114 Some Uses and Modifications for Treatment

therapist is going to be able to perform all ne- side. In that situation wet-wipes or an astrin-
cessary techniques with the greatest ease and gent lotion should be available for use.
that the recipient is at all times warm and
comfortable.
Warn participant

Even if the participant has frequent massages,

Materials
always warn what to expect as a result of this
Various oils may be used, most commonly session, e.g. pre-compet1t1on stimulating
vegetable based, ice and non-steroidal anti- massage may induce a feeling of warmth but the
inflammatory gel. Towels, ranging from small rules of warm-up must still be observed.
to very large, and inflatable pillows.

Massage manipulations in
Skin preparation
sports massage
Many sportspeople shave their legs before com-
petition and small nicks are not unusual. The massage manipulations used in sports
Aseptic conditions should apply with absolute massage are as described in Chapter 2, plus acu-
cleanliness essential. pressure and ice massage.

Joint position Acupressure

In the treatment rooms positioning as described Acupressure/acupuncture (acu is Chinese for

in previous chapters should be adhered to. At needle) points are stimulated by finger or thumb
track or pitch side be prepared to be innovative pressure. There is a complete therapy using the
and use whatever is available and suitable to 'tsubos' - specific sensitive points used in acu-
obt~in the best joint position. pressure and also shiatsu (in Japanese shi =
finger, atsu = pressure) where whole hands,
elbows, feet and knees may be used to massage
Technique
the body (Jarmey & Tindall 1991).
This will be addressed later in the chapter. In sports massage acupressure tends to be
to specific trigger points. These points are
identified as tense, sometimes hard, and always
Check
producing pain in the muscle/connective tissue.
Always ask the patient if the massage is deep Once the point to be treated has been
enough, too deep, or as they want it. identified, the finger or thumb is used to apply
pressure to that specific point. The technique is
similar to that used in circular frictions but only
Clean up
one finger or the thumb tip is used. There are
Participants cannot enter the competition arena many different opinions as to the length of time
covered in oil. A basketball player with oil on the pressure should be held. A firm pressure
his thighs can get this on to his hands with dis- accompanied with a slight circular motion
astrous results. Soap and water are available in applied for a maximum of one minute, relaxed
the treatment room but not necessarily at pitch and re-applied three or four times, gives good
Massage in Sport 115

results. The object is to try to get muscle relax- These six specific sports massages may have to
ation in as short a time as possible, thus making be carried out at pitch or track side and it may
this technique very useful immediately prior not always be possible to follow to the letter
to activity by removing particular spots of the manipulations, routines and methods sug-
muscle/tissue tension. The use of both acupres- gested. The therapist must be prepared to be
sure and shiatsu in sport is growing and there adaptable and use the manipulations and skills
are many varying theories on the subjects, from at his/her command in the most advantageous
basic applications to reduce muscle tensions way to aid the participant in their chosen event.
right up to the complete science of the full
holistic concept of Oriental medicine (Downer
Massage in conditioning
1992).
The conditioning time of year for any
sportsperson will depend entirely on what their
Ice massage
goals are for that particular year. The actual
The most convenient method of application of time of year will vary from sport to sport,
ice massage is to use a polystyrene cup which dependent on the competitive season and major
has been filled with water and then frozen. Cut event(s). The object involves the SAID princi-
a 1.25 cm ring from the top edge of the cup and ple: Specific Adaptation Imposed Demands
then massage the injured area with the ice until (Wallis & Logan 1964). This principle puts the
an erythema is achieved. If dealing with tendi- body through safe and intense development, to
nous or small areas an ice cube held in a tissue achieve peak condition at the time of major
is best. competition. There may have to be more than
one time of 'peaking' in each year, e.g. to
qualify for Olympic selection in June and then
Sports massage to compete in the Olympic Games in September.
Massage at the time of conditioning plays a
Sports massage can be divided into: very important part in the training regime.

(1) Specific sports massage

(2) Non-specific sports massage Objects
(1) To promote recovery from a hard training
session. It is to be expected after a hard
Specific sports massage bout of exercise that the sportsperson will
experience various aches, pains and a
Specific sports massage is given for a particu-
feeling of tired and heavy limbs. Massage
lar reason and can be used in six different
can be invaluable in speeding up recovery
situations:
at this time.
(1) Massage in conditioning (2) To aid cool down. The object of cool
(2) Massage as treatment down is to return the body to its pre-
(3) Pre-competition massage exercise state as quickly and painlessly as
(4) Inter-competition massage possible. Massage at this time can be used
(5) Post competition massage to aid circulation, assist in the removal of
(6) Post travel massage waste products and enable the participant
116 Some Uses and Modifications for Treatment

to perform their cool down regimes more Stroking - to provide relaxation and aid venous
effectively. return.
(3) To prevent delayed onset muscle soreness Tapotement/shaking/vibrations - to stimulate
(DOMS). It is widely appreciated that and give a feeling of wellbeing.
intense bouts of exercise will produce Effleurage - to aid venous and lymphatic
varying degrees of muscle soreness after return, and to assess the final state of the
the event. This soreness may not be tissues.
noticed for up to 24 hours after cessation
of the activity. Many learned sources will
Method
insist that there is no specific proof that
massage will, in any way, prevent the Start with the back, then the limbs, concentrat-
occurrence of DOMS. On the other hand ing on the muscles most used in the training
observation and anecdotal evidence lead session. Often finish with a foot massage.
those who are actively engaged in the
field of sport massage to feel DOMS
Duration
can be, and is, influenced positively by
the application of the correct massage Whole body one to one and a half hours, half
techniques. body half to three quarters of an hour. This
(4) Psychological effect. The importance of massage can be given on a daily basis through-
the psychological effect of touch has never out the conditioning period, with the first
been fully quantified. At this hard time of massage being given the day before the first day
training for the sportsperson a massage of hard training.
performed by a good knowledgeable prac-
titioner can make a vast difference to their
Contra-indications
continued wellbeing and can enhance the
benefits of the conditioning period. As described in Chapter 3, paying particular
attention to identifying and avoiding any micro
trauma that may have been occasioned by a
Contact materials
particularly hard training session.
Oils, mild warming rubs.

Massage as treatment
Routine and manipulations used
Massage as a treatment for sports injuries can
Light effleurage - accustoms the person to be used after 48 hours if all bleeding and tissue
touch, also tests to see if there has been any swelling has ceased. In the case of haematoma,
micro trauma to soft tissue as a result of hard after four days or dependent on the patient's
training. tolerance.
Deep effleurage - to promote venous and lym-
phatic drainage.
Objects
Petrissage - to mobilise the soft tissues.
Deep effleurage - as above. (1) To stimulate circulation. Forty eight hours
Acupressure - to address any specific tension or after trauma it is important to clear away
trigger spots identified. the debris of the incident and remove the
Massage in Sport 117

excess tissue fluid. Massage can play a slight stretch on those tissues; also to reduce
useful part in reaching these goals. muscle spasm.
(2) To promote recovery from injury. As Effleurage - as above.
stated above, to stimulate circulation and Frictions - Counter-irritant effect as described
also to ensure the continued good state of in Chapter 2, to mobilise and break down
surrounding tissues. scar tissue.
(3) To break down adhesions. The most Tapotement - excitation effect as described in
important result after injury in sport Chapter 2, plus a feeling of wellbeing.
must be that the individual has not Effleurage - as above.
been left with a tight shortened scar in Shaking - applied both locally and to a total
any soft tissue. Adhesions and scar tissue limb aids relaxation and relief of muscle
are sources of trouble and can result in tension and cramp. Acupressure - by stimu-
further trauma producing bigger and lating trigger points it is possible to gain
thicker areas of adherent tissue. Massage muscle relaxation or increase in muscle tone,
can play a very important part in the dependent on depth and length of pressure
recovery. applied.
(4) To promote flexibility. It is essential that Connective tissue massage - to mobilise the
all participants have returned at least to deep reticular layers of the dermis.
their previous level of flexibility after Rolling - as described in Chapter 2.
injury. Massage can provide a useful Effleurage - as above and to assess the final
adjunct to the essential stretch routines state of the tissues.
performed by the patient.
(5) To improve the range of movement. Most
types of injury, both soft tissue and bony, Method
may well necessitate periods of strapping Always massage proximal and then distal areas
and/or immobilisation. A return to full of the body before concentrating on the treat-
range movement is necessary prior to ment area proper.
return to full training and competition.
Massage is used extensively to facilitate
achieving a full range of movement. Duration
Dependent on area and sensitivity of the area
Contact materials to be treated - may be ten to thirty minutes.
Oil, cream, heat rub, ice, anti-inflammatory gel The treatment can be used daily depending on
patient's level of discomfort and training/com-
or cream.
petition schedule.

Routine and manipulations used

Contra-indications
Stroking - accustom the sportsperson to touch
and discover any areas of sensitivity. As described above, plus not within three days
Effleurage - to promote venous and lymphatic of training or competition if the methods are
return; depth will depend on injury. used to treat scar tissue or adhesions. Never if
Petrissage - to mobilise soft tissue and induce the patient cannot tolerate treatment.
118 Some Uses and Modifications for Treatment

Pre-competition massage and mobilising soft tissues. Massage prior

to activity will make it easier to carry out
Massage prior to competition is to many sports-
the specific stretches needed for any
people part of the ritual carried out before their
performance.
sporting endeavour. The time of this massage
(2) To aid warm-up effect. As the term
as part of the adjunct to performance must be
implies, warm-up is about warming the
carefully planned. If dealing with a team sport
body prior to activity. The vasodilatation
and all players require a massage, there must be
caused by massage will enhance this phase
adequate staff so that massages are not carried
of physical preparation.
out many hours before the actual physical
(3) Psychological effect. The time spent on the
warm-up. In the case of individual perfor-
massage couch is often used by partici-
mance, the report time and/or start time will
pants to prepare mentally for the forth-
decide the time of the pre-competition massage;
coming action. This may be done in
for example: start time 10.30 AM, report time
conversation with the therapist or may be
10.10 AM, warm-up one hour, therefore the pre-
inward and silent. There is a great advan-
competition massage must start at 8.40 AM at
tage if the therapist knows the competitor
the latest.
well and knows whether or not they like
Warm-up is the preparation of the body
to talk at this stage. It is also a good time
for physical activity. It is divided into three
to reinforce positive messages and allay
components:
fears about injury worries and the state of
the opposition.
(1) Raising body temperature and increasing
cardiovascular activity
(2) Putting all joints through a full range of Contact materials
movement and all muscles into their great- These must be carefully selected dependent
est length of flexibility on the activity about to take place and great
(3) Sport specific warm-up by practising the care must be taken to clean the area well after
activities to be carried out. the massage. Oils, creams, talcum are all appro-
priate, but do not use any heating agent. All
Thus, a rugby player will end his/her warm-up rubefacients will cause vasodilatation of the
with ball skills, passing and tackling; a hurdler skin and this will prove to be detrimental to the
will hurdle; and a discus thrower will practise warm-up. The vasodilatation needs to be great-
the movements required to throw the discus. est below the dermis to aid warm-up.
This massage cannot be used instead
of the participant's own physical warm-up
Routine and manipulations used
but definitely can be used to enhance the
preparation. Stroking - to accustom the person to touch.
Effleurage - to promote venous and lymphatic
return, and discover any area which is par-
Objects
ticularly tight, tense, or giving pain.
(1) To prepare muscles for exertion. By Petrissage - to increase mobility of the soft
increasing the circulation to specific areas tissues and stimulate circulation.
Massage in Sport 119

Tapotement/shaking/vibration - all or one or During a compet1t10n which has several

two to promote feeling of wellbeing and give rounds such as qualifying, quarter-final, semi-
relief from muscle tension. final and perhaps even finals on the same day,
Effleurage - to finish massage and ascertain that there are periods of rest in between. This is
the desired effects have been produced. when massage can be very useful to the partici-
Trigger point acupressure - may be needed if pant; also in multi-events at track and
there are specific areas of muscle spasm, field, when the men do ten events over two
tension or increased tone. days and the women seven. In this circum-
stance, if the athletes spent their normal time
before and after each discipline doing warm-
Method
up and cool-down, they would be too tired
As requested by the participant. Many sports- to compete. Cool-down is the time immedi-
people only want/need massage to a particular ately after training or competition when the
area, e.g. hamstrings or calf, while others participant will jog and perform specific exer-
request a full body massage. cises all aimed at returning the body to its
resting state. Massage is extremely useful to
complement a shortened warm-up and cool-
Duration
down, but again cannot replace these essential
Dependent on the area to be covered and length activities. The only time massage can replace
of time to achieve the desired effect of stimula- cool-down is if the participant is too exhausted
tion and to decrease any spasm or increased to perform an active cool-down or if injury pre-
tone. Frequently 20-30 minutes but a max- cludes activity. Massage can never replace
imum time of one hour. As a last minute active warm-up.
attempt to decrease specific muscle tension, five
minutes of acupressure can be used. It is best
Objects
performed immediately prior to warm-up and
it may well be followed by particular muscle (1) To promote recovery. After a bout of exer-
stretch techniques such as contract/relax, cise there will be waste products in the
stretch/relax as used in progressive neuromus- tissues. Massage, by stimulating venous
cular facilitation techniques. Do not use hot and lymphatic return, aids the process of
rubs. elimination of such products.
(2) To refresh the competitor. In a prolonged
competition it is not unusual to experience
Contra-indications
muscle fatigue and general tiredness.
As already stated and not if the competitor has Stimulating massage can be advantageous
not used massage prior to competition on pre- to combat both feelings.
vious occasions. (3) To work out niggles. After hard exercise
there may well be a feeling of tightness in
certain muscle groups, which will not
Inter-competition massage
respond to the competitor's normal series
When there is prolonged competition it will be of stretching exercises. Massage can be
necessary to provide inter-competition massage. used to help physically and also to reassure
120 Some Uses and Modifications for Treatment

the part1c1pant that there is no maJor Method

problem developing.
As needed by the competitor. Early on in the
(4) To prevent muscle cramps and spasms. It
day the request may be to address one specific
is not unusual, especially if the competi-
area that is bothering the competitor. But as
tion is taking place in a situation where
the competition continues and usually before
dehydration can occur, to be presented
and/or after the last event of the day, it may be
with cramps. While the competitor rehy-
necessary to cover the full body.
drates with the correct fluids, massage can
be used to help increase the circulation to
the affected part. Duration
As time allows; may be for only several minutes
Contact materials or up to an hour. It is best to perform inter-
Be careful to select the correct medium. If the competition massage immediately after cool-
area is sweaty or has sand or chalk on it, it must down and/or prior to the next warm-up.
first be cleansed. The pores will be open and
you do not want to clog these with any medium Contra-indications
which will impede heat loss. A very light oil or
soapy water is best. Never use any hot rubs at As previously stated, and any area of recent
this stage. It may be necessary to use ice trauma must be avoided.
massage if there is an area where there could be
actual tissue damage. Post competition massage
At the cessation of activity the competitor will
Routine and manipulations used
do cool-down. Massage can be used to enhance
Stroking - to accustom the person to touch the effects of this procedure. On certain occa-
and to assess the temperature and state of the sions it may be necessary to replace active cool-
area to be massaged. down with massage and passive movements,
Effleurage - to promote venous and lymphatic e.g. after a marathon, long distance event, or
return and discover any particularly tense when the competitor has sustained an mJury
spot(s). which precludes active cool-down.
Petrissage - to help remove the waste products
and mobilise the soft tissues. The rolling
Objects
manipulations described in Chapter 2 are
particularly useful here. (1) To carry away waste products - as used
Acupressure - to any area which is excessively in inter-competition massage.
tense or tending to cramp. (2) To allow body functions to return to
Vibrations and shaking - whole limb shaking normal. At the end of any period of phys-
and vibration are very good towards the end ical activity the cardiovascular system
of this massage to ensure the limb is ready may be working excessively hard, or as a
for the next bout of exerise and unlikely to result of the cessation of activity the blood
go into cramp. pressure can suddenly drop. Massage,
Effleurage - to complete the session and prepare especially centripetal effleurage, is very
the competitor for their warm-up. useful in restoring normality.
Massage in Sport 121

(3) To prevent post-exercise pain - as Duration

previously described m massage m
Dependent on the area to be covered it may last
conditioning.
15-30 minutes or may take a full hour. This
(4) To work out niggles. Frequently after
massage is best performed after the active cool-
activity the participant may complain of
down and preceded by a tepid shower. When
certain specific areas of pain or tension.
taking the place of an active cool-down it is
If any tissue damage is suspected, ice
essential to ensure that the participant is
massage can be applied. If the cause is
adequately rehydrating as well as receiving
purely exercise induced, then massage is
massage.
beneficial to remove the tightness.
(5) Psychological effect. As previously des-
cribed this can be very important either Contra-indications
if the competitor is on a 'high' after com-
Again as previously described, and being very
peting successfully or, conversely, 'down'
circumspect around painful areas which might
after a poor performance.
well be caused by micro trauma, in which case
only ice massage should be applied.
Contact materials
Ice, soapy water, light oil but not any hot rubs Post travel massage
or talcum. It is very common for all types of sportspeople
to have to travel varying distances to partici-
pate in competition all over the world.
Routine and manipulations used Wherever possible sufficient time should be
All manipulations to be used slowly and rhyth- allowed to permit adequate acclimatisation
mically. Stroking - to assess the area and both to time change and climatic conditions.
accustom the sportsperson to touch. In reality the competitors may not be able to
Effleurage - at first light and centripetal, then allow this time to adjust. The length of time
deeper if there is no tension or pain. It can spent on travel and the frequency of this travel
be performed in all directions, to increase cir- can adversely affect performance.
culation and remove waste products. Travel problems highlighted in sport are:
Petrissage - starting fairly light and deepening
• General feeling of stiffness
to a level the participant can tolerate.
• Feeling of lassitude
Effleurage - interspersed between all other
• Aches, especially in the lower back, neck
strokes and for at least five minutes at the end
and shoulders
of the massage to enhance tissue drainage.
• Swelling of lower legs and feet

Solutions are:
Method
As requested by the competitor, may be only to • Light exercise
one specific area or may be to whole body area • Shower
and in some instances may be used in place of • Jacuzzi
active cool-down. • Massage
122 Some Uses and Modifications for Treatment

Objects hour. Best results are gained if the participant

has already carried out some gentle activity,
(1) To increase the venous and lymphatic
such as a jog and gentle stretches, and then had
flow, thus removing swelling and stiffness.
a tepid shower prior to massage.
(2) Gently and deeply to stretch the soft
tissues, to remove aches and increase
flexibility. Contra-indications
(3) To remove any residual stiffness without
As previously described, paying particular
tiring the competitor with exercise.
attention to the effects of dehydration.
(4) To restore the normal balance of the body.
(5) To create a feeling of wellbeing.

Non-specific sports massage

Contact materials
Oil or creams. Do not use talcum or hot rubs There are times in the competitor's year when
as there may well be some dehydration present. there is no competition or conditioning taking
place. At those times the athlete will still be
maintaining his/her body in a state of pre-
Routine and manipulations used paredness for the activities of the future.
Stroking - to assess the condition of the skin Massage can play a very important and helpful
and accustom to touch. part at those times and is referred to as non-
Effleurage - first centripetal to aid tissue specific massage. This term also applies to
drainage and increase venous and lymphatic massage given when the competitor has arrived
return. Then multi-directional to promote at the competition site ahead of the event by at
tissue stretching. least two days, or finished competition and is
Petrissage - especially kneading, wringing, still present at the competition site, waiting
picking up and rolling techniques to assist for the rest of the team to complete com-
drainage and stretch the soft tissues. petition and return home. Basically we are
Effleurage - should be interspersed regularly referring to a massage which is given for no
with all other strokes. specific treatment purpose, and is not before,
Tap6tement, vibration and shaking - to aid between or after competition or travel. Non-
venous and lymphatic return and to promote specific sports massage can be divided into two
a feeling of wellbeing. applications:

(1) General body massage

Method
(2) Specific areas of massage
Start with the back and neck, then the legs and
if necessary the arms as well. Finish with
General body massage
assisted stretches to the major muscle groups
used in the participant's activity. Sportspeople spend a large part of their
lives conditioning and preparing their bodies
for the rigours of their particular sport. Many
Duration
of them firmly believe that regular full body
Dependent on the areas to be covered. A massage will aid them in their pursuit of
minimum of 30 minutes but may last over an excellence.
Massage in Sport 123

Objects turn, foot massage as opposed to facial massage

and, if deemed necessary, finish by returning to
(1) To enhance a general feeling of wellbeing
the back.
(2) To promote relaxation if this is desired by
For objects 1 and 3, as described in pre-
the participant
competition massage.
(3) To stimulate if requested by the
For object 4, extra effleurage at the start and
participant
finish of the session.
(4) To monitor the condition of the muscula-
For object 5, as described in treatment massage.
ture and soft tissues
(5) To highlight and deal with any area which
could develop into a problem Duration
For objects 1 and 2, as long as is needed to gain
desired relaxation, usually an hour to an hour
and a half. It is important that the competitor
Contact materials
can lie and relax for at least half an hour after
Oils. If knowledgeable, aromatherapy can be completion of the massage.
used (see Chapter 10), creams, mild warming For objects 1 and 3, as described in pre-
rub, talcum powder. competition massage.
For object 4, a few extra moments at the end
of each session.
For object 5, as your findings necessitate.
Routine and manipulations used
For objects 1 and 2: Contra-indications
Stroking - to accustom to touch.
Effleurage - long slow manipulations used As previously described.
continuously.
Kneading - deep enough not to tickle, slow Specific areas of massage
and rhythmical.
Dependent on the muscle groups most used
Effleurage - slow to end the session.
in their particular event, the competitor may
For objects 1 and 3:
request an area of body to receive massage,
As described in precompetition massage.
rather than a full body, e.g. throwers - back
For object 4:
and/or shoulders; sprinters - hamstrings,
Deep effleurage.
quadriceps and calf muscles; distance events
For object 5:
and soccer players - calf massage.
Trigger pointing and friction may be added
and in this case the non-specific massage
will change to a treatment massage if Objects, contact materials and manipulations
specific problem areas are highlighted. As described in general body massage.

Method
Method
Concentrate on the area highlighted by the par-
For objects 1 and 2, as described in Chapter 2, ticipant but do not forget to clear the sur-
starting with back and neck, then each limb in rounding area.
124 Some Uses and Modifications for Treatment

Duration time is of the essence is to be absolutely clear

about the main object of this massage. It may
As long as is needed to gain the desired effects.
be to eliminate a particular point of tension or
increase range of movement. Having identified
Contra-indications the object, choose which of the techniques can
best deliver the desired effect and use them. If
As previously described.
the sport is an outdoor activity it may not even
be possible to remove clothing, e.g. skiing, ori-
enteering, distance running - participants fre-
Summary
quently wear tights or jogging bottoms to
protect their legs. In instances like these whole
• Never give a first massage to a participant
limb shaking, vibration or trigger pointing
within 48 hours of competition
through the clothing will be the best massage
• Arrange for the first massage to take place
techniques to use.
when there is plenty of time for any adverse
effects to be worked off
• Adverse effects may be
- producing too much relaxation References
- stirring up old problems such as scar
tissue Downer, J. (1992) Headway Lifeguides. Hodder &
Sports massage may be sport specific and any Stoughton, London.
therapist involved must know and understand Jarmey, C. & Tindall, J. (1991) Acupressure for
Common Ailments. Gaia Books, London.
the principles of that sport. Most importantly,
Wallis, E.L. & Logan, G.A. (1964) Figure
the rules and call-up times of the sport must be
Improvement and Body Conditioning Through
understood. As already stated, there will not Exercise. Prentice Hall, New York.
always be time to perform the beginning, Williams, J. (1974) Massage and Sport. Bayer,
middle and end of a massage as you might wish. Switzerland.
The most important issue in a situation where
144 Some Uses and Modifications for Treatment

relax and maintain a prolonged treatment manipulations. The object is not to work
without undue fatigue. deeply, but to spread the lather and loosen
scales of skin. As the scaly patches are loosened,
use a swab to remove them from the work area.
The treatment
If the lather dries up or disappears, re-
Using oil or lanolin or ung. eucerin moisten your palms and work them together
first. You may find the lather reforms, but if
Open the container and leave the cap off. If
not recreate lather by following the above
using oil, pour a little into the dish.
procedure.
Examine the part to be treated and using
On completion of the treatment:
your finger or thumb tips apply the lubricant
to the margins, then to the centre of the area. either wipe the whole area with swabs, working
If possible, support your forearms or elbows on a whole limb from proximal to distal, or
adjacent to the treatment area and, using your on a smaller part from centre to periphery.
lubricated finger or thumb tips, work from the This will leave a thin coat of oil on the area.
periphery to the centre of the area. or wash the area by first washing your own
As you work, the lubricant may 'disappear' hands and rinsing them, then lathering them
so add more, a small amount at a time, on the so that you can apply a non-oily lather to the
area on which you are at present working. Do part to wash it.
not at any point swamp or flood the area.
Rinse, swab clean as above, then dry the part if
On completion:
necessary.
either leave the residual lubricant on the skin
or gently swab most of it away, using a clean
swab for each subsection cleaned, and wiping Massage for scars, burns and
the central area first followed by the margins. plastic surgery

All scars, whether primary lesions, secondary

Using soap and oil
repairs or grafts, have a tendency to contract by
Open the container of oil and pour a little into as much as a third of their length. All injuries
the small dish. Put the palmar surface only of to the skin, whatever the cause, also tend to
your hands on to the surface of the hot water, become oedematous, and may become slow-
so that the dorsal surface does not become wet. healing and indurated. The oedema can be a
Use the soap to work up a good lather on the disaster in the case of a skin graft which may
front of your hands. Pour about 5 ml (one tea- be 'lifted' and prevented from 'taking' by the
spoon) of oil on to the palm of one hand, and oedema.
work your palms together to distribute the oil At best, permanently contracted scars will
into the lather. cause inconvenience and at worst they cause
Apply your hands to the area to be treated, gross deformities with severe functional
spreading the lather over the whole area. If you limitation.
need more lather repeat the above procedure, Along with other measures, the appropriate
but you will find the lather spreads over a large application of suitable massage techniques will
area. Now, work with one or both hands over help to maintain scar length and assist the
the whole area using stroking or kneading type movement of oedema so that it may be resolved
Massage for Conditions 145

or absorbed. The appropriate moment at which

to massage any scar, healing burn or plastic
repair will be determined by the state of the
healing process, the other underlying injuries or
lesions and the imperative need to prevent the
above complications. It must be borne in mind
that over-zealous and too early massage may
encourage the formation of hypertrophic
(keloid) tissue to which burns victims are espe-
cially prone.
Contact materials are usually used as they
lubricate the skin, allow gliding without friction
and often make painful manipulations more Fig. 11.1 Compressive palmar kneading to the
tolerable. The different oils and their uses are dorsum of a burnt and grafted hand.
explained on p. 144, and it should be noted that
where wounds are still unhealed, great care
must be taken to avoid infection. The selected
lubricant should be sterile and renewed daily or
at each treatment, and it should be used only
up to the margin and not over the open wound.
The massage manipulations which are used
are those suitable to treat the state at that
moment. Thus, the initial or persistent oedema
must be treated by clearing the venous and
lymphatic vessels proximal to the wound, using
the techniques described for oedema on p. 148.
The localised area of oedema may need
fingertip vibrations, effleurage strokes initially
at the margins and gradually encroaching on to Fig. 11.2 Finger kneading to the periphery of the
the more central area, followed by finger or burnt hand.
thumb kneading interspersed with effleurage
strokes, until the swelling is softer and the
patient tolerates handling better. imal lymph glands, including the scar in the
Next, use as much of your hand as possible strokes if possible. It may be necessary to work
to apply pressure over a larger area (Fig. 11.1). more lightly over the scar itself with these
The central (unhealed) area may be covered strokes.
with a sterile dressing and gently kneaded, The scar which is less oedematous but more
maintaining even pressure and attempting to bound down or contracted greatly, is treated
compress and move the whole scarred and by initial and gradually deepening effleurage
swollen area. Rocking the whole area may be strokes round the periphery, followed by finger
feasible, using your hands as in muscle rolling and thumb tip kneading to the same area (Figs
(Fig. 2.25). Complete your work, by effleurage 11.2, 11.3, 11.4 ). Then, work on to the scar with
strokes from distal, round the scar to the prox- the small kneading manipulations, continuing
146 Some Uses and Modifications for Treatment

Fig. 11.3 Encroaching and deepening the finger Fig. 11.5 Stroking the central area. Note that the
kneading. wrinkle at the thumb tips indicates some skin
mobility.

Fig. 11.4 I humb kneading to the central and more Fig. 11.6 Rocking the whole area from side to side.
mobile area of burns to the back of the knee.

until the skin is either warmer to touch or pink, Intersperse with rocking the whole scar (Fig.
or both. Start slowly and increase your speed as 11.6) along its length from side to side using
the patient's tolerance increases. either one or both hands, and then attempt
Now start to use stretching manipulations, small wringing manipulations (Figs 11. 7 and
which may be finger or thumb tip kneading 11.8). Identify the worst areas and give them
with greater depth and slightly greater range, or special attention, perform local skin wringing
stretching strokes (Fig. 11.5), working along and skin rocking, and finish with effleurage
the length of the scar and gradually using the round and to the whole area from distal to it,
side of your thumb or finger to push up against and up to the proximal lymph glands.
the scar as you stroke along the margin. In some cases, you may find it better to
Massage for Conditions 147

Fig. 11.7 Wringing a small area using tinger and

thumb tips on the back of the knee.
Fig. 11.9 Squeeze kneading to each finger with
stretch on the tip to maintain extension.

At the completion of the massage, the

surplus lubricant may be wiped off with the
swabs, or may be left on the skin to facilitate
its lubrication. The patient should, if possible,
be taught to use a selection of appropriate
manipulations on his or her own scars.

Treatment for haematoma

Fig. 11.8 Wringing on the side of the hand to Painful areas may be treated by massage in an
mobilise the adherent skin. attempt to relieve the pain. Areas of disorder
often have local spasm which is protective. As
the attempt to protect against movement of
support the more distal part of a limb manually the part spreads, yet more spasm will spread to
and apply stretch with your supporting hand as the adjacent areas. Spasm prevents drainage
the tissues become warm and softer (Figs 11. 8 and thus causes local congestion. Metabolites
and 11.9). The stretch should be so gentle as to accumulate and increase the disorder and
be unobtrusive and should not make the patient discomfort.
aware of increased discomfort. Bruising or haematoma are the consequence
In the section on kneading in Chapter 2, it of injury and may both present at the site of
was stressed that the circling of the hand should the injury, and in adjacent or distal areas into
avoid sudden points and becoming pear shaped. which the extravasated blood will spread. It
In working to stretch scars by kneading, a more is important to differentiate between the local
pear shaped manipulation should be cultivated, haematoma at the site of the injury, which
the 'point' of the pear shape being the moment should not be treated for up to four days until
of greatest stretch on the tissues. damaged small blood vessels have had time to
.

Self Myofascial Release

LEVEL - 1
 Self Myofascial Release
• Myofascial Release is a safe and very effective self
hands – on technique that involves applying gentle
sustained pressure into the Myofascial connective
tissue restrictions to reduce chronic pain, restore
shortened muscles to normal range with flexibility
and also improves function & Performance.

• Fascia - is a collective tissue that essentially holds

the entire body together.
 Pain & Trigger point
• Pain - Defined as unpleasant sensation accompanied
by the tendency or a reactive regional tension. These
tensions can sometimes express themselves as
trigger points.

• Trigger points - defined as an area of dysfunction

refers sensation to another area of the body. This
often happens in predictable patterns, but not
always.
 CONTRAINDICATIONS
The following are several reasons you may not want to
include SMR, or areas to avoid:
• Recently injured areas
• Circulatory problems
• Chronic pain conditions (e.g., fibromyalgia)
• Bony prominences/joints

Why?
Trigger point & Referred pain
Trigger point & Referred pain
 Self Myofascial Release Tools
• Foam Roller
• Mini Roller
• Grid Roller
• Lacrosse Ball
• Tennis Ball
• Theraband Roller (Stick)
• Vibrate Roller
• Medicine Ball
• Spine Roller(Peanut ball)
• Soft Ball
• Barbell
 POSITIONING
Positioning while on the foam roller is critical for
several reasons:
• Poor alignment may stress the supporting muscles
and/or joints (e.g., if the elbow is too far away from
the shoulder, instead of being placed underneath it,
you could strain the muscle/joint).
• Improper placement can lead to excessive fatigue of
the supporting musculature.
• Improper placement can lead to excessive pressure
on the trained area, which decreases compliance. (If
it hurts too much, you won’t want to do it again!)
 General Guidelines
• Spend 1-2 minutes per self myofascial release
technique and on each side (when applicable).
• When a trigger point is found (painful area) hold for
30-45 seconds.
• Keep the abdominal muscles tight which provides
stability to the lumbo-pelvic-hip complex during
rolling.
• Remember to breathe slowly as this will help to
reduce any tense reflexes caused by discomfort.
• Complete the self myofascial release exercises 1-2 x
daily.
 .

Result
• Pain reduction
• Feeling of ease and smoothness in motion
• Increased range of motion
• Reduced inflammation

Methods
• “Smashing,”
• “Back & Front”
• “Rolling,”
• “Breaking up scar tissue”
• “Holding with compression”
 Lower Body
• Plantar Fascia
• Gastrocnemius
• Soleus
• Achilles Tendon
• Peroneals
• Tibialis Anterior
• Tensor Fascia Latae
• Gluteus Minimus
• IT Band
• Quadriceps
• Gluteus Maximus
• Gluteus Medius
• Hamstrings
• Piriformis
• Adductors
 *Gastrocnemius, Soleus &
*Plantar Fascia – Can be done Achilles tendon - Can be done
with : . with :
Lacrosse ball, Tennis ball, Lacrosse ball, Tennis ball,
Barbell, Barbell,
Dumbell, Mini roller , Stick Foam Roller, Mini roller , Grid
roller, Vibrator, Stick
*Peroneals, Tibialis Anterior – *TFL , Glute minimus – Can be done
Can be done with . with:
Foam roller,Grid roller, Mini Foam roller,Grid roller, Mini Roller,
Roller, Tennis ball, Lacrosse ball , Tennis ball, Lacrosse ball , Sitck,
Sitck Medicine ball
•IT Band – Can be done with : *Quadriceps – Can be done with:
.

Foam roller,Grid roller , Mini Foam roller, Grid roller , Mini

roller , Lacrosse ball, roller , Lacrosse ball, Vibrator,
Medicine ball , Stick
Tennis ball,Vibrator
*Gluteus Maximus , Gluteus *Hamstring – Can be done with :
Medius – Can be done with : .
Foam roller, Grid roller , Lacrosse
Foam roller, Grid roller , Lacrosse ball, Vibrator, Medicine ball ,
ball, Vibrator, Medicine ball . Mini Roller.
*Piriformis – Can be done with: *Adductor – Can be done with:
Foam roller, Grid roller , Lacrosse Foam roller, Grid roller , Lacrosse
.
ball, Vibrator, Medicine ball ball, Vibrator, Medicine ball
,Lacross ball,Tennis ball. ,Lacross ball,Tennis ball ,Stick.
 Upper Body
• Pectoralis
• Latissimus Dorsi
• Triceps
• Posterior Shoulder Capsule
• Thoracic Spine
• Infraspinatus
• Teres Minor
• Wrist Flexors
• Wrist Extensors
• Rhomboids
•Pectoralis – Can be done with: *Latissimus dorsi – Can be done
Tennis ball, Lacrosse ball , Mini .
with:
roller, Foam roller. Tennis ball, Lacrosse ball , Mini
roller, Foam roller.
*Triceps – Can be done with *Posterior Shoulder Capsule –
Foam roller,Mini Roller, .
Can be done with:
Lacrosse ball , Tennis ball, Lacrosse ball, Tennise ball,
Dumbell Mini roller.
*Thoracic Spine – Can be done . *Infraspinatus / Teres minor-
with Can be done with:
Foam Roller,Lacrosse ball, Lacrosse ball, Tennis ball
Tennis ball , Sipne ball
 .
*Rhomboids – Can be done
•Wrist flexors & Extensors – Can with:
be done with Lacrosse ball
,Tennis ball , mini Roller , Foam roller , Lacrosse ball ,
Dumbell Tennis ball, Spine ball.
54 INTRODUCTION TO SPECIFIC MASSAGE TECHNIQUES

importance of fascia in maintaining optimum func-

tion in the body has recently gained great interest.
As a result, numerous soft-tissue manipulation
techniques that focus on fascia have become key
tools for soft-tissue clinicians. Much of the credit
for the emphasis on therapeutic soft-tissue treat-
ment directed at fascia is due to the pioneering
efforts of Ida Rolf.36 Many of her students have
elaborated on her theories to develop new ideas
and ways to encourage health in the fascial tissues
of the body.37 Treatment techniques that are spe-
cifically aimed at the fascia run from the deep and
Figure 4.17 Active engagement/lengthening with sometimes painful approaches that were used in
stripping applied to the gastrocnemius. the early days of structural integration (Rolfing),
to the subtle and often puzzling effects of treat-
ments such as myofascial release.38
The key component of all myofascial work is to
increase its pliability by applying tensile force to
the connective tissue. For many years descriptions
of myofascial techniques focused on the mechanical
response of the fascia to this pulling force. Propo-
nents of these myofascial techniques emphasized
the transformation of fascia from a thicker and
gelatinous (gel) state to the more soluble or fluid
(sol) state.36,39 However, many found this explana-
tion challenging because it seemed unlikely that
tensile forces applied to fascia during therapeutic
treatments could produce this kind of change.
Figure 4.18 Active engagement/lengthening with
additional resistance applied to the elbow flexors. Biomechanical studies have found that the
amount of tensile force necessary to produce change
in connective tissue would be too great and more
The intensity of muscle contraction can be altered
likely cause tissue tearing and damage.40 In addition,
with either of these methods by adding additional
tensile force would have to be applied on the fascial
resistance. A greater number of muscle fibers are
tissue for close to 1 hour to make significant changes
recruited with additional resistance and this makes
according to physiological models.25 Yet numerous
the pressure level more effective due to increased
clinicians attest to the palpable change in tissue ten-
tissue density. Increase muscular recruitment with
sion felt after only short durations of tensile force
resistance bands, weights, or manual resistance. If
on superficial connective tissues. In most of these
resistance bands or weights are used for the eccentric
applications change is felt with tensile force loads
contraction, both hands are freed up to perform the
much smaller than mechanical models dictate would
longitudinal stripping methods (Fig. 4.18).
be necessary for fascial elongation from mechanical
stretch alone.6,38
New research shows that fascia contains smooth
MYOFASCIAL APPROACHES
muscle cells and has its own contractile properties
Fascia envelops every soft tissue in the body creat- and an abundance of specialized sensory recep-
ing an intricate network of connective tissue that tors.41,42 These neurological receptors, especially
serves important structural and neurological the Ruffini endings, are particularly sensitive to
functions. Originally considered by many to be tangential pulling forces applied to the fascia.25 Tan-
a connective tissue of minor consequence, the gential forces are those that offer only light pressure
 Myofascial approaches 55

loads on the tissue and exert primarily tensile (pulling) connective tissues in the area. This technique is
force on the fascia. Even when exposed to very light usually performed with minimal or no lubrication
tensile loads, these neural receptors in the fascia mod- so that the practitioner’s hands or fingers do not
ulate activity in the nervous system which then pro- easily glide across the skin but instead pulls across
duces a corresponding reduction in muscle tension. the skin creating greater effect on the fascial layers
The function of fascia is so tightly integrated with under the skin.
muscle tissue that these two are most appropriately In some techniques the treating hand glides slowly
considered myofascial tissues.43,44 Therefore when a along the direction of the muscle and fascia being
relaxation is produced in the fascial tissues, there is treated (Fig. 4.20). Slow movement is recommended
tension reduction in muscular tissue as well, and thus because the lack of lubricant can produce discomfort
the palpable change felt by soft-tissue practitioners due to the excess friction. As with the longitudinal
(Fig. 4.19). stripping methods the practitioner can use a broad
The primary purpose of myofascial techniques is contact surface (palm, forearm, knuckles, etc.) for
to reduce tension in the fascial and muscular more general applications or a small contact surface
tissues. There are many different myofascial tech- (thumbs, fingers, or elbow) for a specific application.
niques, so this discussion focuses on the elements In other myofascial techniques the tangential
that are common to most of these methods. Once force applied to the fascia is performed without
an area of muscular or fascial restriction is identi- moving the treatment hand(s). This method is most
fied, a tangential or pulling force is applied to the commonly referred to as myofascial release.38 To

Figure 4.19 Feeling change in myofascial tissues. “Myofascial tissue as a school of fish. A practitioner working with
myofascial tissue may feel several of the motor units responding to touch. If the practitioner then responds supportively
to their new behavior, the working hand will soon feel other fish joining, and so forth. Figure by Twyla Weixl, Munich,
Germany.” Reprinted with permission from Schleip R. Fascial plasticity – a new neurobiological explanation. Journal of
Bodywork and Movement Therapies. 2003;7(1):11–19.
56 INTRODUCTION TO SPECIFIC MASSAGE TECHNIQUES

many other rehabilitation specialists have advocated

it as a beneficial means for injury prevention and
treatment. There seems to be little argument that
stretching hypertonic or restricted tissues is a valu-
able part of injury treatment. However, recent stud-
ies into the effects of stretching have been unable to
find a correlation between stretching and injury pre-
vention.47–51 There are likely benefits to stretching
as a preventive measure in certain circumstances,
but not in all. Stretching is routinely incorporated
with massage in the treatment of pain and injury
conditions so this discussion of stretching empha-
Figure 4.20 Myofascial gliding technique applied with sizes its use as a rehabilitative practice more than a
the back of the hand to the lateral neck muscles. preventive one, although the two are closely related.
The primary purpose of any stretching technique
is to enhance pliability and flexibility in the soft
tissues. Stretching is generally aimed at muscle and
fascial tissue, but there is evidence that stretching
procedures can enhance elasticity in tendon tissue
as well.52 Stretching procedures can be divided into
two separate, but equally important components:
connective tissue effects and neurological effects.

Connective tissue effects

Every single muscle fiber is wrapped in fascia and
there are fascial sheets enveloping bundles of fibers
as well as the entire muscle. Consequently a key factor
Figure 4.21 Non-gliding myofascial technique applied in the flexibility of any muscle is the pliability of its
to the upper thoracic region. surrounding connective tissue. The discussion of fas-
cial physiology in Chapter 2 and in the above section
perform this method, one or both hands are used to on myofascial approaches is also relevant when
apply a light tensile load to the fascial tissue. The considering stretching procedures. Eliciting relaxa-
hands are pulled away from each other just enough tion effects from the sensory receptors in fascial tissue
to take the slack out and create a low tensile force is most effective when a prolonged tensile load
on the tissue (Fig. 4.21). The force is often so light is applied to the tissue.53,54 Stretching produces a
that it does not seem like anything could possibly tensile load on connective tissues. Holding this ten-
be stretching the tissues of the body. Yet fascial elon- sile load for a certain period reduces tension in the
gation and a reduction in muscular hypertonicity connective tissue and subsequently aids overall myo-
result from these methods.45 The amount of time fascial extensibility. There is debate about the ideal
to hold this tensile force varies, and may range from length of time to hold a stretch. Several factors related
a few seconds to several minutes. Many practitioners to the ideal time of stretch are discussed below in the
advocate holding the tensile force until a sensation of section on specific stretching techniques.
tissue release is felt by the client or practitioner.46
Neurological effects
The function of muscle tissue is to generate intra-
STRETCHING METHODS
muscular contraction forces in order to create or limit
Stretching is used extensively as a soft-tissue treat- movement in the body. The muscular system is a
ment method. For years clinicians, athletes, and highly complex feedback system with an extensive
 Stretching methods 57

array of sensory receptors including the Golgi muscular contraction (and subsequent overcon-
tendon organs and muscle spindle cells. These two traction injury) by shutting off a muscle contrac-
specialized proprioceptors are critically important in tion if the contraction stimulus was too strong.
understanding various stretching techniques. Both However, we have now learned that the GTO does
proprioceptors play different roles in helping to not function in this way and the reflex cessation of
manage tension in the muscle and also its ability overly strong muscular contraction results more
to elongate during stretching. from excessive stimulation of free nerve endings
The Golgi tendon organ (GTO) is located in the (pain receptors).55
musculotendinous junction (Fig. 4.22). Its primary Another erroneous perception about GTO
function is to relay information back to the central function that still persists suggests that passive
nervous system about the amount of contraction muscle stretching pulls on the musculotendinous
force in muscles. When muscle fibers contract, they junction and stimulates the GTO, thereby causing
pull on the tendon, which then transmits the con- a corresponding decrease in muscle tension. The
traction force to the bone. Due to its location in the GTO is activated by muscle contraction, but in
musculotendinous junction, the GTO is ideally posi- many cases not activated at all by passive stretch-
tioned to give the central nervous system informa- ing.55 Therefore stimulation of the GTO with
tion about the level of tension or pulling force that passive stretching does not occur and is not a
its muscle generates. Its predominant role is to help mechanism for increasing stretching effectiveness.
manage appropriate muscular contraction forces. The other muscle proprioceptor that is essential
Tendons can be pulled either by a muscular for understanding stretching effectiveness is the
contraction or a passive tensile force, such as a muscle spindle cell. Muscle spindle cells are located
stretching procedure. During a strong muscular throughout muscle tissue (Fig. 4.23). Their pri-
contraction the muscle pulls on the musculotendi- mary function is to help regulate levels of muscle
nous junction and the GTO is stimulated. It was tension and stretch. While the GTO is receptive
once thought that the GTO prevented excessive to the level of contraction force in a muscle, the
spindle cells primarily focus on the degree of mus-
cle stretching. Spindle cell physiology is complex
and involves both sensory cells in the spindle as
well as motor fibers to the spindle itself that help
Muscle fibers manage appropriate muscle length. The spindle
cell is primarily responsive to the muscle’s change
in length (how much a muscle lengthens) and
Capsule the rate of change (how fast it lengthens).
If a muscle elongates either too far or too fast,
Golgi tendon organ the muscle spindles report that change to the
central nervous system and an automatic reflex
muscular contraction ensues to reduce the excess
Sensory neuron to
spinal cord stretch. This reflex is called the myotatic (or
stretch) reflex. Its primary function is to prevent
muscle tearing that would result from overstretch-
ing. Practitioners should be careful with any
stretching procedure not to elicit the stretch reflex
by stretching the client too far or too fast because
the reflex contraction directly reduces the benefit
Tendon
of any stretching procedure.
There is a wide variety of stretching procedures or
systems used to increase myofascial flexibility. The
most common stretching methods fall under one
Figure 4.22 Structure of the Golgi tendon organ. of three categories: static, ballistic, or active-assisted