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肌筋膜触发点手法治疗联合自我拉伸方案治疗足底足跟痛的有效性:一项随机对照试验。

Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: a randomized controlled trial.

机构信息

Hospital Ouro Verde, Escola de Osteopatía de Madrid, Campinas, Sao Paulo, Brazil.

出版信息

J Orthop Sports Phys Ther. 2011 Feb;41(2):43-50. doi: 10.2519/jospt.2011.3504. Epub 2011 Jan 31.


DOI:10.2519/jospt.2011.3504
PMID:21285525
Abstract

STUDY DESIGN: A randomized controlled clinical trial. OBJECTIVE: To investigate the effects of trigger point (TrP) manual therapy combined with a self-stretching program for the management of patients with plantar heel pain. BACKGROUND: Previous studies have reported that stretching of the calf musculature and the plantar fascia are effective management strategies for plantar heel pain. However, it is not known if the inclusion of soft tissue therapy can further improve the outcomes in this population. METHODS: Sixty patients, 15 men and 45 women (mean ± SD age, 44 ± 10 years) with a clinical diagnosis of plantar heel pain were randomly divided into 2 groups: a self-stretching (Str) group who received a stretching protocol, and a self-stretching and soft tissue TrP manual therapy (Str-ST) group who received TrP manual interventions (TrP pressure release and neuromuscular approach) in addition to the same self-stretching protocol. The primary outcomes were physical function and bodily pain domains of the quality of life SF-36 questionnaire. Additionally, pressure pain thresholds (PPT) were assessed over the affected gastrocnemii and soleus muscles, and over the calcaneus, by an assessor blinded to the treatment allocation. Outcomes of interest were captured at baseline and at a 1-month follow-up (end of treatment period). Mixed-model ANOVAs were used to examine the effects of the interventions on each outcome, with group as the between-subjects variable and time as the within-subjects variable. The primary analysis was the group-by-time interaction. RESULTS: The 2 × 2 mixed-model analysis of variance (ANOVA) revealed a significant group-by-time interaction for the main outcomes of the study: physical function (P = .001) and bodily pain (P = .005); patients receiving a combination of self-stretching and TrP tissue intervention experienced a greater improvement in physical function and a greater reduction in pain, as compared to those receiving the self-stretching protocol. The mixed ANOVA also revealed significant group-by-time interactions for changes in PPT over the gastrocnemii and soleus muscles, and the calcaneus (all P<.001). Patients receiving a combination of self-stretching and TrP tissue intervention showed a greater improvement in PPT, as compared to those who received only the self-stretching protocol. CONCLUSIONS: This study provides evidence that the addition of TrP manual therapies to a self-stretching protocol resulted in superior short-term outcomes as compared to a self-stretching program alone in the treatment of patients with plantar heel pain. LEVEL OF EVIDENCE: Therapy, level 1b.

摘要

研究设计:随机对照临床试验。 目的:探讨触发点(TrP)手法治疗联合自我拉伸方案在足底跟痛患者管理中的作用。 背景:先前的研究表明,小腿肌肉和足底筋膜的拉伸是足底跟痛的有效管理策略。然而,尚不清楚是否包含软组织治疗可以进一步改善该人群的结果。 方法:60 名患者,15 名男性和 45 名女性(平均年龄±标准差,44±10 岁),临床诊断为足底跟痛,随机分为 2 组:自我拉伸(Str)组接受拉伸方案,自我拉伸和软组织 TrP 手法治疗(Str-ST)组接受 TrP 手法干预(TrP 压力释放和神经肌肉方法)以及相同的自我拉伸方案。主要结局是生活质量 SF-36 问卷的身体功能和身体疼痛领域。此外,由不了解治疗分配的评估者评估受影响的腓肠肌和比目鱼肌以及跟骨上的压痛阈值(PPT)。在基线和 1 个月随访(治疗期末)时评估感兴趣的结局。混合模型方差分析(ANOVA)用于检查干预对每个结局的影响,以组为组间变量,时间为组内变量。主要分析是组间时间交互作用。 结果:2×2 混合模型方差分析(ANOVA)显示研究的主要结局存在显著的组间时间交互作用:身体功能(P=.001)和身体疼痛(P=.005);接受自我拉伸和 TrP 组织干预相结合的患者在身体功能方面的改善更大,疼痛减轻更多,而接受自我拉伸方案的患者则更少。混合方差分析还显示,腓肠肌和比目鱼肌以及跟骨上的 PPT 变化存在显著的组间时间交互作用(均 P<.001)。接受自我拉伸和 TrP 组织干预相结合的患者的 PPT 改善更大,而仅接受自我拉伸方案的患者则更少。 结论:这项研究提供的证据表明,与单独进行自我拉伸方案相比,在治疗足底跟痛患者时,将 TrP 手法治疗添加到自我拉伸方案中可获得更好的短期结果。 证据水平:治疗,1b 级。

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