Comparing Bowen Therapy and Tennis Ball Technique for Pain and Disability in Plantar Fasciitis Patients, A Randomized Controlled Trial (PF)

Comparative Effects of Bowen Therapy and Tennis Ball Technique on Pain and Functional Disability in Patients With Plantar Fasciitis, A Randomized Controlled Trial

Plantar fasciitis is one of the most common causes of heel pain and can make everyday activities such as walking, standing for long periods, or climbing stairs difficult and uncomfortable. It usually occurs due to stress and inflammation in the plantar fascia, a thick band of tissue that supports the arch of the foot. People suffering from this condition often experience sharp pain, especially during the first steps in the morning or after long periods of rest.

This study focuses on comparing two non-invasive treatment methods: Bowen Therapy and the Tennis Ball Technique. Bowen Therapy is a gentle manual therapy that uses soft rolling movements over muscles and connective tissues to reduce tension, improve circulation, and promote the body's natural healing process. On the other hand, the Tennis Ball Technique is a simple self-treatment method in which patients roll a tennis ball under the foot to massage the plantar fascia, relieve tightness, and reduce pain.

The main purpose of this research is to determine which technique is more effective in decreasing pain and improving functional ability in patients with plantar fasciitis. By comparing these two methods, the study aims to provide a safe, affordable, and easy treatment option that can improve mobility, reduce discomfort, and enhance the quality of life of individuals suffering from heel pain.

Study Overview

• Status: Completed
• Conditions: Plantar Fasciitis
• Intervention / Treatment: Procedure: Bowen therapy; Procedure: Self myofascial release by Tennis ball technique

Detailed Description

Plantar fasciitis is a musculoskeletal condition that causes pain and tenderness in the heel and the bottom of the foot. It develops when the plantar fascia, a strong fibrous tissue that connects the heel bone to the toes, becomes irritated or overstretched due to repeated stress. The condition is commonly seen in individuals who spend long hours standing, athletes, overweight individuals, and people with improper foot posture or unsuitable footwear. Patients often complain of severe heel pain during the first few steps after waking up or after prolonged sitting. If not treated properly, the pain can gradually interfere with walking, work performance, physical activity, and overall quality of life.

Different conservative treatment approaches are used to manage plantar fasciitis, including stretching exercises, manual therapy, massage techniques, strengthening programs, and pain-relieving modalities. Among these approaches, Bowen Therapy and the Tennis Ball Technique have gained attention because they are simple, non-surgical, and cost-effective methods that may help reduce pain and improve foot function.

Bowen Therapy is a gentle hands-on therapy that involves specific rolling movements over muscles, tendons, and soft tissues. The technique is performed with pauses between movements, allowing the body to respond naturally and promote relaxation and healing. It is believed that Bowen Therapy helps improve blood circulation, reduce muscle tightness, decrease stress on the plantar fascia, and restore normal movement patterns. Because the technique is gentle and non-invasive, it may be suitable for patients who cannot tolerate aggressive manual treatments.

The Tennis Ball Technique is a self-management approach commonly used for stretching and releasing tension in the plantar fascia. In this method, a patient rolls a tennis ball under the sole of the foot while applying controlled pressure. This movement provides a massage-like effect that may help loosen tight tissues, improve flexibility, stimulate circulation, and reduce discomfort in the heel area. The technique is easy to perform at home, requires minimal equipment, and can be incorporated into daily routines, making it a practical treatment option for many patients.

The purpose of this study is to compare the effectiveness of Bowen Therapy and the Tennis Ball Technique in reducing pain and improving functional disability in individuals with plantar fasciitis. The research aims to evaluate which treatment method provides better outcomes in terms of pain relief, mobility, and the ability to perform daily activities comfortably. Understanding the comparative effects of these two interventions may help healthcare professionals select more effective rehabilitation strategies and provide patients with accessible and beneficial treatment options for long-term management of plantar fasciitis.

• Study Type: Interventional
• Enrollment (Actual): 80
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan
      • Alara Healthcare Wapda town Lahore

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria: Patients aged 20-50 years. Diagnosis of plantar fasciitis is outlined by a physiotherapist or medical expert. The condition lasts more than 4 weeks

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Exclusion Criteria:

• History of injury in the lower limb within the last 6 months or surgery on the lower limb within the last 6 months. Known diseases which are systemic (or neurological) in nature (e.g., diabetes, rheumatoid arthritis, peripheral neuropathy). The use of corticosteroid injections or medications that disrupt the connective tissue has continued to be administered

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Bowen Therapy Group; Participants in Group A will receive Bowen Therapy. The procedure will be as follows: Frequency and Duration:Bowen therapy sessions will be conducted twice a week for a duration of 12 weeks.Each session will last approximately 30 to 45 minutes.; Treatment Focus: During each Bowen therapy session, the therapist will apply gentle and precise neuromuscular manipulations to specific anatomical points, focusing on the lower limb and foot. These points include fascial trigger spots and other myofascial tension areas that are implicated in plantar fasciitis. The Bowen technique involves rolling motions applied with the therapist's fingers or thumbs, working through the fascia and muscle tissues to promote fascial release, improve circulation, and reduce pain.	Procedure: Bowen therapy; Participants in Group A will undergo Bowen Therapy and the treatment will be provided twice weekly for 12 weeks, with each session lasting about 30 to 45 minutes, depending on individual response and condition. During each session, the therapist will apply gentle, targeted rolling movements using fingers or thumbs on specific points of the lower limb and foot. These points are selected based on areas of muscle tightness, fascial restriction, and pain related to plantar fasciitis. The technique aims to promote muscle relaxation, improve tissue circulation, and reduce pain by working on the fascial system and supporting overall neuromuscular balance
Experimental: Tennis Ball Technique Group; Participants in Group B will perform self-myofascial release (SMR) using a tennis ball. The procedure for self-administration will be as follows: Frequency and Duration:Participants will be instructed to perform the self-myofascial release (SMR) using a tennis ball once a day for 12 weeks.Each session will last about 10 to 15 minutes, with the participant rolling the tennis ball under the foot for about 5 to 10 minutes per foot.; Technique and Procedure: The participants will be taught the correct technique for rolling the tennis ball under the sole of the foot, with emphasis on applying appropriate pressure to trigger points or areas of tightness (e.g., arch, heel, and plantar fascia). A standardized pressure will be recommended to ensure the ball is rolled with sufficient force to produce fascial release without causing excessive discomfort or injury.	Procedure: Self myofascial release by Tennis ball technique; Participants in Group B will perform self-myofascial release (SMR) using a tennis ball. The procedure for self-administration will be as follows: Frequency and Duration:Participants will be instructed to perform the self-myofascial release (SMR) using a tennis ball once a day for 12 weeks.Each session will last about 10 to 15 minutes, with the participant rolling the tennis ball under the foot for about 5 to 10 minutes per foot.; Technique and Procedure: The participants will be taught the correct technique for rolling the tennis ball under the sole of the foot, with emphasis on applying appropriate pressure to trigger points or areas of tightness (e.g., arch, heel, and plantar fascia). A standardized pressure will be recommended to ensure the ball is rolled with sufficient force to produce fascial release without causing excessive discomfort or injury.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
pain Intensity	Pain (VAS): Pain is the subjective experience of discomfort related to plantar fasciitis, measured using the Visual Analog Scale (VAS). Participants rate their pain on a 10-point scale from 0 (no pain) to 10 (worst possible pain), assessing pain at rest, during activity, and in the morning	Baseline and 12 weeks post intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
change in function disability	Foot Function Index (FFI): The Foot Function Index (FFI) is a self-reported tool that measures pain and functional limitations caused by plantar fasciitis. It consists of three subscales-pain, disability, and activity limitation-each scored from 0 (no difficulty) to 10 (extreme difficulty), evaluating the impact on daily activities like walking and standing	Baseline and 12 weeks post intervention

Collaborators and Investigators

• Sponsor: Green International University
• Investigators: Principal Investigator: Department of physical therapy, Alara Healthcare Wapda town Lahore

Study record dates

Study Major Dates

• Study Start (Actual): November 2, 2025
• Primary Completion (Actual): April 29, 2026
• Study Completion (Actual): May 6, 2026

Study Registration Dates

• First Submitted: May 23, 2026
• First Submitted That Met QC Criteria: May 23, 2026
• First Posted (Actual): June 1, 2026

Study Record Updates

• Last Update Posted (Actual): June 1, 2026
• Last Update Submitted That Met QC Criteria: May 23, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: plantar fasciitis; tennis ball technique; bowen therapy
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Foot Diseases; Fasciitis; Fasciitis, Plantar
• Other Study ID Numbers: GIU/REC/26-29 (Other Identifier: Green International University)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: only IPD used in the results publication will be shared
• IPD Sharing Time Frame: It will be available after the completion of the study
• IPD Sharing Access Criteria: Through the corresponding author
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No