The World of Sports and Exercise Massage

Objective

This text is written with many objectives. It should provide information to answer some of the questions listed in Box 1-1, at least those about exercise, athletes, and what it takes to work with this group of clients. However, it cannot explain why you want to work in this realm. No textbook or teacher can answer that question for you. I am still figuring it out for myself. Many years of working with hundreds of athletes (for real), as well as with thousands of “ordinary” people, have blessed me with accumulated therapeutic massage experience, most of which has been learned independently of formal classroom training. One of the main purposes of this text is to consolidate this experience so that it won’t take others over 30 years to become proficient at this type of massage application.

This text targets the sports/fitness/physical rehabilitation client. These clients range from individuals involved in physical rehabilitation requiring exercise programs, including cardiovascular and cardiorespiratory rehabilitation, and physical therapy for orthopedic injury; persons incorporating exercise as part of a comprehensive fitness and wellness program, including weight management; and recreational and competitive athletes, both amateur and professional. Return to the questions in Box 1-1 and really look at them. What is your motivation for wanting to learn how to use therapeutic massage to serve this population?

The sports, fitness, and rehabilitation communities are using massage at an increased rate; however, many misconceptions, much inaccurate information, and even dangerous methods such as extreme stretching and invasive inflammatory “deep tissue” massage are being taught and practiced as sports massage. Complaints from those who have received ineffective massage that was not worth the time and money are common. This is unacceptable. Members of the profession have the responsibility to provide safe and effective massage care for all populations.

Objective

Since the first edition of this book was published in 2005, advances have been made in our understanding of the effects of massage, the importance of exercise, and the physical and physiologic demands on athletes. Research has exposed many myths about massage and components of sports training. These myths will be discussed and more current and accurate information presented. As a massage therapist, especially when working with clients who place excessive demands on their bodies, it is absolutely essential that lifelong learning is a priority, as is remaining current with research evidence.

It is assumed that the reader is proficient in the following areas of knowledge:

In the first edition of this textbook, review content for these areas was included because it was difficult to determine the baseline education of the reader. Now, as massage therapy entry level education has begun to be standardized and more resource material is available for your review, this content has been reduced but does appear on the Evolve website that accompanies this book. You should already know about anatomy and physiology, sanitation, draping, massage manipulations, and techniques such as body mechanics, assessment, charting, and treatment plan development, as well as ethics and professionalism. These foundational skills and knowledge are even more important when specializing in a target population.

This information should have been presented in your initial massage therapy education. However, we all need ongoing review and updates. It is strongly suggested that you obtain the most current edition of the following books and online courses, which provide the foundation necessary to learn the material in this book:

These two textbooks and the online course will provide you with the most current information about massage therapy and an excellent review of all the necessary sciences. The online course that accompanies the Essential Sciences text is interactive, comprehensive, and fun.

For further study on bones, joints, and muscles and how they function together, take advantage of Joe Muscolino’s texts:

This textbook is an excellent resource:

The following two books are comprehensive and will provide the opportunity to expand on the information in this textbook:

For updated information on the importance of fascia, read the following:

Objective

This textbook is designed to be a teacher, and I hope that it can be somewhat like a mentor. A teacher presents new information and skills and refines and targets previous learning. A mentor has professional experience, has achieved individual excellence, and wants to help others achieve their own success.

It is important for you to confirm that your teachers and mentors provide you with information and skills for you to excel, and that they are qualified to teach you. I have been a massage therapist for over 30 years and a school owner and educator for over 25 years, teaching more than 4000 students. I have written many textbooks and have created an online science course. My experience with professional athletes is extensive, including an educational partnership with the Detroit Lions organization for 14 years, as well as with individual players from multiple NFL teams, NBA players. and PGA golfers. I have worked with famous athletes and amateurs. I still work with professional athletes, and some of them have been my clients for over 15 years (Box 1-2).

I present these qualifications to support my role for you as a teacher and a mentor.

I have been fortunate in my career to have great teachers and mentors. One of these was Dr. David Gurevich—Russian physician, physical medicine specialist, soccer player, and tango dancer. It was an honor to learn from him for 8 years. He taught me a practical and innovative application of massage, which he learned as a battlefield surgeon and a long-time specialist in physical and rehabilitative medicine in Russia.

Dr. Leon Chaitow is also my teacher and mentor. His review and consolidation of research supporting soft tissue methods provide much of the foundation material for this book. And of course, every client I have worked with and every student I have taught has served as both a teacher and a mentor (Box 1-3).

Athletes provide great learning experiences because, as a group, they present many different and complex problems that must be solved to help them reach and maintain their desired goals.

The world of athletics is culturally diverse and rich in cultural experience and has no room for prejudice. Other than the military, I don’t think that multicultural interaction toward a common goal is displayed any better than in team sports. Most competing amateur and professional athletes are young, ranging from adolescence to 40 years of age. Advances in medical care have extended the playing age. As a 60 year–plus Mom-type person, I have stayed current and tolerant through these interactions.

The hard part of this work is learning how to be a professional in the sports/fitness/rehabilitation environment. You cannot be a groupie—no asking for autographs and no type of interaction with the athletes other than ultimate professionalism. A professional gender-neutral appearance is essential. Ethical conduct, especially as related to confidentiality, is mandatory. For example, I have worked with athletes for whom a specific injury was not disclosed or completely explained by the team to protect the athlete from being targeted by the opposing team during play. Most professional athletes have competed with injuries, and if the opposition knows the details, it is possible that they will target the defensive play to take advantage of the vulnerable area of the player. Although athletes do not typically intend to harm each other, it is common for reinjury to occur as part of the defensive play. Also, there is a distinct difference between an athlete’s professional life and his or her personal life. Most have families and are in committed relationships. Spouses have to constantly put up with groupies, and their private life is often invaded by fans asking for autographs. Athletes and their families should not endure the same demands from their massage therapist.

An ongoing question I ask myself as a teacher and a mentor is how I can instill the desire for excellence and awareness and acceptance of the time, practice, and persistence required to work with these types of issues and clients. I hope this textbook becomes part of the answer to my question. It is necessary for all massage therapists to conduct themselves with integrity, and those in a position of authority need to remember that they must be a quality example of ethical behavior and professional conduct.

So, here is the reality: There is no such thing as “sports massage”—only appropriate massage as applied for each client. Whether your client is a runner, bowler, swimmer, surfer, or golfer; is a baseball, basketball, football, or soccer player; or has just completed a treadmill stress test—this is an important factor to consider as part of the treatment plan. This text also provides skill development for treating the general population: any client can sprain an ankle, develop post-exercise soreness, or have a headache or backache. Do not limit use of this text just to those considered athletes. We are all athletes in some form anyway.

Objective

This text is presented as an integrated outcome-based approach to massage. It is not based on specific massage and bodywork types (Swedish massage, reflexology, shiatsu, deep tissue massage, and the seemingly never-ending list of others), because specific styles of massage do not support individual applications based on client goals. Instead, we will discuss the application of mechanical force to stimulate the neuroendocrine/neuromuscular systems, to affect myofascial structure and function, to assist fluid movement, and to support homeostasis. The content should prepare the massage professional to interact effectively with various treatment, training, and rehabilitation protocols of the sports and fitness world. General lifestyle requirements such as sleep, nutrition, and stress management are an important part of the athlete’s world. These will be addressed as part of the knowledge foundation needed to be an effective massage practitioner with this type of client.

Although this text is based on theory, it is more focused on practice. It is more about how than why. Practical application comes from years of working in the real world.

Out of necessity—the mother of invention—my students, fellow instructors, and I have figured out applications that you may not have considered but that we have found worked well. Examples related to body mechanics, positioning of the client, and ways of adapting massage applications are provided throughout the textbook. So, please keep an open mind and give these things a try before you judge. I share all of this with you in this first chapter not to brag but to establish that I have been there, done that, made mistakes, and learned something from most of them, and that I will not try to candy-coat this career track.

Objectives

The reality check of building a professional practice with professional athletes is a wake-up call. The truth is that it does not happen very often, and if it does, working with the professional athlete takes a lot of time, travel, and flexibility. The professional sports community is very mobile. You seldom work with this level of athlete for more than a season or two. Boundaries are a big deal. This population can be needy and demanding because of the pressures of performance.

There are not that many professional or Olympic athletes around—fewer than 400 NBA basketball players and fewer than 2500 NFL football players. The numbers for other team sports are somewhere in between. Individual professional athletes such as tennis players, golfers, and bowlers also make up small communities.

Most massage therapists will serve the high school, collegiate, amateur, or semiprofessional athlete and those in rehab or striving to achieve, or maintain, fitness.

A common misconception is that professional athletes make millions and millions of dollars. Only a few are in that category. Most make far less, and amateurs generate no athletic income at all. For those athletes who have limited income, justifying the cost versus the benefit of therapeutic massage is an ongoing issue, or the athlete knows the benefit but cannot afford the cost. Participation in sports, fitness, and rehabilitation costs money, and often lots of it. If a person is going to use massage on a regular basis, the fees need to be manageable.

The immediacy and intensity of the athlete’s world demand an integrated body/mind/spirit approach delivered by well-trained massage professionals. Exceptional demands are placed on professionals who work with athletes and those in physical rehabilitation because of the extraordinary circumstances of these individuals. The environment of competitive sports and physical rehabilitation makes for “bigger-than-life” moments. There is the drama of win or lose, the trauma of injury, and the career-determining or even life-or-death situations of surgery and rehabilitation. Working in the world of sports and fitness can be like a roller coaster ride, but with a lot of monotony between the highs and the lows. I have spent many hours waiting for athletes while they received treatment, slept, were interviewed, had meetings, or forgot appointments. Much of this text was written during this time.

The massage therapist not only must be highly skilled in massage applications for each mode of sports or fitness activity but also must have motivation, maturity, reliability, compassion, tenacity, tolerance, stamina, flexibility, commitment, faith, hope, perseverance, humility, self-esteem, little need for personal glory, and the ability to work behind the scenes, to improvise, and, above all else, to think and solve problems.

This book does not have all the answers or even all the information you will need to be a competent massage therapist. It is virtually impossible to describe in depth each and every sport in a single volume. It is your responsibility to learn about the particular sport of each of your clients. However, this text does cover the general movement patterns used in sports and fitness: running, throwing, hitting, kicking, and so forth. Each sport has an ideal performance form; superimposed on this is the form modified and adapted by the individual athlete. You do not need to be able to expertly perform the sport to understand the demands placed on the body.

The individual athlete is the best expert on his or her own situation. If you are going to be able to help individuals with massage, they need to be willing to teach you and you have to be willing to learn. I have spent hours watching a variety of workouts and types of performance training. I can’t throw a football very well but have had the quarterbacks show me how to hold the ball and attempt to throw it. This event was the source of lots of laughter but was a great learning experience for me. I can’t dribble a basketball very well either but have had basketball players show me how. I have attempted to do strength and conditioning activities, including using the weight machines and performing balance exercises. I have done the warm-ups and even got stuck on a bar attempting to do a stretch that one of the ice skaters was doing and had to be rescued. In all of these endeavors, I looked really silly, but that is okay.

Primarily I am a teacher, so I wrote this text the same way that I teach a class. The approach that I use, and that seems to work best, is an integrated massage style based on valid scientific research coupled with the clinical success of some massage methods still awaiting validation. Research has identified massage benefits in relatively concrete terms based on physiologic mechanisms. An overview of sport-specific research will be presented later.

Basically, massage aims to produce three types of effect on the body systems: structural, physiologic, and psychological. Although these effects are closely related, it is the initial mechanical effects brought about by the manual skills of a massage therapist that lead to the physiologic and psychological effects. Hence, the stroking, squeezing, compression, rubbing, and so forth that are applied to the skin and underlying soft tissues not only produce physical benefits but also trigger physiologic and psychological responses. To achieve the desired balance and results, it is vital to understand the principles behind the various massage techniques. The type and extent of effect on the body depend on the technique itself, the depth to which it is applied, and the area of the body being massaged.

In addition to massage, those involved in sports, fitness, and rehabilitation are often interested in adjunct therapies, including hydrotherapy, aromatherapy, Asian bodywork methods, magnets, and various forms of relaxation/meditation. Unit Two is devoted massage application and the inclusion of adjunct methods to this content. Understanding sports injuries and massage application requires knowledge of tissue susceptibility to trauma and the mechanical forces involved. Unit Three is devoted to this content. The final unit of this text, Unit Four, combines all of the presented information in a series of case studies. By studying the various cases, the reader can integrate the textbook content into practical hands-on applications.

This book is written as a textbook to support the classroom environment. It can also be used to self-teach. Once the information has been assimilated, the text becomes a reference text because it is impossible to remember it all. The chapters are set up in typical textbook form with objectives and outlines. At the end of each chapter is a workbook section. Throughout the text are various commentaries by athletes and those involved in rehabilitation and associated professions, stories to illustrate a lesson or to bring a concept alive, and helpful hints. It is logical to start at the beginning and work sequentially to the end of the text because each chapter builds on the one before it. You can’t just read this book. You need to do it, just as athletes do in training. They practice over, and over, and over.

 Workbook

Visit the Evolve website to download and complete the following exercises.