Effects of Hamstring Flossing on Balance and Foot Function in Female Patients with Plantar Fasciopathy: A Randomized Controlled Study
-
Eman Ahmed Ahmed
,
Nagui Sobhi Nassif
,
Yassmin Essam Mohamed
,
Rafeek Elmaamoon Mohamed
,
Amal Ahmed Elborady
Abstract
Background: A relation between hamstring tightness and Plantar Fasciopathy (PF) has been reported in the literature. Hamstring flossing was reported to improve hamstring flexibility, however its effect on balance and foot function in patients with PF was not clearly investigated. The aim of this study was to compare the efficacy of conventional physical therapy treatment protocol plus hamstring flossing with 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 into study group (A) patients received hamstring flossing in addition to the conventional physical therapy treatment protocol, whereas patients in control group (B) received only the conventional physical therapy treatment protocol. Foot function was evaluated by Foot Function Index (FFI), while Overall Stability Index (OSI) was assessed by the Biodex Balance system. The outcomes were evaluated at the baseline and after three weeks of intervention. The groups were compared using the two-way mixed design MANOVA test.
Results: Results revealed a significant improvement in the post testing mean values of FFI score and OSI compared with the pre testing ones in flossing and control groups (p = 0.001). No significant differences for both variables post-treatment between both groups were found (P>0.05).
Conclusion: The combination of conventional treatment of PF and hamstring flossing had no additive gain compared with conventional treatment only for managing patients with plantar fasciopathy
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3. Palomo-López P, Becerro-De-Bengoa-Vallejo R, Losa-Iglesias ME, et al. Impact of plantar fasciitis on the quality of life of male and female patients according to the foot health status questionnaire. J Pain Res, 2018; 11, 875–80. doi: 10.2147/JPR.S159918
4. Iglesias M, Sperone E, Macklin Vadell A, Bigatti A. Plantar Fasciitis: Analysis of Therapeutic Options, Rev Asoc Argent Ortop Traumatol. 2022; 87(3): 413–21. https://doi.org/10.15417/issn.1852-7434.2022.87.3.1359
5. Cutts S, Obi N, Pasapula C, Chan W. Plantar fasciitis. Ann. R. Coll. Surg Engl. 2012; 94: 539–42. https://doi.org/10.1308/003588413X13511609957812
6. 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. Orthop J Sports Med. 2015; 45(4):265–72. doi: 10.2519/jospt.2015.5155
7. Tariq H, Mazhar F, Ghaffar E, Arif T, Irshad U, Aqdas A. Association between Plantar Fasciitis and Hamstring Tightness among Runners. JHRR. 2024; 4(2): 343–347. DOI: https://doi.org/10.61919/jhrr.v4i2.803
8. Sayed MA, El-megid SF, El-azizy HM, El-Khozamy HM. The Correlation between Hamstring Tightness and Plantar Fasciitis. Med J Cairo Univ. 2019; 87(1):309-13.
9. Manju, Meetu, Pradyumna Krishna, Sameer. Effect of Various Conventional Treatments on Plantar Fasciitis: A Brief Review. Int J Health Res. 2023; 8(3): 276–80. DOI: https://doi.org/10.52403/ijshr.20230338
10. Ismail MM, Ahmed S. The Incorporation of Balancing Board Exercises in the Management of Plantar Fasciitis. Int J Health Sci. 2011; 16(1): 19–28.
11. Latt LD, Jaffe DE, Tang Y, Taljanovic MS. Evaluation and Treatment of Chronic Plantar Fasciitis. Foot Ankle Orthop. 2020; 5(1): 1-11. doi.org/10.1177/2473011419896763
12. Vidhi S, Anuprita T, Asmita K, et al. Comparison of PNF technique with NDS technique for hamstrings tightness in asymptomatic subjects. Indian J. Physiother. Occup. 2014; 8(3):158-61. DOI:10.5958/0973-5674.2014.00375.X
13. 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. J Musculoskelet Res 2014; 17(2): 1751-63.https://doi.org/10.1142/S0218957714500092
14. 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. Int J Sports Phys Ther, 2021; 16(3): 689–94. doi: 10.26603/001c.24144
15. Kaneda H, Takahira N, Tsuda K, et al. Effects of Tissue Flossing and Dynamic Stretching on Hamstring Muscles Function. J Sports Sci Med. 2020; 19: 681–89.
16. Prakash S, Misra A. Effect of Manual Therapy versus Conventional Therapy in Patients with Plantar Fasciitis-A Comparative Study. Article in International Journal of Physiotherapy and Research, 2014; 2(1): 378–82.
17. Bolívar, Y. A., Munuera, P. v., Padillo, J. P. Relationship between tightness of the posterior muscles of the lower limb and plantar fasciitis. Foot and Ankle International, 2013; 34(1): 42–8. https://doi.org/10.1177/1071100712459173
18. Garceau De D, Dean D, Requejo SM. The Association Between Diagnosis of Plantar Fasciitis and Windlass Test Results. Foot Ankle Int. 2003; 24(3): 251-55. https://doi.org/10.1177/107110070302400309
19. 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. Pak J Med Sci 2008; 24(3): 372-77.
20. Konrad A, Bernsteiner D, Budini F. et al. Tissue flossing of the thigh increases isometric strength acutely but has no effects on flexibility or jump height. EUR J SPORT SCI 2021; 21(12): 1648–158.
21. Driller M, Mackay K, Mills B, Tavares F.. Tissue flossing on ankle range of motion, jump and sprint performance: A follow-up study. Phys Ther Sport 2017; 28: 29–33. https://doi.org/10.1016/j.ptsp.2017.08.081;
22. 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. J Clin Med. 2022; 11(9). 2298. https://doi.org/10.3390/jcm11092298
23. Kim J, Sung DJ, Lee J. The Therapeutic Effect of the Flossing Technique on Knee Flexibility and Functional Performance: A Pilot Study. J Sports Sci Med. 2017; 16, 130–136.
24. Huffer D, Hing W, Newton R, Clair M. Strength training for plantar fasciitis and the intrinsic foot musculature: a systematic review. Phys Ther Sport. 2016; 24: 44–52. DOI: 10.1016/j.ptsp.2016.08.008
25. Cohen J. 1988. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, New Jersey: Lawrence Erlbaum Associates
26. Pearce CJ, Seow D, Lau BP. Correlation Between Gastrocnemius Tightness and Heel Pain Severity in Plantar Fasciitis. Foot Ankle Int. 2021; 42(1): 76–82. doi: 10.1177/1071100720955144
27. Gupta R, Malhotra A, Masih GD, et al. Comparing the Role of Different Treatment Modalities for Plantar Fasciitis: A Double Blind Randomized Controlled Trial. Indian J Orthop. 2020; 54(1): 31–37. doi: 10.1007/s43465-019-00038
28. 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 Int 2018;39(1):75–82.
29. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012; 15(2). https://doi.org/10.1002/14651858.CD007146.pub3
30. Scattone Silva, Smitheman HP, Smith AK, Silbernagel KG. Are static foot posture and ankle dorsiflexion range of motion associated with Achilles tendinopathy? A cross-sectional study. Braz J Phys Ther 2022; 6(6): 100466. https://doi.org/10.1016/j.bjpt.2022.100466
31. Petrofsky J, Laymon Ml, Lee H. Local heating of trigger points reduces neck and plantar fascia pain. J Back Musculoskelet Rehabil. 2020; 33(1):21-28. doi.org/10.3233/bmr-181222
32. Sullivan J, Burns J, Adams R, Pappas E, Crosbie J. Musculoskeletal and activity-related factors associated with plantar heel pain. Foot Ankle Int. 2015; 36: 37–45. doi: 10.1177/1071100714551021
33. Wei Z, Zeng Z, LiuM, Lin 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): https://doi.org/10.1371/journal.pone.0266525
34. Behm DG, Wilke J. 2019. Do Self-Myofascial Release Devices Release Myofascia? Rolling Mechanisms: A Narrative Review. Sports Med. 49: 1173–1181. doi: 10.1007/s40279-019-01149-y
35. Russell PJ, Decoster LC, Enea D. Effects of Gastrocnemius, Hamstring, and Combined Stretching Programs on Knee Extensibility. Athl Train Sports Health Care 2010; 2(2): 67–73. https://doi.org/10.3928/19425864-20100226-06
36. Myers TW. 2009. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists; Elsevier Health Sciences: Amsterdam, The Netherlands.
37. Fauris P, López-De-celis C, Canet-Vintró, M, Martin JC, Llurda-Almuzara L, Rodríguez-Sanz J, Labata-Lezaun N, Simon M, Pérez-Bellmunt A. 2021. Does self-myofascial release cause a remote hamstring stretching effect based on myofascial chains? A randomized controlled trial. Int J Environ Res. Public Health, 18(23): https://doi.org/10.3390/ijerph182312356
38. Siriphorn A, Eksakulkla S. Calf stretching and plantar fascia-specific stretching for plantar fasciitis: A systematic review and meta-analysis. J Bodyw Mov Ther 2020; 24 (4): 222–232. doi: 10.1016/j.jbmt.2020.06.01336.
39. Kawano MM, Ambar G, Beatriz IR,et al, Influence of the gastrocnemius muscle on the sit-and-reach test assessed by angular kinematic analysis. Braz J Phys Ther. 2010; 14(1):10-15. doi: 10.1590/s1413-35552010000100003.
40. Radford JA, Landorf KB, Buchbinder R, Cook C. Effectiveness of calf muscle stretching for the short-term treatment of plantar heel pain: A randomized trial. BMC Musculoskeletal Disorders. 2007; 8:36 doi:10.1186/1471-2474-8-36
41. 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. J Musculoskelet Neuronal Interact 2020; 20(3):411-420.
42. Lee, J., & Kim, J. (2022). 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, 26(4), 14–21. https://doi.org/10.20463/pan.2022.0020
43. Wu, S. Y., Tsai, Y. H., Wang, Y. T., 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). https://doi.org/10.3390/ijerph19031427.
2. 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. https://doi.org/10.3390/life11121287
3. Palomo-López P, Becerro-De-Bengoa-Vallejo R, Losa-Iglesias ME, et al. Impact of plantar fasciitis on the quality of life of male and female patients according to the foot health status questionnaire. J Pain Res, 2018; 11, 875–80. doi: 10.2147/JPR.S159918
4. Iglesias M, Sperone E, Macklin Vadell A, Bigatti A. Plantar Fasciitis: Analysis of Therapeutic Options, Rev Asoc Argent Ortop Traumatol. 2022; 87(3): 413–21. https://doi.org/10.15417/issn.1852-7434.2022.87.3.1359
5. Cutts S, Obi N, Pasapula C, Chan W. Plantar fasciitis. Ann. R. Coll. Surg Engl. 2012; 94: 539–42. https://doi.org/10.1308/003588413X13511609957812
6. 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. Orthop J Sports Med. 2015; 45(4):265–72. doi: 10.2519/jospt.2015.5155
7. Tariq H, Mazhar F, Ghaffar E, Arif T, Irshad U, Aqdas A. Association between Plantar Fasciitis and Hamstring Tightness among Runners. JHRR. 2024; 4(2): 343–347. DOI: https://doi.org/10.61919/jhrr.v4i2.803
8. Sayed MA, El-megid SF, El-azizy HM, El-Khozamy HM. The Correlation between Hamstring Tightness and Plantar Fasciitis. Med J Cairo Univ. 2019; 87(1):309-13.
9. Manju, Meetu, Pradyumna Krishna, Sameer. Effect of Various Conventional Treatments on Plantar Fasciitis: A Brief Review. Int J Health Res. 2023; 8(3): 276–80. DOI: https://doi.org/10.52403/ijshr.20230338
10. Ismail MM, Ahmed S. The Incorporation of Balancing Board Exercises in the Management of Plantar Fasciitis. Int J Health Sci. 2011; 16(1): 19–28.
11. Latt LD, Jaffe DE, Tang Y, Taljanovic MS. Evaluation and Treatment of Chronic Plantar Fasciitis. Foot Ankle Orthop. 2020; 5(1): 1-11. doi.org/10.1177/2473011419896763
12. Vidhi S, Anuprita T, Asmita K, et al. Comparison of PNF technique with NDS technique for hamstrings tightness in asymptomatic subjects. Indian J. Physiother. Occup. 2014; 8(3):158-61. DOI:10.5958/0973-5674.2014.00375.X
13. 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. J Musculoskelet Res 2014; 17(2): 1751-63.https://doi.org/10.1142/S0218957714500092
14. 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. Int J Sports Phys Ther, 2021; 16(3): 689–94. doi: 10.26603/001c.24144
15. Kaneda H, Takahira N, Tsuda K, et al. Effects of Tissue Flossing and Dynamic Stretching on Hamstring Muscles Function. J Sports Sci Med. 2020; 19: 681–89.
16. Prakash S, Misra A. Effect of Manual Therapy versus Conventional Therapy in Patients with Plantar Fasciitis-A Comparative Study. Article in International Journal of Physiotherapy and Research, 2014; 2(1): 378–82.
17. Bolívar, Y. A., Munuera, P. v., Padillo, J. P. Relationship between tightness of the posterior muscles of the lower limb and plantar fasciitis. Foot and Ankle International, 2013; 34(1): 42–8. https://doi.org/10.1177/1071100712459173
18. Garceau De D, Dean D, Requejo SM. The Association Between Diagnosis of Plantar Fasciitis and Windlass Test Results. Foot Ankle Int. 2003; 24(3): 251-55. https://doi.org/10.1177/107110070302400309
19. 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. Pak J Med Sci 2008; 24(3): 372-77.
20. Konrad A, Bernsteiner D, Budini F. et al. Tissue flossing of the thigh increases isometric strength acutely but has no effects on flexibility or jump height. EUR J SPORT SCI 2021; 21(12): 1648–158.
21. Driller M, Mackay K, Mills B, Tavares F.. Tissue flossing on ankle range of motion, jump and sprint performance: A follow-up study. Phys Ther Sport 2017; 28: 29–33. https://doi.org/10.1016/j.ptsp.2017.08.081;
22. 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. J Clin Med. 2022; 11(9). 2298. https://doi.org/10.3390/jcm11092298
23. Kim J, Sung DJ, Lee J. The Therapeutic Effect of the Flossing Technique on Knee Flexibility and Functional Performance: A Pilot Study. J Sports Sci Med. 2017; 16, 130–136.
24. Huffer D, Hing W, Newton R, Clair M. Strength training for plantar fasciitis and the intrinsic foot musculature: a systematic review. Phys Ther Sport. 2016; 24: 44–52. DOI: 10.1016/j.ptsp.2016.08.008
25. Cohen J. 1988. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, New Jersey: Lawrence Erlbaum Associates
26. Pearce CJ, Seow D, Lau BP. Correlation Between Gastrocnemius Tightness and Heel Pain Severity in Plantar Fasciitis. Foot Ankle Int. 2021; 42(1): 76–82. doi: 10.1177/1071100720955144
27. Gupta R, Malhotra A, Masih GD, et al. Comparing the Role of Different Treatment Modalities for Plantar Fasciitis: A Double Blind Randomized Controlled Trial. Indian J Orthop. 2020; 54(1): 31–37. doi: 10.1007/s43465-019-00038
28. 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 Int 2018;39(1):75–82.
29. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012; 15(2). https://doi.org/10.1002/14651858.CD007146.pub3
30. Scattone Silva, Smitheman HP, Smith AK, Silbernagel KG. Are static foot posture and ankle dorsiflexion range of motion associated with Achilles tendinopathy? A cross-sectional study. Braz J Phys Ther 2022; 6(6): 100466. https://doi.org/10.1016/j.bjpt.2022.100466
31. Petrofsky J, Laymon Ml, Lee H. Local heating of trigger points reduces neck and plantar fascia pain. J Back Musculoskelet Rehabil. 2020; 33(1):21-28. doi.org/10.3233/bmr-181222
32. Sullivan J, Burns J, Adams R, Pappas E, Crosbie J. Musculoskeletal and activity-related factors associated with plantar heel pain. Foot Ankle Int. 2015; 36: 37–45. doi: 10.1177/1071100714551021
33. Wei Z, Zeng Z, LiuM, Lin 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): https://doi.org/10.1371/journal.pone.0266525
34. Behm DG, Wilke J. 2019. Do Self-Myofascial Release Devices Release Myofascia? Rolling Mechanisms: A Narrative Review. Sports Med. 49: 1173–1181. doi: 10.1007/s40279-019-01149-y
35. Russell PJ, Decoster LC, Enea D. Effects of Gastrocnemius, Hamstring, and Combined Stretching Programs on Knee Extensibility. Athl Train Sports Health Care 2010; 2(2): 67–73. https://doi.org/10.3928/19425864-20100226-06
36. Myers TW. 2009. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists; Elsevier Health Sciences: Amsterdam, The Netherlands.
37. Fauris P, López-De-celis C, Canet-Vintró, M, Martin JC, Llurda-Almuzara L, Rodríguez-Sanz J, Labata-Lezaun N, Simon M, Pérez-Bellmunt A. 2021. Does self-myofascial release cause a remote hamstring stretching effect based on myofascial chains? A randomized controlled trial. Int J Environ Res. Public Health, 18(23): https://doi.org/10.3390/ijerph182312356
38. Siriphorn A, Eksakulkla S. Calf stretching and plantar fascia-specific stretching for plantar fasciitis: A systematic review and meta-analysis. J Bodyw Mov Ther 2020; 24 (4): 222–232. doi: 10.1016/j.jbmt.2020.06.01336.
39. Kawano MM, Ambar G, Beatriz IR,et al, Influence of the gastrocnemius muscle on the sit-and-reach test assessed by angular kinematic analysis. Braz J Phys Ther. 2010; 14(1):10-15. doi: 10.1590/s1413-35552010000100003.
40. Radford JA, Landorf KB, Buchbinder R, Cook C. Effectiveness of calf muscle stretching for the short-term treatment of plantar heel pain: A randomized trial. BMC Musculoskeletal Disorders. 2007; 8:36 doi:10.1186/1471-2474-8-36
41. 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. J Musculoskelet Neuronal Interact 2020; 20(3):411-420.
42. Lee, J., & Kim, J. (2022). 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, 26(4), 14–21. https://doi.org/10.20463/pan.2022.0020
43. Wu, S. Y., Tsai, Y. H., Wang, Y. T., 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). https://doi.org/10.3390/ijerph19031427.
| Issue | Articles in Press | |
| Section | Research Article(s) | |
| Keywords | ||
| Fasciitis Plantar Hamstring Flossing Balance Foot Function | ||
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How to Cite
1.
Ahmed E, Nassif N, Mohamed Y, Mohamed R, Elborady A. Effects of Hamstring Flossing on Balance and Foot Function in Female Patients with Plantar Fasciopathy: A Randomized Controlled Study. jmr. 2025;(-).
