A few years ago I was doing post-event sports massage at the finish line of the Western States Endurance Run. A woman approached my massage table in extreme pain. She had just spent the last 23 hours running 100 miles over steep terrain. She looked like she could really benefit from a sports massage.

I made sure she had cooled down first by walking for 10 or 15 minutes before she got on my table. Laying supine, she kept her left knee up as she was unable to rest her leg on the table. Any attempt to lower her leg to the table caused her severe pain.

I palpated extreme tightness in her left psoas muscle, and I remembered that reciprocal inhibition techniques work well with muscle cramps. Even though I was never taught how to do reciprocal inhibition on the psoas, I was able to do it because I knew the principle of the technique and the relevant anatomy.

I held her knee up in a position where she experienced no pain or discomfort, then I asked her to gently try to bring her knee to the table against my resistance. She seemed anxious about this request so I assured her that I would hold her knee so it would not move. As she tried to extend her hip she was using her gluteus maximus and hamstrings. This caused a relaxation of her psoas, so that after she quit trying to lower her knee, I was able to slowly bring her knee to the table. 

After her psoas released she was amazed at how much better she felt. I talked with her about gentle stretches she could do, and some things she could do to help prevent muscle cramps (like not running 100 miles in under 24 hours).

Sports Massage has become one of the fastest growing areas of massage. It is growing in popularity because of the public’s concern with fitness, and the aches and pains they develop during the fitness activity. I believe it is also popular because the techniques can work with anyone, whether they are a professional athlete, a weekend warrior, or a couch potato.

Sports massage, as the term implies, is designed to improve athletic performance. It can aid in the recovery or rehabilitation of an athlete after an injury or event. The techniques used in sports massage require an understanding of the physiological basis of those techniques. This knowledge along with knowing major muscles and attachments is very important in knowing what to use in a given situation. In this article I hope to share some of the techniques we use in sports massage along with an understanding of how and why they are effective.

Utilizing sports massage techniques can help you build your practice, because the techniques will work with anyone. Your muscles and tendons don’t know the difference between an injury from playing tennis, or from too much web surfing. Our bodies respond the same to any injury. No matter what the cause, the techniques that will help an athletic injury will help other injuries as well.

Benefits of Sports Massage

Improving Athletic Performance

This can be done by increasing flexibility through stretching, releasing tension in antagonist muscles, and releasing trigger points that can negatively affect performance. The techniques you choose depend on the sport that the athlete needs to perform.

Stretching-- Some examples of stretching include Active Isolated Stretching, Facilitated Stretching, and PNF (Proprioceptive Neuromuscular Facilitation) stretches. Stretching is especially suitable for athletes such as gymnasts, dancers, and practitioners of martial arts.

Releasing antagonist muscles -- When an antagonist muscle is tight, the agonist muscle will have more work to do to perform its action. Releasing an antagonist muscle will make the action of the agonist more efficient.

Releasing trigger points -- When an athlete has latent trigger points they will often feel as if their timing is off, or that they are out of sync. Trigger points rob muscles of energy, thereby decreasing performance.

Recovery and Rehabilitation

A sports massage treatment is invaluable in helping an athlete recover from post-event soreness, resume training, or participate in the next event. If you have clients that exercise regularly, they can appreciate sports massage as it can reduce the day after soreness so that they can exercise more frequently. It can also help keep clients motivated because they don’t feel so sore from their workouts.

Training Necessary for Sports Massage

Training for sports massage should include training in anatomy, physiology, assessment skills, and treatment skills, including working with pre-event and post-event massage. It is also important to have a good knowledge of the sport your client participates in.

Anatomy and Physiology

I cannot overemphasize the importance of a good grounding in anatomy when learning sports massage techniques. The techniques in sports massage are based on physiological principles. If you understand both the principles of a technique and the origin, insertion, and action of a muscle, you can figure out how to apply that technique to that muscle. If you do not know the anatomy you will be doing a lot of memorizing of techniques, and you will be applying them without a clear understanding of what you are doing.

Say that there are 30 major muscles or muscle groups in the body, and 6 different techniques you learn that can be done with those muscles. If you do not know basic anatomy you will have to memorize 180 different techniques. If you know the anatomy you can figure out techniques based on the principles. You develop more creativity in your approach as you do techniques in different positions then how you were taught.

Sports massage techniques are based on physiological principles. Understanding the physiology behind the principle will allow you to remember the technique and use it appropriately. An example of a physiological principle and its application is Sherrington's Second Law.

Sherrington’s Second Law (Reciprocal Inhibition)--When contraction of a muscle is stimulated, there is a simultaneous neurological inhibition of its antagonist.  When I learned this law in medical school many years ago, it was a boring physiological principle, without much practical significance. Since then I have found it to be one of the most practical concepts I have learned for working with clients.

This law has a wonderful application in sports massage. Muscle cramps are very common in athletes, especially after an event. If your client is having a cramp of the gastrocnemius and soleus you may be tempted to stretch it. If you do that you can tear muscle fibers. The best thing to do is to allow the muscle to be in the cramped position, with the ankle plantarflexed, and then have the client try to stretch it against your resistance. They will be using their tibialis anterior to try to dorsiflex their ankle and by reciprocal inhibition their gastrocnemius will be told to relax.

This technique can be applied to any muscle in the body. One time in class a student was having a back spasm. Fortunately he was lying supine, so I placed my hands on his shoulders and asked him to try to sit up. He used his trunk flexors (rectus abdominis, etc.) to try to sit up, and by reciprocal inhibition his trunk extensors (quadratus lumborum, erector spinae) let go, causing instant relief of his back spasm.

Reciprocal Inhibition techniques are only first aid for muscle cramps. The causes of most muscle cramps are dehydration or mineral deficiencies. The minerals most involved are calcium, magnesium, and potassium. The 3 AM muscle cramps many people get are often from calcium and magnesium deficiencies. In sports massage most muscle cramps are from a potassium deficiency. Potassium is lost in the body fluids (sweating, vomiting, diarrhea, and excess urination from diuretics). It can be replenished with sport drinks, or with fresh fruits and vegetables.

This principle of reciprocal inhibition is also utilized in other treatment modalities besides muscle cramps. For example, in Soft Tissue Release, your client is actively stretching the muscle you are working on. Since they are using the antagonist to stretch the muscle, the muscle being stretched is neurologically inhibited and is therefore more relaxed.

Reciprocal inhibition is only one of many principles that are important to understand when doing sports massage. Other aspects of physiology that are important to know are post isometric relaxation, stretch reflexes, mechanisms and stages of injury healing, the use of heat and cold, and the physiology of exercise.

Assessment Skills

When dealing with an injured client it is important to do a thorough assessment before beginning treatment. The assessment should begin with a good client history, followed by questions about any areas of pain. If you start working on a client in pain without asking questions first, they may doubt your competence. This is especially true when your treatment does not help them.

Palpatory literacy is also necessary. It is important to be able to distinguish the feel of trigger points, scar tissue and adhesions, and to feel where tension is being held. Much of this comes from practice and experience.

Assessment skills may also include testing – using active, passive and resisted motions to help determine which tissues are affected and what your treatment plan should be.

Treatment Skills

There is a saying that if your only tool is a hammer, then everything will look like a nail. The more techniques you have in your bag of tricks for helping your client, the more effective you will be in helping them.

Knowing when to use a specific technique with a client is part of the art of massage therapy. Clients respond differently to techniques, so that what works great for one client may not work at all for someone else. Often times you may not know what will work for a client until you start working with them. Fortunately massage is not like brain surgery, so there is room to experiment and find out what will work with your client.

Techniques used in sports massage include various forms of stretching such as Active Isolated Stretching, Facilitated Stretching, and PNF Stretches. Other techniques include Reciprocal Inhibition, Trigger Point & Counterstrain, Cross Fiber, and Soft Tissue Release.

Pre-event and Post-event Massage

The techniques used will be determined by whether the sports massage is given pre-event or post-event. If you were to give a full one-hour Swedish massage to a client just before a marathon, they would not be able to run. A much shorter, quicker treatment without oil will energize them. Pre-event massage needs to be rapid and vigorous to energize a client before an event.

Post-event massage requires more tuning into the client and their condition. It is important to go slowly and pay attention to how your client is responding. Knowledge of reciprocal inhibition is essential since muscle cramps can occur after an event.

The school that I direct, Healing Arts Institute, organizes the post-event sports massage at the finish line of the Western States Endurance Run. This is a 100-mile run that starts in the mountains at an elevation of 6200 feet and ends at an elevation of 1250 feet. Up to 500 people compete in this race, and top runners complete this race in less than 16 hours. The race is closed at 30 hours. The runners coming in toward the end of the 30 hours have been running longer and are in much worse condition.

Some of them can be in very rough shape when they cross the finish line. Fortunately there is medical help available as well as a foot clinic set up by a podiatry college. The runners are very appreciative of the massage they receive, as it helps them recover faster. At events like this therapists often share techniques and learn from each other.  Our students and graduates who work at this event find it to be an invaluable learning experience.

Marketing Sports Massage

I believe your best chance in succeeding with sports massage is in the results you make with your clients. If your work with the athletes results in better performance and overall sense of well being, they will be excited about telling others. Another approach is working on people who can give you referrals. I know of sports therapists who work on personal fitness trainers who then refer their clients. Of course the other way to promote your practice is to do post-event massage at different athletic events. Often this massage is done for free or for tips, but you can hand out your business cards and pick up regular clients. You can find out about athletic events through local massage schools, running clubs and magazines, and local sporting good stores. Contact the event organizers and if they don’t have massage available you can explain why it is needed and you can volunteer to help organize it.

Dr. James Mally is a graduate of Bastyr University in Seattle. He has been doing massage since 1976 and is the director of Healing Arts Institute in Citrus Heights, CA. He teaches workshops on deep tissue massage and sports massage, and has produced DVDs and workbooks on Swedish Massage, Deep Tissue Massage, and Sports Massage, which are being used in massage schools worldwide. Information on his DVDs can be found at www.abundanthealth.com