Massage & Bodywork

July/August 2013

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3 Deep stripping techniques are applied to the gastrocnemius and soleus muscles while the client pulls the foot into dorsiflexion. routinely be linked to dysfunctional biomechanical patterns during gait, upper-body muscle tension from long static loads, or biomechanical imbalance in other portions of this kinetic chain. Treatment Strategies Due to complex biomechanical relationships, it is important to keep in mind that no single intervention is likely to be effective on its own. A variety of treatment approaches is most beneficial. Also, the various treatments do not work for everyone; treatment should be tailored to the specific needs of the client. Traditional treatments for plantar fasciitis include: biomechanical remedies for improper gait or foot function, Botox injections, changes in footwear, extracorporeal shockwave therapy, ice for pain, medications and cortisone shots, orthotics, physical therapy, particular stretching regimens, and rest from offending activities. Acupuncture also shows positive results, and naturopathy can cover overall health issues that may be impeding tissue healing. The importance of proper shoes should not be underemphasized. Traditional treatments focus on supporting the arches with orthotics or shoes with greater support. They also call for shoes with hard insoles. If there is a blood-flow issue, however, these treatments seem contraindicated. An arch support could potentially shorten or bowstring the 104 massage & bodywork july/august 2013 abductor hallucis muscle, compressing the tissues and thus the medial plantar artery, and lead to further problems with blood flow. It is highly recommended that sufferers change to shoes with a wide toe box and a relatively level heel and forefoot position to decrease stress on the affected structures. Another type of treatment that needs more consideration is soft-tissue therapy applications— but not just to the foot. Because the fascial connection pathway of the superficial back line extends from the cranium down to the bottom of the foot, soft-tissue treatment methods need to focus on all of these regions. Vaughn has found the most benefit in treating plantar fascia problems by performing soft-tissue therapy on all of the muscles along the superficial back line— from the foot all the way through the neck. In addition to specifically targeted massage treatments, such as active engagement methods, Vaughn finds fascial mobilization methods using tools, such as the gua sha technique, to be highly effective. This same approach has been popularized in the chiropractic profession under the name Graston Technique, which uses specially shaped tools to perform scraping movements on the skin and superficial fascia and encourage full fascial mobility. (Special training is required for proper use of these tools and techniques. See Massage & Bodywork, November/ December 2012, "Smooth Movement," page 94.) Vaughn also points out that the hip rotator and abductor muscles play a major role in proper gait mechanics that can result in plantar foot pain when they are not functioning properly. Therefore, soft-tissue treatment and stretching methods should include the deep lateral hip rotators like the piriformis, as well as the gluteus medius and minimus, which function during medial hip rotation and abduction. The soft tissues that have received the most attention in terms of stretching protocols are those contained in the superficial and deep posterior compartments. Massage to these muscles can also be very effective in releasing tightness. One of the best ways to encourage pliability and mobility in these tissues is to perform movement simultaneous with the soft-tissue treatment methods. This is done most effectively with active engagement techniques.

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