Order by Phone (USA) 1 800 741 5716

Order by Phone (USA) 1 800 741 5716



Plantar Fasciitis Trigger Point Therapy


Study provides evidence that trigger point therapy improves the outcome for patients with plantar heel pain

Whilst it's certainly true that we still know comparatively little about trigger points, there is a lot that we do know as a result of an ever growing body of research.

In today's blog we summarize a research study that was completed in 2011 and which looked specifically at the treatment of plantar fasciitis.





About Plantar Heel Pain

Plantar fasciitis or plantar heel pain is the most common foot pain condition treated by healthcare providers. 

It has been estimated that plantar fasciitis occurs in approximately 2 million Americans annually and affects as much as 10% of the general population over the course of a lifetime. 

In fact, some authors have reported that plantar fasciitis accounts for between 8% and 15% of foot complaints in nonathletic and athletic populations. 

Plantar heel pain is disabling, and has a significant negative impact on general health-related quality of life. 

To date, there is evidence that this condition may not be characterized by inflammation but, rather, by non-inflammatory degenerative changes in the plantar fascia.

Clients with plantar heel pain usually describe a sharp pain under the heel, particularly upon weight bearing after a period of non-weight bearing. 

The pain is typically reported being worse in the morning, with the first steps after getting out of bed. 

The pain also typically diminishes with activity but will often tend to worsen toward the end of the day. In some cases the level of disability and affect on daily functions can be quite severe.


Both surgical and non-surgical approaches have been proposed for the management of plantar heel pain. 

Clinical practice guidelines have concluded that there has been limited evidence for the effectiveness of corticosteroid therapy, conflicting evidence for low-energy extracorporeal shockwave therapy, and no evidence for therapeutic ultrasound or low-intensity laser, in reducing pain in individuals with this condition.

Among non-surgical interventions, stretching of the gastrocnemius muscle and the plantar fascia have however shown moderate evidence of effectiveness for the management of this condition, although only in the short term.



Heel Pain Trigger Point Therapy

Trigger Point Therapy - Plantar Fasciitis



Trigger Points and Plantar Heel Pain

Simons et al suggested that taut bands myofascial/muscle trigger points (TrPs) in the gastrocnemius muscles may be involved in the development of plantar heel pain.

A generation or two of trigger point therapists have found this to be the case, and have developed widely used treatment protocols.

TrPs are defined as hyper-irritable areas associated within a taut band of a skeletal muscle that are painful on compression, contraction, or stretching of the muscles, and elicit a referred pain distant to the TrP. 

Studies have found that the stiffness of a TrP taut band is 50% greater than that of the surrounding muscle tissues. 

It is probable that the increased stiffness induced by taut bands with TrPs may reduce the effectiveness of muscle stretching alone.

Therefore, as soft tissue work may help further improve the effectiveness of stretching in the management of plantar heel pain, a randomized controlled clinical trial was undertaken in 2011 to compare the effects of combined stretching and TrP manual therapy to stretching alone.

Details of the Study

Sixty patients, 15 men and 45 women with a clinical diagnosis of plantar heel pain were randomly divided into 2 groups: a self-stretching (Str) group who received a stretching protocol, and a self-stretching and soft tissue TrP manual therapy (Str-ST) group who received TrP manual interventions (TrP pressure release and neuromuscular approach) in addition to the same self-stretching protocol.

The primary outcomes assessed were physical function and bodily pain as related to a quality of life questionnaire.

Additionally, pressure pain thresholds (PPT) were assessed over the affected gastrocnemii and soleus muscles, and over the calcaneus, by an assessor blinded to the treatment allocation.

Outcomes of interest were captured at the baseline and at a 1-month follow-up which was the end of the treatment period. 

Self Stretching Protocol

All participants were instructed in a self-stretching protocol, including calf muscles and plantar fascia-specific exercise, which has moderate evidence of effectiveness for the management of plantar heel pain. 

The dosage for calf and plantar fascia-specific self-stretching exercises was 2 times per day, using intermittent stretching of 20 seconds, followed by 20 seconds rest for a total of 3 minutes for each stretch. Hence, the total self-stretching protocol lasted 9 minutes. 

Trigger Point Therapy

The TP control group were examined for the presence of active TrPs in the gastrocnemius muscles by a clinician with more than 5 years of experience in the management of TrPs.

TrP diagnosis was conducted according to: (1) presence of a palpable taut band, (2) presence of a hypersensitive area in the taut band, (3) local twitch response provoked by the snapping palpation of the taut band, or (4) reproduction of referred pain in response to compression. 

These patients received a TrP pressure release technique over both gastrocnemii muscles. Pressure was applied over TrPs until an increase in muscle resistance (tissue barrier) was perceived by the clinician. 

The pressure was maintained until the therapist perceived release of the taut band. At this stage, the pressure was increased to return to previous level of muscle TrP tension and the process was repeated for 90 seconds (usually 3 repetitions).

These patients also received a neuromuscular technique (longitudinal stroke) over the gastrocnemius muscle.

This is a technique has been found to be effective for reducing TrP pressure sensitivity. 

With the patient in prone, the thumb of the therapist was placed over the taut band and 3 longitudinal strokes were performed from the ankle to the knee. 

In each case, TrP manual therapies were applied depending on clinical findings related to the location of the TrP on the affected leg. No predetermined TrP location was considered.


The 2 × 2 mixed-model analysis of variance (ANOVA) revealed a significant group-by-time interaction for the main outcomes of the study: physical function (P = .001) and bodily pain (P = .005); patients receiving a combination of self-stretching and TrP tissue intervention experienced a greater improvement in physical function and a greater reduction in pain, as compared to those receiving the self-stretching protocol.

The mixed ANOVA also revealed significant group-by-time interactions for changes in PPT over the gastrocnemii and soleus muscles, and the calcaneus (all P<.001).

Patients receiving a combination of self-stretching and TrP tissue intervention showed a greater improvement in PPT, as compared to those who received only the self-stretching protocol.


This study provides evidence that the addition of TrP manual therapies to a self-stretching protocol resulted in superior short-term outcomes as compared to a self-stretching program alone in the treatment of patients with plantar heel pain.


The above is a summary of the study: Effectiveness of Myofascial Trigger Point Manual Therapy Combined With a Self-Stretching Protocol for the Management of Plantar Heel Pain: A Randomized Controlled Trial. This was published in Journal of Orthopaedic & Sports Physical Therapy, 2011 Volume:41 Issue:2 Pages:43–50 DOI: 10.2519/jospt.2011.3504



Find a Trigger Point Professional in your area

Recent Articles - Treating Plantar Fasciitis

Vacuum Cupping Course (Online)

Recent Articles - Treating Trigger Points

Dry Needling for Trigger Points

NAT Professional Courses



About NAT Courses

As a manual therapist or exercise professional, there is only one way to expand your business - education!

Learning more skills increases the services that you offer and provides more opportunity for specialization.

Every NAT course is designed to build on what you already know, to empower you to treat more clients and grow your practice, with a minimal investment in time and money.

Help Desk


About Niel Asher Education

Niel Asher Education is a leading provider of distance learning and continued education courses.

Established in the United Kingdom in 1999, we provide course and distance learning material for therapists and other healthcare professionals in over 40 countries.

Our courses are accredited by over 90 professional associations and national accreditation institutions including the National Academy of Sports Medicine (NASM) and National Certification Board for Therapeutic Massage and Bodywork (NCBTMB). Full details of all international course accreditations can be found on our website.  

Printed course materials and other products offered on our websites are despatched worldwide from our 3 locations in the UK (London), USA (Pennsylvania) and Australia (Melbourne).

More About Us



We are honored to have received the 2018 "Excellence in Education" Award from the National Association of Myofascial Trigger Point Therapists.

Since 1999 Niel Asher Education has won numerous awards for education and in particular for education and services provided in the field of trigger point therapy.

Read Full Article 


Award Winning Instructors

Niel Asher Healthcare course instructors have won a host of prestigious awards including 2 lifetime achievement honorees - Stuart Hinds, Lifetime Achievement Honoree, AAMT, 2015, and Dr. Jonathan Kuttner, MD, Lifetime Achievement Honoree, NAMTPT, 2014. NAT Instructor Paul Townley PT is a recipient of the Elsevier Award for excellence in education.

Meet the Instructors


NAT Certification

If you are a qualified/licensed manual therapist or exercise/fitness professional you can expand your credentials with NAT certification.

In addition to national accreditation for continued education, each course that we offer includes "NAT Learning Credits". By taking and completing courses you can accumulate NAT credits to qualify for NAT certification.

There are currently 3 levels of NAT certification. Certifying NAT is a valuable way to show your clients that you take continued education seriously, and to promote your skills and qualifications.

About NAT Certification


Niel Asher Technique

Since 1999 the Niel Asher Technique for treating trigger points has been adopted by over 100,000 therapists worldwide, and has been applied to the treatment of a number of common musculoskeletal injuries.

The Niel Asher Technique for treating frozen shoulder was first introduced and published in 1997 and has been widely adopted by therapists and exercise professionals working within elite sports and athletics.

Read More


Worldwide Free Shipping

Most of our courses are available as either "Printed" or 'Download" editions. When you purchase a download edition, you receive immediate lifetime access to all course material. Course texts can be downloaded and printed if required. 

When you purchase a "Printed" edition, you will also receive free access to the download edition.

We ship Worldwide from locations in the USA, UK, and Australia. Most items are despatched within 24 hours and shipping is FREE for all orders over US$50.



Where to Start?

We offer a range of over 50 courses, presented by some of the worlds leading manual therapists. All courses are reviewed annually, and new courses are regularly added.

Our courses are modular, and designed to build on what you already know. For more information, please visit our "Where to Start?" page.

Start Here  






This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell. 





feel good learning
NAT Global Campus Logo
NAT global campus

Learn More for Less

NAT Global Campus

Unlimited access to all CE courses for just $19.95/mo