title: Graston instrument soft tissue mobilization and home stretching for the management of plantar heel pain: a case series.
abstract: OBJECTIVE
  The purpose of this prospective case series was to describe the outcome of a set of patients with plantar fasciitis treated with Graston Instrument Soft Tissue Mobilization techniques (GT) and a home stretching program.
  
  
  METHODS
  Ten patients with a primary report of plantar heel pain completed self-report questionnaires including the Global Rating of Change Scale (GRC), the Numeric Pain Rating Scale, and the Lower Extremity Functional Scale. Patients were treated with GT directed to the triceps surae, soleus, plantar fascia, and medial calcaneal tubercle. Participants received a maximum of 8 treatments over a time frame ranging from 3 to 8 weeks at a frequency of 1 to 2 sessions per week. Each patient was instructed to perform the stretching program at home 3 times daily. Patients completed all outcome measures at baseline, sixth visit (GRC), and at discharge or the eighth visit. The number of successful outcomes on the GRC was examined using a binomial test. Dependent t tests were used to examine if a significant difference existed in secondary outcome measures of pain and function.
  
  
  RESULTS
  The subjects had a mean duration of symptoms of 32.4 weeks (SD, 31.1). Patients were treated for an average of 6.9 visits (SD, 1.3). There was a statistically significant difference between the number of patients who did and did not achieve a successful outcome (P = .047). There was also a significant improvement from baseline to follow-up for the Numeric Pain Rating Scale (P = .002) and Lower Extremity Functional Scale (P = .017).
  
  
  CONCLUSIONS
  The group of patients selected for this case series who were treated with GT and home stretching experienced clinically meaningful improvement.
authors.affiliation: Advanced Injury Treatment Center, Bedford, NH, USA. BJLooney@hotmail.com
authors.forename: Brian
authors.initials: B
authors.lastname: Looney
authors.forename: Terry
authors.initials: T
authors.lastname: Srokose
authors.forename: César
authors.initials: C
authors.lastname: Fernández-de-las-Peñas
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Cleland
mesh_terms: D036981:Fasciitis, Plantar / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D052580:Muscle Stretching Exercises; D026741:Physical Therapy Modalities / Q000295:instrumentation*; D011446:Prospective Studies; D012648:Self Care; D016896:Treatment Outcome