A Sports Massage Therapist must understand the process of athletic training and competition, the physiology of muscle function and what happens when someone trains and competes, and the kinesiology of movement for particular sports.
Physiology of Fitness
Aerobic Training Builds aerobic fitness which is the body’s ability to take in, transport and use oxygen. Aerobic Training is work done at an intensity that puts stress on the athlete’s respiratory and cardiovascular systems. Beyond this stress level is the aerobic threshold, the point at which the athlete goes from aerobic training (having enough oxygen) to anaerobic (not enough oxygen to sustain the activity).
During Aerobic training, an athlete uses their heart rate or breathing as a guide to proper intensity. If the training heart rate is more than 80% of the maximum heart rate, they are considered to be outside of the aerobic threshold. If the training creates the sensation of not being able to take in enough air ( creating a need for rapid breathing), the athlete is considered to be above the aerobic threshold.
Proper aerobic training has the following effects:
- strengthens the heart muscle
- enlarges arteries to carry more blood
- increases the number of red blood cells so that more oxygen can be carried
- increases the number of mitochondria which increases the rate the cells pick up and use oxygen from the blood
- increases the cell’s ability to create ATP which is the essential protein for metabolism
Aerobic training should be activities that are performed continuously for a minimum of 15 to 20 minutes at a level of 70% to 90% of maximal heart rate; no less than three times a week. The goals of the athlete will determine the frequency, intensity and duration of the training.
As aerobic fitness increases, the athlete can increase the load to stay within the aerobic training parameters.
Aerobic capacity is the ability to work using oxygen in combination with fats and carbohydrates as fuel sources to produce energy.
At low-aerobic levels, fat is the primary fuel source. At high-aerobic levels, glycogen – stored carbohydrate in muscle – predominates as a fuel source.
Strength is the ability of the muscle to contract. As a muscle increases in strength, the muscle fibers thicken (hypertrophy). Tendons and ligaments also respond to training by thickening. Muscle thickening or hypertrophy is the main factor in muscle growth.
Hypertrophy is an increase in the size of the muscle due to an increase in the size of the muscle fibers, while hyperplasia is an increase in the number of muscle fibers. Hypertrophy comes in two forms, sarcomere hypertrophy, an increase in the size of the contractile portion of the muscle; and sarcoplasmic hypertrophy, an increase in the non-contractile portion of the muscle. Sarcomere hypertrophy involves a smaller increase in the diameter of the muscle, but muscle density increases. Sarcoplasmic hypertrophy shows an increase in muscle diameter and a decrease in density. All hypertrophy will involve both processes; the ratio is dependent on training intensity and frequency.
Hyperplasia is the splitting of muscle fibers, resulting eventually in a greater number of fibers the same size as the originals or so the theory goes. Even with everything we know, we don’t really know how muscles strengthen.
Strength training stresses the muscles by gradually increasing the workloads and alternating with periods of adaptation and rest (growth). By repeatedly overloading the work capacity of the muscle, mico-damage to the tissue results. This is healed in the adaptive phases. If the repair is not completed before more stress is applied, abnormal healing such as adhesions, microspasm and inflammation may result increasing the risk of injuries.
Endurance is the ability of a muscle to work over a period of time. Muscles need a steady supply of oxygen and nutrients to function and as the muscle tires, it looses its supplies of nutrients and the ability to respond. Specific training can increase the body’s ability to use it’s supply of oxygen and its stores of nutrients more efficiently.
For runners, greater endurance means longer periods of work at maximum function. It also means using the muscles to their depletion of stored nutrients. For precision sports such as baseball and tennis, it means an increase of accuracy and speed. A fatigued muscle lacking adequate oxygen and nutrients is slow to respond to nerve signals.
Muscular endurance depends on:
- Availability of nutrients- the fuel muscles burn to produce ATP (energy) is glycogen which is a type of sugar that is stored in the muscles. The amount present at the time of exercise comes from what was eaten approximately 12 hours earlier. When muscles are depleted they become heavy and unresponsive. This is often called “hitting the wall” or “bonking”. The storage of sugar can be increased by depleting the store and then loading up on carbohydrates. Repeatedly exercising to depletion can cause more nutrients to be stored during the recovery and rest periods which will increase performance.
- Availability of oxygen which is necessary to burn the muscle sugar and complete the metabolic process. Good aerobic fitness can help ensure an adequate supply of oxygen.
- Proper removal of wastes that build up in the muscle and inhibits proper contraction is also necessary. There is much controversy over the theory of lactic acid building up in a muscle and the recovery time. (Lactating Mythers Massage and the Lactic Acid Myth Keith Eric Grant, Ph.D.)
- Thermal control. The build up of heat reduces the muscle response and tissue damage. Cramps may also be a result of overheating of the muscle (although there are also other reasons for cramping). Muscles cannot function properly unless they are adequately cooled.
Flexibility is the muscle’s ability to stretch which influences an athlete’s range of motion and overall strength and endurance.
Flexibility is affected by several factor such as:
- structural alignment
- over-developed muscles
- tight muscles, tendons and ligaments
- joint restrictions
- temperature of muscle and training area
Stretching can facilitate flexibility. Stretching before and after a workout adds strength to the body, aids in the prevention of injury, and dramatically increases recovery time.
When a muscle is in a tightened position, the fibers of the muscle are not able to contract fully. That means that in regular exercise, the muscle is not being strengthened to it’s fullest. Training is slower and less efficient.
A tight muscle that is lacking flexibility also is at an increased risk of injury which will end or restrict an athlete’s training.
Sports Massage Strokes
Sports Massage Pre-Event Guidelines
Sports Massage is basically applying the principles of bodywork and massage to athletes. What makes it different is that athletes have very special needs. Knowing the person and the sport is what will make your treatment of greater value.
This is a short, specific treatment given immediately before ( 30 minutes- 24 hours before) and event. The goal of treatment is to increase the circulation, flexibility and mental clarity of the client to improve performance. It does not replace the athletes warm up but complements it. It is important to know your clients sport or activity and what muscles are used the most. It is also necessary to assess the athlete’s condition and needs prior to treatment. Factors such as temperature, nervousness, fatigue, hyperactivity are considered before giving a treatment. If the client is cold more warming things need to be done. If they are already warmed up, focus on flexibility. If they are nervous some soothing strokes may be called for.
The amount and depth of treatment is the most important key to effective treatment. Deep tissue work is contraindicated as it may cause too much of an increase in flexibility and it may interfere with the clients timing and strength. Keep the goal in mind at all times.
- Use brisk invigorating variations of sport massage strokes to specific muscles as per sport
- Create long lasting hyperemia
- Use gymnastics, stretching, PNF if athlete has used them before.
- Begin light and gradually increase pressure and speed
- Energize or calm down as needed
- Do Not comment on tightness at this point-it may be too negative and depressing
- If an athlete is unprepared or injured or tight to the point of causing an injury, bring this up with caution
- Consider the time remaining before and event. If it is 30 minutes, give a really short (5-10 minute) treatment. If it is the day before, a little longer treatment is ok.
- Be aware of how much a client has had massage previously to an event. It will determine how their body will react to the treatment.
- In endurance sports, concentrate on overall energy and flexibility.
- In strength related sports, concentrate on the specific muscles used.
- Do Not Treat Stress points/Triggerpoints: Use only 24 hours before competition and only if the athlete is used to having such a treatment before and event.
Sports Massage Post Event Guidelines
Post Event treatments are done immediately after an event, usually within 1-2 hours. The goal of the session is to flush the tissue of the lactic acid and other by products of metabolism. The intent is to cool down the body and return it to homeostasis. Muscle tension, cramping, and inflammation are also addressed. Remember anyone competing in an event usually gives it their all in terms of effort and are left extremely fatigued. Massage can reduce the recovery time of such an effort.
Ask the Athlete these questions to assess the condition of the person:
- How much water have you had since the event?
- How did you do in the event?
- Are you hurt or feeling tension anywhere?
- What do you want worked on?
- Do you feel hot/cold?
- Is there another event after this?
- Use light draining strokes moving toward the heart: concentrate on moving fluid out of there.
- Use jostling or vibration
- Use general compression
- Start lightly and gradually apply more pressure
- Use gymnastics to assess the joint range of motion: Do Not Do active resistive exercises on tired muscles
- Use gentle compressions and light circular friction to aid in circulation and reduce spasming
- Use effleurage and pettrissage for lymph drainage
- You may not be able to use oil or lotion so keep that in mind.
Things to watch for during Post Event Treatments:
- Hyperthermia Definition: When the rate of heat production exceeds that of heat loss for a sufficient period of time, resulting from inadequate fluid replacement or from failure of the thermoregulatory systems of the body
- Heat Exhaustion Signs/Symptoms: Headache, nausea, hair erection on upper arms and chest, chills, unsteadiness, fatigue, skin cool and pale, sweating, dizziness, thirst
- Treatment: Refer to medical aid unit to be placed in a cool environment and allowed to “sip” water.
- Heat Stroke- Failure of the thermoregulatory systems: Extreme Emergency
- Signs/Symptoms: incoherent speech, acute confusion, aggressiveness, rapid unconsciousness, absence of sweating (ocaisionally sweating), weakness, irrational behavior
- Treatment: Refer to Medical Unit : Decrease the body temperature immediately with cold compresses to the head and neck, alcohol rubs, place in cool environment
Thermal Stress Conditions:
- Hypothermia- the rate of heat production is exceeded by heat loss: unable to maintain adequate core temperature: can be worse on cool, wet windy days.
- Signs/Symptoms: shivering, euphoria, appearance of intoxication: shivering may stop as core temperature drops even more. Lethargy, muscle weakness followed by disorientation, hallucination, combative behavior, unconsciousness
- Treatment: Refer to Medical aid unit: Restore body warmth with protective covering and surface friction. Remove wet clothing and move to warm environment.
- Cramps Definition: complete muscle spasm without complete contraction of the fibers accompanied by intense pain
- Causes: fatigue, dehydration, electrolyte imbalance ( calcium, potassium, magnesium), muscle strain, injury
- Treatment: Bring origin and insertion of muscle closer together. Avoid further spasm. Direct pressure may also help. Ice massage, replace fluids and electrolytes.
Sports Massage Training Guidelines
Training massages are given throughout the training stage of athletic performance. An athlete will have an event in mind and begin a regimen of training as needed to reach that goal. They begin with building a base of strength and endurance and continue to attain maximum performance level. Massages can be given before or after a workout depending on the needs of the athlete. Treatments are geared toward the areas of highest stress during the workout. Each sport varies as does each athlete’s stress points.
Benefits of Massage for Athletes in Training:
- Faster recovery from micro damage and trauma from workouts
- Increase in flexibility and range of motion
- Relieve fatigue and rejuvenate
- Reduces the strain of repetitive motions
- Reduces the healing time of injuries
- The main goal is to keep an athlete injury free. What do you need to do to accomplish this?
- Find out what their schedules are like. Do they lift weights, run, stretch, drink enough water?
- Are they doing more strength training, endurance training or both? Are they sore from tightness or lactic acid build up?
Massage before a workout guidelines: Massage before a workout can make a athlete feel weaker and unmotivated. They may not even want to do their workout after the session. Be sure to know your clients needs before proceeding and warn them as to the effects of such a treatment. Once you get to know your clients schedule and training methods, you will be better able to determine if a session should be done before workout or after a workout.
- Find out when they last worked out and what they did in the workout. What areas are tight, fatigued or over stressed
- Check to see when they will be working out. That day? A few hours away? The next day? The time may influence the type and length of massage session.
- Work to increase flexibility and range of motion.
- Know your athlete’s event. Ask them. They know where they hurt and take the most stress.
- Look at your client’s overall body alignment to determine areas of higher stress.
- If they are fatigued you may want to use more effleurage and other strokes to drain lactic acid build up. If they are tight, you may want to use Trigger point methods.
Massage after a workout guidelines:
- Find out what they did today and provide treatment accordingly. How did they feel today? When is their next workout?
- Do they need flushing out or relief from tightness?
- Are there other areas not directly involved in their activity that may be bothering them?
Areas of Greatest Stress By Sport
- Long distance: Hamstrings, Quadriceps, Adductors, Gastrocnemius, Knees, Ankles, Plantar Fascia, Quadratus Lumborum, Piriformis, Gluteals, Iliopsoas, Abdominals, Trapezius, Deltoids, Teres Major, Teres Minor, Distance running stresses the joints because of the repetitive pounding and jarring of the hips, knees, ankles and feet. The balance of the foot determines stress areas. Pronation or supination can occur due to imbalances in the hip and psoas.
- Sprinters: Iliopsoas, Gastrocnemius, Hamstrings, Piriformis, Quadratus Lumborum
Short bursts of speed require strength with higher leg lift and faster cycles of leg turnover. Running on the toes puts excess strain on the lower legs. Running one way on the track around curves put strain on the inside hip and leg. Iliotibial bands absorb stress. The balance of the foot is important.
Groin injuries and hamstring injuries can occur during starts off the blocks.
Neck strain from excess speed should be treated as needed.
- Cycling: Low back from constant flexion; neck – extensors, SCM ; shoulders- pectoralis, trapezius, arms, wrists, hands from weight bearing on handle bars, quadriceps, hamstrings, gluteals, gastrocnemius. Watch for overuse of hamstrings as they are in a constant shortened position. Wrist strain may occur from clenched fists and flexor contraction.
- Weight Lifting: Total body stress. Excessive abdominal exercises can lead to imbalances in the psoas. Back problems may occur. Strains occur when improper technique is used or lifting too much before they are strong enough. One side is often weaker than the other which is reinforced with the lifting. It is necessary to work all areas to build balance as injuries are usually due to imbalances in the agonist/antagonist groups.
- Cross-Country : Endurance sport. abdominals, shoulders, arms, quadriceps
- Downhill: The body is in constant isometric contraction. quadriceps, iliotibial bands
- Rock Climbing: forearm flexor and extensors, hand and wrist, quadriceps
- Tennis/Raquetball/Handball: Arm stress especially forearm is common. Elbow stress, Shoulder stress – deltoids, trapezius lower fibers. Elbow and forearm stress are usually from improper posture or technique. Iliotibial bands are usually overused with the side to side movements.
- Baseball: Shoulder alignment is important for throwing. The pectoral muscles, latissimus dorsi and teres major are often affected. Quadriceps and Hamstrings can become tight from quick starts running to base or fielding.
- Basketball: Knees affected with jumping and landing. Calves and achilles tendons are strained with jumping. Hamstrings are often tight. Chest muscles are overstreched as players hold arms up in air. Iliotibial bands are stressed with all the running.
- Soccer: Knee strain can occur with twisting from running and kicking. Hips, groin, leg, knees and ankles. Running with short bursts of speed and quick stops cause strain.