2022; 87(3):413-21. [DOI:10.15417/issn.1852-7434.2022.87.3.1359]

Mushtaq N, Abbasian A. Plantar fasciitis. Annals of the Royal College of Surgeons of England. 2013; 95(3):229. [DOI:10.1308/003588413X13511609957812] [PMID]

Shashua A, Flechter S, Avidan L, Melayev A, Kalichman L. The effect of additional ankle and midfoot mobilizations on plantar fasciitis: A randomized controlled trial. The Journal of Orthopaedic and Sports Physical Therapy. 2015; 45(4):265-72. [DOI:10.2519/jospt.2015.5155] [PMID]

Tariq H, Mazhar F, Ghaffar E, Arif T, Irshad U, Aqdas A. Association between plantar fasciitis and hamstring tightness among runners. Journal of Health and Rehabilitation Research. 2024; 4(2):343-7. [DOI:10.61919/jhrr.v4i2.803]

Sayed MA, El-megid SF, El-azizy HM, El-Khozamy HM. The correlation between hamstring tightness and plantar fasciitis. The Medical Journal of Cairo University. 2019; 87(1):309-13. [DOI:10.21608/mjcu.2019.52353]

Manju, Meetu, Pradyumna Krishna, Sameer. Effect of various conventional treatments on plantar fasciitis: A brief review. International Journal of Science and Healthcare Research. 2023; 8(3):276-80. [DOI:10.52403/ijshr.20230338]

Ismail MM, Ahmed S. The Incorporation of balancing board exercises in the management of plantar fasciitis. International Journal of Health Sciences. 2011; 16(1):19-28. [Link]

Latt LD, Jaffe DE, Tang Y, Taljanovic MS. Evaluation and treatment of chronic plantar fasciitis. Foot & Ankle Orthopaedics. 2020; 5(1):2473011419896763. [DOI:10.1177/2473011419896763] [PMID]

Vidhi S, Anuprita T, Asmita K, et al. Comparison of PNF technique with NDS technique for hamstrings tightness in asymptomatic subjects. The Indian Journal of Physiotherapy & Occupational Therapy. 2014; 8(3):158-61. [DOI:10.5958/0973-5674.2014.00375.X]

Ganacharya PM, Pagare VK, Sareen A, Palekar TJ. Effect of neurodynamic sliding technique versus static stretching on hamstring flexibility in football players with short hamstring syndrome. Journal of Musculoskeletal Research. 2014; 17(2):1751-63. [DOI:10.1142/S0218957714500092]

Maust Z, Bradney D, Collins SM, Wesley C, Bowman TG. The effects of soft tissue flossing on hamstring range of motion and lower extremity power. International Journal of Sports Physical Therapy. 2021; 16(3):689-94. [DOI:10.26603/001c.24144] [PMID]

Kaneda H, Takahira N, Tsuda K, Tozaki K, Kudo S, Takahashi Y, Sasaki S, Kenmoku T. Effects of tissue flossing and dynamic stretching on hamstring muscles function. Journal of Sports Science & Medicine. 2020; 19(4):681. [PMID]

Prakash S, Anand M. Effect of manual therapy versus conventional therapy in patients w ith plantar fasciitis–A com parative study. International Journal of Physiotherapy and Research. 2014; 2(1):378-82. [Link]

Bolívar YA, Munuera PV, Padillo JP. Relationship between tightness of the posterior muscles of the lower limb and plantar fasciitis. Foot & Ankle International. 2013; 34(1):42-8. [DOI:10.1177/1071100712459173] [PMID]

Garceau De D, Dean D, Requejo SM. The association between diagnosis of plantar fasciitis and windlass test results. Foot & Ankle International. 2003; 24(3):251-55. [DOI:10.1177/107110070302400309] [PMID]

Karimi N, Ebrahimi I, Kahrizi S, Torkaman G. Evaluation of postural balance using the biodex balance system in subjects with and without low back pain. Pakistan Journal of Medical Sciences. 2008; 24(3):372. [Link]

Konrad A, Bernsteiner D, Budini F, Reiner MM, Glashüttner C, Berger C, et al. Tissue flossing of the thigh increases isometric strength acutely but has no effects on flexibility or jump height. European Journal of Sport Science. 2021; 21(12):1648-58. [DOI:10.1080/17461391.2020.1853818] [PMID]

Driller M, Mackay K, Mills B, Tavares F. Tissue flossing on ankle range of motion, jump and sprint performance: A follow-up study. Physical Therapy in Sport. 2017; 28:29-33. [DOI:10.1016/j.ptsp.2017.08.081] [PMID]

Rutkowski R, Gizińska M, Gałczyńska-Rusin M, Kasprzak MP, Budiman-Mak E. The importance of foot function assessment using the foot function index-revised short form (FFI-RS) questionnaire in the comprehensive treatment of patients with rheumatoid arthritis. Journal of Clinical Medicine. 2022; 11(9):2298. [DOI:10.3390/jcm11092298] [PMID]

Kim J, Sung DJ, Lee J. The therapeutic effect of the flossing technique on knee flexibility and functional performance: A pilot study. Journal of Sports Science and Medicine. 2017; 16:130-6. [Link]

Huffer D, Hing W, Newton R, Clair M. Strength training for plantar fasciitis and the intrinsic foot musculature: A systematic review. Physical Therapy in Sport. 2017; 24:44-52. [DOI:10.1016/j.ptsp.2016.08.008] [PMID]

Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. New York: Routledge; 1988. [DOI:10.4324/9780203771587]

Pearce CJ, Seow D, Lau BP. Correlation Between Gastrocnemius Tightness and Heel Pain Severity in Plantar Fasciitis. Foot & Ankle International. 2021; 42(1):76-82. [DOI:10.1177/1071100720955144] [PMID]

Gupta R, Malhotra A, Masih GD, Khanna T, Kaur H, Gupta P, et al. Comparing the role of different treatment modalities for plantar fasciitis: A double blind randomized controlled trial. Indian Journal of Orthopaedics. 2020; 54(1):31-37. [DOI:10.1007/s43465-019-00038-w] [PMID]

Engkananuwat P, Kanlayanaphotporn R, Purepong N. Effectiveness of the simultaneous stretching of the achilles tendon and plantar fascia in individuals with plantar fasciitis. Foot & Ankle International. 2018; 39(1):75-82. [DOI:10.1177/1071100717732762] [PMID]

Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the community. The Cochrane Database of Systematic Reviews. 2012; 2012(9):CD007146. [DOI:10.1002/14651858.CD007146.pub3] [PMID]

Scattone Silva R, Smitheman HP, Smith AK, Silbernagel KG. Are static foot posture and ankle dorsiflexion range of motion associated with Achilles tendinopathy? A cross-sectional study. Brazilian Journal of Physical Therapy. 2022; 26(6):100466. [DOI:10.1016/j.bjpt.2022.100466] [PMID]

Petrofsky J, Laymon M, Lee H. Local heating of trigger points reduces neck and plantar fascia pain. Journal of Back and Musculoskeletal Rehabilitation. 2020; 33(1):21-8. [DOI:10.3233/BMR-181222] [PMID]

Sullivan J, Burns J, Adams R, Pappas E, Crosbie J. Musculoskeletal and activity-related factors associated with plantar heel pain. Foot & Ankle International. 2015; 36(1):37-45. [DOI:10.1177/1071100714551021] [PMID]

Wei Z, Zeng Z, Liu M, Wang L. Effect of intrinsic foot muscles training on foot function and dynamic postural balance: A systematic review and meta-analysis. Plos One. 2022; 17(4):e0266525. [DOI:10.1371/journal.pone.0266525] [PMID]

Behm DG, Wilke J. Do self-myofascial release devices release myofascia? Rolling mechanisms: A narrative review. Sports Medicine. 2019; 49(8):1173-81. [DOI:10.1007/s40279-019-01149-y] [PMID]

Russell PJ, Decoster LC, Enea D. Effects of gastrocnemius, hamstring, and combined stretching programs on knee extensibility. Athletic Training & Sports Health Care. 2010; 2(2):67-73. [DOI:10.3928/19425864-20100226-06]

Myers TW. Anatomy trains: Myofascial meridians for manual and movement therapists. Amsterdam: Elsevier Health Sciences; 2009. [Link]

Fauris P, López-de-Celis C, Canet-Vintró M, Martin JC, Llurda-Almuzara L, Rodríguez-Sanz J, et al. Does self-myofascial release cause a remote hamstring stretching effect based on myofascial chains? A randomized controlled trial. International Journal of Environmental Research and Public Health. 2021; 18(23):12356. [DOI:10.3390/ijerph182312356] [PMID]

Siriphorn A, Eksakulkla S. Calf stretching and plantar fascia-specific stretching for plantar fasciitis: A systematic review and meta-analysis. Journal of Bodywork and Movement Therapies. 2020; 24(4):222-32. [DOI:10.1016/j.jbmt.2020.06.013] [PMID]

Kawano MM, Ambar G, Oliveira BI, Boer MC, Cardoso AP, Cardoso JR. Influence of the gastrocnemius muscle on the sit-and-reach test assessed by angular kinematic analysis. Revista Brasileira de Fisioterapia. 2010; 14(1):10-5. [DOI:10.1590/S1413-35552010000100003] [PMID]

Radford JA, Landorf KB, Buchbinder R, Cook C. Effectiveness of calf muscle stretching for the short-term treatment of plantar heel pain: A randomised trial. BMC Musculoskeletal Disorders. 2007; 8:36. [DOI:10.1186/1471-2474-8-36] [PMID]

Boonchum H, Bovonsunthonchai S, Komsak S, Kunanusornchai W. Effect of a home-based stretching exercise on multisegmental foot motion and clinical outcomes in patients with plantar fasciitis. Journal of Musculoskeletal & Neuronal Interactions. 2020; 20(3):411-20. [PMID]

Lee J, Kim J. Effects of an 8-week lunge exercise on an unstable support surface on lower-extremity muscle function and balance in middle-aged women. Physical Activity and Nutrition. 2022; 26(4):14-21. [DOI:10.20463/pan.2022.0020]

Wu SY, Tsai YH, Wang YT, Chang WD, Lee CL, Kuo CA, et al. Acute effects of tissue flossing coupled with functional movements on knee range of motion, static balance, in single-leg hop distance, and landing stabilization performance in female college students. International Journal of Environmental Research and Public Health. 2022; 19(3):1427. [DOI:10.3390/ijerph19031427] [PMID]

IssueVol 19 No 4 (2025) QRcode
SectionResearch Article(s)
DOI https://doi.org/10.18502/jmr.v19i4.19777
Keywords
Fasciitis Plantar Hamstring flossing Balance Foot function

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1.
Ahmed E, Nassif N, Elmaamoon Radwan R, Abdelrahman Elborady A, Mohamed Y. Effects of Hamstring Flossing on Balance and Foot Function in Female Patients with Plantar Fasciopathy: A Randomized Controlled Study. jmr. 2025;19(4):405-414.