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Pre-Event Sports Massage
Earl Wenk, ATC CSCS NCTMB

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.

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.



Post-Event Sports Massage
Earl Wenk, ATC CSCS NCTMB

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


Therapeutic Sports Massage
Earl Wenk, ATC CSCS NCTMB

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.



Earl Wenk, ATC CSCS NCTMB
Earl Wenk has over 15 years of experience in the field of sports medicine, working as both a certified athletic trainer and massage therapist. In addition, he has achieved certification as a strength and conditioning specialist through the National Strength and Conditioning Association. He works with athletes of all ages and skill levels from recreational runners to Olympic medalists. His clients include the University of Michigan Track and Cross Country teams, professional track and field athletes, paralypians, and world-class figure skaters. Visit him at: http://www.musclewisdom.com.


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