• May 22-23,  Sports Massage – Upper Body:  Detroit, Michigan
• July 10-11, Sports Massage – Lower Body:  Chicago, Illinois
• August 21-22, Sports Massage – Upper Body:  Cleveland, Ohio
• October 9-10, Sports Massage – Lower Body:  Kalamazoo, Michigan

Please see the Course Schedule page for details.  More seminars will be added this summer as my calendar will allow.  Please contact me if you would like a course in your area.

In previous articles, I have discussed pre-event, inter-event, and post-event sports massage. In this article, I will complete our series by covering the therapeutic sports massage.

To review: Sports massage involves the application of therapeutic massage and stretching to assist an athlete’s performance and recovery from activity. However, there are different types of sports massage based on when you give the massage in relation to the competition:

• Immediately before competition (Pre-Event)
• Between competitions on the same day (Inter-Event)
• Immediately after competition (Post-Event)
• During the training program (Therapeutic)

Again, when approaching these different types of sports massage, I prefer to focus on the purpose of the massage to direct me to the appropriate techniques.

The purpose of therapeutic (or “maintenance”) sports massage is to correct soft tissue dysfunction that has been caused by high intensity training or from previous competition. We have the same approach as a traditional (non-athletic) therapeutic massage, but we place more emphasis on the muscles and movements utilized in the sporting activity. In organized athletics, the sports massage therapist may work in coordination with the overall sports medicine team, including team physicians, athletic trainers, and physical therapists.

To provide the best benefit possible to your athletes, I strongly recommend learning as much as you can about their activity, including the mechanics of the sport, as well as the typical training they perform. This knowledge will help guide you when you are presented with an injury to understand the mechanism and what other structures may be involved. For instance, you may be presented with a chronic hamstring strain that is partially due to shortness in the hip flexors, creating an anterior pelvic tilt, and more stress on the hamstrings. Or, perhaps even a baseball pitcher who develops shoulder impingement because their opposite foot has a broken toe, causing them to change their throwing mechanics (Dizzy Dean, for you baseball historians!).

An additional benefit of learning about the sport is the athlete will place more value in your work if you can show that you understand their sport and what they are doing to their body. So, a little research can pay dividends in your massage effectiveness as as well as your reputation as a sports massage therapist.

Therapeutic Sports Massage Timing

Now, one big question I had when starting out was: If the athlete is practicing hard during the week, shouldn’t I avoid any deep therapeutic techniques with a therapeutic/maintenance sports massage? The short answer is no.

Even though the athlete is doing high-intensity workouts throughout the week, they still will benefit from deep-tissue techniques. Ideally, you would schedule the massage around their workout schedule, so you perform the massage on a light workout day (Archer, 2007), or even later in the day after a hard workout. From personal experience (feedback from my track athletes), they find that their legs feel “loose” the day after I work on them, but a few have said their legs feel “unresponsive” or “dead” for one day after I have used deep massage techniques.

Using this experience, I also coach new athletic clients, to let them know what to expect for the next 2 days after I have worked on them. Managing their expectations can be very important. It is better to let them know that they may feel a little sore or “dead-legged” the day following their massage, rather than letting them think you hurt them somehow and they never come back to see you!

Likewise, knowing that I may create adverse effects for 24 hours following a therapeutic massage, I want to schedule an athlete at least 48 hours before competition (that is, if they have an injury that requires serious work). If the client is not used to receiving massages, I will push this back to 3 or 4 days prior to competition, to ensure their bodies have a chance to incorporate the changes from the massage.

Techniques

In general, any technique you can think of can be utilized in a therapeutic/maintenance sports massage. In most of my sessions, I incorporate myofascial techniques, stretching and joint mobilizations to restore the normal resting muscle length after strenuous activity. For athletes with acute injury, lymphatic drainage is extremely valuable for reducing swelling and reducing the time it takes an athlete to return to competition (Fritz, 2005).

When working with a post-operative athlete, it is essential to work with the sports medicine team, to insure the athlete is getting the appropriate treatment for their stage of rehabilitation. This may require some work by the sports massage therapist to educate the other healthcare providers about the benefits and capabilities of manual therapy (lymphatic drainage, scar tissue healing, etc.). But, it also requires effort from the massage therapist to learn about the stages of rehabilitation and avoid stressing the injured tissue too quickly.

To wrap-up my little series, I find sports massage to be a very fun, challenging, and rewarding experience. I feel very fortunate to work with elite athletes who are very in-tune with their bodies and push themselves to their physical limits. Because they are always working to get better, it also drives me to look for ways to improve my approach, so I can always give them the best possible sports massage.

References

Archer, Pat.  Therapeutic Massage in Athletics, Philadelphia:  Lippincott Williams & Wilkins, 2007 (p.209-210).
Fritz, Sandy.  Sports & Exercise Massage, St. Louis:  Elsevier Mosby, 2005.

In a previous article, I discussed the pre-event and inter-event sports massage. In this article, I will continue the path to cover the post-event sports massage.

Sports massage involves the application of therapeutic massage and stretching to assist an athlete’s performance and recovery from activity. However, there are different types of sports massage based on when you give the massage in relation to the competition:

• Immediately before competition (Pre-Event)
• Between competitions on the same day (Inter-Event)
• Immediately after competition (Post-Event)
• During the training program (Therapeutic)

Again, when approaching these different types of sports massage, I prefer to focus on the purpose of the massage to direct me to the appropriate techniques.

The purpose of the post-event sports massage is to help the athlete to recover from their high-intensity exercise. They have just finished a competition, or a hard training session. At this time, we have a few key goals as massage therapists:

1) Improve the Circulation:
We can assist the athlete by improving the venous return and lymphatic circulation. A research study found that myofascial massage assisted in the recovery of diastolic blood pressure after high-intensity exercise to pre-exercise levels (1).

2) Reduce Muscle Tension
Muscles used in high-intensity activity have a tendency to remain at a higher level of tonus immediately after activity. Massage and stretching can help to restore normal resting tonus. A recent study (2) found that massage reduced EMG amplitude and vigor (muscle activity) when applied as a passive recovery technique immediately after exercise.

3) Calm the Athlete
The work we do has both strong physiological and psychological benefits. Massage can stimulate the parasympathetic nervous system, improving the immune system (3). But just as important, it has been shown to improve the perceived fatigue level of the athlete. By helping the athlete to feel more recovered, they were able to generate more power in repeated exercise tests (4).

Post-Event Technique

The post-event massage is typically given anywhere from 30 minutes up to 24 hours after competition or activity. When working with runners after a marathon, I will focus on post-event techniques even up to 48 hours after their race, because of the damage they are doing to their muscles. This massage should be brief (30 minutes) and utilize techniques to enhance circulation and calm muscles after activity. Techniques can include effleurage (stroking), petrissage (kneading), broadening compression, joint mobilizations, and assisted stretching.

With post-event massage, effleurage (stroking) and petrissage (kneading) are the key techniques, and as long as they have not incurred significant muscle damage and soreness, you can employ deep pressure. Be sure to start with light pressure and move do deeper pressure as you check in with your athlete. When performing effleurage, also make sure to work distal to proximal, to enhance venous return. I start with light effleurage with the palms of my hands and gradually increase the pressure by changing to loose fist or forearm effleurage.

The same thing goes for the petrissage and broadening compression. Start light and be very mindful of your pressure, as they often cannot handle deep pressure at the beginning (especially on the quadriceps in sports involving running or cycling). Check in with them often and look for the non-verbal signals of holding their breath or clenching their fists.

Any deep tissue work must be avoided at this time. It doesn’t matter how much you want to work out a knot in their thigh. Their muscles have experienced micro-trauma to the contractile proteins. Keep that deep transverse friction on hold for now (and schedule them for a therapeutic massage in a few days!). Just keep with the effleurage and petrissage, and you will feel the lumps smooth out in a few mintues.

I spend the final 10 minutes of a 30 minute post-event routine on stretching to the primary muscles used in the sport. I use a combination of static stretching, Muscle Energy Techniques (MET) and Active Isolated Stretching (AIS), depending on how the client is feeling from the competition. This stretching is key to restore the muscles to their normal resting lengths after strenuous activity.

These principles have helped me improve the recovery of marathon runners, NCAA track athletes, as well as cyclists at a touring event riding 100 miles per day for four straight days. I often see marathon runners limping into my clinic like Frankenstein and walking out with a big grin, feeling as if they hadn’t just run 26.2 miles. Post-event massage can be a very powerful tool to an athlete!

In Summary

• Perform post-event massage 30 minutes to 24 hours after the event
• Limit the massage to 30 minutes on the muscles used in the sports activity (don’t over-do it)
• Focus on effleurage, petrissage and broadening compression – Don’t dig in with friction!
• Check-in with the client about pressure often
• Utilize stretching (static, MET, AIS) to restore the muscles to their normal resting lengths

References

1. Arroyo-Morales M, Olea N, Martinez M, Moreno-Lorenzo C, Díaz-Rodríguez L, Hidalgo-Lozano A. Effects of myofascial release after high-intensity exercise: a randomized clinical trial. J Manipulative Physiol Ther 2008; 31 (3): 217-23.

2. Arroyo-Morales M, Olea N, Martínez MM, Hidalgo-Lozano A, Ruiz-Rodríguez C, Díaz-Rodríguez L. Psychophysiological effects of massage-myofascial release after exercise: a randomized sham-control study. J Altern Complement Med 2008; 14 (10): 1223-9.

3. Arroyo-Morales M, Olea N, Ruíz C, del Castilo Jde D, Martínez M, Lorenzo C, Díaz-Rodríguez L. Massage after exercise–responses of immunologic and endocrine markers: a randomized single-blind placebo-controlled study. J Strength Cond Res 2009; 23 (2): 638-44.

4. Ogai R, Yamane M, Matsumoto T, Kosaka M. Effects of petrissage massage on fatigue and exercise performance following intensive cycle pedalling. Br J Sports Med 2008; 42 (10): 534-8.

The role of massage in athletics is growing. It is a very common occurrence to see sports massage therapists at events ranging from 5K fun runs to the Olympic games.

Sports massage involves the application of therapeutic massage and stretching to assist an athlete’s performance and recovery from activity. However, there are different types of sports massage based on when you give the massage in relation to the competition:

• Immediately before competition (Pre-Event)
• Between competitions on the same day (Inter-Event)
• Immediately after competition (Post-Event)
• During the training program (Therapeutic/Maintenance)

When approaching these different types of sports massage, I prefer to focus on the purpose of the massage to direct me to the appropriate techniques. In this article, I will discuss the Pre-Event and Inter-Event sports massage.

The purpose of the pre-event sports massage is to prepare the athlete for high-intensity activity. The athlete is in the final stages of preparation and our job is to get the muscles loose without decreasing their psychological focus or causing significant physiological changes to their bodies. It is important to keep in mind that for this massage we are not looking to correct dysfunction or reduce stress, two primary goals of a typical massage therapy. Sounds crazy, doesn’t it? But it is true in this situation.

Pre-Event Sports Massage Workshop

Psychological Benefits

Besides the physiological benefits of massage, a pre-event sports massage can provide many unique psychological benefits to the athlete. First, they may gain the confidence that any perceived muscle issues are being corrected, leaving them to compete at their highest level. They may also believe that they are getting something that the other athletes are not receiving, and thus getting an edge-up on competition.

Further, many athletes make massage part of their pre-game ritual. When they come in for their pre-event massage, it helps them focus because it is part of their pre-event routine, similar to listening to a specific song before every competition. Athletes are commonly very habitual and superstitious, so when building a relationship with an athlete, I would advise to stay consistent with your pre-event massage routine. Don’t make any drastic changes do what you do with them, or you may have a negative impact on their mental focus.

Finally, during a pre-event massage it is definitely not the time to point out any problems you have noticed. For example, don’t tell an athlete about to compete “boy, your right hamstring is really tight today.” The last thing we should do is draw their attention to a specific body part!

Pre-Event Timing

A pre-event massage is performed the day of the competition, usually between 30 minutes to 2 hours before competition. Some massage therapists suggest 1-2 hours before, but in general, you want to give the athlete at least 30 minutes from the end of the massage to the start of their competition. The duration of the sports massage should be just 10-20 minutes in length.

Pre-Event Techniques

The techniques I utilize in my pre-event massage are: Effleurage, compression/broadening, petrissage (kneading), ROM, Active Isolated Stretching, vibration, and tapotement (percussion). If you use oil/lotion on them before they compete, be sure they are able to wipe or wash off the excess, as it could interfere with their heat regulation through their skin. When working at the NCAA track championships, I would often perform the pre-event massage at the hotel and encourage the athletes to take a quick shower to wash off any excess oil.

All techniques should be performed at an up-tempo pace. Remember, we are not trying to soothe the athlete before competition. Keeping the pace of the effleurage and petrissage quicker than you would in a normal massage can even help to psych-up the athlete before competition.

When performing pre-event massage, the therapist should avoid using deep pressure on the athlete. Although some studies have found no change in performance following a pre-event massage (1), a study published in the British Journal of Sports Medicine (2) found a decrease in muscle force production of the knee extensors immediately following a lower limb massage. From personal experience, I have received feedback from track athletes that deep work makes their legs feel “dead” and unresponsive following deep tissue work.

Further, we do not want to perform relaxation techniques. At the time of the pre-event massage, the athletes are trying to get “hyped-up” for competition, and soothing Swedish massage techniques can inhibit the sympathetic nervous system and potentially harm their performance.

Finally, right before competition is not the time to achieve significant increases in flexibility, as the athlete is not used to the increased flexibility, and they may not have adequate strength in this new range of motion. Any work to improve range of motion should be saved for the therapeutic sports massage sessions you provide in the weeks leading up to competition, when the athlete will be able to properly adapt their neuromuscular control to these changes. Just remember, they’ve gotten this far with the flexibility they have, now is not the time to make big changes.

Inter-Event Massage

The inter-event massage is a massage performed between multiple competitions on the same day. Sports such as swimming, tennis, wrestling, track and field, softball, baseball, and volleyball often require athletes to compete in a tournament format, with a short rest between bouts. An inter-event massage has been shown to improve muscle recovery between repeated bouts of strenuous exercise (3)(4).

The main difference between a pre-event and inter-event massage is duration. While a pre-event massage is given for just 10-20 minutes, an inter-event massage should be even more brief (about 10 minutes). This type of sports massage should focus on just the main muscles stressed during the previous competition. So, be sure to talk with your athlete about the event they just finished to see what they felt during it and customize your work to help them feel they have recovered as best as they can before competing again.

References

1. Goodwin JE, Glaister M, Howatson G, Lockey RA, McInnes G. Effect of pre-performance lower-limb massage on thirty-meter sprint running. J Strength Cond Res 2007; 21 (4): 1028-31.

2. Hunter AM, Watt JM, Watt V, Galloway SD. Effect of lower limb massage on electromyography and force production of the knee extensors. Br J Sports Med 2006; 40 (2): 114-8.

3. Brooks CP, Woodruff LD, Wright LL, Donatelli R. The immediate effects of manual massage on power-grip performance after maximal exercise in healthy adults. J Altern Complement Med 2005; 11 (6): 1093-101.

4. Ogai R, Yamane M, Matsumoto T, Kosaka M. Effects of petrissage massage on fatigue and exercise performance following intensive cycle pedaling. Br J Sports Med 2008; 42 (10): 534-8.

Arroyo-Morales M, Olea N, Martínez MM, Hidalgo-Lozano A, Ruiz-Rodríguez C, Díaz-Rodríguez L. Psychophysiological effects of massage-myofascial release after exercise: a randomized sham-control study. J Altern Complement Med 2008; 14 (10): 1223-9.

This study suggests a few things to me:

First, it shows the potential effectiveness of post-event sports massage to aid in the recovery of an athlete.  The quicker we can calm down the muscles after intense activity, the faster the body’s natural healing processes can get into action.

Second, I believe it shows the potential error of using deep tissue work in a pre-event or inter-event massage.  In these situations, we do not want to calm the muscles, but rather keep them at a semi-excited state to allow them to contract with maximum power in the upcoming competition.

Overview

Of all sporting activities, the golf swing is one of the most analyzed movements.  It is very common to see computer motion analysis offered at driving ranges and practice facilities.  Can you think of another sport where this high-tech analysis is readily available?  For my purposes here, the golf swing will be broken down into 3 phases:  the backswing, downswing, and the follow-through.

At my massage clinic, I will often ask my golfing clients to demonstrate their swing for me, so I can see which of the movements described below are limited.

The starting position of the golf swing has the golfer standing with a slight knee bend, bent at the waist to maintain the lumbar curve and their arms hanging relaxed in front of them holding the club just behind the ball.  The golf swing then involves a slow trunk rotation away from the ball to generate muscle tension (a “pre-stretch”) and weight shift, followed by an explosive trunk rotation toward and through the golf ball, ending with the weight shifted to the front leg.

This trunk rotation generates power that is transferred into the arms and down the golf club into the golf ball upon contact.

(NOTE:  The description of movement is for a right-handed golf swing)

Backswing

From the starting position, the trunk rotates to the right, as the right hip internally rotates and the left hip externally rotates.  Meanwhile, the left shoulder will horizontally adduct and internally rotate as the right elbow bends and the right shoulder externally rotates to allow the golf club to move around the body into the top position.  As the shoulder rotates, the right scapula retracts (adducts) and the left scapula protracts (abducts).  At the end of the backswing phase, the golf club is held above the head, with the left elbow straight and the left shoulder horizontally adducted so the left humerus is under the chin.

Common Muscular Problems with the Backswing

Legs & Hips (Right Internal Rotation, Left External Rotation, Right Pelvic Rotation)
Problem:  Limited hip rotation to the right
Action:  Release right gluteus maximus, medius and piriformis, left adductors, left TFL

Trunk (Right Trunk Rotation)
Problem:  Limited right trunk rotation
Action: Release left abdominal obliques and left quadratus lumborum

Shoulders (Left Horizontal Adduction & Internal Rotation, Right External Rotation)
Problem:  Limited left shoulder horizontal adduction
Action:  Release left posterior and medial deltoids, infraspinatus and teres minor, latissimus dorsi, and left rhomboids and middle trapezius

Problem: Limited right shoulder external rotation
Action:  Release right subscapularis, right pectoralis major, and right serratus anterior

Downswing and Follow-Through

The downswing phase generates club head speed and power to transfer massive energy to the golf ball.  The real power is generated by a “kinetic chain” in which the sequential motion of the legs, hips, torso, and then arms will occur.  This sequential firing of the body segments creates whip-like energy, much greater than if one body segment moved in isolation.

First, the muscles of the legs and hips will fire, with the right hip quickly moving into external rotation, turning the pelvis to the left, over the stationary left leg.  This rotation of the pelvis will transfer up into the trunk, which will powerfully rotate to the left.  Finally, the arms will begin movement, starting with the left shoulder horizontally abducting and externally rotating as the right shoulder internally rotates and the right elbow extends to drive the head of the golf club down to the golf ball.

The follow-through phase in the golf swing occurs after contact has been made with the golf ball.  This phase involves the deceleration of the body and is for the most part passive, with the exception of the core stabilization muscles.

Common Muscular Problems with Downswing and Follow-Through

Legs & Hips (Right External Rotation and Left Internal Rotation, Left Pelvic Rotation)
Problem:  Shooting sciatic sensation down left leg
Action:  Client is most likely swinging too hard, causing compression on sciatic nerve by the piriformis muscle

Problem:  Left lateral knee pain
Action:  Release the muscles involved with the IT Band (gluteus maximus and tensor fascia latae).  Also make sure client is rotating their torso and not shifting their body too much to the left

Problem:  Limited hip rotation to the left
Action:  Release left gluteus maximus, medius and piriformis, right adductors, right TFL

Trunk (Left Rotation)
Problem:  Limited left trunk rotation
Action:  Release right abdominal obliques and right quadratus lumborum

Shoulders (Left Horizontal Abduction and External Rotation, Right Horizontal Adduction and Internal Rotation)
Problem:  Pain in right medial epicondyle, especially upon contact with golf ball
Action:  Address right forearm flexor musculature.  This is a sign of medial epicondylitis (“golfer’s elbow”).

Problem:  Limited right shoulder horizontal adduction
Action:  Release right posterior and medial deltoids, infraspinatus and teres minor, latissimus dorsi, and right rhomboids and middle trapezius

Problem: Limited left shoulder external rotation
Action:  Release left subscapularis, left pectoralis major, and left serratus anterior

Related Posts:

Sports Massage for Ice Hockey

The Drive Leg
The skating motion involves a strong hip extension, abduction and external rotation of one leg while the body weight is supported on the opposite leg.  This motion primarily involves the piriformis and gluteus maximus.  Over time, these muscles will become very short and tight, so that you will see the clients feet rotated out when they lie supine on your table.  The adductor muscles are often strained from this rapid, forceful movement but this is usually caused by weakness in the adductors and a muscle imbalance with the strong hip abductors.

As the hip moves to generate the majority of the propulsion, the ankle will simultaneously evert and plantarflex to add a “snap” to the end of the leg drive.  The peroneals and lateral gastrocnemius is often a site of overuse with this activity.  Be sure to check the ability of the ankle to invert when you work on a skater…You will be surprised at the stiffness you will find!

The Stance Leg
While the rear leg is driving into hip extension, abduction and external rotation, the torso will forward flex and rotate toward the bent support leg.  This action places strain on the lumbar erectors, obliques and especially the quadratus lumborum muscles, as well as the quadriceps from supporting the body in a bent-knee position.  Speaking from my experiences playing recreation-league hockey, the day after the first game of the season was a slow moving time for me because of this low back stiffness.

Just yesterday, my clinic partners and I were providing sports massage to a local marathon training group, when one of my partners caught my eye to show me the stiffness in her client’s legs.   After seeing the stiffness in his hips, I said to him “You played hockey, didn’t you?”.  He was a little shocked & said “yes, for about 30 years” and I told him we could tell that simply from seeing his limited range of motion.  It was a guess, but by seeing many skaters over the years gave me a strong understanding of their movement restrictions and made it a very educated guess.

Most often, the pain is felt along the medial border of the shins, about 1/3 to 1/2 way up the tibia.  The muscle most commonly mentioned as a cause of this pain is the tibialis posterior, but the muscle just as likely involved is the medial portion of the soleus.  Both muscles run up the medial border of the tibia, but the tibialis posterior muscle dips underneath the soleus very distal to the usual site of pain to attach on the posterior border of the tibia.  So if the pain is higher up than the lower 1/3 of the tibia, this leaves the soleus as the muscle involved.

Tibialis Posterior

When looking into the biomechanics of the area, the tibialis posterior and medial soleus muscles are put under strain when the subtalar joint of the foot falls into over-pronation.  Because a function of the tibialis posterior muscle is to support the medial longitudinal arch and over-pronation involves the collapsing of the arch, this action will cause a rapid stretching of the tibialis posterior.

Likewise, repeated eversion of the calcaneus that takes place with subtalar pronation will increase the strain on the medial portion of the soleus muscle.  Over time, the strain placed on these muscles will be transmitted up to their origins on the tibia, creating strain at the attachments on the periosteum of the bone (periostitis).

The athlete will complain of  pain along their inner shin, and point to the medial border of the tibia.  This pain will increase with activity and decrease with rest.  They will have tenderness or pain on palpation of the distal medial border of the tibia.  If you find one small spot that is the source of all the pain, the athlete should be referred to a physician to rule out the possibility of a stress fracture.

Because pronation increases the stress on the medial musculature, a goal for us is to reduce the causes of pronation.  One of the first things we should address is the footwear of the athlete.  I have built strong relationships with the running shoe stores in my city, and refer my clients to them to find the correct shoe for their gait.  By supporting the medial longitudinal arch, the pronation is reduced and the strain on the medial muscles is eliminated.

With massage, it is easy to focus on the site of injury, but remember that pain is a symptom!  We need to treat the structures that are potentially the cause of the condition.  Tight peroneals will pull the foot into eversion and upon weight bearing, pronation.  Additionally, we want to focus on the lateral gastrocnemius and soleus.  With pronation, the lateral belly of the gastrocnemius will typically hold itself tighter than the medial side.

Besides the muscles of the shin, I also recommend looking at the great toe extension (see my earlier post for explanation), the lateral hamstrings and even the lateral rotators of the hip.  All these can promote pronation by externally rotating the leg and forcing the weight to roll off the inside of the foot when walking or running.

I have been invited to provide sports massage this week for the University of Michigan Track & Field athletes at this year’s NCAA championships (my 5th championship trip).  The location changes year-to-year.  This year they are held in Fayetteville, Arkansas.  The track and field championships run from Wednesday through Saturday, with the athletes competing in preliminary rounds over the first two days to qualify for the finals on Friday and Saturday.

My job here is to help the athletes recover between each round, keeping their legs loose and feeling fresh.  If an athlete competes early in the day, I will give them a post-event “flush-out” massage and assisted stretching at the sports medicine area next to the track facility, but the majority of my work is done back at the hotel in the evening after each day’s events (I usually work until about 11:00pm).   I will also perform pre-event sports massage in the mornings if an athlete has a late evening competition, so I really find myself on-call all day during this week.

Because the athletes compete so often, I do not perform any deep trigger point work while I am here.  Instead, I use broad pressure massage and light stretching techniques to ensure I do not cause any soreness or muscle inhibition the following day.  I also keep the duration of these sports massages brief, about 20 minutes on average — just enough time to loosen their legs.

A key component of this work is that the athletes have received sports massage from me throughout the season, and their bodies have become accustomed to my techniques.  This ensures they will not feel sore from the massage as well as not feel I am doing anything new or unfamiliar to them before the biggest competition of their career.

As I tell the participants in my sports massage courses, a great perk of working an event like this is the opportunity to meet with other massage therapists and sports medicine professionals, something I plan do do as much as possible this week.  There is always more to learn, and I enjoy looking for new techniques and tips from the other therapists at these events.

Working a NCAA Championship is a fantastic experience, and I feel very fortunate to be here.  I can’t tell you how great my job is when I am able to work with an athlete all season and then see them fulfill their dreams of winning a national title!

Let’s say you have a client who comes in for a sports massage complaining of shoulder pain.  They state they have pain when they raise their arm overhead in either full shoulder flexion or abduction (remember the difference?  Flexion is raising the shoulder forward & abduction is raising it out to the side).

The first step is to have your client lie supine (face up) on the massage table.  This will stabilize the back and eliminate any compensatory movement.  Now have them slowly raise their arm fully overhead in shoulder flexion.

If they experience pain with this movement, you then have them return their arm to the starting position.  They will repeat the motion, but this time you will assist their scapula in its normal movement.  Sit or kneel at the side of the table and slide one hand under the lower part of the client’s scapula, hooking your fingers as best you can on the medial (vertebral) border.  Now instruct the client to raise their arm overhead once more, but as their shoulder flexes, gently pull their scapula into abduction and outward rotation.  Chances are good that the pain will be reduced or eliminated completely.

Assisting Scapular Motion

Why?  Because a significant percentage of shoulder injuries are due to scapular movement dysfunction.  In a previous post, I mentioned that the scapula needs to abduct and rotate outward when the shoulder flexes or abducts.  When the scapula cannot properly move, the glenohumeral joint will try to increase its movement to compensate for the loss, leading to impingement of the supraspinatus tendon or other soft tissue under the acromion.

Working at the site of the pain will simply be treating the symptom, and the client will not show significant improvement until the supporting musculature are addressed.

So, if you find yourself with a client who fits this scenario, you need to work on releasing the muscles that prevent the abduction and external rotation.  Namely, the levator scapula, pectoralis minor and rhomboids.  In addition, these clients will often show weakness in the serratus anterior muscle, which has the job of scapular abduction and outward rotation.

You can also use the assessment test as a means of training the client’s muscles to fire correctly.  Simply have them perform slow, full shoulder flexion while you assist the scapular movement into abduction and outward rotation.  Over time, these repeated movements will re-educate the muscles (and nervous system) to how active they should be during shoulder flexion.  Just be sure this movement remains pain-free!