Abstract
BACKGROUND: Myofascial tissues are interconnected, and fascia connects them to forming a web of myofascial chains. This research investigated whether incorporating myofascial release along the superficial backline offers additional benefits compared to a localized gastrocnemius release in managing clinical symptoms and plantar fascia thickness in individuals with chronic plantar fasciitis. METHODS: This was an add-on design a single-blind randomized clinical trial that was conducted with 30 chronic plantar fasciitis patients. Subjects were randomized into two groups: the Gastrocnemius Myofascial Release (G-MFR) group and the Chain Myofascial Release (C-MFR) group. Each participant underwent four MFR sessions over two weeks. Outcome measures included the Numeric Pain Rating Scale (NPRS), the Foot Function Index (FFI), and ultrasound-based evaluations of plantar fascia thickness. Due to the non-normal distribution of change scores, between-group comparisons were performed using the Mann-Whitney test with the Hodges-Lehmann estimator, and effect sizes were reported using r values. RESULTS: Both groups exhibited significant improvements in NPRS and FFI scores post-intervention (P<0.001), with the C-MFR group showing greater reductions in both measures (for NPRS: P=0.004, r=0.686 and for FFI: P=0.004, r=0.518). However, while plantar fascia thickness decreased significantly in the C-MFR group (P=0.001, r=0.829), no significant change was observed in the G-MFR group (P=0.422, r=0.206). The reduction in thickness for C-MFR compared to G-MFR was not statistically significant (P=0.233, r=0.222). CONCLUSION: This study suggests that myofascial release in the superficial backline chain is more effective than isolated gastrocnemius release for improving NPRS and FFI scores in chronic plantar fasciitis. Future studies with longer follow-ups may clarify the long-term effects of these interventions on plantar fascia thickness.