Sports Massage Techniques

Beyond the basic massage techniques of effleurage and petrissage, there are a range of techniques that make Sports & Remedial Massage so effective ...

Soft tissue release (active and passive)

What is soft tissue release and what does it aim to do?

Soft tissue release is a technique for stretching soft tissues, primarily muscles, fascia & tendons. The aim of soft tissue release is to increase an individual's range of movement (ROM), this is done by using a range of manual techniques on the affected muscles & associated soft tissue to promote healing and break down any scar tissue.

How is soft tissue release done?

Soft tissue release is conducted after the body is warmed up with the use of effleurage and petrissage in most cases. There are three types of soft tissue release, active, passive & resisted (or weight bearing).

Active soft tissue release: This is a soft tissue therapy that treats problems with the muscles, tendons, ligaments and fascia. Combining directed pressure and tension with very specific patient movements depending on the patient's needs. This combination applies very strong localised stretching to the affected area, reducing the excessive muscular tension and freeing up scar tissue.

This is a very good treatment for repetitive use complaints such as sciatica, planta fasciitis, tennis elbow and so many more. Overuse of the muscle (& other factors) can leave a muscle in a state of constant contraction which creates tension, pain and restriction of movement, if untreated this can build up scar tissue and the muscles become shorter, weaker & this can lead to tendinopathies (tendonitis, trapped nerves etc).

Assisted soft tissue release session involve assessment of the area both through discussion and using hands to feel how tight and the texture of the tissue, the tightness and movement of the muscles and facia and any issues with ligaments & nerves.

Direct pressure is applied to affected areas and the patient is asked to preform specific movements to enhance the stretch in a localised and targeted area.

Passive soft tissue release would work in a similar way with the therapist moving the patient's body rather than the patient doing so themselves.

Due to its nature, soft tissue release can be quite physically demanding (the therapist will be breaking down adhesions and applying pressure) and during your treatment your therapist will use a pain scale with you from 1-10 to ensure that you can communicate the level of your pain and be in control throughout your treatment.

Connective tissue therapy

Coats and Keir (1991) explain that connective tissue massage (CTM) is a technique that enables the diagnosis and treatment of a wide range of pathologies.

Connective Tissue Massage involves the observation and manipulation of the skin and subcutaneous tissue (the deepest layer of the skin). Connective tissue therapy treats the whole body, rather than focusing on specific areas.

Connective tissue massage works predominantly on the fascia, this contains nerves, blood vessels and lymphatic vessels and as a result any treatments will be beneficial for both the circulatory systm and in removing any restrictions. With the help of CTM connective tissue can remodel and repair itself in some conditions and is usually as a result of stretching and the breaking down of collagen cross linkage contained within the tissue.

Connective tissue massage works from the surface of the skin to the deep tissue, ensuring that the areas is fully warmed up with flat hands (effleurage) whilst any areas of potential adhesions are identified. You will feel the pressure being applied in a range of different directions in order to establish any potential restrictions in movement.

As a restriction is identified the therapist will hold the tissue in a stretch for around 30 seconds. Once this has been done the massage will progress with the area being pinched between the fingers gently and rolled so that it releases. The fingers may also be walked along the skin whilst the skin and fascia are being held together (as pictured).

Transverse frictions

Transverse frictions are used to break down or restructure adhesions in muscles, tensons, ligaments and joint capsules. These frictions are pressure applied to the muscle across the muscle fiber.

The benefits of frictions are that they increase the mobility of soft tissue, assist muscles by removing physical restriction to their movement and helps with the formation of scar tissue during soft tissue repair.

Transverse frictions help with the physical realignment of collagen fibers, removal of excessive scar tissue, removal of adhesions, reductions of congestion in the area. Increased local circulation and increase range of movement.

It is worth noting that transverse frictions are not suitable for areas that have neuromuscular hyperactivity (nerve damage) or breaks in the skin.

This treatment can be uncomfortable, and your therapist will check continually that you are able to tolerate the continuation of treatment (sports massage is not aimed to hurt but can be uncomfortable at points based on the techniques needed).

How Transverse frictions are applied:

The area will first be palpated (touched to check the area in the muscle) these treatments are short and follow effleurage (effleurage will be used between the frictions towards the lymph nodes (ensuring the toxins can be removed).

The frictions are short, repeated movements at right angles to the muscle fibers that are being broken down, using a reinforced thumb or index finger to apply the friction transversely (across) the muscle fibers. Care will be taken to avoid excessive superficial skin friction.

Muscle energising techniques

Muscle energising techniques (METs) are a form of assisted stretching that are used widely across therapeutic services.

There are a variety of MET techniques including Post Isometric Relaxation (PIR) and Reciprocal Inhibition (RI) that can be used by your therapist, these two types are both beneficial for easing muscle tension, the decision as to which type of treatment is used is down to personal preference and discussion with your therapist.

The aim of METs is to lengthen the muscle where there is limitation caused by proprioceptors (this is caused by neurological restrictions). The muscles have muscle spindles and Goldi tendon organs (receptors that sense the length and tension of the muscle to avoid injury), METs help to encourage more flexibility.

How Post Isometric Relaxation (PIR) is applied:

Post Isometric Relaxation (PIR) targets the agonistic or effected target muscle. The therapist will slowly move the limb to the point of bind (the bit where the muscle feels that it is restricted), from there the therapist will hold the limb for 10 seconds whilst the limb is contracted against the therapist, giving 20-30% of a maximum contraction (the therapist will counter this contraction ensuring no movement occurs).

The therapist will then continue to slowly and progressively continue the cycle twice and then hold the final point of bind for 20 seconds (passively). Once the cycle is finished the limb will be returned to its normal position gently.

How Reciprocal Inhibition (RI) is applied:

Reciprocal Inhibition (RI) is similar in its principle, although it is targeting the antagonistic muscle to that which is tight. The only difference being that during the 10 second contraction, the isometric stretch will be on the antagonistic muscle (the opposite muscle to the one being stretched).

It is important for the patient to be fully engaged in these techniques and to become aware of the muscles being targeted – you will be able to say when you are feeling the stretch. The therapist will communicate to you throughout the treatment.

Trigger Point Techniques

What is a trigger point?

A trigger point is an area within a muscle that has become hyper-irritable. Trigger points can lead to a range of issues including a reduction in range of movement (ROM) and muscle weakness.

Ward (2003) explains that trigger points occur as a result of muscle imanlanace, overuse of muscles or compensatory movements that are untreated over a period of time.

'The sciency bit'

Trigger points occur from a physiological perspective as a result of energy production within the muscles during the sliding filimant theory (see video). During the process of energy production the process of Actin and Myosin shortening can cause an involutary localised spasm that leaves the unaffected sarcomeres of the myofibril in a state of stretch. As a result within the bundles of muscle fibres, there is a temporary stabilising effect that can create pain and further restriction. This process creates a chamical cyctle that reduces movement and provides an area for debris (from energy production) to build up within the muscles.

So what is 'Trigger Pointing'

The aim of trigger point therapy (TP) is to alter the chemical cycle that has developed and release the tension in a specific area within the sarcomeres (muscle fibres).

TP involves applying pressure to the areas in order to deprive the areas temorarily of oxygen which will reduce the spasm (ischaemic pressure).

This is done for 10 seconds initially to establish if trigger pointing is the correct action to use.

The pressure can be firmly applied and then released until the spasm disperses.

The overall aim is for the Sports Massage Therapist to elicit the response of the parasympatheric nervous system (restoring homeostasis - calm balance within the body) and as such TP should not be excessively painful.

How is Trigger Poining applied?

There are a range of methods for using TP within a treatment. An example of two such techniques is explained below:

Method 1. Maintain consistant direct pressure on the effected area for up to 20 seconds. Gradually increasing the pressure up to a pain resport of level 7/10, and then repeat this up to a minute.

Method 2. Apply consisten and direct pressure (up to a pain response of level 7/10) for 2 seconds. Reapply this pressure at the same intensity for upto 5 seconds and then reduce the time to 2 seconds. This can be continued for up to 2 minutes.

Tools can be used to assist with TP techniques as shown in the images.