Self-dosed and pre-determined progressive heavy-slow resistance training have similar effects in people with plantar fasciopathy: a randomised trial

• Main Authors: Henrik Riel, Martin Bach Jensen, Jens Lykkegaard Olesen, Bill Vicenzino, Michael Skovdal Rathleff
• Format: Article
• Language: English
• Published: Elsevier 2019-07-01
• Series: Journal of Physiotherapy
• Online Access: http://www.sciencedirect.com/science/article/pii/S183695531930058X

Question: For people with plantar fasciopathy, is a 12-week self-dosed heavy-slow resistance training program more beneficial than a 12-week pre-determined heavy-slow resistance training program? Design: A randomised trial with concealed allocation, partial blinding, and intention-to-treat analysis. Participants: Seventy people with plantar fasciopathy confirmed on ultrasonography. Intervention: Both groups performed a repeated heel raise exercise in standing for 12 weeks. Participants in the experimental group were self-dosed (ie, they performed as many sets as possible with as heavy a load as possible, but no heavier than 8 repetition maximum). The exercise regimen for the control group was pre-determined (ie, it followed a standardised progressive protocol). Outcome measures: The primary outcome was the Foot Health Status Questionnaire pain domain. Secondary outcomes included: a 7-point Likert scale of Global Rating of Change dichotomised to ‘improved’ or ‘not improved’; Patient Acceptable Symptom State defined as when participants felt no further need for treatment; and number of training sessions performed. Results: There was no significant between-group difference in the improvement of Foot Health Status Questionnaire pain after 12 weeks (adjusted MD −6.9 points, 95% CI −15.5 to 1.7). According to the Global Rating of Change, 24 of 33 in the experimental group and 20 of 32 in the control group were improved (RR = 1.16, 95% CI 0.83 to 1.64). Only four participants achieved Patient Acceptable Symptom State: three of 35 in the experimental group and one of 35 in the control group. No significant between-group difference was found in the number of training sessions that were performed (MD −2 sessions, 95% CI −8 to 3). Conclusion: Self-dosed and pre-determined heavy-slow resistance exercise programs are associated with similar effects on plantar fasciopathy pain and other outcomes over 12 weeks. Advising people with plantar fasciopathy to self-dose their slow-heavy resistance training regimen did not substantially increase the achieved dose compared with a pre-determined regimen. These regimens are not sufficient to achieve acceptable symptom state in the majority of people with plantar fasciopathy. Registration: ClinicalTrials.gov NCT03304353. Key words: Tendinopathy, Plantar fasciopathy, Exercise, Rehabilitation, Strengthening