Figure. Forest plot for AOFAS Ankle Hindfood Scale.
Ankle sprains are among today’s most common injuries. They can range from mild with no loss of function to debilitating and even disabling. And while a significant number of patients will go on to develop chronic ankle instability (CAI), there remains no ideal management. Conservative therapy is the first line, with surgical interventions used as a last resort. While there are multiple conservative options, ranging from oral non-steroidal anti-inflammatory drugs to bracing to immobilization to functional rehabilitation training, patients have a difficult time sticking to the routine and the outcomes are not ideal.
Tuina is a Chinese therapeutic massage based on traditional Chinese medicine theories, integrating modern biomedical theory (biomechanical function, anatomy, pathology, and physiology) with traditional practice. Several clinical randomized controlled trials have shown that massage plays an important role in CAI and tuina has been specifically shown to relax the tense soft tissues around the ankle joint, improve blood circulation, and promote better recovery of joint function. Yet, its use is not universal. This meta-analysis was conducted to evaluate the effectiveness and safety of tuina in treating CAI and aims to provide high-quality evidence for this promising treatment.
13 RCTs involving 984 patients were included in this study. While the overall methodological quality of the studies was low, the meta-analysis revealed the following:
1. The clinical effective rate was higher in the treatment group compared to the control group (OR = 6.51, 95% CI [3.76, 11.28]).
2. The treatment group performed better in reducing the Visual Analogue Scale score (MD = -1.59, 95% CI [-2.59, -0.59]).
3. The Baird-Jackson Ankle Score was superior in the treatment group (MD = 8.20, 95% CI [6.37, 10.04]).
4. The improvement in the AOFAS Ankle Hindfoot Scale was greater in the treatment group (MD = 14.52, 95% CI [9.81, 19.23]).
All differences were statistically significant. Regarding adverse events, there were no significant differences in incidence rates between the groups.
The authors concluded tuina is an effective and safe treatment option for CAI.
Source: Liu L, Huang J, Li T, et al. Efficacy and safety of Tuina (Chinese Therapeutic Massage) for chronic ankle instability: A systematic review and meta-analysis of randomized controlled trials. PLoS One. 2025;20(6):e0321771. doi: 10.1371/journal.pone.0321771. Use is per CC BY.
