Massage Therapy for Plantar Heel Pain

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Massage Therapy for Plantar Heel Pain

Plantar heel pain (previously 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.

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 that is being explored is the use of massage therapy for patients who suffer from plantar heel pain.

Existing evidence suggests that massage therapy (joint mobilization and soft tissue massage) is helpful in improving function and reducing plantar heel pain (Fraser et al. 2017, Martin et al. 2014, Mischke et al. 2017, Piper et al. 2016, Sutton et al. 2016)

Why Does Massage Therapy Work for Heel Pain?

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 plantar heel pain

The plantar nerves.

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
• Lumbricals
• Adductor Halluscis
• Flexor Hallucis Brevis
• Tibialis Anterior
• Metatarsals & Interossei
• Peroneals
• Tibialis Posterior
• Triceps Surae
• Hamstrings

Stretch Training for Plantar Heel Pain

Calf tightness and reduced dorsiflexion are a possible factor for plantar heel pain (Bolivar 2013, Pascual Huerta 2014, Patel & DiGiovanni 2011). Therapists may want to consider including calf stretches part of a rehabilitation program.

Preliminary findings suggest stretch training is a viable way to stimulate architectural adaptation in the lower limb. Changes in the passive elastic properties and ROM induced by stretch training 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)

Intrinsic Foot Training

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 laid out by McKeon et al. 2015 that will help recondition foot muscles.

More to Explore

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https://www.ncbi.nlm.nih.gov/pubmed/17400020

Barnes, A., Sullivan, J., Pappas, E., Adams, R., Burns, J. (2017). Clinical and functional characteristics of people with chronic and recent onset plantar heel pain. PM R.
https://www.ncbi.nlm.nih.gov/pubmed/28461226

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Blazevich, A.J., Cannavan, D., Waugh, C.M., Miller, S.C., Thorlund, J.B., Aagaard, P., Kay, A.D. (2014). Range of motion, neuromechanical, and architectural adaptations to plantar flexor stretch training in humans. J Appl Physiol (1985).
https://www.ncbi.nlm.nih.gov/pubmed/24947023

Bolívar Y.A., Munuera P.V., Padillo J.P. (2013). Relationship between tightness of the posterior muscles of the lower limb and plantar fasciitis. Foot Ankle Int.
http://www.ncbi.nlm.nih.gov/pubmed/23386760  

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Digiovanni, B. F., Nawoczenski, D. A., Malay, D. P., Graci, P. A., Williams, T. T., Wilding, G. E., & Baumhauer, J. F. (2006). Plantar Fascia-Specific Stretching Exercise Improves Outcomes In Patients With Chronic Plantar Fasciitis. The Journal of Bone and Joint Surgery-American.
https://www.ncbi.nlm.nih.gov/pubmed/16882901

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Martin, R. L., Davenport, T. E., Reischl, S. F., Mcpoil, T. G., Matheson, J. W., Wukich, D. K., . . . Godges, J. J. (2014). Heel Pain—Plantar Fasciitis: Revision 2014. Journal of Orthopaedic & Sports Physical Therapy.
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McDonald, K.A., Stearne, S.M., Alderson, J.A., North, I., Pires, N.J., Rubenson, J. (2016). The Role of Arch Compression and Metatarsophalangeal Joint Dynamics in Modulating Plantar Fascia Strain in Running. PLoS One.
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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.
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Mischke, J.J., Jayaseelan, D.J., Sault, J.D., Emerson Kavchak, A.J. (2017). The symptomatic and functional effects of manual physical therapy on plantar heel pain: a systematic review. J Man Manip Ther.
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Patel, A., DiGiovanni, B. (2011). Association between plantar fasciitis and isolated contracture of the gastrocnemius. Foot Ankle Int.
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Piper, S., Shearer, H. M., Côté, P., Wong, J. J., Yu, H., Varatharajan, S., . . . Taylor-Vaisey, A. L. (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.
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Sutton, D. A., Nordin, M., Côté, P., Randhawa, K., Yu, H., Wong, J. J., . . . Taylor-Vaisey, A. (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.
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