Embedding pain neuroscience education in the physical therapy management of patients with chronic plantar fasciitis: a prospective case series

ABSTRACT

Objectives

The purpose of this case series was to describe the effects of a biopsychosocial approach that embeds pain neuroscience education (PNE) within physical therapy for improving foot and ankle function, pain, and psychosocial factors in patients with chronic plantar fasciitis.

Methods

Seven female patients (mean [SD] age = 49.0 [11.4] years) receiving physical therapy for chronic plantar fasciitis were enrolled. Along with formal physical therapy, patients received six 15-minute PNE sessions. Knowledge of pain neuroscience was assessed before and after PNE with the Revised Neurophysiology of Pain Questionnaire. Patients completed questionnaires for foot and ankle function (Activities of Daily Living subscale of the Foot and Ankle Ability Measure), pain intensity (Numeric Rating Scale), pain catastrophizing (Pain Catastrophizing Scale), and fear of movement (Tampa Scale for Kinesiophobia) at baseline (before treatment) and 6 and 12 weeks. Local and remote pain sensitivity was assessed using a pressure algometer at baseline and 6 weeks.

Results

Patients attended a mean (range) of 8.7 (7 to 12) physical therapy sessions over a mean (range) of 46.7 (42 to 56) days. After PNE, six (86%) patients demonstrated increased knowledge of pain neuroscience. At 12 weeks, six (86%) patients met or exceeded minimally clinically important difference (MCID) for foot and ankle function and pain. Five (71%) patients met or exceeded MCID for pain catastrophizing and fear of movement. Local pain sensitivity was reduced in six (86%) patients.

Conclusions

Physical therapy integrating PNE is potentially beneficial for patients with chronic plantar fasciitis. Future studies should examine the efficacy of PNE in randomized trials with larger representative samples.

KEYWORDS:

• Chronic pain
• musculoskeletal pain
• pain management
• pain neuroscience education
• physical therapy modalities
• plantar fasciitis

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the National Center for Advancing Translational Sciences [CTSA Award No. UL1 TR002243]; Tennessee Physical Therapy Association. Its contents are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.

Notes on contributors

Katherine M. Mills

Katherine Mills, PT, DPT, MMHC is a staff physical therapist at Vanderbilt University Medical Center. She specializes in the physical therapy management of patients after trauma and lower extremity limb loss. Dr. Mills obtained her Doctor of Physical Therapy degree from Mayo Clinic and Master of Management in Healthcare from Vanderbilt University.

Emily B. Preston

Emily Preston, PT, MPT graduated from East Tennessee University with as Master's in Physical Therapy degree. She works as a staff physical therapist in the orthopaedics department at Vanderbilt University Medical Center. She is actively engaged in clinical research, primarily in the area of rehabilitation after ACL reconstruction.

Breanna M. Choffin Schmitt

Breanna Choffin, PT, DPT, OCS, CMT is a staff physical therapist at Vanderbilt University Medical Center. She is a graduate of St. Ambrose University DPT and residency programs. She is a board certified orthopaedic clinical specialist and has a certificate in manual therapy.

Haley K. Brochu

Haley Brochu, MSA, ATC is a graduate of Mercyhurst University in Erie, PA where she earned her Bachelor's of Science in Athletic Training. She provides patient care at Vanderbilt University Medical Center. She is an Epic certified Clinical Content Builder supporting rehabilitation services.

Eden A. Schafer

Eden Schafer, MPH is a Research Coordinator in the Department of Orthopaedic Surgery at Vanderbilt University Medical Center. She is a graduate of the University of Michigan School of Public Health. She has been working in research at Vanderbilt for 10 years.

Payton E. Robinette

Payton Robinette, MA is a Research Coordinator in the Department of Orthopaedic Surgery at Vanderbilt University Medical Center. She holds a degree in English and a Master's degree in Medicine, Health, and Society from Vanderbilt University. She plans on attending medical school next year.

Emma K. Sterling

Emma Sterling, BE is a Medical Student at George Washington University School of Medicine and Health Sciences. She previously worked as a Research Analyst in the Department of Orthopaedic Surgery at Vanderbilt University Medical Center. She graduated with a degree in Biomedical Engineering from Vanderbilt University.

Rogelio A. Coronado

Rogelio Coronado, PT, PhD is a Research Assistant Professor in the Department of Orthopaedic Surgery and Department of Physical Medicine and Rehabilitation at Vanderbilt University Medical Center. He is core faculty for the Vanderbilt Center for Musculoskeletal Research. Dr. Coronado received his doctoral degree from the University of Florida and physical therapy degree from Texas Tech University Health Sciences Center.