Massage Therapy for Plantar Fasciitis
Massage therapy as a therapeutic intervention is being embraced by the medical community. This is in part because it is a non-pharmacological therapeutic intervention that is simple to carry out, economical, and has very few side effects.
One area of the body that massage therapy has been shown to be particularly helpful is for foot pain (Fraser et al. 2018). More specifically plantar fasciitis (also known as plantar heel pain), which is a particular type of foot pain that is generally described as sharp or stabbing pain that is worse in the morning. The pain can decrease with activity, but can return after long periods of standing or after getting up from a seated position.
It is worth noting that just because this condition is referred to as plantar fasciitis, does not mean that the plantar fascia is the primary contributor to symptoms. There is research to suggest that irritation of the tibial nerve and its branches in the tarsal tunnel can contribute to the complex clinical picture of plantar fasciitis (Plaza-Manzano et al. 2018).
Why Does Massage Therapy Work For Plantar Fasciitis
The responses to massage therapy are multifactorial - physiological and psychological factors interplay in a complex manner. The biopsychosocial model provides a practical framework for investigating the complex interplay between massage therapy and clinical outcomes.
Based off the biopsychosocial model, investigation into mechanisms of action should extend beyond local tissue changes and include peripheral and central endogenous pain modulation. An observed favorable outcome may be explained by a number of overlapping mechanism in the periphery, spinal cord, and brain represented in the image below.
Rehabilitate The Whole Person, Not Just Injured Tissues
A massage therapy treatment plan should be implemented based on patient-specific assessment findings and patient tolerance. Clinicians should also be thoughtful and skilled in managing the load and enhancing supporting structures through a number of rehabilitation considerations including, but are not limited to:
• Manual Therapy (joint mobilization, neural mobilization, soft tissue massage, IASTM)
• Education on psychosocial factors such as fear avoidance
• Loading Programs (eg. concentric, eccentric, isometric)
For practical purposes there are a number of specific structures to keep in mind while assessing and treating patients suffering from plantar fasciitis. Which may include the neurovascular structures and investing fascia of:
• Plantar Fascia
• The Foot Core
• Tibialis Anterior
• Metatarsals & Interossei
• Tibialis Posterior
• Triceps Surae
More to Explore
Alshami et al. (2008). A review of plantar heel pain of neural origin: differential diagnosis and management. Man Ther.
Basson et al. (2017). The Effectiveness of Neural Mobilization for Neuro-Musculoskeletal Conditions: A Systematic Review and Meta-Analysis. JOSPT.
Caratun et al. (2018). Stubborn heel pain: Treatment of plantar fasciitis using high-load strength training. Can Fam Physician.
Fraser et al. (2017). Utilization of Physical Therapy Intervention Among Patients With Plantar Fasciitis in the United States. JOSPT.
Fraser et al. (2018). Does manual therapy improve pain and function in patients with plantar fasciitis? A systematic review. J Man Manip Ther.
McKeon & Fourchet (2015). Freeing the foot: integrating the foot core system into rehabilitation for lower extremity injuries. Clin Sports Med.
McKeon et al. (2015) The foot core system: a new paradigm for understanding intrinsic foot muscle function. Br J Sports Med.
Mischke et al. (2017). The symptomatic and functional effects of manual physical therapy on plantar heel pain: a systematic review. J Man Manip Ther.
Nahin, R.L. (2018). Prevalence and Pharmaceutical Treatment of Plantar Fasciitis in United States Adults. J Pain.
Petraglia et al. (2017). Plantar fasciitis in athletes: diagnostic and treatment strategies. A systematic review. Muscles Ligaments Tendons J.
Piper et al. (2016). The effectiveness of soft-tissue therapy for the management of musculoskeletal disorders and injuries of the upper and lower extremities: A systematic review by the Ontario Protocol for Traffic Injury management (OPTIMa) collaboration. Manual Therapy.
Plaza-Manzano et al. (2018). Widespread Pressure Pain Hypersensitivity in Musculoskeletal and Nerve Trunk Areas as Sign of Altered Nociceptive Processing in Unilateral Plantar Heel Pain. J Pain.
Pollack et al. (2018). Manual therapy for plantar heel pain. Foot (Edinb).
Rasenberg et al. (2018). Efficacy of foot orthoses for the treatment of plantar heel pain: a systematic review and meta-analysis. Br J Sports Med.
Riel et al. (2017). Is 'plantar heel pain' a more appropriate term than 'plantar fasciitis'? Time to move on. Br J Sports Med.
Renan-Ordine et al. (2011). Effectiveness of Myofascial Trigger Point Manual Therapy Combined With a Self-Stretching Protocol for the Management of Plantar Heel Pain: A Randomized Controlled Trial. JOSPT
Saban et al. (2014). Deep massage to posterior calf muscles in combination with neural mobilization exercises as a treatment for heel pain: A pilot randomized clinical trial. Manual Therapy.
Stanek et al. (2018). Comparison of Compressive Myofascial Release and the Graston Technique for Improving Ankle-Dorsiflexion Range of Motion. J Athl Train.
Sutton et al. (2016). The Effectiveness of Multimodal Care for Soft Tissue Injuries of the Lower Extremity: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Journal of Manipulative and Physiological Therapeutics.
Tu, P. (2018). Heel Pain: Diagnosis and Management. Am Fam Physician.