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

Pelin PişiriciBahçeşehir University, Health Sciences Faculty, Physiotherapy and Rehabilitation Department, Ihlamur Yıldız Caddesi, No:8, Gayrettepe, 34353 Beşiktaş, Istanbul, Turkey.

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Elif Tuğçe ÇilYeditepe University, Health Sciences Faculty, Physiotherapy and Rehabilitation Department, Inönü Mah, Kayışdağı Cd. No:326A, 34755 Ataşehir/Istanbul.

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Dilber Karagözoğlu CoşkunsuBahçeşehir University, Health Sciences Faculty, Physiotherapy and Rehabilitation Department, Ihlamur Yıldız Caddesi, No:8, Gayrettepe, 34353 Beşiktaş, Istanbul, Turkey.
Yeditepe University, Health Sciences Faculty, Physiotherapy and Rehabilitation Department, Inönü Mah, Kayışdağı Cd. No:326A, 34755 Ataşehir/Istanbul.
Fenerbahçe University; Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation. Atatürk Mah. Ataşehir Bulvarı, Metropol Istanbul, 34758, Ataşehir - Istanbul.

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ŞaylıAcıbadem Sağlık Grubu, Bağdat Caddesi Tıp Merkezi Bağdat Cad. No:314/A, Caddebostan/İstanbul.

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Feryal SubaşıYeditepe University, Health Sciences Faculty, Physiotherapy and Rehabilitation Department, Inönü Mah, Kayışdağı Cd. No:326A, 34755 Ataşehir/Istanbul.

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Abstract

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

Methods: Sixty-nine patients were randomly assigned to 3 groups as ESWT+SEs (Gr I), GT®+SEs (Gr II) and SEs (CG) (ratio 1:1:1). SEs program twice/day, for 8-week was standard for all. Gr I received low intensity ESWT while in Gr II, GT® was the selected method. Visual analog scale (VAS) (for initial step and activity pain); foot function index (FFI); short form-12 (SF-12), and Tampa Scale were used at pretreatment, posttreatment and follow-ups (8-week and 6-month).

Results: VAS and FFI scores improved in the posttreatment and follow-ups in all (p<.00) While effect sizes in Gr I and Gr II were greater than CG in initial step pain at posttreatment and 8-week-follow-up, Gr II had highest effect size at 6-month-follow-up. The mean SF-12 scores in Gr I and Gr II showed improvement on the posttreatment assessment. Furthermore, Gr II showed significant improvements in FFI scores compared to other groups in 6-month-follow-up (F=6.33, p=.003).

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

Corresponding Author: Dilber Karagözoğlu Coşkunsu, PT, PhD, Bahçeşehir University, Health Sciences Faculty, Physiotherapy and Rehabilitation Department, Ihlamur Yıldız Caddesi, No:8, Gayrettepe, 34353 Beşiktaş, Istanbul, Turkey; Fenerbahçe University; Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation. Atatürk Mah. Ataşehir Bulvarı, Metropol Istanbul, 34758, Ataşehir - Istanbul. (E-mail: dilbercoskunsu@gmail.com)