ASTYM® TREATMENT AS AN ADJUNCT TO STANDARD PHYSICAL THERAPY

CARE FOR CHRONIC HEEL PAIN: A MULTIPLE PATIENT CASE REPORT

Shannon Hay, DPT, Mallory Mountz, DPT, Monika Thelen, DPT
Benchmark Rehab Partners, Ooltewah, TN

Pain rating (NRPS)

7

Case Reports
Background/Purpose Patient 1: Insidious onset of right heel pain located locally along the plantar surface of his calcaneus. Pain was
6

Plantar heel pain is the most common diagnosis aggravated with prolonged walking and eased with using medicated gel and wearing his orthotics. Pt was treated
5

for foot & ankle pain, and approximately 1 in 10 2x/week for 4 weeks for a total of 8 visits. At conclusion of care, there were improvements in pain level, LEFS 4

individuals will experience plantar heel pain score, plantarflexion strength, and muscle extensibility of the gastrocnemius and soleus complex.
during the course of their life. Current research 3

suggests that the underlying pathology behind Patient 2: Insidious onset of bilateral heel pain located on the plantar surface of the calcaneus and occasional 2

chronic plantar heel pain is the result of a sharp pain along the medial and lateral aspects of his foot. Pain was worse in the morning and following 1

degenerative process, as opposed to prolonged standing and walking; relief with rest. Pt was treated 2x/week for 6 weeks for a total of 13 visits. At
inflammation, which has significant implications conclusion of care, there were improvements in pain level, LEFS score, bilateral ankle dorsiflexion ROM, muscle
0
Patient 1 Patient 2 Patient 3

for its treatment. The use of Astym® therapy has extensibility of the gastrocnemius and soleus complex, and tenderness to palpation at the plantar calcaneus. Pre-Treat Post-Treat

been shown to promote cell regeneration and LEFS scores

decrease presence of scar tissue resulting in Patient 3: Insidious onset of right heel pain that began in the plantar heel and progressively worsened to include 70

improved ROM, decreased pain, and improved the Achilles tendon. Pain was aggravated with walking and relieved with rest and use of an anti-inflammatory gel. 60

function in several tendinopathies and chronic Pt was treated 2x/week for 5 weeks for a total of 9 visits. At conclusion of care there were improvements in pain
soft tissue injuries. Currently, there is limited level, LEFS score, ankle ROM, plantarflexion strength, and muscle extensibility of the gastrocnemius and soleus
50

evidence for the effectiveness of Astym therapy complex. 40

as an adjunct to standard physical therapist

30

services in the treatment of plantar heel pain.

20

Patient 1 Patient 2 Patient 3

The purpose of this case report is to describe the 10

outcome of three patients treated with the

Astym soft tissue approach including exercise and Age 65 53 26
0
Patient 1 Patient 2
Pre-Treat Post-Treat
Patient 3

stretching for plantar heel pain.

Sex Male Male Female
Results
Patients were treated for an average of 10
Methods Symptom duration 3 months 18 months 3 months visits (SD, 2.6) over an average of 55 days (SD,
Three patients with a referral for heel pain 34.2). All three patients reported lower pain
completed a numeric pain rating scale and a Lower from an average of 5.7 (SD, 1.5) to 2.3 (SD,
Extremity Functional Scale (LEFS) which were 0.6). In addition, each patient had an
administered at baseline and conclusion of care. improved LEFS score averaging 58.3 (SD,4) at
Each patient was treated with Astym therapy using baseline and increasing to 64.7 (SD, 0.6) at
the lower extremity protocol 2 times a week over a conclusion of care.
span of 4-6 weeks. Astym treatment was used in
conjunction with standard physical therapist services
including manual therapy, therapeutic exercise, and
education in a home program. Conclusions
This study suggests Astym therapy is an
effective treatment approach when combined
References with standard physical therapist services when
1. Cleland J a, Abbott JH, Kidd MO, et al. Manual physical therapy and exercise versus electrophysical agents and exercise in the management of plantar heel pain: a multicenter randomized clinical trial. J Orthop Sports Phys Ther. 2009;39(8):573-585. doi:10.2519/jospt.2009.3036. treating patients with chronic plantar heel
2. Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc.2003;93:234-237.
3. Davidson CJ, Ganion LR, Gehlsen GM, Verhoestra B, Roepke JE, Sevier TL. 1997. Rat tendon morphologic and functional changes resulting from soft tissue mobilization. Medicine and Science in Sports and Exercise 29(3):313–319 DOI 10.1097/00005768-199703000-00005. pain.
4. Gehlsen GM, Ganion LR, Helfst R. 1999. Fibroblast responses to variation in soft tissue mobilization pressure. Medicine and Science in Sports and Exercise 31(4):531–535 DOI 10.1097/00005768-199904000-00006.
5. Slaven, EJ. The role of Astym® treatment in the management of lateral epicondylosis: A single case research design. Orthopaedic Physical Therapy Practice 2014; 26(1): 44-8.
6. Tyler A, Slaven E. The Role of the Astym® Process in the Management of Osteoarthritis of the Knee: A Single-Subject Research Design. Journal of Student Physical Therapy Research. 2013;6(2):1-10.
7. McCormack JR. The management of mid-portion Achilles tendinopathy with Astym® treatment and eccentric exercise: a case report. The International Journal of Sports Physical Therapy. 2012; 7(6):672-677.
8. McCormack JR. The management of bilateral high hamstring tendinopathy with ASTYM® treatment and eccentric exercise: a case report. Journal of Manual and Manipulative Therapy. 2012; 20(3):142-146.
9. Slaven EJ, Mathers J. Management of chronic ankle pain using joint mobilization and
Astym® treatment: a case report. Journal of Manual and Manipulative Therapy. 2011;19(2):108-112.