The Massage Therapist’s Guide to Sports Massage

There are many different types of massage, and some are more popular than others.

The Mayo Clinic shares that Swedish, deep tissue and trigger point massage are three that often top the list of most requested massage services, and there is another type that is practiced quite regularly as well. It is sports massage.

Sports massage is similar to Swedish massage, and research published in the North American Journal of Sports Physical Therapy explains that sports massage refers to “a collection of massage techniques performed on athletes or active individuals for the purpose of aiding recovery or treating pathology.”

Simply, it is massage designed to help active people prevent and address injuries while engaging in their favorite sport.

James Waslaski of Integrated Manual Therapy & Orthopedic Massage, and a long time insurance policy holder of Massage Magazine Insurance Plus agrees with this definition, adding that sports massage serves other valuable purposes as well. 

For instance, it helps athletes better prepare their bodies for an upcoming competition, and it can also enhance their performance during the event. But it’s also important to realize that each athlete has different needs with regard to sports massage services.

“When I worked with the [New York] Yankees and the 1996 Olympic athletes, they would want specific, different techniques,” says Waslaski, a certified personal trainer with the National Academy of Sports Medicine (NASM) who teaches approximately 40 seminars per year around the globe.

Each of these techniques provide different results, thus also providing the athlete with more individualized benefits.

As far as actual benefits received, Waslaski explains that it is often the stage the athlete is in that determines the value a particular sports massage technique has to offer. These can be broken down into two categories: pre and post-event.

Pre-event sports massage benefits

A former supervisor of the Boston Marathon, Waslaski says that pre-event sports massages are often used to “activate weak muscles and check firing patterns.”

These two factors can enhance the athlete’s performance by helping the body more fully prepare for the upcoming physical activity.

Research has confirmed that pre-event sports massages can provide athletes with additional benefits as well. These often include experiencing a lower blood pressure, an increase in strength and improvements in flexibility.

Jonny Pietrunti, LMT, CSCS, is the director of clinical services at Pacific College of Oriental Medicine in New York, New York. He shares that he’s seen the last effect, increased flexibility, firsthand with his clients.

“Due to the repetitive nature of some sports, many of my clients develop limitations in range of motion,” says Pietrunti. “While a certain amount of ‘function tightness’ is important for athletes, excessive limitation in ROM [range of motion] and simple aches and pains from repetitive use can be problematic, and sports massage can help with that.”

Multiple pieces of research have found this same result. For instance, a systematic review and meta-analysis published in the Journal of Physical Therapy Science in February 2017 found that “massage therapy significantly improved the shoulder range of motion.”

Additionally, the most favorable effect for this area of the body was found in movements related to flexion and abduction.

Post-event value of sports massages

Sports massage is also beneficial post-event as it helps promote recovery, says Waslaski. Studies have found the same, indicating that one way in which massage aids in the recovery process is by helping the body remove blood lactate, a lactic acid that appears in the blood when tissues don’t get enough oxygen during anaerobic metabolism.

This same research found that massage further helps by reducing issues related to delayed onset muscle soreness (DOMS). DOMS is not only painful to the athlete, but it can also reduce ROM or decrease muscle strength.

Massage can also be especially helpful post-event if there is an injury, says Waslaski. In these cases, massage therapists can assist the athlete in overcoming the injury by first performing a clinical massage to assess and evaluate the problem.

The next step, says Waslaski, is to implement the appropriate sports massage technique to help it begin to heal.

Sports massages can also provide athletes relaxation benefits, a factor that Pietrunti says is “often understated” yet can help them get into a better mental state not only for the event, but for life in general.

“Many athletes and weekend warriors put themselves under a great deal of mental stress in preparation for a competition,” says Pietrunti. “For many amateur athletes, this is exacerbated by other day-to-day stressors from their jobs, families and life. Sometimes, just setting aside an hour to relax and unwind can be a huge step towards better performance and quality of life.”

Julie McElroy, LMT, specializes in sports massage and adds that this type of massage also provides “an unintended additional benefit” to athletes, which is the opportunity to discuss various details related performance with the massage therapist.

This includes talking about topics such as overtraining, psychological stress and family issues as “athletes’ challenges are both physical and emotional,” says McElroy. “A relationship with a sports therapist who ‘gets it’ seems to positively add to the therapy.”

Every massage therapist has specific techniques that they prefer to use in sports massage sessions, but there are a few basic types which are commonly used to help treat the athlete client. A comprehensive review published in the Journal of Sports Medicine and Physical Fitness breaks them down into five general categories, which are:

1. Effleurage. The review shares that the strokes used in effleurage, which are of varying pressure and applied consistent with lymph and venous flow, are intended to “relax the client, warm the tissue, assist circulation and tissue drainage, stretch muscle and fascia, and soothe painful or sore areas.”
2. Petrissage. This kneading technique can be used to either relax or stimulate the athlete’s muscle, but it also provides additional benefits, such as those related to improved circulation and enhanced removal of metabolic waste.
3. Tapotement. By using “repetitive light striking movement to the skin with the ulnar portion of hands or with hands in a cupped position,” this review shares that the therapist can provide energy and stimulation to the athlete’s muscle tissues.
4. Friction. Friction massage, the type of sports massage in which strokes are applied in circular or linear motion, is intended to help the athlete by creating an inflammatory response, thus breaking down and separating scar or adhered tissues.
5. Vibration. Used in pre-event massage sessions, vibration works by shaking the target muscle groups, a movement that promotes relaxation and improved circulation.

This review goes on to explain that sports massage sessions can also involve the use of “more specialized techniques.” These particular techniques are often dictated by whether the massage is provided before or after the event, but often include the use of compressive strokes, jostling strokes and broad circular friction.

Providing sports massage services offers the therapist the ability to work with people of all ages and skill levels. For instance, according to the National Collegiate Athletic Association (NCAA), there are almost eight million high school students currently playing sports.

An additional 249,154 male and 175,553 female athletes compete at the collegiate level, playing for their college or university in baseball, basketball, cross country, football, hockey, soccer and various other competitions.

Combine these with the 4,146 active players in the NFL (National Football League) MLB (Major League Baseball), NBA (National Basketball Association), NHL (National Hockey League) and MLS (Major League Soccer); the 244 Olympic athletes on Team USA who competed in the 2018 Winter Games; and all of the “weekend warriors” who play sports on a more sporadic basis and this represents a huge number of individuals who rely on their bodies to consistently perform at higher levels.

According to the Bureau of Labor Statistics, the mean annual income for an athlete in spectator sports is $104,900. Pro sport wages can easily enter the millions, with some players contracted for 10 or more times that amount.

So, although some athletes play for fun, others engage in sports activities as a way to earn a living for themselves and their families, making their total health and wellness even more critical.

Either way, it’s important for athletes of all levels and engaged in all sports to develop and maintain a fit body. This goal can be accomplished via a well-designed health and wellness regimen, and receiving regular sports massages is a beneficial part of this type of program.

What makes a sports massage different than other types of massages available to athletes and non-athletes alike?

A sports massage, which is often called an orthopedic massage or clinical massage, “does involve deep work,” says Waslaski, “but it also involves looking at injuries, performance enhancement and recovery.” That’s why he stresses the importance of massage therapists in the sports space learning orthopedic assessment.

McElroy adds that another difference between sports massage and other massage therapies is “the feedback necessity that goes on in sports massage work.” She goes on to explain that “the athlete is actively engaged in the work, whether that’s verbal cues on pressure or information on the cause or the onset of the pain.”

And if you’re working with an athlete who is participating in a formal training program, feedback is often provided there as well.

One factor that changes for Pietrunti when performing sports massage versus other types of massage is the client intake.

“To start, I use a few different movement screens that I add in addition to my general intake,” he says. “This allows me to see how the client moves relative to their needs and gives me a baseline for tracking improvement over multiple sessions.”

This additional screening enables Pietrunti to customize his treatment plan to better suit the individual athlete. “I employ a variety of joint mobilizations, muscle energy techniques and stretches based on the movement patterns for each client’s needs,” he says.

Pietrunti also shares that he is often “more vigorous and dynamic” when providing sports massage versus other types of massages. “I use a lot of deeper techniques,” he says, “as well as some Tui Na hand techniques and other eastern modalities that allow me to move in a more rhythmic fashion.”

Pietrunti says he also uses “little to no lubricant” when performing these sessions, and the client is completely clothed in loose workout gear.

Although sports massage can provide a number of great benefits for individuals who prefer to live an active life, there are some people for whom this type of massage is potentially unsafe.

According to the National Center for Complementary and Integrative Health (NCCIH), this includes individuals with bleeding disorders, low blood platelet counts, or those who are taking blood thinning medications. When these types of conditions are present, the NCCIH indicates that a sports massage with deep tissue work is generally not recommended.

The NCCIH adds that massage therapy may also be potentially harmful to women who are pregnant. Even though research has found that it offers this demographic some positive effects, such as decreased depression and anxiety and reduced leg and back pain, it is still important to obtain approval from her healthcare provider first to ensure that she can receive a safe sports massage.

Massage should also not be conducted in areas where there is cancer, a tumor or open wounds adds the NCCIH, as these can be potentially harmful to the client as well.

Research has also found that extra care should be taken by individuals with diabetes. In a systematic review published in Diabetes Spectrum, the authors share that, while massage has been found to offer benefits to individuals with this particular blood sugar condition, “massage at injection sites may increase insulin absorption.”

Some of the studies found that these effects can potentially continue for as long as 45 minutes post-massage.

The authors further indicated that massage not directed at the injection site should use continuous effleurage. And if gentle friction is applied to the lower extremities, this should only occur after “a sufficient amount of effleurage” (which they define as 7 to 10 treatment sessions) is conducted if diabetes-related nerve damage is present.

U.S. Pharmacist further warns that extra care should be taken when performing massage therapy on individuals who are on some type of analgesic or anti-inflammatory medication. Because their sense of pain is compromised, they may not be able to tell if the pressure is too much.

Why might a therapist specialize in sports massage versus other types of massage? For some therapists, this type of massage provides some distinct and very rewarding benefits.

“I decided to go into sports massage when I experienced its effects on me as an athlete,” says McElroy. “Despite having no experience as a competitive runner in high school or college, I joined a team and realized I was pretty good. I trained while working full-time and ran my first marathon, missing the Olympic trial qualifying time by 21 seconds.

“To get to that level, I sought out sports massage. I experienced firsthand how important it is to optimizing performance,” McElroy adds.

For Pietrunti, an interest in sports massage began as part of his military experience. Serving as a Navy Chief Petty Officer where he was a fitness leader at various naval commands, Pietrunti says, “I began to look into corrective exercise to help my sailors and clients with athletic performance and pain management, but I felt that something was missing.”

Alhough he was a Certified Strength and Conditioning Specialist (CSCS) through the National Strength and Conditioning Association at the time, Pietrunti says that he ultimately decided to pursue licensure in massage therapy as well. This provided that missing link while also being “a good way to ‘bridge the gap’ and provide a better service to my clients,” he says.

A practicing powerlifter himself, Pietrunti’s fiancé is sports-focused as well as she is a record-holding strongwoman and bodybuilder, so he also uses the strategies he’s learned in sports massage within their social circle of competitive athletes.

Even in this less professional setting, he is still able to help fellow athletes who are “looking to increase their performance and deal with the aches and pains that come with consistent hard training.”

Waslaski shares that another benefit that he’s realized by specializing in sports massage is that it “opened the door to work with pro sports team.” That’s why he entered this field in the 1990s, he says. (Plus, it enabled him to go to Yankee games.)

There are several others he knows who have enjoyed this benefit as well, one of whom currently works with Cirque du Soleil athletes and makes six figures in this role.

When specializing in sports massage, there are a few additional trainings, certifications and modalities massage therapists may want to consider learning as practicing them can potentially take you higher in your field.

For instance, injury recovery and sports recovery techniques are critical in sports massage, says Waslaski.

Many elite level therapists have these additional trainings, making them more effective at serving their athletic patients. Learning good orthopedic assessment and clinical reasoning enables you to “match your technique to the pathology of the athletic injury,” Waslaski says.

Advanced skills in injury prevention and treatment can open more doors too, putting in in just the right position to “work hand-in-hand with athletic trainers and medical staff,” he says.

Alhough some massage therapists specialize in just one or two things, “diversity is key,” says Waslaski. It’s important to have effective evaluation skills for different biomechanics if you want to be truly successful, he says.

For instance, in baseball, the biomechanics of a catcher are different than those of a pitcher. Being knowledgeable in all of these various areas helps you provide a better service to the individuals and teams who come to you to become better players.

Additionally, Waslaski recommends that massage therapists interested in sports massage specifically “get trained by people who’ve done all these things.”

In other words, find a mentor with knowledge and experience in sports massage. Let that person help guide you through what you need to do, the steps you need to take to be a successful and effective sports massage therapist.

McElroy adds that, while she stays “pretty traditional in the therapy,” she does use compression and icing treatments on her athlete patients from time to time.

One narrative review in Open Access Journal of Sports Medicine explains that the impact of using these two modalities combined are somewhat inconclusive, mainly due to research limitations; however, after looking at 21 randomized controlled trials, the author ultimately concluded that “the effects of cold and static compression are clearly better than no treatment.”

Pietrunti shares that it has also benefited him to maintain his CSCS certification so he can help his clients by constructing and monitoring their exercise and conditioning routines.

He also provides his patients corrective exercise programming and other “homework” they can do in between sports massage sessions.

Pietrunti further states that his education in applied sport psychology also enables him to provide various consulting services for the athletes he sees. This includes performing services related to mindset training, visualization training, energization training, goal-setting training and performance coaching.

Specializing in sports massage enables therapists to treat a wide variety of clients, from the weekend warrior to the seasoned pro.

Regardless of the individual’s level of sport or why they choose to participate in that particular event, sports massage provides them a valuable service.

When utilized pre-event, this type of massage can help enhance performance. Post-event sports massage aids in recovery and, if there is an injury, helps it better heal.

ALhough this modality isn’t right for everyone, particularly if certain other medical conditions are present, it can be a rewarding path to take in the massage field.

Plus, by earning additional certifications and expanding training to encompass areas important to athletes of all levels and sport, you’re able to provide better services to those who need you most.