Advanced Clinical Therapy-Plantar Foot Techniques-A Clinical Study
Copyright © Ted Nissen May 2004

SPEAKER: Ted Nissen Date

Printable Research Group Session Notes #1: http://www.anatomyfacts.com/muscle/rgsession1.htm

Results of Study: http://www.anatomyfacts.com/Muscle/researchpapers.htm

Phone: (562) 439-3803

Office:

Advanced Physiocare

440 Redondo Ave. # 201

Long Beach Calif. 90814

LECTURE/WORKSHOP NOTES SESSION # 1

1 Ted Nissen Background

Ø Ted Nissen has a successful private practice and has been in business as a massage therapist for over 30 years.

2 What you will Learn

1.) How to Test Massage Techniques on your clients.

2.) A unique view of why people hurt, the areas that pain can refer, and how to help them feel better.

3.) How to do pain rating using a scale

3 Agenda

1.) Single Case Single Visit Anecdotal Study Defined

2.) Why do a Study?

3.) What is a Theory and Why Have One?

4.) Oh, My Aching Feet-Why Do They Hurt?

5.) What is the Study Title & what does it mean?

6.) Who Should Be Excluded from and Included in the Study?

7.) What kind of Treatment will be used and how can we measure progress?

8.) Question and Answer

4 Notes

v Single Case Single Visit Anecdotal Study

These studies help you determine the relative effectiveness of massage technique for various conditions by applying scientific method to a single case on a single visit. They are easy to do & give you practice with the process steps involved in research. However, they don’t prove or disprove anything conclusively.

v Rationale for Study

Since their aren’t large research grants for massage therapy single case studies provide the sole practitioner quick and cheap methodology for analytical inquiry. Statistical tools and research design and methodology can be tested for later use in larger studies.

v Rational for the Theoretical Perspective and Study of Tendon and Ligament Trigger Points

The purpose of the theoretical perspective and subsequent study is to explain the nature of tendon and ligament trigger points and examine the efficacy of clinical massage therapy as a viable curative treatment.

v Guessing about Nature

Theory, helps explain the questions our current understanding does not readily answer and provides clues to effective treatment.

v Theoretical Thinking-Why Do Our Feet Hurt? Illus.#1 thru #10

The feet bear the weight of our bodies under enormous pressure to the connective tissue structures, which support the arch. The cells of these structures need 02, glucose & protein to thrive & survive. Active persons engaged in frequent weight bearing activity are likely to stress these structures beyond the circulatory supply of essential nutrients. Connective tissue cells near bone attachments or at biomechanical stress points become stressed causing vasoconstriction and metabolite irritation. Cells may die producing inflammatory chemicals, which further irritate afferent nerve supply. Pain is referred distally into the plantar surface of the foot and the Achilles tendon. (Illus.#5) Compression and stretching may help re-establish circulatory supply, increase nutrition to connective tissue cells and disperse irritants.

v Hypothesis

Compression and stretching of the connective tissue structures of the plantar foot will significantly reduce Achilles tendon tenderness as subjectively reported by clients. Subsequent treatment (Compression and stretching of plantar foot connective tissues) visits will continue to reduce Achilles tendon tenderness as subjectively reported by clients. This reduced Achilles tendon tenderness will persist even after treatment is discontinued.

v Illustration # 1-Why Do We Hurt?

v Illustration # 2- Dermatomes ALL

v Illustration # 3- Dermatomes L1-S3 Front

v Illustration # 4- Dermatomes L1-S4 Back

v Illustration # 5- Extrasegmental Referral

v Illustration # 6- Cell Stress/Death of Intrinsic Foot Structures-Direction of Pressure

v Illustration # 7- Muscle Bone Attachments-Foot Plantar Right

v Illustration # 8- Bones Foot Plantar Surface

v Illustration # 9- Plantar Aponeurosis (Fascia) Illustrated

v Illustration # 10- Plantar Aponeurosis (Fascia) Picture

v Study Title Single/Multiple Visit Study

Single Visit Study=“Single Case Single Visit Outcome (Anecdotal) Study-Plantar Foot-Superficial & Intrinsic Foot Structure Attachments -The Treatment Effects of Compression and Stretching.” Multiple Visit Study=“Single Case Multiple Visit Outcome (Anecdotal) Study-Plantar Foot-Superficial & Intrinsic Foot Structure Attachments -The Treatment Effects of Compression and Stretching.”

v Pre-Screening

EXCLUDE-Lumbar Pathology, Lumbar Pain, Early AM Heal Pain, Achilles Tendonitis and Sedentary (40-60 yr old) recently active women. CAN INCLUDE-Frequent Weight Bearing Activities, Wear Shoes w/ Elevated Heals, and Plantar Foot Tenderness (Right Foot) (Illus.#11) (Technique Plantar Foot) MUST INCLUDE-Achilles Tendon Tenderness (Right Foot) (Illus.#12) (Palpation Achilles Tendon)

v Illustration # 11-Technique Plantar Foot

v Illustration # 12-Palpation Achilles Tendon

v Treatment Technique and Sensation Intensity Rating

Pre-Treatment Rating (0-10) (Sensation Intensity Rating Scale) using 3 lbs pincer (pinching) pressure along Achilles Tendon (Right Foot) (Illus.#12) (Palpation Achilles Tendon) Compression and Stretching Treatment at (Right Foot) Calcaneal Tuberosity (Medial & Lateral Process), bases of the 2nd-5th metatarsals, and between the Proximal Heads of the Metatarsal bones. Both a standard technique using thumbs to compress the connective tissue attachments at the bone (Illus.#11) (Technique Plantar Foot) or alternate techniques with the client prone can be used. (Alternate Technique) Post-Treatment Rating (0-10) (Sensation Intensity Rating Scale) using 3 lbs pincer (pinching) pressure along Achilles Tendon (Right Foot) (Illus.#12) (Palpation Achilles Tendon).

v Single Case Multiple Visit (Anecdotal) Studies Plantar Foot Protocol

Subsequent visits (2-5) are from 2-3 days apart and the final visit is 7 days exactly from the 5^th visit. Pre and Post ratings and the date of the visit are recorded for each session. The rational for multiple visits helps determine the relative influence of the Gate, Placebo, and Curative effects.

v Test Your Knowledge

v Course Evaluation