Facebook Pixel
Brookbush Institute Logo

Tuesday, June 6, 2023

IASTM: Plantar and Crural Fascia (Lower Leg)

Brent Brookbush

Brent Brookbush

DPT, PT, MS, CPT, HMS, IMT

IASTM: Plantar and Crural Fascia (Lower Leg)

By Brent Brookbush DPT, PT, COMT, MS, PES, CES, CSCS, ACSM H/FS

Plantar Fascia (13:38)

[@portabletext/react] Unknown block type "span", specify a component for it in the `components.types` prop

Crural Fascia (21:18)

[@portabletext/react] Unknown block type "span", specify a component for it in the `components.types` prop

Crural Fascia

The crural (lower leg) fascia presents with a mean thickness of 924 μm (μm = micrometer = 1/1000 mm), and is composed of two or three layers of collagen fiber bundles with a mean thickness of 277.6 μm. A thin layer of loose connective tissue, with a mean thickness 43 μm, usually separates the different layers. In each layer, a prevalent direction of the fibers is recognizable, forming angles of 80–90° to those in adjacent layers (146, 147). Surprisingly, elastin only exists at the borders of the crural fascia and in loose connective tissue, and is nearly absent in the layers of overlapping deep fascia (146). This may imply that restrictions are not due to a loss of "elasticity," but rather movement between layers, or binding between layers that does not allow for the "uncrimping" of the wavy fascial sheaths. Although more research is needed, this hypothesis does seem to favor instrument assisted soft tissue mobilization (IASTM), pin and stretch and other myofascial techniques that create shear forces between layers of tissue. Treatment of the crural fascia with IASTM and Pin-and-Stretch techniques has proven effective in practice, especially relative to enhancing carry over of mobility gains.

Plantar Fascia

The plantar fascia is an important fascial structure, aiding in stabilization of the medial longitudinal arch of the foot, resisting pronation and increasing the rigidity necessary for push-off during gait (via the "windlass mechanism"). The importance of this structure can be seen in the effect rupture/release of the plantar fascia has on the mechanics of the foot, generally resulting in pes planus (feet flatten ) (152, 153). The plantar fascia has been implicated as a source of injury/dysfunction, commonly resulting in complaints of pain around the medial tubercle of the calcaneus, generally worst with the first few steps upon waking, and commonly diagnosed as plantar fasciitis (154). This set of symptoms and diagnosis has been shown to be linked to altered biomechanics, including feet flatten and a loss of dorsiflexion (admittedly, an assumption is being made that the loss of dorsiflexion is correlated with the increase in forefoot pressure in the studies cited) (155, 156). As mentioned above this dysfunction results in a thickening of the plantar fascia, a loss of extensibility, and perhaps an increased risk of rupture (weakening) (157, 158). It is important that these changes are carefully considered before interventions are selected. If a loss of extensibility is due to inflammation and being "stuck" in a lengthened position due to feet flatten and a loss of dorsiflexion , rolling the bottom of the foot on a ball cannot be expected to have any long-term positive affect. Correction of biomechanics, reducing stress on the plantar fascia and methods of reducing inflammation may be more pertinent means of addressing the issue.

  1. (146) Stecco, C., Porzionato, A., Lancerotto, L., Stecco, A., Macchi, V., Day, J. A., & De Caro, R. (2008). Histological study of the deep fasciae of the limbs. Journal of bodywork and movement therapies, 12(3), 225-230.
  2. (147) Stecco, C., Pavan, P. G., Porzionato, A., Macchi, V., Lancerotto, L., Carniel, E. L., … & De Caro, R. (2009). Mechanics of crural fascia: from anatomy to constitutive modelling. Surgical and Radiologic Anatomy, 31(7), 523-529.
  3. (152) Hicks, J. H. (1954). The mechanics of the foot: II. The plantar aponeurosis and the arch. Journal of anatomy, 88(Pt 1), 25.
  4. (153) Sharkey, N. A., Ferris, L., & Donahue, S. W. (1998). Biomechanical consequences of plantar fascial release or rupture during gait: part I-disruptions in longitudinal arch conformation. Foot & ankle international, 19(12), 812-820.
  5. (154) Neufeld, S. K., & Cerrato, R. (2008). Plantar fasciitis: evaluation and treatment. Journal of the American Academy of Orthopaedic Surgeons, 16(6), 338-346.
  6. (155) D’Ambrogi, E., Giurato, L., D’Agostino, M. A., Giacomozzi, C., Macellari, V., Caselli, A., & Uccioli, L. (2003). Contribution of plantar fascia to the increased forefoot pressures in diabetic patients. Diabetes Care, 26(5), 1525-1529.
  7. (156) Giacomozzi, C., D’ambrogi, E., Uccioli, L., & Macellari, V. (2005). Does the thickening of Achilles tendon and plantar fascia contribute to the alteration of diabetic foot loading?. Clinical biomechanics, 20(5), 532-539.
  8. (157) Kane, D., Greaney, T., Shanahan, M., Duffy, G., Bresnihan, B., Gibney, R., & FitzGerald, O. (2001). The role of ultrasonography in the diagnosis and management of idiopathic plantar fasciitis. Rheumatology, 40(9), 1002-1008.
  9. (158) Huerta, J. P., & García, J. M. A. (2007). Effect of gender, age and anthropometric variables on plantar fascia thickness at different locations in asymptomatic subjects. European journal of radiology, 62(3), 449-453.
  10. Karmail, A., Walizada, A., & Stuber, K. (2019). THE EFFICACY OF INSTRUMENT-ASSISTED SOFT TISSUE MOBILIZATION FOR MUSCULOSKELETAL PAIN: A SYSTEMATIC REVIEW. Journal of Contemporary Chiropractic, 2, 25-33.
  11. Cheatham, S. W., Lee, M., Cain, M., & Baker, R. (2016). The efficacy of instrument assisted soft tissue mobilization: a systematic review. The Journal of the Canadian Chiropractic Association, 60(3), 200.
  12. Aspegren, D., Hyde, T., & Miller, M. (2007). Conservative treatment of a female collegiate volleyball player with costochondritis J Manipulative Physiol Ther (Vol. 30, pp. 321-325). United States.
  13. Bailey, L. B., Shanley, E., Hawkins, R., Beattie, P. F., Fritz, S., Kwartowitz, D., et al. (2015). Mechanisms of Shoulder Range of Motion Deficits in Asymptomatic Baseball Players. Am J Sports Med, 43(11), 2783-2793.
  14. Baker, R. T., Hansberger, B. L., Warren, L., & Nasypany, A. (2015). A NOVEL APPROACH FOR THE REVERSAL OF CHRONIC APPARENT HAMSTRING TIGHTNESS: A CASE REPORT. Int J Sports Phys Ther, 10(5), 723-733.
  15. Bayliss, A. J., Klene, F. J., Gundeck, E. L., & Loghmani, M. T. (2011a). Treatment of a patient with post-natal chronic calf pain utilizing instrument-assisted soft tissue mobilization: a case study J Man Manip Ther (Vol. 19, pp. 127-134). England.
  16. Bayliss, A. J., Klene, F. J., Gundeck, E. L., & Loghmani, M. T. (2011b). Treatment of a patient with post-natal chronic calf pain utilizing instrument-assisted soft tissue mobilization: a case study. J Man Manip Ther, 19(3), 127-134.
  17. Black, D. W. (2010). Treatment of knee arthrofibrosis and quadriceps insufficiency after patellar tendon repair: a case report including use of the graston technique. Int J Ther Massage Bodywork, 3(2), 14-21.
  18. Bove, G. M., & Chapelle, S. L. (2012). Visceral mobilization can lyse and prevent peritoneal adhesions in a rat model. J Bodyw Mov Ther, 16(1), 76-82.
  19. Burke, J., Buchberger, D. J., Carey-Loghmani, M. T., Dougherty, P. E., Greco, D. S., & Dishman, J. D. (2007). A pilot study comparing two manual therapy interventions for carpal tunnel syndrome J Manipulative Physiol Ther (Vol. 30, pp. 50-61). United States.
  20. Butler, D. (2000). The Sensitive Nervous System. Adelaide, Australia: Noigroup Publications.
  21. Davidson, C. J., Ganion, L. R., Gehlsen, G. M., Verhoestra, B., Roepke, J. E., & Sevier, T. L. (1997). Rat tendon morphologic and functional changes resulting from soft tissue mobilization. Med Sci Sports Exerc, 29(3), 313-319.
  22. Davis, D. S., Ashby, P. E., McCale, K. L., McQuain, J. A., & Wine, J. M. (2005). The effectiveness of 3 stretching techniques on hamstring flexibility using consistent stretching parameters. J Strength Cond Res, 19(1), 27-32.
  23. Depino, G. M., Webright, W. G., & Arnold, B. L. (2000). Duration of maintained hamstring flexibility after cessation of an acute static stretching protocol. J Athl Train, 35(1), 56-59.
  24. Fowler, S., Wilson, J. K., & Sevier, T. L. (2000). Innovative approach for the treatment of cumulative trauma disorders. Work, 15(1), 9-14.
  25. Gehlsen, G. M., Ganion, L. R., & Helfst, R. (1999). Fibroblast responses to variation in soft tissue mobilization pressure. Med Sci Sports Exerc, 31(4), 531-535.
  26. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. (2015). Lancet, 386(9995), 743-800.
  27. Hammer, W. I. (2008a). The effect of mechanical load on degenerated soft tissue J Bodyw Mov Ther (Vol. 12, pp. 246-256). United States.
  28. Hammer, W. I. (2008b). The effect of mechanical load on degenerated soft tissue. J Bodyw Mov Ther, 12(3), 246-256.
  29. Hammer, W. I., & Pfefer, M. T. (2005a). Treatment of a case of subacute lumbar compartment syndrome using the Graston technique J Manipulative Physiol Ther (Vol. 28, pp. 199-204). United States.
  30. Hammer, W. I., & Pfefer, M. T. (2005b). Treatment of a case of subacute lumbar compartment syndrome using the Graston technique. J Manipulative Physiol Ther, 28(3), 199-204.
  31. Hodges, P. W. (2011). Pain and motor control: From the laboratory to rehabilitation. J Electromyogr Kinesiol, 21(2), 220-228.
  32. Howitt, S., Jung, S., & Hammonds, N. (2009). Conservative treatment of a tibialis posterior strain in a novice triathlete: a case report. J Can Chiropr Assoc, 53(1), 23-31.
  33. Hreljac, A., Marshall, R. N., & Hume, P. A. (2000). Evaluation of lower extremity overuse injury potential in runners. Med Sci Sports Exerc, 32(9), 1635-1641.
  34. Järvinen, T. A., Järvinen, T. L., Kääriäinen, M., Kalimo, H., & Järvinen, M. (2005). Muscle injuries: biology and treatment. Am J Sports Med, 33(5), 745-764.
  35. Kassolik, K., Andrzejewski, W., Dziegiel, P., Jelen, M., Fulawka, L., Brzozowski, M., et al. (2013). Massage-induced morphological changes of dense connective tissue in rat's tendon. Folia Histochem Cytobiol, 51(1), 103-106.
  36. Langevin, H. M., Fox, J. R., Koptiuch, C., Badger, G. J., Greenan-Naumann, A. C., Bouffard, N. A., et al. (2011). Reduced thoracolumbar fascia shear strain in human chronic low back pain. BMC Musculoskelet Disord, 12, 203.
  37. Laudner, K., Compton, B. D., McLoda, T. A., & Walters, C. M. (2014). Acute effects of instrument assisted soft tissue mobilization for improving posterior shoulder range of motion in collegiate baseball players. Int J Sports Phys Ther, 9(1), 1-7.
  38. Lee, J. J., Kim do, H., & You, S. J. (2014a). Inhibitory effects of instrument-assisted neuromobilization on hyperactive gastrocnemius in a hemiparetic stroke patient Biomed Mater Eng (Vol. 24, pp. 2389-2394). Netherlands.
  39. Lee, J. J., Kim do, H., & You, S. J. (2014b). Inhibitory effects of instrument-assisted neuromobilization on hyperactive gastrocnemius in a hemiparetic stroke patient. Biomed Mater Eng, 24(6), 2389-2394.
  40. Loghmani, M. T., & Warden, S. J. (2009a). Instrument-assisted cross-fiber massage accelerates knee ligament healing. J Orthop Sports Phys Ther, 39(7), 506-514.
  41. Loghmani, M. T., & Warden, S. J. (2009b). Instrument-assisted cross-fiber massage accelerates knee ligament healing. J Orthop Sports Phys Ther, 39(7), 506-514.
  42. Loghmani, M. T., & Warden, S. J. (2013). Instrument-assisted cross fiber massage increases tissue perfusion and alters microvascular morphology in the vicinity of healing knee ligaments. BMC Complement Altern Med, 13, 240.
  43. Looney, B., Srokose, T., Fernandez-de-las-Penas, C., & Cleland, J. A. (2011). Graston instrument soft tissue mobilization and home stretching for the management of plantar heel pain: a case series. J Manipulative Physiol Ther, 34(2), 138-142.
  44. Macedo, L. G., Latimer, J., Maher, C. G., Hodges, P. W., McAuley, J. H., Nicholas, M. K., et al. (2012). Effect of motor control exercises versus graded activity in patients with chronic nonspecific low back pain: a randomized controlled trial. Phys Ther, 92(3), 363-377.
  45. Markovic, G. (2015). Acute effects of instrument assisted soft tissue mobilization vs. foam rolling on knee and hip range of motion in soccer players. J Bodyw Mov Ther, 19(4), 690-696.
  46. McLaughlin, E. (2006). An Evaluation of the Effectiveness of the Modified Graston Technique on Reducing Edema Following an Acute Ankle Sprain . Bloomington, IN: Indiana University.
  47. MT, L., & SJ, W. (2009). Instrument-assisted cross-fiber massage accelerates knee ligament healing. J Orthop Sports Phys Ther, 39(7), 8.
  48. Nelson, R. T., & Bandy, W. D. (2004). Eccentric Training and Static Stretching Improve Hamstring Flexibility of High School Males. J Athl Train, 39(3), 254-258.
  49. Portillo-Soto, A., Eberman, L. E., Demchak, T. J., & Peebles, C. (2014). Comparison of blood flow changes with soft tissue mobilization and massage therapy. J Altern Complement Med, 20(12), 932-936.
  50. Sainz de Baranda, P., & Ayala, F. (2010). Chronic flexibility improvement after 12 week of stretching program utilizing the ACSM recommendations: hamstring flexibility. Int J Sports Med, 31(6), 389-396.
  51. Schaefer, J. L., & Sandrey, M. A. (2012). Effects of a 4-week dynamic-balance-training program supplemented with Graston instrument-assisted soft-tissue mobilization for chronic ankle instability. J Sport Rehabil, 21(4), 313-326.
  52. Sevier, T. L., & Stegink-Jansen, C. W. (2015). Astym treatment vs. eccentric exercise for lateral elbow tendinopathy: a randomized controlled clinical trial. PeerJ, 3, e967.
  53. Sevier, T. L., & Wilson, J. K. (1999). Treating lateral epicondylitis. Sports Med, 28(5), 375-380.
  54. Starkey, C. (2004). Therapeutic Modalities (3rd ed.). Philadelphia, PA: F.A. Davis.
  55. Starrett, K., & Cordoza, G. (2013). Becoming A Supple Leopard (Vol. 1). Las Vegas: Victory Belt Publishing Inc.
  56. Stow, R. (2011). Instrument-Assisted Soft Tissue Mobilization. International Journal of Athletic Training & Training, 16(3), 3.
  57. Tucker, K., Larsson, A. K., Oknelid, S., & Hodges, P. (2012). Similar alteration of motor unit recruitment strategies during the anticipation and experience of pain. Pain, 153(3), 636-643.
  58. Vardiman, J. P., Siedlik, J., Herda, T., Hawkins, W., Cooper, M., Graham, Z. A., et al. (2015). Instrument-assisted Soft Tissue Mobilization: Effects on the Properties of Human Plantar Flexors. Int J Sports Med, 36(3), 197-203.
  59. White, K. E. (2011). High hamstring tendinopathy in 3 female long distance runners J Chiropr Med (Vol. 10, pp. 93-99). United States: 2011 National University of Health Sciences. Published by Elsevier Inc.
  60. Jones, E. R., Finley, M. A., Fruth, S. J., & McPoil, T. G. (2019). Instrument-Assisted Soft-Tissue Mobilization for the Management of Chronic Plantar Heel Pain: A Pilot Study. Journal of the American Podiatric Medical Association, 109(3), 193-200.
  61. MacDonald, N., Baker, R., & Cheatham, S. W. (2016). The effects of instrument assisted soft tissue mobilization on lower extremity muscle performance: a randomized controlled trial. International journal of sports physical therapy, 11(7), 1040.
  62. Cheatham, S. W., Kreiswirth, E., & Baker, R. (2019). Does a light pressure instrument assisted soft tissue mobilization technique modulate tactile discrimination and perceived pain in healthy individuals with DOMS?. The Journal of the Canadian Chiropractic Association, 63(1), 18-25.
  63. Stroiney, D. A., Mokris, R. L., Hanna, G. R., & Ranney, J. D. (2018). Examination of Self-Myofascial Release vs. Instrument-Assisted Soft-Tissue Mobilization Techniques on Vertical and Horizontal Power in Recreational Athletes. Journal of strength and conditioning research.
  64. Gunn, L. J., Stewart, J. C., Morgan, B., Metts, S. T., Magnuson, J. M., Iglowski, N. J., … & Arnot, C. (2019). Instrument-assisted soft tissue mobilization and proprioceptive neuromuscular facilitation techniques improve hamstring flexibility better than static stretching alone: a randomized clinical trial. Journal of Manual & Manipulative Therapy, 27(1), 15-23.
  65. Bush, H. (2019). GRASTON TECHNIQUE PROTOCOL VS. INSTRUMENT ASSISTED SOFT TISSUE MOBILIZATION FOR DORSIFLEXION CHANGES.
  66. Baker, R. T., Start, A., Larkins, L., Burton, D., & May, J. (2018). Exploring the Preparation, Perceptions, and Clinical Profile of Athletic Trainers Who Use Instrument-Assisted Soft Tissue Mobilization. Athletic Training and Sports Health Care, 10(4), 169-180.
  67. Baker, R. T., Start, A., Larkins, L., Burton, D., & May, J. (2018). Exploring the Preparation, Perceptions, and Clinical Profile of Athletic Trainers Who Use Instrument-Assisted Soft Tissue Mobilization. Athletic Training and Sports Health Care, 10(4), 169-180.
  68. Ikeda, N., Otsuka, S., Kawanishi, Y., & Kawakami, Y. (2019). Effects of Instrument-assisted Soft Tissue Mobilization on Musculoskeletal Properties. Medicine and science in sports and exercise.
  69. Carlson, S., Rife, G., & Williams, Z. (2019). Comparing the Effects of Tissue Flossing and Instrument Assisted Soft Tissue Mobilization on Ankle Dorsiflexion.

Comments

Guest