Massage therapy is highly focused on addressing muscles. However, tendon and ligament injuries are quite common and can be the source of soft-tissue pain. The massage techniques we learn are aimed at muscles, but common massage therapy methods are easily adapted for tendon and ligament pathologies as well.

How to Discern if Tendons and Ligaments are Injured: A Simple Distinction

Assessment is the best way to determine whether tendons or ligaments are injured, though that’s beyond the scope of this article. However, in very general terms, tendon pathologies often arise from gradual repetitive overload, while ligament injuries generally occur from acute (sudden) overload. This is a simplification of these injuries, but is a good starting point for the majority of tendon and ligament pathologies.

Massage for Tendon Injuries: What You Need to Know and the Benefits of Friction Massage

Treatment for chronic overuse tendon pathologies can be a little counterintuitive. Tendon injuries generally involve collagen degeneration, though tearing is also possible with severe injury. Complete rest so the tissue can rebuild seems like an effective way to deal with these types of injuries.

Some degree of rest from the offending activity is certainly helpful. However, we now understand that stressing the tendon with certain types of load, especially eccentric muscle load, helps the tendon adapt to the stresses and leads to quicker recovery. So, despite the fact that injury was caused by excessive use, exercising the tendon is actually a crucial part of the healing process as well.

See Also: Can Massage Therapy Help Those Diagnosed with Sciatica?

Deep friction massage is a common approach for addressing chronic overuse tendon disorders. Formerly, the primary benefit of this technique was thought to be reducing unhealthy scarring within the torn tendon fibers. We may not yet understand the mechanism of healing, but we do know that deep friction massage produces clinically beneficial results.

One possible explanation is that pressure and movement applied to the tendon may stimulate fibroblast activity and encourage tissue healing within the damaged collagen matrix of the tendon.

Similarly, friction massage is still used with clients suffering from tenosynovitis. The primary theory around massage for tenosynovitis is that friction massage can help reduce dysfunctional adhesion and binding between the tendon and surrounding synovial sheath. Friction massage has never been confirmed through research, so right now, we recognize this strategy as beneficial but still needing further investigation.

Working on Associated Muscles

Another very important facet of treating any tendon pathology is working on the muscles associated with the injured tendons. In addition to decreasing aggravating activities, tensile loads on the tendon can be reduced by decreasing tightness in the tendon’s associated muscle. A wide variety of massage techniques are effective in achieving that goal.

Massage for Ligament Sprains: What You Need to Know

Working with ligament sprains follows a similar track. Ligament sprains result from an excess tensile force on the ligament. In a mild sprain, the fibers may be slightly overstretched, whereas in a more severe sprain, there may be fiber tearing along with significant inflammation and potential long-term tissue damage.

Whether or not massage can do anything significant to encourage the healing process of a sprained ligament is still unclear. Massage may help with encouraging tissue regeneration to some degree, as with tendons.

Additionally, a joint that is not properly mobilized during the healing process may develop fibrous adhesion between the healing ligament fibers and adjacent tissues.

Frequent friction of the healing ligament, including self-massage multiple times during the day, may help reduce the likelihood that adhesions adversely bind the healing ligament and prevent full range of motion in the future.

Massage therapists need to remember that ligaments do not contain contractile tissue, so do not contract. Some massage techniques supposedly “release” the ligament, but we must remember that because ligaments don’t contract, they also don’t release.

In fact, releasing a ligament is one of the main things you don’t want to do because ligaments are designed to be stiff and hold joint contact surfaces in proper orientation with each other.

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To give clients the most benefit, massage therapists need to understand how different soft tissues function, what happens to them when injured, and how our massage techniques interface with those tissue disorders.

As we continue to learn more about tendon and ligament physiology, we may also develop more strategies that will help our clients get back to activities even sooner.