Massage Therapy for Plantar Heel Pain

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ARTIST - ARNAULD-ELOI GAUTIER-DAGOTY (1741-1771)

ARTIST - ARNAULD-ELOI GAUTIER-DAGOTY (1741-1771)

Massage Therapy for Plantar Heel Pain

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.

This post will explore the use of massage therapy for patients who suffer from plantar heel pain.

Rehabilitate The Whole Person, Not Just Injured Tissues

Plantar heel pain (also known as plantar fasciitis) is generally described as sharp or stabbing, and 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.

The presentation of plantar heel pain, does not always mean that the fascia is the primary contributor to pain. There is research that suggests that mechanical tension or irritation of the tibial nerve and its branches in the tarsal tunnel contributes to the complex clinical picture of plantar heel pain.

This is why clinicians should be thoughtful and skilled in managing the load on the tendons and supporting structures through a number of rehabilitation considerations including, but are not limited to:
• Manual Therapy (joint mobilization, nerve mobilization, soft tissue massage, IASTM)
• Education on psychosocial factors such as fear avoidance
• Loading Programs (eg. concentric, eccentric, isometric)

Why Does Massage Therapy Work for Heel Pain?

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.

Structures To Be Aware of When Treating Plantar Heel Pain

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 plantar heel pain may include neurovascular structures and investing fascia of:
• Plantar Fascia
• The Foot Core
• Tibialis Anterior
• Metatarsals & Interossei
• Peroneals
• Tibialis Posterior
• Triceps Surae
• Hamstrings

Remedial Exercises for Plantar Heel Pain

The plantar nerves.

Intrinsic foot muscles play a crucial role in supporting the medial longitudinal arch, providing the foot stability and flexibility for shock absorption. There are a number of footcore exercises that will help recondition foot muscles (McKeon et al. 2015).

Additionally, therapists may also want to consider including calf stretches part of a rehabilitation program, as calf tightness and reduced dorsiflexion are a possible factor for plantar heel pain (Bolivar et al. 2013). 

Changes in the passive elastic properties and ROM induced by stretch training may alter the progression of heel pain, which is due to both increases in stretch tolerance and changes in passive properties of muscle. For a more indepth looks at theses changes you may want to check out these recent studies:
• 6 weeks of loaded stretch training of the plantar flexors resulted in hypertrophic like adaptations of the gastrocnemius (Simpson et al. 2017)
• 3 weeks of twice daily stretch training (4 × 30 s) lead to an increase in dorsiflexion range of motion (ROM)  a 28% increase in passive joint moment (Blazevich et al. 2014). 
• 4-week static stretch training program changes the flexibility of the gastrocnemius muscle tendon unit (Nakamura et al. 2012)
 

More to Explore

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