Know the difference. The third principle is being able to differentiate among mobility, flexibility, stability and central nervous system control. Mobility is what the joint has to offer you and has an orthopedic range of motion value given to it. Your shoulder, for example, should have 90 degrees of external range of motion. If your client only has 70 degrees, you need to know why. Flexibility indicates tissue extensibility. Perform a bilateral comparison and note any differences. Does the right hamstring look different than the left? Stability is having neuromuscular control, which isn’t possible if joints are misaligned. Central nervous system control refers to how well the body is communicating with the brain. Could a calcium spur, herniation, bulge, fascial adhesion or misalignment be interrupting the normal neurological signal from the brain to the joint or muscle, causing the body to compensate? Massage therapists need to be prepared to consider these questions.

Timing is everything. The fourth principle is timing. When I traveled and worked with a professional baseball player, I had to pay attention to his changing physical needs during preseason, in season and right out of season. In preseason, you are getting your athlete ready to perform. In season, you are usually treating injuries and helping them maintain their conditioning. At the end of season, overuse injuries might start popping up. Timing can also refer to when a massage therapist provides massage: pre-event or post-event. You don’t want to choose an aggressive technique that might change their muscle length tension relationship around a joint right before an event. You could make them more vulnerable to an injury. Before the event, massage therapy should focus on increasing blood flow using techniques like compression and shaking, and warming the tissues to help make them more pliable. Post-event, you are helping to speed and aide in recovery from the exertion of their sport. You might use long broadening strokes, effleurage, medium depth compression, or petrissage to encourage increased lymphatic flow.

Assume nothing. The fifth principle is to never assume anything. Assess the athlete you’re working with prior to beginning a session. Ask them what they are having trouble with or the goals they have for massage. Check in with them during a session. Again, many athletes are going to be very self-aware and know their bodies, so you want to make sure you’re including them in the process.

Setting Your Space

So what should a typical sports therapy session look like in your office, clinic or even home visit? Determine where the athlete is in their season and/or their training routine.

Screen for abnormalities—all complaints and non-complaints. Base your approach on your assessment, not your palpation skills. A non-painful failed screen is just as important as a painful one. The non-painful poor movement pattern can give you a clue to why they have a particular complaint. During the session, screen, massage, screen, massage, screen, massage until the complaint has lessened.

Use heat and ice where appropriate.

Invite the athlete to follow up with you to determine success of massage session and plan additional sessions if necessary. There really is more to sports massage therapy than most therapists realize. Mastering the application of sports massage therapy takes years of education and experience. But with the proper training and client management, you can truly help each of your clients gain more confidence in the sports they love.

Here is an example of how applying a technique without assessing ended up being unhelpful for the client:

Chief Complaint was hamstring tightness. The massage therapist palpates the tissues and determines the piriformis is tight. Massage cupping technique is applied to the hamstring and the piriformis muscle. A week later, the client returns with the same complaint and additional hip pain. Massage therapists uses the same treatment plan. This client now returns with complaints of hamstring, hip, and SI pain that stopped them from running.

Here is the end result: The client went to a physical therapist who assessed the hip and determined there was a potential labrial tear. An MRI confirmed the assessment.

The question here becomes: Was the tear the original reason for the hamstring pain? Was there a precursor of a calcium deposit on the hip? If the answer to either of those questions is “yes,” the FABER (Flexion, Abduction, and External Rotation) assessment would have revealed lack of range of motion of the hip. A one-leg stance test or a manual muscle test would have told the therapist there was also lack of stability. Lack of stability combined with lack of range of motion can be an indicator of degenerative joint disease or a tear. Again, the key with athletes is assessment. Without a good assessment protocol, massage therapists can’t confidently provide massage that will help and not hurt.

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