Plantar Fasciitis Workbook

P R O FESSIO N AL AN D HO ME U SE
TREATMENT
GUIDE
P L A N T A R F A S C II T I S
N IEL ASHER EDU C ATIO N / LAWFO R D C O LLEG E

Contents
About Us . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
What is Plantar Fasciitis? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Which muscles may be affected by Plantar Fasciitis? . . . . . . . . . . . . . . . . 6
What Are the Symptoms of Plantar Fasciitis? . . . . . . . . . . . . . . . . . . . . . . . 9
Differential Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Trigger Point Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Stretching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Taping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Your personal six week diary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Trigger Point Therapy - Treatment Assessment . . . . . . . . . . . . . . . . . . . . 39
Lifestyle changes to consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
More About Trigger Points and Trigger Point Therapy . . . . . . . . . . . . . . 45
Trigger Point Therapy - Frequently Asked Questions . . . . . . . . . . . . . . . . 50
P l a n t a r F a s c i i t i s 3
About Us
Niel Asher Healthcare was founded in 1997 and is now the leading online
publisher of educational material and other learning resources for manual
therapy.
We provide e-learning tools and services to medical and para-medical

practitioners, and information, advice and self-help solutions to patients,
using digital media.
We deliver continuous enhancements providing the most relevant

solutions for our customers. This commitment to excellence keeps us at
the forefront of this industry.
Disclaimer
This Trigger Point Workbook 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 or healthcare professional if you
think you need treatment. Your use of this information does not mean
that a doctor - patient relationship has been established between you
and the authors of this guide.
The authors represent that this information is formulated with a

reasonable standard of accuracy. Except for this representation, the
authors make no representations or warranties, express or implied,
including any implied warranty of merchantability or fitness for a
particular purpose, with respect to this information.
This Trigger Point Workbook may be retained for personal or educational
use. Information should not be edited or modified. Any resale, or
redistribution of all or portions of the information is not permitted.
The content provided by Niel Asher Healthcare is for information

purposes only and is in no way intended to be a substitute for medical
consultation with a qualified professional. Although we carefully
review our content, Niel Asher Healthcare cannot guarantee nor take
responsibility for the medical accuracy of documents we publish.
What is Plantar Fasciitis?
Plantar Fasciitis is a common disorder, which causes heel pain.
It is the most frequent injury of the plantar fascia and refers to an

inflammation of a thick band of tissue that runs across the bottom of your
foot and connects your heel bone to your toes.
Your plantar fascia supports the arch of your foot and if strained, becomes
weak, swollen and inflamed. Repeated strain can bring about small tears
in the ligament causing pain and swelling. This will be felt when you stand
or walk.
Repeated injuries to the plantar fascia, which support the arch of the foot,
seem to be the main cause of Plantar Fasciitis.
Plantar Fasciitis could develop in one foot or both feet.
Which Muscles May be Affected by Plantar Fasciitis?
(The image on the right details the trigger point and pain map)
QUADRATUS PLANTAE
SOLEUS
GASTROCNEMIUS
(The lower image details the trigger point and pain map)
OVERVIEW OF KEY MUSCLES
SOLEUS
From a dynamic postural viewpoint, the soleus prevents the body

falling forward at the ankle joint during standing. In gait, the muscle
eccentrically decelerates subtalar joint pronation and internal rotation of
the lower leg at heel-strike. It also decelerates dorsi flexion of the foot.
The soleus typically refers pain into the posterior aspect and plantar
surface of the heel and to the distal end of the Achilles tendon. A rare
myofascial trigger point spreads pain to the ipsilateral sacroiliac joint, and
can also refer pain to the jaw in extreme cases.
GASTROCNEMIUS
Several myofascial trigger points can form in this muscle, referring pain
and a sense of stiffness or tension into the medial plantar aspect of the
foot, and diffuse pain spread over one or both of the gasters. Pain can
also refer up into the medial hamstrings.
Typically, individuals will try to statically stretch the symptoms away this
will irritate the muscle spindle response and serve only to compound the
symptoms.
QUADRATUS PLANTAE
The quadratus plantae is a muscle in the foot that extends from the
anterior (front) of the calcaneus (heel bone) to the tendons of the
digitorum longus muscle in the leg. It assists the flexor digitorum longus
with toe flexing. The muscle brings the pulley of the flexor digitorum
longus in line with the length of the foot. The quadratus plantae muscle
also increases stability of the foot by resisting extension of the toes.
What are the Symptoms of Plantar Fasciitis?
People who suffer from Plantar Fasciitis often feel a sharp pain that
usually occurs with their very first steps in the morning. Once the foot
limbers up, the pain of Plantar Fasciitis is known to decrease, but has
been noted to reappear after long periods of standing or after getting up
from a seated position.
Sudden stretching of the sole of the foot may increase the pain. In
extreme cases, symptoms include numbness, tingling and swelling as a
result of small tears in the ligament.
Who is Prone to Plantar Fasciitis?

Around 10% of people experience Plantar Fasciitis at some point in their
lives.
Plantar Fasciitis most commonly arises in older people, but may also
occur in younger individuals who are on their feet for many hours of the
day.
It is particularly typical for runners to experience Plantar Fasciitis. It may

occur if one starts running on a different surface, such as road instead of
track.
In addition, it is known to affect individuals with extreme inward rolling of

the foot, which is connected with flat feet.
Plantar Fasciitis is also identified with age, obesity and lack of physical
exercise.
Another common cause might be wearing shoes with insufficient support.
DIFFERENTIAL DIAGNOSIS - What Else Could It Be?
Here’s a list of other conditions which can present as ankle pain they
are more likely to be painful if there hasn’t been a twist or a trauma.
Please note a very small percentage of them can be serious, so if you are
concerned please check with your doctor or therapist
Bone Issues
• (Avulsion) fracture
• Stress fractures
• Tarsal tunnel syndrome
• Bone spurs (heel)
• Broken ankle/broken foot
• Referred pain from the low back (S1 radiculopathy)
• Severs disease (Children/youth)
Inflammatory
• Gout
• Osteomyelitis
• Pseudogout
• TB
• Pagets disease of the bone
• Osteoarthritis
• Reactive arthritis
• Psoriatic arthropathy (from psoriasis)
• Subcalcaneal bursitis
Functional
• Achilles tendonitis or rupture

• Achilles bursa pathology
• Mortons Neuroma
Very rarely
• Fibrosarcoma
RED FLAGS
• Lateral plantar nerve, 1st branch entrapment

• Calcaneal stress fracture
• Tarsal tunnel syndrome
• Plantar fascia tear, partial tear, or rupture
• Sciatica, discogenic pain, other back disorder
• Achilles tendinitis
• Rheumatoid arthritis
• Other arthritis as above (seronegative or other associated HLA B27
arthritis, such as with IBS, ankylosing spondylitis, psoriatic arthritis,
arthralgia or Reiter’s Syndrome)
• Neoplasm, calcaneal bone cyst
• Gout
• Infection, osteomy
• Drop foot - signals nerve or muscle damage that can originate well
north of your feet - as far as your back or even shoulder or neck.
Certain chemotherapy drugs can also cause trouble lifting the front
part of the foot while walking or standing
• Toes that turn red, white and blue
GASTROCNEMIUS
SOLEUS
QUADRUS PLANTAE
Your Trigger Point Treatment Program for Plantar Fasciitis
Before starting this Program we recommend consulting with a therapist

or doctor to obtain a proper diagnosis.
This program has been written specifically for sufferers of Plantar

Fasciitis.
In this section we will introduce 3 techniques to help alleviate the pain

from Plantar Fasciitis. They are
• Trigger Point Therapy (TPT)

• Stretching
• Exercise
For each, we have provided clear and simple instructions on how to

perform the technique and how often. There are also associated images
to help you.
We would recommend starting with the Trigger Point Therapy followed by

gentle stretching and ending with some exercises.
If at any time you experience an adverse reaction to any of these

techniques or your pain is greatly increased as a result, stop immediately
and seek medical advice where necessary.
FOR HOW MANY

TECHNIQUE REPETITIONS HOW OFTEN?
WEEKS?
TRIGGER POINT As per
3-4 times per day 6
THERAPY instructions
STRETCHING 3 times 2-3 times daily 6
EXERCISES 30 times 2-3 times daily 6
TRIGGER POINT THERAPY
The treatment protocol provided here is based on a technique called

Trigger Point Therapy (TPT).
TPT includes a range of hands-on pressure-point techniques, two of

which are explained here
• ‘Deep Stroking Massage’ (DSM) where the sore/trigger point is gently

massaged rhythmically to and fro to stimulate inner repair and,
• Inhibition Compression Technique (ICT) which uses sustained
pressure on the sore/trigger point until it releases.
Both DSM and ICT are very safe and effective but can leave some soreness
for a few minutes to hours afterwards. Very occasionally they may leave
bruising if performed overzealously or if you are on certain medication
(especially blood thinners).
How do I know it is a trigger point?
You are looking for
• Stiffness in the affected muscle

• Spot tenderness (exquisite pain)
• A palpable taut/tight nodule or band
• Presence of referred pain (as indicated on the trigger point maps
showing you where you should feel pain when pressed)
• Reproduction of your symptoms (accurate)
• The affected area may be moister or warmer (or colder) than the
surrounding tissues, and may feel a little like sandpaper
Take a look at the images below and follow these instructions for
maximum effect.
Technique - Inhibition Compression Technique (ICT)

1. Identify the tender/trigger point you wish to work on.
2. Place the host muscle in a comfortable position, where it is relaxed
and can undergo full stretch.
3. Apply gentle, gradually increasing pressure to the tender point until
you feel resistance. This should be experienced as discomfort and
not as pain. You should feel some radiation of the pain.
4. Apply sustained pressure until you feel the tender point yield and
soften. This can take from a few seconds to several minutes.
5. Steps 3-4 can be repeated, gradually increasing the pressure on the
tender/trigger point until it has fully yielded.
6. To achieve a better result, you can try to change the direction of
pressure during these repetitions.
7. At the end of each self help “treatment”, massage the area with
some cream, oil or lotion in the direction of the muscle. You can
also apply warmth or a heat rub afterwards.
How Often?
3 to 4 times per day for up to 6 weeks.
Gastrocnemius
Use your tool as shown
Use your leg or tool as shown
Soleus
Use your thumb or tool as shown
Plantaris
Quadrates Plantae
Technique:
• Identify the trigger point by having a look at the image and then feel
for the taut muscle or band
• Lubricate the skin with oil, cream or lotion
• Identify and locate the tender/trigger point or taut band
• On the tummy with the knee bent
• Locate the tender/trigger point in the bottom of the foot (see
anatomy) press it and hold it still using your thumb/elbow/trigger
point tool on the taut band - if you use your fingers you can reinforce
with your other hand. This should be experienced as discomfort and
not as pain
• Hold still until the pain melts away - come away slowly
• Repeat three times but approach the tender spot from a different
direction
Dose:
Perform three to four times a day for up to six weeks.
What then?
Follow pressure sessions by massaging the area with some cream, oil or
lotion in the direction of the muscle. You can use warmth or heat- rub
afterwards.
Perform self-stretching on the hour every hour for 2-3 minutes
Gastrocnemius - Deep Stroking Massage
Technique:
• Identify the trigger point by having a look at the diagrams and then
feel for the taut muscle or band
• Lubricate the skin with oil, cream or lotion
• Identify and locate the tender/trigger point or taut band
• On the tummy with the knee bent
• In 1 direction only - work from the knee level towards the outside of
the ankle – don’t forget to go right down to the bottom of the foot
(see anatomy) perform slow stroking rhythmic massage using your
thumb/elbow/trigger point tool on the taut band, and reinforce with
your other hand it should feel a bit like squeezing toothpaste from a
tube. This should be experienced as discomfort and not as pain
• Come away and repeat three times
Dose
Perform three to four times a day for up to six weeks
What then?
Follow pressure sessions by massaging the area with some cream, oil
or lotion in the direction of the muscle. You can use warmth or heat-rub
afterwards
Perform self-stretching on the hour every hour for 2-3 minutes
STRETCHING
Stretch 1: Gastrocnemius (calf muscle ) stretch
Adopt the position shown
Technique:
• Stand on the edge of a ledge (somewhere stable like the stairs or the
gutter is ideal)
• You will need to have enough of your foot on the edge of the ledge so
that it does not slip off
Make sure you are stable, this will allow you to hold your stretch for a
longer period (better quality of stretch)
• Lower both heels over the edge of the ledge
• Try lowering one leg at a time. This increases the weight on the calf
muscle and increases the intensity of the stretch
• To specifically target the Soleus muscle bend both knees
• You will feel the stretch move lower and to the inside of the shin
How often?
• Hold stretch for between 30-50 seconds, 3 times each side every two
to three hours
Stretch 2: Gastrocnemius (calf muscle ) stretch
Adopt the position shown
Technique:
• Place the leg to be stretched behind and lean forward, ensuring the
heel is kept in contact with the floor at all times
• A stretch should be felt at the back of the lower leg. If not then move
the back leg further back
• A more advanced version of a calf stretch is to use a step and drop
the heel down from it
How Often?
Hold the stretch for 20 to 30 seconds and repeat 3 times
This can be repeated several times a day and should not be painful
Stretch 3: Hamstring stretch
Stretch as shown
Technique:
• Stand
• Keep one leg on ground put one foot on chair or a step with leg
straight.
• Bend forward at the hip. Hold for 30 seconds.
• Repeat on other side
• Do not attempt to touch your toes as this will stretch your back, and
the goal of this exercise is to isolate your hamstring muscles in the
leg that is being supported by the chair
How Often?
3 times, twice daily
Stretch 4: Gluteus medius stretch
Stretch as shown
Technique:
• Lie on the edge of a bed

• In side lying, bring the upper leg over the body and let it hang over
the side of the bed
• Slightly rotating the pelvis and placing upper arm behind the back
• Stretch will be felt in the area of the buttocks and side of hip
• Hold for 30 seconds
How Often?
Repeat three times twice daily (repeat on the other side)
Stretch 5: Soleus
Stretch as shown
Technique:
• To stretch the soleus muscle the back leg should be bent

• Place the leg to be stretched behind and lean against a wall keeping
the heel down
• A stretch should be felt lower down nearer the ankle at the back of
the leg
• If this stretch is not felt then a more advanced version is to place the
forefoot of the front leg against the wall with the heel on the floor
and push the front knee towards the wall
• Hold for 30-50 seconds repeat 3 times one each leg
How Often?
3 times each side, twice daily
Stretch 6: Deep foot flexors
Stretch as shown
Technique:
• In sitting position, gently hold foot with one hand

• With the opposite hand pull all five toes up towards the body
How Often?
Hold for 30-50 seconds 2 times each side, twice daily
EXERCISES
Exercise 1 : Calf raises
Adopt the positions shown
Technique:
• Begin by standing in front of a step or riser with feet shoulder width

apart, facing forward
• Step up onto the step with both feet, holding on a rail or chair, and
letting heels hang off the edge
• Rising up onto your toes as high as possible in one smooth motion.
Hold for a couple seconds
• Slowly lower heels as far as possible, below the level of the step to
complete one repetition
Special Instructions - You can extend your arms out to your sides or
lightly rest your fingertips on a wall or chair to help with balance
Make it harder one-leg calf raises following the same instructions.

Alternate feet after completing one set on each side
How Often?
On both legs – repeat 10 x 3reps each leg
Repeat 30 times, twice daily
Exercise 2: Towel lifts
A towel grab can help to strengthen and alleviate pain in the soles of your
feet caused by flat feet, also called fallen arches
Technique:
• Place a hand towel on the floor the towel should be completely flat
• Stand with your foot over the towel and use your toes and the
bottom of your foot to scrunch up the towel
• Next use your toes and feet to flatten the towel
• Repeat 10 times
How Often?
10 reps, 3 times daily
Taping methods for plantar fasciitis using kt tape, kinesiotape or
kinesiology tape
Technique:
1. Measure tape from heel from the ball of the foot and cut to that length.
Cut it into to four tails leaving the last 2 inches uncut as an anchor (you
can use a solid strip if you have a problem with the tails loosening)
2. Flex your foot pointing your toes up, and anchor the 2 inch base to the
heel
3. Apply the tails towards your toes with no stretch
4. Measure another piece of tape around your foot
5. Anchor this strip at the outside top edge of your foot. Tape from outside
to inside to support the arch, pulling up a little with the tape at the end
6. Lay down the end with no tension on the top of your foot
7. Gently run over the tape with hand to provide some pressure. Tape
should stay on for a few days , thereafter it will start to peel. At this point it
can be removed and re applied with a new strip
GASTROCNEMIUS
The use of kinesiology tape can help provide an accumulated off-

loading effect by lifting the tissue around trigger points. This is generally
recommended for use after and between treatments.
GASTROCNEMIUS
ORIGIN
Medial head popliteal
surface of femur
above medial condyle.
Lateral head lateral
condyle and posterior
surface of femur.
ACTION
Plantar exes foot at TAPING
ankle joint. Assists in
INSTRUCTIONS
exion of knee joint.
A main propelling Stretch - Plantar
force in walking and flexion.
running. Antagonist
tibialis anterior. Tape - Tape from
under the heel origin
INSERTION along the line of the
Posterior surface muscle fibers. Be
of calcaneus (via sure to measure and
tendo calcaneus, a cut tape the correct
fusion of tendons of
length.
gastrocnemius and
soleus). Stabilization - Anchor
at Heel with 30-40 %
REFERRED PAIN
PATTERNS load on tape.
Several trigger Decompression - at
points in each trigger point sites.
muscle belly, and Palpation the key.
attachment trigger 90% load on tape.
point at ankle. The
four most common
points are indicated
diagrammatically for
medial and lateral
heads.
SOLEUS
The use of kinesiology tape can help provide an accumulated off-

loading effect by lifting the tissue around trigger points. This is generally
recommended for use after and between treatments.
SOLEUS
ORIGIN tendon origin. 4–5

Posterior surfaces cm zone of pain in
of head of bula and ipsilateral sacroiliac
upper third of body region (rare).
of bula. Soleal line
and middle third of
medial border of
tibia. Tendinous arch
between tibia and
bula.
ACTION
Plantar exes ankle
joint. Frequently in
contraction during
standing, to prevent
body falling forward TAPING
at ankle joint, i.e. INSTRUCTIONS
to offset line of pull
through body’s Stretch - Plantar
center of gravity, thus flexion.
helping to maintain
upright posture. Tape - Tape from
under the heel origin
Antagonist tibialis
along the line of the
anterior.
muscle fibers. Be
INSERTION
sure to measure and
With tendon of
cut tape the correct
gastrocnemius into
posterior surface of length.
calcaneus. Stabilization - Anchor
REFERRED PAIN at Heel with 30-40 %
PATTERNS load on tape.
Pain in distal Achilles
Decompression - at
tendon and heel to
posterior half of foot. trigger point sites.
Calf pain from knee Palpation the key.
to just above Achilles 90% load on tape.
YOUR PERSONAL 6 WEEK DIARY
Tick each box on completion
WEEK 1 MON TUES WED THUR FRI SAT SUN

TPT
STRETCH
EXERCISE

TPT
STRETCH
EXERCISE

TPT
STRETCH
EXERCISE

TPT
STRETCH
EXERCISE

TPT
STRETCH
EXERCISE

TPT
STRETCH
EXERCISE
Tr i g g e r P o i n t T h e r a p y - Tr e a t m e n t A s s e s s m e n t
Patient: Care provider: Date:
blue = pain; yellow = numbness; orange = tingling; green = cramp; purple = tightness
R L
R L L R
Top of the head.
Right side. Left side.

Reason for visit:
Most distressing symptoms:
Additional patient comments (quality and nature of pain, aggravating factors, what has been tried and results):
Changes:
Needs (including prescriptions, therapies or tests):
Action items (patient and care provider):
Tr i g g e r P o i n t T h e r a p y - Tr e a t m e n t A s s e s s m e n t
Patient: Care provider: Date:
blue = pain; yellow = numbness; orange = tingling; green = cramp; purple = tightness
R L
R L
Top of the head. Pubic bone
Sitting bones
R L
Anus
Coccyx
Sacrum
Underarm areas. Pelvic area.
Pubic bone
Additional patient input:
Sitting bones
Care provider comments: Anus

Coccyx
Sacrum
Action items patient:
Next visit:
Action items care provider:
Lifestyle Changes to consider
If you are on your feet for a lot of the time, or if you do lots of walking,
running, standing, etc, when you are not used to it
Recommended to take regular breaks and rest between long periods of

standing, walking
Get moving if you are currently conducting a sedentary lifestyle
If you have recently started exercising on a different surface - for example,

running on the road instead of a track, change your training schedule
gradually
If there is overuse or sudden stretching of your sole - for example, athletes

who increase running intensity or distance poor technique starting ‘off
the blocks
If you have a tight Achilles tendon (the big tendon at the bottom of your
calf muscles above your heel), it can affect your ability to flex your ankle
and make you more likely to damage your plantar fascia. Therefore, make
sure you stretch during the day. Calf stretches can be done easily at the
office on a simple step or against the wall
Try to regularly change training shoes used for running or walking
Wearing shoes with good cushioning in the heels and good arch support
Losing weight if you are overweight
Regularly stretching the plantar fascia and Achilles tendon, especially

before exercise
Avoiding exercising on hard surfaces
Recommended sports
• Cycling
• Swimming
• Water aerobics
• Pilates
• Yoga
Non-recommended sports and activities
• Running
• Soccer
• Jumping sports such as basketball, volleyball
• Standing long periods
Diet
Studies have demonstrated that underlying health issues—such as folic

acid, iron, vitamin, and/or mineral deficiency—may both contribute to
and perpetuate trigger point activity.
It is worth noting that tendons do not repair in the presence of nicotine!

Furthermore, recent studies have indicated that the modern lifestyle
tends to “under load” muscles and tendons, leading to internal fatty
changes and increased vulnerability to damage.
Other factors such as fatty foods and exposure to free radicals may also
have a detrimental effect on our soft tissues. Supplements—for example
omega-3, zinc, magnesium, iron, and vitamins K, B12, and C, as well as
folic acid—may help to speed up your recovery.
What Next?
We would always recommend seeing a doctor or therapist for an initial

consultation to get a proper diagnosis if you haven’t done so already.
To make a diagnosis your doctor or therapist should give you a thorough

physical exam including assessing the pulses around your foot (dorsalis
paedis). If your doctor thinks it is appropriate, you may also be offered
X-rays, MRIs (Magnetic Resonance Imaging), CT (Computed Tomography)
scans and/or other tests to rule out fractures and or nerve damage.
During the acute period you should stick to the RICE protocol (rest, ice,
compression, elevation), although gentle trigger point therapy followed
by gentle stretching may be useful.
Much of the advice here will depend on how ‘fresh’ or severe your
problem has become. As a rule if it has been there for more than six
months then try the self help for three to four weeks and if there is no
change then see a therapist. If your problem has been there for less time
then you should get a proper diagnosis but can can try our self help tips
for up to six weeks. If there is no improvement after six weeks then we
would urge you to see a therapist.
Once you have a diagnosis you should review our self-help and advice
pages and then put together a treatment plan. This should include self
massage and trigger point massage with balls/tools, stretching and
modifying your lifestyle to avoid or modify any aggravating activities.
Try to stick to the same pair of shoes and remember to build-up the
exercises slowly and respectfully adding only a few extra repetitions
every week. It’s a fact that we walk, run and cycle using our feet and
think nothing of it but when irritated, foot muscles and tendons become
exquisitely tender and do not respond well to sudden loading. Please bear
this in mind when performing rehabilitation.
You can search for a local manual therapist at

www.nielasher.com/therapists.
Look out for other workbooks in the Trigger Point Workbooks series.
We wish you a speedy recovery!
Team NAT
More About Trigger Points and Trigger Point Therapy
Trigger Points
We first heard the term trigger point used in 1942 by a woman called
Dr. Janet Travell. She came up with the phrase to describe the painful
lumps, or nodules, felt within tight bands of muscle. Since then, we’ve
learnt a lot more about trigger points and the features they have in
common
• Pain, often exquisite, at the specific point

• A nodule set deep within a tight band of muscle
• When pressed, pain radiates out in a specific way that can be
reproduced (map)
• The pain felt can not be explained by a neurological examination
One thing to remember about trigger points is that where you feel pain,
may not be the same place as where the trigger point is embedded. This
is partly the reason that some therapies fail to help because a therapist
or doctor will tend to concentrate on the place that hurts, rather than
locating the source of the pain.
What a trigger point does is to make its host muscle shorter and fatter,
as well as reducing its level of efficiency. This can can lead to significant
pressure being put on your nerves and blood vessels. However, by taking
the time to understand trigger points and their maps, you can get closer
towards finding the source of your pain.
What are the physical characteristics of trigger points?
Sadly, we do not have suitable language to define the sensation felt from
a trigger point. The following points though should together provide an
adequate description
• Small nodules the size of a pinhead

• Pea-sized nodules
• Large lumps
• Multiple large lumps next to each other
• Sore spots embedded in tightly-stretched bands of semi-hard muscle
that feels like a cord
• Rope-like bands lying next to each other like partially cooked
spaghetti
• The skin over a trigger point is slightly warmer to the touch (due to
increased metabolic/autonomic activity)
Acute and chronic pain
It is estimated that in 75 to 95% of muscular pain cases myofascial trigger

points are one of the main causes! In understanding more about trigger
points, hopefully one day we can learn to “switch them off” and help end
unnecessary pain for good.
Long-standing, or chronic pain, is due to the muscles around the pain

area (and sometimes ones not even nearby) altering themselves in order
to compensate for the pain. Trigger points are divided into two categories
active (painful), or inactive (latent). In addition, they can also cause pain
in different parts of the body to the one they appear in.
When a trigger point becomes active, the pain emitted can mimic a wide
range of medical conditions angina, bursitis, prostatitis, appendicitis,
cystitis, arthritis, esophagitis, carpal tunnel syndrome, pelvic
inflammatory disease, diverticulosis, costochondritis, sciatica, and pain
from a heart or gall bladder attack.
What is Trigger Point Therapy?
Many of us suffer from stiff, achy muscles caused by knots. Trigger point
therapy encompasses a variety of ways to deactivate these painful knots
and eventually get rid of them. One of the great things about trigger point
therapy is that it’s simple to perform, both at home with a partner, or on
your own with some special trigger point tools.
If you combine trigger point therapy with some simple changes in your
lifestyle, the results can be almost instant. And, what’s more, they can
last. Many manual therapists already use trigger point therapy as part of
their daily work because it’s a great way to
• identify the correct trigger point(s)

• understanding how, or why, they manifest themselves in the first
place
• work out the best way to deactivate the point(s)
• develop methods to stop them returning in the future
What happens when you press on a trigger point?
By doing so you:
• numb and reduce the pain, not only in the treated area, but also
where you perceive the pain to be
• lessen the pain feedback pathways
• interrupt the pattern of pain and spasm
• stretch out tight muscles, which will indirectly affect other tissues
• open out the plastic-wrap-like myofascial bag that encompasses
your muscles
• stimulate the blood supply helping to remove debris and toxins
• up your body’s release of powerful pain-killing endorphins
• affect the autonomic/automatic nervous system
What is a referred pain map?
When we’re talking about trigger point referred pain, it’s not the same as
the referred shoulder pain you get from appendicitis, or, even the pain
you get in your jaw or arm when having a heart attack. Instead, when you
press on a trigger point for five or six seconds, it results in part, or all, of
the pain map turning on, replicating your symptoms. Often, where the
trigger point is, and where you feel the pain, are two entirely different
places on your body.
Frequency of treatment
If you plan to treat yourself at home through self-help, hands-on

treatments, you should schedule no more than one session a day, with a
three or four day gap in-between. If you are using balls, rollers or hooks
on the other hand, then these can be used more often up to 10 minutes a
session, up to six times a day.
If you’re getting treatment through a therapist, then he/she will plan a

suitable course for you.
Possible side eﬀects
If you feel sore or bruised after treatment, don’t worry. It’s quite normal
to feel this way for up to 36 hours afterwards. However, we don’t know for
certain yet whether this is a side effect, or a result of the treatment.
Cervical manipulation can result in some severe treatment reactions,

which can be somewhat proportional to how effective the treatment was.
These reactions can include fatigue or “flu-like” symptoms, needing to
urinate more often, feelings of sluggishness and increased sleepiness.
Our Autonomic Nervous System (ANS) deals with bodily functions like
sweating, digesting, and breathing. During trigger point therapy, you
might experience unaccountable ANS symptoms which include sweating,
redness, skin blanching, coldness, gooseflesh, excessive sweating,
dysmenorrhea, toiletry dysfunction, earache, dizziness, stuffiness, and
difficulty breathing.
Trigger Point Therapy - Frequently Asked Questions
How do I press/self-treat a trigger point?

For those of you who have worked with trigger points before, this concept
will be very familiar. For the rest of you, there are two very simple, safe
and effective techniques (1) ischemic compression technique (ICT), and
(2) deep stroking massage (DSM).
How much pressure do I use?

This is something that comes with experience, but as a rule of thumb the
more painful the tissue, the slower and deeper the pressure. In all cases,
the key words are “work slowly,” “sensitively,” and “thoroughly.” Deep
stroking massage should feel a bit like gently squeezing toothpaste out of
a tube.
Which direction should the pressure/force be applied?

It is desirable to apply steady, deep, direct pressure to the nodule or
pea-like trigger point. We have tried to represent this by the idea of a hot
zone indicated within the images in the self help pages of this guide. The
heart of the trigger point is located somewhere in this zone. You need to
find the direction of pressure that, where possible, exactly reproduces
the pain. It often amazes us that a slight change in the direction of the
pressure can cause a totally different pain elsewhere. You will feel when
you are “there.”
How do I know when I have done enough pressing?

Hold the trigger point for 6 seconds
If the pain diminishes rapidly, stay with it until the trigger point softens or
evaporates beneath your pressure.
If the pain stays the same or gets worse, come away for 15 seconds and
then try again.
Repeat 3 times if necessary.
If the trigger point still does not deactivate after the third repetition, note
it down as it may be a secondary or satellite point.
What do I do after I have come away from the point?

Follow all deep work with a gentle generalized effleurage massage. The
area where you did the deep work may still be tender, but do not avoid it.
This will help to dispel pain-inducing toxins from the area and stimulate
the repair of the fascia.
How often should I treat a trigger point with a massage tool?

This depends on how acute or chronic the problem is. For a chronic
trigger point, you can work the area up to six times a day persistence
pays off. An acute problem may require less work than a chronic one. If
you see an experienced practitioner, this will change. But note that the
required frequency can vary from case to case because of a variety of
factors.
Can I do any harm?
If you identify the correct point and deactivate it with care and love,
the answer is—probably not. There may well be some soreness for up
to 48 hours after treatment. If the soreness lasts or gets worse, please
discontinue treatment immediately and seek a medical opinion.
Will bruising occur?
Bruising should not occur if you follow the instructions, but may occur if
you are on blood-thinning medication. With time and experience, bruising
becomes increasingly rare. We have found that it is not the depth of
treatment (force) that will cause a bruise but usually the result of pressure
being applied too quickly (velocity).
Try to feel the muscles and tender nodules beneath the skin. Arnica
creams and tablets have been suggested to reduce the incidence and
severity of bruising. Unfortunately some people bruise more easily than
others.
Will I be sore afterwards or experience side effects?
It is not uncommon to feel sore or bruised for 24–36 hours after treatment,
but it is unclear whether these conditions are treatment effects or side
effects. Treatment reactions are common and most severe following
cervical manipulation they are, somewhat controversially, proportionally
related to treatment efficacy. Reactions may include other associated
symptoms, such as fatigue or “flu-like” feelings, increased peeing,
lethargy, and increased sleepiness.
www.nielasher.com
N IEL ASHER EDU C ATIO N / LAWFO R D C O LLEG E
© 2019 NIEL ASHER EDUCATION. ALL RIGHTS RESERVED.

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What is plantar fasciitis?

What is plantar fasciitis?

What are some treatment options discussed for plantar fasciitis?

What are some treatment options discussed for plantar fasciitis?

P R O FESSIO N AL AN D HO ME U SE

N IEL ASHER EDU C ATIO N / LAWFO R D C O LLEG E

What is Plantar Fasciitis? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Which muscles may be affected by Plantar Fasciitis? . . . . . . . . . . . . . . . . 6

What Are the Symptoms of Plantar Fasciitis? . . . . . . . . . . . . . . . . . . . . . . . 9

Trigger Point Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Your personal six week diary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Trigger Point Therapy - Treatment Assessment . . . . . . . . . . . . . . . . . . . . 39

Lifestyle changes to consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

More About Trigger Points and Trigger Point Therapy . . . . . . . . . . . . . . 45

Trigger Point Therapy - Frequently Asked Questions . . . . . . . . . . . . . . . . 50

We provide e-learning tools and services to medical and para-medical

We deliver continuous enhancements providing the most relevant

This Trigger Point Workbook is intended to be used for information

This information is designed as educational material, but should not be

The authors represent that this information is formulated with a

The content provided by Niel Asher Healthcare is for information

What is Plantar Fasciitis?

Plantar Fasciitis is a common disorder, which causes heel pain.

It is the most frequent injury of the plantar fascia and refers to an

Plantar Fasciitis could develop in one foot or both feet.

From a dynamic postural viewpoint, the soleus prevents the body

Who is Prone to Plantar Fasciitis?

It is particularly typical for runners to experience Plantar Fasciitis. It may

In addition, it is known to affect individuals with extreme inward rolling of

Another common cause might be wearing shoes with insufficient support.

• Achilles tendonitis or rupture

• Lateral plantar nerve, 1st branch entrapment

Before starting this Program we recommend consulting with a therapist

This program has been written specifically for sufferers of Plantar

In this section we will introduce 3 techniques to help alleviate the pain

• Trigger Point Therapy (TPT)

For each, we have provided clear and simple instructions on how to

We would recommend starting with the Trigger Point Therapy followed by

If at any time you experience an adverse reaction to any of these

FOR HOW MANY

The treatment protocol provided here is based on a technique called

TPT includes a range of hands-on pressure-point techniques, two of

• ‘Deep Stroking Massage’ (DSM) where the sore/trigger point is gently

How do I know it is a trigger point?

You are looking for

• Stiffness in the affected muscle

Technique - Inhibition Compression Technique (ICT)

3 to 4 times per day for up to 6 weeks.

Use your tool as shown

Use your leg or tool as shown

Use your thumb or tool as shown

Use your tool as shown

Use your tool as shown

Perform three to four times a day for up to six weeks.

Perform self-stretching on the hour every hour for 2-3 minutes

Perform three to four times a day for up to six weeks

Perform self-stretching on the hour every hour for 2-3 minutes

Stretch 1: Gastrocnemius (calf muscle ) stretch

Adopt the position shown