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Extracorporeal Shockwave Therapy Versus Graston Instrument-Assisted Soft-Tissue Mobilization in Chronic Plantar Heel Pain: A Randomized Controlled Trial

Pelin PisiriciPhysiotherapy and Rehabilitation Department, Bahcesehir University, Health Sciences Faculty, Istanbul, Turkey.

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 PT, PhD
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Elif Tugce CilPhysiotherapy and Rehabilitation Department, Yeditepe University, Health Sciences Faculty, Istanbul, Turkey.

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 PT, MSc, PhD
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Dilber Karagozoglu CoskunsuPhysiotherapy and Rehabilitation Department, Bahcesehir University, Health Sciences Faculty, Istanbul, Turkey.
Department of Physiotherapy and Rehabilitation, Fenerbahce University, Faculty of Health Sciences, Istanbul, Turkey.

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Ugur SaylıAcıbadem Saglık Grubu, Istanbul, Turkey.

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Feryal SubasiPhysiotherapy and Rehabilitation Department, Yeditepe University, Health Sciences Faculty, Istanbul, Turkey.

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Background: Although there are studies showing that extracorporeal shockwave therapy (ESWT) and instrument-assisted soft-tissue mobilization methods are effective in chronic plantar heel pain (CPHP) treatment, there is a need for studies comparing these techniques. We compared the effectiveness of ESWT versus instrument-assisted soft-tissue mobilization using Graston Technique (GT) instruments in addition to stretching exercises (SEs) in CPHP.

Methods: Sixty-nine patients were randomly assigned to three groups: ESWT+SEs (group 1), GT+SEs (group 2), and SEs only (control group) (ratio, 1:1:1). The SEs, twice daily for 8 weeks, were standard for all. Group 1 received low-intensity ESWT; in group 2, GT was the selected method. Visual analog scales (for initial step and activity pain), the Foot Function Index (FFI), the 12-item Short-Form Health Survey (SF-12), and the Tampa Scale for Kinesiophobia were used pretreatment, posttreatment, and at 8-week and 6-month follow-up.

Results: Visual analog scale and FFI scores improved posttreatment and during follow-up in all groups (P < .001). Although effect sizes were greater in groups 1 and 2 than in the control group in initial step pain posttreatment and at 8-week follow-up, group 2 had the highest effect size at 6 months. Mean SF-12 scores in groups 1 and 2 improved on the posttreatment assessment. Furthermore, group 2 showed significant improvements in FFI scores compared with the other groups at 6-month follow-up (F = 6.33; P = .003).

Conclusions: Although ESWT+SEs and GT+SEs seem to have similar effects on initial step pain posttreatment and at 8-week follow-up, GT+SEs was found most effective for improving functional status at 6 months in the management of CPHP.

Corresponding author: Dilber Karagozoglu Coskunsu, PT, PhD, Physiotherapy and Rehabilitation Department, Bahçeşehir University, Health Sciences Faculty, Ihlamur Yıldız Caddesi, No:8, Gayrettepe, 34353 Besiktas, Istanbul, Turkey; or Department of Physiotherapy and Rehabilitation, Fenerbahce University, Faculty of Health Sciences, Ataturk Mah. Atasehir Bulvarı, Metropol Istanbul, 34758, Atasehir – Istanbul, Turkey. (E-mail: dilbercoskunsu@gmail.com)