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Katherine L. Helly, Katherine A. Bain, Phillip A. Gribble, and Matthew C. Hoch

Plantar massage is an intervention hypothesized to stimulate the plantar cutaneous receptors and increase tactile acuity. 9 By augmenting sensory input, massage should improve the efficacy of motor output, and this sensorimotor alteration could be illustrated in the form of postural control measurements

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Christopher J. Burcal, Alejandra Y. Trier, and Erik A. Wikstrom


Both balance training and selected interventions meant to target sensory structures (STARS) have been shown to be effective at restoring deficits associated with chronic ankle instability (CAI). Clinicians often use multiple treatment modalities in patients with CAI. However, evidence for combined intervention effectiveness in CAI patients remains limited.


To determine if augmenting a balance-training protocol with STARS (BTS) results in greater improvements than balance training (BT) alone in those with CAI.


Randomized-controlled trial.


Research laboratory.


24 CAI participants (age 21.3 ± 2.0 y; height 169.8 ± 12.9 cm; mass 72.5 ± 22.2 kg) were randomized into 2 groups: BT and BTS.


Participants completed a 4-week progression-based balance-training protocol consisting of 3 20-min sessions per week. The experimental group also received a 5-min set of STARS treatments consisting of calf stretching, plantar massage, ankle joint mobilizations, and ankle joint traction before each balance-training session.

Main Outcome Measures:

Outcomes included self-assessed disability, Star Excursion Balance Test reach distance, and time-to-boundary calculated from static balance trials. All outcomes were assessed before, and 24-hours and 1-week after protocol completion. Self-assessed disability was also captured 1-month after the intervention.


No significant group differences were identified (P > .10). Both groups demonstrated improvements in all outcome categories after the interventions (P < .10), many of which were retained at 1-week posttest (P < .10). Although 90% CIs include zero, effect sizes favor BTS. Similarly, only the BTS group exceeded the minimal detectable change for time-to-boundary outcomes.


While statistically no more effective, exceeding minimal detectable change scores and favorable effect sizes suggest that a 4-week progressive BTS program may be more effective at improving self-assessed disability and postural control in CAI patients than balance training in isolation.

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Erik A. Wikstrom and Patrick O. McKeon

life scores. 14 Ankle joint mobilizations clearly improve DFROM in those with CAI. 15 , 16 Stretching and plantar massage have also improved DFROM in different populations. 17 , 18 Most recently, a randomized controlled trial (RCT) reported that ankle joint mobilizations, calf stretching, and plantar

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Christina Jones, Kyle B. Kosik, Phillip Gribble, and Matthew C. Hoch

with CAI. Potential interventions, such as plantar massage, may have the ability to stimulate the plantar cutaneous receptors in patients with CAI. In a recent randomized controlled trial, six 5-min bouts of petrissage and effleurage plantar massage treatments delivered over a 2-week period created

Open access

Bridget M. Walsh, Katherine A. Bain, Phillip A. Gribble, and Matthew C. Hoch

per week BTS group: the same BT protocol as BT group with a combination of calf stretching, ankle joint traction, anterior/posterior ankle joint mobilizations, and plantar massage CG: calf muscle stretching instruction TG: 15–20 min of neuromuscular training combined with a 15-min sham joint

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Nicole J. Chimera and Mallorie Larson

.1016/S0004-9514(14)60377-9 10.1016/S0004-9514(14)60377-9 11676731 25. 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 ; 52 ( 7 ): 629 – 635 . PubMed ID

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Masafumi Terada, Megan Beard, Sara Carey, Kate Pfile, Brian Pietrosimone, Elizabeth Rullestad, Heather Whitaker, and Phillip Gribble

, Blackburn, Brown, & Guskiewicz, 2007 ), plantar massage ( Wikstrom, Song, Lea, & Brown, 2017 ), and ankle joint manipulation ( Lopez-Rodriguez, Fernandez de-Las-Penas, Alburquerque-Sendin, Rodriguez-Blanco, & Palomeque-del-Cerro, 2007 ) to “unfreeze” the sensorimotor system in a patient following LAS

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Abbis Jaffri, John J. Fraser, Rachel M. Koldenhoven, and Jay Hertel

week after receipt of mobilization. Previous study of MT in this population found that rearfoot joint mobilizations and plantar massage increased dynamic balance through likely mechanical and neurophysiological mechanism, improvements that persisted up to 1 month following treatment. 28 Due to the

Free access

Cameron J. Powden, Rachel M. Koldenhoven, Janet E. Simon, John J. Fraser, Adam B. Rosen, Abbis Jaffri, Andrew B. Mitchell, and Christopher J. Burcal

responder rate for improving balance after stretching (25%), joint mobilizations (45%), and plantar massage (53%) from a large clinical trial. Additionally, participant-level analysis of 6 balance training studies showed a 40% response rate at improving balance following balance training in patients with