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Plantar Fasciitis: A Unique Treatment


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Dr. Perry Nickelston, DC, FMS, SFMA presentation for the Association of NJ Chiropractors on Plantar Fasciitis. Using movement and laser therapy as treatment.

Published in: Health & Medicine
  • Great tip on hip extension drill, it's one of my favorite to incorporate into rehab routine.
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Plantar Fasciitis: A Unique Treatment

  1. 1. ‘ Step Outside the Foot’ Perry Nickelston, DC, FMS, SFMA Pain Laser Center, LLC
  2. 2. Case Study Plantar Fasciitis ? Assessment/Evaluations Treatment Protocols Grassroots branding
  3. 3. <ul><li>35 year old female runner </li></ul><ul><li>Pain on bottom of right foot and heel </li></ul><ul><li>8-months </li></ul><ul><li>*Podiatrist (orthotics) </li></ul><ul><li>*Physical Therapy (US, stim, exercise) </li></ul><ul><li>*Chiropractic </li></ul><ul><li>*Cortisone injections (2) </li></ul>
  4. 4. <ul><li>Insanity - ‘Doing the same thing over and over expecting a different result.’ </li></ul><ul><li>MOVEMENT DYSFUNCTION </li></ul><ul><ul><li>Joint by joint kinematic chain </li></ul></ul><ul><ul><li>Mobility, stability, muscle activation </li></ul></ul><ul><li>Site vs. Source </li></ul><ul><ul><li>Treat both parameters </li></ul></ul><ul><ul><li>Laser…functional movement… </li></ul></ul>
  5. 5. <ul><li>“ The physician arrives at a diagnosis not from the evidence furnished by one painful movement but by careful determination of a consistent pattern.” </li></ul><ul><li>-Dr. James Cyriax </li></ul>
  6. 6. <ul><li>Multi-Segmental Flexion </li></ul><ul><li>Multi-Segmental Extension </li></ul><ul><li>Multi-Segmental Rotation </li></ul><ul><li>Single Leg Stance </li></ul><ul><li>Squatting Pattern </li></ul><ul><li>Upper Extremity Movement Patterns </li></ul><ul><li>Cervical Movement Patterns </li></ul>
  7. 7. Each assessment of the SFMA must be scored with one of four possible answers: 1. Functional and Non-Painful (FN) 2. Functional and Painful (FP) 3. Dysfunctional and Painful (DP) 4. Dysfunctional and Non-Painful (DN)** SCORING SYSTEM
  8. 8. * Dysfunctional does not always mean limited movement…..can also be an abnormal pattern, timing, or increased exertion. KEY POINT
  9. 9. Don’t Chase PAIN Traditional model attacks the inflamed tissue. We want to find and treat the source of the pain using a systematic examination.
  10. 10. <ul><li>Decreased ankle dorsi-flexion (B) R>L </li></ul><ul><li>Decreased hip extension (R) </li></ul><ul><li>Decreased hip internal rotation (B) </li></ul><ul><li>Decreased T-Spine rotation (L) </li></ul><ul><li>Decreased Cervical Spine Flexion/ (L) rotation </li></ul><ul><li>Decreased hip stability (L) </li></ul><ul><li>Spinal Fixations: </li></ul><ul><li>Occiput…T12/L1…Sacral Apex </li></ul>
  11. 11. <ul><li>Trigger points </li></ul><ul><li>Soleus, gastroc, tibialis posterior/anterior, vastus medialis/lateralis, adductor longus/magnus, psoas,) </li></ul><ul><li>Hip Cuff </li></ul><ul><li>(Medius/minimus, piriformis, TFL, ITB, QL) </li></ul>
  12. 12. <ul><li>Plantar </li></ul><ul><li>Sacrotuberous </li></ul><ul><li>Glutei Maximi Slip </li></ul><ul><li>Thoracolumbar </li></ul><ul><li>Suboccipital </li></ul>*Lateral Line *Deep Frontal Line *Spiral Line
  13. 13. <ul><li>Diagnosis </li></ul><ul><li>Dosages per square area </li></ul><ul><ul><li>Joules </li></ul></ul><ul><li>Application process </li></ul><ul><li>Frequency of therapy </li></ul>Photo-biostimulation Cellular regeneration
  14. 14. <ul><li>1,000 J Thoracolumbar Fascia </li></ul><ul><li>500J Suboccipital </li></ul><ul><li>500J L5/S1 </li></ul><ul><li>1,000J (B) Hip </li></ul><ul><li>1,500J Gastroc/Soleus </li></ul><ul><li>1,500 J Plantar Surface </li></ul><ul><li>Settings: </li></ul><ul><li>10W CW 10 Min session </li></ul><ul><li>6 treatments 2x week / 3 Weeks </li></ul>
  15. 15. (MFR, Tp, ART) Foam Rollers Laser Therapy Active Isolated Stretching
  16. 16. <ul><ul><li>Mulligan (B) hips </li></ul></ul><ul><ul><li>Mulligan (B) ankles </li></ul></ul><ul><ul><li>Ankle mobility drills </li></ul></ul><ul><ul><li>Diversified Spinal </li></ul></ul>
  17. 17. <ul><li>Glute activation Drills </li></ul><ul><li>Mini-bands </li></ul><ul><li>Hip Extension Drills </li></ul>MUSCLE ACTIVATION
  18. 18. <ul><li>Diaphragmatic Breathing </li></ul><ul><li>Diaphragm Release </li></ul><ul><li>Laser Therapy Diaphragm </li></ul><ul><li>T-Spine Rotation </li></ul>
  19. 19. <ul><li>How do you assess movement? </li></ul><ul><li>Squatting </li></ul><ul><li>Stepping </li></ul><ul><li>Lunging </li></ul><ul><li>Reaching </li></ul><ul><li>Leg raising </li></ul><ul><li>Push-up </li></ul><ul><li>Rotational stability </li></ul>
  20. 20. <ul><li>Eight laser treatments Class 4 Laser </li></ul><ul><li>Ten sessions of soft tissue </li></ul><ul><li>Six sessions of activation/stabilization </li></ul><ul><li>Two sessions of breathing instruction </li></ul><ul><li>Released from care asymptomatic with </li></ul><ul><li>instructions on use of foam roller/stretching. </li></ul><ul><li>Maintenance program every FOUR weeks. </li></ul>
  21. 21. <ul><li>Class 4 Laser Therapy </li></ul><ul><li>Movement Assessment </li></ul><ul><li>Mobility/Stability </li></ul><ul><li>Soft Tissue </li></ul><ul><li>Stop Chasing Pain </li></ul>
  22. 22. <ul><li>Why did she seek me out for care? </li></ul><ul><ul><li>RESULTS </li></ul></ul><ul><ul><li>LASER </li></ul></ul><ul><ul><li>UNIQUENESS </li></ul></ul><ul><li>Workshop/Seminar evaluations for her running club. </li></ul><ul><ul><li>Runners know runners </li></ul></ul><ul><ul><li>Plantar fasciitis knows… </li></ul></ul>