Massage Therapy and Ankle Sprains

foot massage

Massage Therapy and Ankle Sprains

Massage therapists are uniquely suited to incorporate a number sensory-targeted rehabilitation strategies for patient with chronic ankle instability (Mckeon et al. 2016) . Following an initial ankle injury there is a risk of re-injury dependent on a combination of factors including, but not limited to: sensorimotor deficits and changes in ankle biomechanics.

A multi-modal rehabilitation approach utilizing exercise (proprioceptive and strengthening) and manual therapy (plantar massage, joint mobilizations and nerve mobilization) to enhance motor control in patients (Doherty et al. 2017Plaza-Manzano et al.  2016).

Why Does Massage Therapy Work for Ankle Sprains?

A biopsychosocial framework helps put into context the interconnected and multidirectional interaction between: physiology, thoughts, emotions, behaviors, culture, and beliefs. In terms of clinical responses to massage therapy there are a couple of proposed mechanisms of action, including but not limited to: neurodynamics, contextually aided recovery, neuromodulation, social grooming and mechanotherapy.

Structures to be Aware of When Treating Ankle Sprains

nerves of the foot

A massage therapy treatment plan should be implemented based on patient-specific assessment findings and patient tolerance. Structures to keep in mind while assessing and treating patients suffering from ankle pain may include neurovascular structures and investing fascia of:

  • Plantar Fascia
  • Lumbricals
  • Adductor Hallucis
  • Flexor Hallucis Brevis
  • Tibialis Anterior
  • Metatarsals & Interossei
  • Peroneals
  • Tibialis Posterior
  • Triceps Surae 

More to Explore

Cleland, J.A., Mintken, P.E., ... Whitman, J.M. (2013). Manual physical therapy and exercise versus supervised home exercise in the management of patients with inversion ankle sprain: a multicenter randomized clinical trial. J Orthop Sports Phys Ther. 
https://www.ncbi.nlm.nih.gov/pubmed/23628755

Doherty, C., Bleakley, C., Delahunt, E., Holden, S. (2017). Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. Br J Sports Med.
https://www.ncbi.nlm.nih.gov/pubmed/28053200

Kalichman, L., Lachman, H., & Freilich, N. (2016). Long-term impact of ankle sprains on postural control and fascial densification.
https://www.ncbi.nlm.nih.gov/pubmed/27814874 

McKeon, P.O., Hertel, J., Bramble, D., Davis, I. (2015). The foot core system: a new paradigm for understanding intrinsic foot muscle function. Br J Sports Med.
https://www.ncbi.nlm.nih.gov/pubmed/24659509

McKeon, P.O., Fourchet, F. (2016). Freeing the foot: integrating the foot core system into rehabilitation for lower extremity injuries. Clin Sports Med.
https://www.ncbi.nlm.nih.gov/pubmed/25818718

McKeon, P.O., Wikstrom, E.A. (2016). Sensory-Targeted Ankle Rehabilitation Strategies for Chronic Ankle Instability. Med Sci Sports Exerc (OPEN ACCESS).
https://www.ncbi.nlm.nih.gov/pubmed/26717498

Paraskevas, G., Natsis, K., Tzika, M., & Ioannidis, O. (2014). Fascial entrapment of the sural nerve and its clinical relevance. Anatomy & Cell Biology. (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/24987554

Plaza-Manzano, G., Vergara-Vila, M., Val-Otero, S., Rivera-Prieto, C., Pecos-Martin, D., Gallego-Izquierdo, T., Ferragut-Garcías, A., Romero-Franco, N. (2016). Manual therapy in joint and nerve structures combined with exercises in the treatment of recurrent ankle sprains: A randomized, controlled trial. Man Ther.
https://www.ncbi.nlm.nih.gov/pubmed/27598553

Powden, C.J., Hoch, J.M., Hoch, M.C. (2017). Rehabilitation and Improvement of Health-Related Quality-of-Life Detriments in Individuals With Chronic Ankle Instability: A Meta-Analysis. J Athl Train.
https://www.ncbi.nlm.nih.gov/pubmed/28704635

Silva, R.D., Teixeira, L.M., Moreira, T.S., Teixeira-Salmela, L.F., de Resende, M.A. (2017). Effects of Anteroposterior Talus Mobilization on Range of Motion, Pain, and Functional Capacity in Participants With Subacute and Chronic Ankle Injuries: A Controlled Trial. J Manipulative Physiol Ther.
https://www.ncbi.nlm.nih.gov/pubmed/28390710

Southerst, D., Yu, H., Randhawa, K., Côté, P., ... Taylor-Vaisey, A. (2015). The effectiveness of manual therapy for the management of musculoskeletal disorders of the upper and lower extremities: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Chiropr Man Therap. 
https://www.ncbi.nlm.nih.gov/pubmed/26512315

Terada, M., Pietrosimone, B.G., Gribble, P.A. (2013). Therapeutic interventions for increasing ankle dorsiflexion after ankle sprain: a systematic review. J Athl Train.
https://www.ncbi.nlm.nih.gov/pubmed/23914912

Truyols-Domí Nguez, S., Salom-Moreno, J., Abian-Vicen, J., Cleland, J.A., Fernández-de-Las-Peñas, C. (2013). Efficacy of thrust and nonthrust manipulation and exercise with or without the addition of myofascial therapy for the management of acute inversion ankle sprain: a randomized clinical trial. J Orthop Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/23485845

Weerasekara, I., Osmotherly, P., Snodgrass, S., ... Rivett, D.A. (2017). Clinical benefits of joint mobilisation on ankle sprains: a systematic review and meta-analysis. Arch Phys Med Rehabil.
https://www.ncbi.nlm.nih.gov/pubmed/28882509

Wikstrom, E.A., Song, K., Lea, A., Brown, N. (2017). Comparative Effectiveness of Plantar-Massage Techniques on Postural Control in Those With Chronic Ankle Instability. J Athl Train.
https://www.ncbi.nlm.nih.gov/pubmed/28535097

Wikstrom, E.A., McKeon, P.O. (2017). Predicting Manual Therapy Treatment Success in Patients With Chronic Ankle Instability: Improving Self-Reported Function. J AthlTrain.
https://www.ncbi.nlm.nih.gov/pubmed/28290704 

Zhao, M., Gao, W., ... Tang, B. (2017). Acupressure Therapy for Acute Ankle Sprains: A Randomized Clinical Trial. PM R.
https://www.ncbi.nlm.nih.gov/pubmed/28634002