It may not come as a surprise that within the realm of professional football — a sport in which the physical demands seem to grow higher every year — musculoskeletal health is of great importance.
Athletes and clinicians alike utilize various treatment approaches in their efforts to optimize health and performance for these athletes, and with increased regularity, massage therapy for athletes is becoming one such modality.
Although hardly a new technique within the sports world, massage therapy has been admittedly slow to integrate fully into many circles within the National Football League.
In a culture where ice and electrical stimulation treatments have long reigned supreme as the normal prescribed treatment for injuries, athletic trainers and physical therapists alike are rediscovering what health practitioners of various stripes have suspected for centuries: There’s something inherently constructive about healthy human touch that promotes healing in the human body — especially bodies that experience repeated trauma.
The Power of Touch
For thousands of years, health care practitioners have utilized massage therapy in the treatment of illness and injury. Chinese writings dating back to 2500 BC describe its use as the prescribed treatment for a variety of medical purposes1.
In injuries that exhibit edema, for instance, effleurage techniques have traditionally been used to facilitate lymphatic drainage. Deep tissue massage and trigger-point techniques have been a preferred method to relieve muscles that exhibit hypertonicity for various reasons.
Today, as football players continue to catch on to the benefits, many players have independently sought out therapists they can integrate into their daily and weekly recovery routines2 — and for more reasons than just injury recovery.
First, if we start at a basic neurohormonal level, massage therapy brags a wide swath of physiological benefits for athletes specifically. It increases levels of dopamine and seratonin, both mood-enhancing neurotransmitters that play roles in fine motor skills. Other effects of massage include the promotion of sleep, which many physicians, athletic trainers and physical therapists argue is vital to a player’s health and rehabilitation4.
We must also bear in mind that these neurohormonal changes promote not only a player’s physiological health, but their psychological health as well (an often-overlooked but vital aspect of a player’s well-being), which no doubt come together to affect a player’s performance5.
In simplest terms, a player experiences health-promoting benefits anytime a trusted practitioner has their hands on the player — a concept that runs counter to a culture focused on wires, electrodes, hot and cold therapies, and medications.
Bearing all this in mind, what might happen when teams begin to integrate regular — as in, daily — sports massage treatments into the schedules of professional football organizations? We have found that the benefits abound.
While useful for day-to-day post-practice recovery, the Tennessee Titans’ medical team incorporates massage as a preparatory activity as well, since pre-event massage work has been suggested as a strategy to decrease pre-competition anxiety and to prepare the muscles for competition3. We have also found that from a rehabilitative standpoint, there is good reason to employ manual work on a daily basis, and massage regularly finds its way into our daily treatment plans for injured athletes.
Each injured player who enters the training room for regular morning treatment sessions receives an individually tailored treatment plan, established following the clinical evaluation and diagnostic process. We regularly use sports massage to achieve specific goals set forth by each treatment plan, and because of massage’s underscored versatility in such environments, those goals can vary widely.
One such approach is to prepare the injured athlete to perform a series of corrective exercises, which massage could facilitate6. Because of the anti-inflammatory and endorphin-releasing effects of massage, 15 to 20 minutes of work to reduce a player’s pain could help them advance to more active forms of recovery sooner than they might have otherwise.
In a training room environment, it’s more common that different modalities which fall outside of a massage therapist’s scope of practice, like dry needling, can be paired with massage to produce striking results7.
In other instances, massage may be used to help reduce localized edema by the facilitation of lymphatic drainage8. In an acute injury, sports massage is widely used for pain modulation9. Depending on how an injured player presents, an adept therapist may choose to use slower, longer work to down-regulate a player’s nervous system (i.e., promote deeper sleep) or faster work in order to target the sympathetic nervous system and raise epinephrine levels to increase alertness prior to workout, corrective exercise, practice or a game10.
Massage may also be used with the intent to increase circulation, making deeper work ideal for promoting healthy blood flow to ischemic tissue. For various purposes and under various circumstances, massage fits snugly into our overall treatment approach to improve efficiency and achieve desired outcomes.
For decades, athletes in the NFL have experienced and believed in the value of massage for their health and performance. Through observations and discussions about the application of massage in the NFL at large, we’ve learned that the majority of teams make little space for massage within their organizations themselves, but rather, refer out to or contract therapists from the community for traditional full-body treatments.
These therapists rarely have collaborative interaction with other health professionals in the organization. For HIPAA and other safety reasons, certain elements of this safeguard are important to keep in place. But what if we could imagine a different organizational workflow?
As we’ve begun to find, the process of imagining and then creating environments where athletic trainers and physical therapists work side by side with massage therapists through an open-flow environment has the possibility of achieving a higher level of care for players while unlocking new frontiers in the efficacy and efficiency of massage for the rehabilitation of sports injuries.
The more insight that we gather on the effects of sports massage, the better able we’ll be to allow clinicians to develop and implement clinically significant and subjectively effective treatment protocols. The demand for massage alone suggests that there may be a greater effect than just palliative care9.
For the sake of the bodies of those athletes whose job it is to bring us together on Sundays in living rooms across the U.S., this knowledge should be expanded on.
Q&A With The Titans’ Blake Mundell, LMT, & Adrian Dixon, DPT
Blake Mundell, LMT, is the team massage therapist for the Tennessee Titans. Adrian Dixon, DPT, is the team’s assistant athletic trainer/rehabilitation coordinator. They sat down with MASSAGE Magazine to offer inside perspectives and advice on what it takes to succeed as a professional football team’s massage therapist.
MASSAGE Magazine: What is required of a massage therapist on a pro football team, in terms of education and experience?
Blake Mundell: I believe that first and foremost, having a nuanced and comprehensive understanding of human anatomy is essential. Personally, having a background in sports — as a player and coach — has proven invaluable in my own career, enabling me to better understand players’ biomechanics and sports injuries.
Additionally, a good therapist will learn to adjust their treatments based on treatment and performance goals. They will know when the next and last workout is/was, when the next and last practice is/was, when the next and last game is or was, and adjust their work accordingly.
Adrian Dixon: I agree with Blake; the understanding of human anatomy and physiology plays a very important role in the ability to be a successful massage therapist in professional sports. Making your treatments properly align with each stage of the inflammatory process makes the difference.
Also, as Blake alluded to, the timing of when any given method of treatment is administered should also fit in the treatment puzzle appropriately. Whatever education or training gets you to this understanding is what I would call proper training.
MM: What qualifications would a pro team be looking for in a massage therapist? (Is massage enough? Does someone stand a better chance of being hired if they are a massage therapist and an athletic trainer, for example?)
BM: I do know that the NHL requires teams to have an LMT on staff, and almost all of them look for someone with dual licensure. MLB and soccer teams generally do too. If I were to take a stab at the character qualities I think are important, I think that you must primarily be able to follow directions.
Most LMTs work on our own, and when we do — especially for a long time — we get used to making the calls and implementing our own tried-and-true treatment plans, often being our client’s primary source of bodywork. When working on a team of other medical professionals, a therapist must rethink their workflow, relinquishing control of any treatment plans, receiving and giving frequent feedback, and acknowledging that they serve as a single cog in a larger machine rather than a one-stop shop.
This requires humility, teamwork and adaptability. Lastly, this job isn’t for the faint of heart, as the schedule and the work itself can be demanding. A therapist in the NFL must be physically and mentally up for the task — which could often mean no days off, including holidays like Thanksgiving and Christmas.
AD: Most NFL teams only require the therapist to be an LMT for credibility purposes and particularly have experience working with high-level athletes. As you may know, this population is quite different than dealing with the general population in many ways. Although it may look great on a résumé and could set you apart from competition for a job, there is no real need to have multiple credentialing due to the specifically defined role.
MM: How would you advise a massage therapist to get in contact with a team’s HR department or another person, in order to even begin the process of talking about working for the team? How does hiring work?
BM: Each team incorporates massage differently into their weekly schedules, so the hiring process is going to look differently everywhere. If I were a therapist with no connections to a specific team, I likely would reach out to the team’s head of medical to inquire and put my name in front of them, but I would focus most of my energy marketing myself to the general public as a massage therapist working in particular with athletes.
I would build my clientele such that it consisted of predominately athletes, and through those channels, start working on the players themselves. If someone in the organization is going to start looking for massage therapists, they’ll start by asking the players who they see already and prefer.
I’ve also had success reaching out to surrounding college and high school programs about massage as a way to gain experience and make connections.
AD: The way most NFL teams are structured, most of the hiring of what is considered medical or performance personnel, goes primarily through the lead person in that department. It won’t do any good to reach out to HR unless there is a job posting that will probably direct you to the medical department. Like Blake said, word of mouth usually goes further when teams are looking to hire a massage therapist.
MM: Is there anything else you’d like to add to benefit massage therapists who might want to get involved in professional sports massage?
BM: Never stop growing and learning. Gain new tools and become a versatile therapist — take stretching courses (I recommend Fascial Stretch Therapy), cupping courses, taping courses — but also develop the willingness to set those tools aside if you’re not called upon to use them in a training room environment.
In your own practice, make your own lane, and be the best therapist you can be in it. In the training room, learn what your lane is, and be the best therapist you can be within it.
AD: I would also echo Blake on this question. Be a lifelong learner. The field that we are in constantly changes in terms of new techniques, research, as well as what the patient feels can help them. It is our responsibility as professionals to remain current and knowledgeable about what can help our clients.
Also, in terms of professional sports, understand that there are many people involved in what I would refer to as the treatment circle of the athlete. Seek to understand each professional’s purpose in that circle and maintain communication and professionalism. This will help to achieve the desired outcome of enabling them to perform well in whatever sport they play.
1. Holey E, Cook E. Evidence-Based Therapeutic Massage. A Practical Guide for Therapists. 2nd ed. Edinburgh: Churchill Livingstone. 2003.
2. Galloway SD, Watt JM. Massage provision by physiotherapists at major athletics events between 1987 and 1998. Br J Sports Med. 2004; 38:235-237.
3. Cassar MP. Handbook of Clinical Massage: A Clinical Guide for Students and Practitioners. 2nd ed. Edinburgh: Churchill Livingstone. 2004.
4. Catherine F. Siengsukon, Mayis Al-dughmi, Suzanne Stevens, Sleep Health Promotion: Practical Information for Physical Therapists, Physical Therapy, Volume 97, Issue 8, August 2017, Pages 826–836, https://doi.org/10.1093/ptj/pzx057.
5. Simpson, Nicholas S. et al. Optimizing sleep to maximize performance: implications and recommendations for elite athletes. Scandinavian journal of medicine & science in sports 27 3 (2017): 266-274.
6. Preyde M. Effectiveness of massage therapy for subacute low-back pain: A randomized controlled trial. CMAJ. 2000;162:1815–1820
7. Mooventhan A, Nivethitha L. Effects of acupuncture and massage on pain, quality of sleep and health related quality of life in patient with systemic lupus erythematosus. J Ayurveda Integr Med. 2014;5(3):186–189. doi:10.4103/0975-9476.140484
8. Vairo GL, Miller SJ, McBrier NM, Buckley WE. Systematic review of efficacy for manual lymphatic drainage techniques in sports medicine and rehabilitation: an evidence-based practice approach. J Man Manip Ther. 2009;17(3):e80–e89. doi:10.1179/jmt.2009.17.3.80E.
9. Brummitt J. The role of massage in sports performance and rehabilitation: current evidence and future direction. N Am J Sports Phys Ther. 2008;3(1):7–21.
10. Diego M, Field, T. Moderate pressure massage elicits a parasympathetic nervous system response, Int J Neurosci. 2009;119:5, 630-638.
About the Authors:
Blake Mundell, LMT, is the team massage therapist for the Tennessee Titans, based in Nashville. He has served on the team’s medical staff for six seasons. Mundell has also worked with MLB, NHL, NCAA and UFC athletes, as well as performers with the Nashville Ballet and the Radio City Rockettes, Iron Man competitors and weekend warriors of all kinds.
Adrian Dixon, DPT, MS, ATC, CSCS, PES, is the assistant athletic trainer/rehabilitation coordinator for the Tennessee Titans. In his role, he designs and manages rehabilitation and treatment programs for injured players and oversees their progression back onto the field. Dixon was formerly an Assistant Athletic Trainer with the NFL’s Tampa Bay Buccaneers. In 2015 he was named to the Professional Football Athletic Trainers Society’s Research Committee.
Photo credit: The authors gratefully acknowledge the photography of Donald Page and Tennessee Football, Inc. for the photographs/still shots in this article. All rights reserved to Tennessee Football, Inc. d/b/a Tennessee Titans for any such photographs. Further or additional use requires permission of the copyright holder: Tennessee Football, Inc. All works of Donald Page under hire by Tennessee Football, Inc. are works made for hire and are the exclusive property of Tennessee Football, Inc. All rights reserved.