This article will summarize some of the available evidence pertaining to massaging a sprained ankle, including different types of massage used in a clinical setting for this type of injury.
Keep in mind that many forms of massage are specific to particular injuries and timelines of recovery, so this may deviate from general massage techniques that most people envision.
Therefore, it’s best not to expect every massage therapist to be well-versed in some of the specifics of massaging a sprained ankle, especially with some of the evidence being very recent. As such, we always recommend consulting with a physiotherapist regarding suitability of massage for your ankle injury.
Is it good to massage a sprained ankle?
Should you massage a sprained ankle? According to some research studies that we examined, there is some evidence showing beneficial effects of plantar massage and deep transverse friction massage (also known as cross friction massage) when rehabbing a sprained ankle.
While the bulk of rehab for a sprained ankle should focus on improving strength and stability, it can be good to incorporate these styles of massage into your rehab plan depending on the phase of your recovery, as well as your physiotherapist’s recommendations.
We will break down these type of massage in more detail below, including a brief summary of the studies we examined to gain this information. Most of this information refers to low ankle sprains.
Plantar Massage for a Sprained Ankle
Plantar massage for a sprained ankle seems rather unintuitive at first glance. If it’s the outside, inside, or bottom of shin portion of the ankle that’s injured, why would we consider massaging the bottom of the foot?
First, it may not be suitable to apply direct pointed pressure over the injured area, particularly in the acute inflammatory phase of healing.
Additionally, even if safe to perform, massaging a ligament and surrounding area with a general massage technique is unlikely to yield any clinical benefit (there is one form of massage specific to ligaments that we will discuss later in the article).
Second, it’s easy to forget that the sole of the foot is the contact point on the ground, meaning it’s the interface between the ground and the ankle. With ankle instability, especially on uneven surfaces, having proper range of motion of the foot and good activation/strength of the muscles in the foot will assist in providing a suitable base of support. This is where plantar massage may be able to assist in improving ankle stability following sprains.
Does plantar massage work for a sprained ankle?
This section will focus on two recent studies that investigated the potential effects of plantar massage on ankle stability.
Study #1
The first study, published by Wikstrom et al 2017, investigated the effects of plantar massage on single leg balance and the Star Excursion Balance Test. The study population included 20 physically active adults with self-reported chronic ankle instability, whereby all participants had manual plantar massage from a clinician, a sensory brush massage from a clinician, as well as self-massage using a ball on the bottom of the foot.
Their results determined that static postural stability as assessed by single leg balance improved with all plantar massage techniques, but no difference in dynamic stability was found.
Furthermore, there did not appear to be any meaningful difference between the types of massage delivered, at least in the context of static and dynamic stability.
While this study could be limited by a small sample size, as well as subjective reporting of chronic ankle stability, it does shed some light on the possible benefits of massaging a sprained ankle.
Additionally, these results were achieved with single 5-minute bouts of massage. The authors suggest that this has more to do with stimulating sensory receptors on the bottom of the foot, as opposed to releasing or relaxing muscle tissue.
Study #2
The second study included in this article was published by Helly et al in 2021 in the Journal of Sport Rehabilitation. This study aimed to answer a more specific question: Does plantar massage improve static postural control (single leg stance) in people with chronic ankle instability? It’s a very similar question to the study above, but more focused, and the study design evaluates a pool of existing literature.
The overall findings of this review study suggest that there is good evidence behind plantar massage for improving static stability in those with chronic ankle instability, and the effects are typically noted immediately following the treatment, and as such, could represent a suitable adjunct to activity-based rehab.
There were some other interesting points noted in this article. For example, the authors state that the effects provided by plantar massage were cancelled out if participants closed their eyes during single leg stance, suggesting the effective on proprioception (i.e. joint position awareness) may not be as good as initially thought.
Additionally, there were some limitations that could be addressed in future studies to provide more clarity on this topic. One is that many studies did not include a separate control group. It would be interesting to know if plantar massage has the same effect on individuals without a history of ankle sprains.
Furthermore, investigating the effects of plantar massage in acute ankle sprains, as well as over the long-term rehab process, would serve to provide more clarity on the clinical effectiveness of this treatment method.
Overall, recent evidence seems to suggest that plantar massage can be a good adjunct to standard physiotherapy for ankle sprains. The massage can be delivered in a variety of ways, including self-massage by rolling over a ball, or a more targeted clinician-delivered massage to the bottom of the foot, and effects may be noted as soon as 5 minutes after the start of the massage.
Deep Transverse Friction Massage for a Sprained Ankle
Deep transverse friction, also known as cross friction massage, is a specific type of massage that is commonly used on ligaments and tendons.
In short, cross friction massage is a targeted massage local to a small area of the ligament and tendon. This is often performed by the clinician during the sub-acute phase of injury recovery, which is the time frame when the ankle just starts to settle down (usually 1-3 weeks post-injury). Depending on the area of the body, the patient can also be educated on how to perform their own deep transverse friction massage.
Cross friction massage works by applying direct pressure over a ligament or tendon with the fingers, or an instrument like a Graston tool. The fingers are then moved back and forth perpendicular to the general direction of the collagen fibers in the ligament.
The massage usually lasts up to 10 minutes. The first few minutes may feel fairly uncomfortable, but then a numbing effect usually occurs. Therefore, cross friction massage can be good for ankle pain that lingers after a sprain. In an ankle sprain, the deep transverse friction massage is usually performed over superficial ligaments, such as the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL).
Cross friction massage was developed many years ago with effectiveness noted by patients. However, given advances in sport medicine research, we know that activity-based treatment is still the most important aspect of treatment, so is it worth spending the 10+ minutes in a clinic having someone rub the ligament or tendon for a while? Let’s consult some recent literature.
Does deep transverse friction massage help a sprained ankle?
Most studies investigating this type of massage are either pre-clinical, such as animal studies, or they don’t involve ligaments damaged in acute ankle sprains. Additionally, many studies are more focused on tendinitis and tendinopathy rather than traumatic ligament sprains, so much of our information will be extrapolated from these types of sources.
Pre-clinical studies are often undervalued, as their results don’t necessarily translate into real-life treatment settings. They are still important though, as they can provide an avenue to investigate treatment strategies in a way that may not be possible in clinical settings.
For example, one study looked at instrument-assisted cross-fiber massage to aid in healing of sprained MCL’s in mice. They began this type of massage on the MCL early after injury and provided a dose of 3 sessions per week for 4 weeks. They found that the collagen fibers in the MCLs that were exposed to the friction massage were better aligned, suggesting a positive effect on ligament healing (Loghmani and Warden, 2009).
So what about clinical settings? One review article published by Brummitt in 2008 reviewed some of the literature regarding deep transverse friction massage in sports injuries. They found that it’s a fairly popular treatment method; however, available research fails to support its use in clinical settings compared to other treatments offered in the clinic.
While there may be some positive effect, it appears to be a low priority for treatment of an ankle sprain, especially regarding return to function.
As usual, it’s always a good idea to check in with a physiotherapist, as they may have more experience providing this treatment in a clinical setting and can provide more clarity on suitability for your own rehab.
What about other types of massage for a sprained ankle?
We’ve discussed a couple unique forms of therapeutic massage techniques that are often considered in the context of ankle sprains. What about just going to a registered massage therapist and receiving a more general massage for a sprained ankle, or combining different forms of massage.
One study conducted by Mobarakeh et al in 2015 studies a variety of treatment interventions on acute ankle sprains, which included the use of effleurage and friction massage, and they found positive effects on decreasing adhesions, as well as improving muscle stiffness and compliance.
They also showed positive effects on muscle strength and balance after 8 weeks of massage, but it was unclear how frequent, or in what setting, the massage was delivered. It is also unclear if there were any lifestyle or training differences between the groups.
Another study conducted by Yoshimura et al in 2022 looked at using a foam roller on the calf muscles to help improve ankle joint range of motion. They found significant improvements in ankle dorsiflexion in the foam rolling group after 3 sets of 1 minute of rolling, with 30s rest in between sets. Whether this improvement in range of motion was maintained for a prolonged period of time is unclear.
Massaging a sprained ankle is just one component to rehab
A sprained ankle is one of the most common ankle injuries in both sports and regular daily living. Lateral ankle sprains are more common than medial ankle sprains and high ankle sprains; however, one of the common themes across the board when it comes to rehab for a sprain is improving ankle stability.
In short, the main reason it’s so important to improve ankle stability is for optimal recovery and prevention of future injuries. An ankle sprain involves structural damage to the ligaments that prevent excessive motion of the foot and ankle joints, and when these ligaments are injured, they often heal in a manner where they are more loose than prior to the injury.
Even if the ligament laxity is just slightly increased, this can still have a noticeable effect on ankle stability. Therefore, it’s important to reinforce the ligaments as much as possible through improving ankle strength and stability.
The main way to achieve this is through therapeutic strengthening. This may start with ankle band exercises early in the rehab process and gradually progress to more weight bearing and functional activities, with return to sport representing the most advanced stage of the rehab process.
Summary of Findings
Overall, massage appears to be helpful for an ankle sprain, but only when used as an adjunct to activity-based treatment, and when performed in the proper setting at the right time.
Additionally, the optimal dose for different types of massage remains unclear, especially in the context of a resolving sprain, which is why we recommend consulting with a physical therapist or massage therapist prior to initiating massage, especially after a traumatic injury.
Generally speaking, here are some points based on the studies above that may help guide your decision when provided with different options for your injured ankle, or at least prompt some questions to ask your healthcare provider:
Plantar Massage: Appears beneficial in reducing discomfort in an injured ankle and improving static ankle stability. This can be done quickly by a clinician or on your own, and as such, may represent an effective adjunct to exercise-based treatment.
Deep Transverse Friction Massage: Evidence is controversial in clinical settings and this technique is somewhat limited in scope, as it’s primarily used on superficial ankle ligaments and tendons. Given the uncertainty, as well as the time it takes to perform this massage, it may not represent an effective adjunct to treatment unless an experienced clinician recommends otherwise.
General Massage Therapy: A massage therapist can assist in improving range of motion at the ankle joint and reducing discomfort in surrounding muscles, but typically doesn’t address the healing ankle ligaments directly.
As such, this may be a good adjunct to physiotherapy treatment of a sprained ankle when improving range of motion is desired, especially if the source of restriction is identified to be the surrounding muscles.
Foam Rolling: This can be helpful to increase ankle dorsiflexion range of motion by rolling the calf muscles. Long term effects are unclear, but short term improvements in range of motion may facilitate exercise-based treatment.
Given the short amount of time it takes to perform, this may be a good adjunct to exercise-based treatment if there is a limitation in ankle dorsiflexion from a tight calf muscle, but won’t address the injured ligaments themselves.
References
Brummitt J. The role of massage in sports performance and rehabilitation: current evidence and future direction. N Am J Sports Phys Ther. 2008 Feb;3(1):7-21.
Helly KL, Bain KA, Gribble PA, Hoch MC. The Effect of Plantar Massage on Static Postural Control in Patients With Chronic Ankle Instability: A Critically Appraised Topic. J Sport Rehabil. 2020 Oct 7;30(3):507-511. doi: 10.1123/jsr.2020-0092.
Loghmani MT, Warden SJ. Instrument-assisted cross-fiber massage accelerates knee ligament healing. J Orthop Sports Phys Ther 2009;39:506-14
Mobarakeh M, Mehdi, Hafidz H. J. O. A. Effect of Friction Technique on Ankle Sprain Grade II Treatment. Biomed Pharmacol J 2015;8(2)
Wikstrom EA, Song K, Lea A, Brown N. Comparative Effectiveness of Plantar-Massage Techniques on Postural Control in Those With Chronic Ankle Instability. J Athl Train. 2017 May 23. doi: 10.4085/1062-6050.52.4.02.
Yoshimura A, Sekine Y, Furusho A, Yamazaki K, Hirose N. The effects of calf muscle self-massage on ankle joint range of motion and tendon-muscle morphology. Journal of Bodywork and Movement Therapies, Volume 32, 2022, Pages 196-200, ISSN 1360-8592. https://doi.org/10.1016/j.jbmt.2022.05.009.
Disclaimer:
The content here is designed for information & education purposes only and is not intended for medical advice.
