As a runner for 28 years and a sports massage therapist for 19 years, I have spent a lot of time on both sides of a massage table. I received regular treatments at least once and often twice a week as a competitive distance runner in college; these massages varied from general work, to pre- and post-event, to injury-specific.
One of my most valuable assets as a sports massage therapist is the amount of work I received as an athlete and continue to receive today. It allowed me to develop a profound understanding of different types of sports massage and provided a foundation for fostering a comprehensive array of treatments and protocols. I can’t emphasize enough how beneficial it is for massage therapists to experience regular massage treatments and different types of massage in order to enhance and develop their skills and techniques.
When Should a Runner Get a Massage?
I am frequently asked the question, “When is the best time for a runner to have a massage?” The answer is anything but straightforward and largely dependent on the objective of the client.
In general, there are four different categories of sports massage: pre-event, post-event, general sports and injury-specific. Each type of massage has a different goal. As a result, there are a number of right times for a runner to receive a sports massage, as long as the type of massage is administered correctly and is in line with your client’s goals.
Goal: To get the body ready for a race or event.
It is important to keep in mind that every client responds differently to massage. This is particularly salient when it comes to pre-event work. Some clients love to get really deep work the day before or even the day of an event; some prefer a light flush; others respond best to over-the-clothes compression; and some don’t want to be touched at all for the three or four days leading up to a race. It is important to experiment with pre-event work prior to a workout or less important race before implementing it as preparation for a more important competition.
That being said, in general, the day or two before a race a runner will usually benefit from light flushing work combined with compressions, rocking and shaking. Keep in mind that your client wants to come out of the massage feeling light, springy and energetic.
You can incorporate some deeper, specific strokes on a tight knot or band, but try to limit this to five to 10 passes per spot. The focused work tends to be most effective if you also incorporate some movements into the stroke such as pin-and-stretch or Active Release Techniques. It can also be useful to incorporate some dynamic stretching, such as Active Isolated Stretching, at the end of the session.
Goal: To expedite recovery from a race and decrease post-exercise soreness.
When administering a post-event massage—generally within 36 hours of a race or competition—keep in mind that your client has just put her body under a tremendous amount of stress. Muscles have undergone micro-trauma and tearing.
The massage should be on the lighter side but slightly deeper than pre-event work, with slow, controlled, flushing strokes. If the work is too deep it can damage muscles further and prolong how long it takes to recover from the event.
Incorporate a moderate amount of static stretching into the massage. One 30-second static hold after massaging a muscle or region is generally an effective approach. To top it off, have your client hop into an ice bath or cold whirlpool after the massage and stretching. The combination of a flushing massage, assisted static stretching and cold therapy is a great formula for decreasing post-exercise soreness and substantially speeding up recovery from a race or event.
General Massage for Runners
Goal: To loosen tight muscles, release trigger points, increase range of motion and reduce the risk of injury.
Runners tend to require and respond best to deeper work when receiving a general massage. This is where the art of massage becomes particularly important. Pay very close attention to what you are feeling in the tissue. Go deep enough to be effective but not so deep that it causes your client to tense up and fight the work. Some soreness for 24 to 36 hours after the massage is generally fine, but if it lasts longer or causes visible bruising, you have probably gone too deep.
Goal: To facilitate healing of an injured muscle, tendon or ligament.
Massage on an injured muscle, tendon or ligament can be extremely effective if applied appropriately. It is always important to work in conjunction with a doctor or physical therapist so your client has a proper diagnosis and the massage is part of a comprehensive treatment plan. Every injury is different, and the massage protocol will vary depending on the type and extent of the injury, but here are a few useful guidelines.
Tendinopathies should be treated two or three times a week. Work the muscle of the injured tendon with deep stripping strokes and perform cross-fiber friction on the tendon itself. It is also useful to utilize a tool such as a gua-sha tool or the one pictured below to scrape the tendon. End the massage by icing the injured tendon for 10 to 15 minutes.
Ligamentous injuries should be treated in a similar fashion to tendons. Make sure to work the muscles on both sides of the ligament with deep, stripping strokes before working on the ligament itself with cross-fiber friction and a tool.
When working on a strained muscle, sessions should be no more than twice a week. The muscle needs time to recover between sessions. In the beginning stages of the injury, work deeply around the injured area but limit the work on the injury itself to light flushing strokes. Incorporate light and very gentle static stretching as well. As the injury starts to heal, apply deeper and deeper pressure with cross fiber friction to the actual site of the injury. Gradually increase the intensity of the static stretch and eventually incorporate resistive stretching towards the end of the rehabilitation process.
Common Injuries for Runners
Iliotibial Band (IT Band)
One of the most common injuries for runners is iliotibial (IT) band syndrome. It is generally characterized by pain at the outside of the knee. A tight IT band can irritate the bursa at the lateral femoral condyle as well as the bone itself.
Treatment should include working all three of the gluteal muscles, tensor fasciae latae and the band itself down the outside of the leg between the greater trochanter and lateral femoral condyle. The IT band usually requires very deep work because of how dense it is. Positioning can play a crucial role in effective IT Band work (see picture 2). You should also check for tightness in the iliopsoas and the vastus lateralis as well. When a client has an IT band injury or chronic IT band tightness, there is almost always an associated weakness in the gluteus medius and gluteus minimus.
Here is an effective abductor strengthening exercise for runners. (See picture 3.)
When treating an Achilles tendon problem, start with deep stripping of the gastrocnemius and soleus muscles, since these muscles connect to the Achilles and can tug on the tendon when tight (see picture 4). Include side-lying work of the deep flexor compartment. This includes work on the tibialis posterior, flexor hallicus longus and flexor digitorum longus (see picture 5). Make sure you check the entire posterior chain of the leg for tightness, including the hamstring, glutes and intrinsic foot muscles on the plantar aspect of the foot.
Runner’s knee is characterized by pain behind or around the kneecap. As the name implies, it is very common in runners, although not exclusive to runners. The underlying causes are often muscular imbalances in the four quad muscles. The vastus lateralis, vastus intermedius and rectus femoris are tight and the vastus medialis obliques (VMO) are weak. The tight muscles should be loosened with massage and stretching, and the VMO should be strengthened. Incorporate cross-fiber friction on both the supra-patellar and infra-patellar tendons as well (see picture 6).
After the massage you should also stretch the quad without putting too much bend into the knee (see picture 7) and then conclude with icing the knee for 10 to 15 minutes. You should also check for tightness in the iliopsoas, hamstrings and calves of the affected leg.
Plantar Fascia Pain
When treating plantar fascia pain and dysfunction, always start with deep stripping of the gastrocnemius, soleus and deep flexor compartment. Tightness in these muscles can tug on the calcaneus and increase the tension on the plantar fascia. You should also work on the plantar itself and intrinsic foot muscles. Include cross-fiber friction on the origin of the plantar fascia at the calcaneus. It can be particularly useful to incorporate use of a tool on the origin of the plantar fascia as well. Conclude the session with 10 to 15 minutes of icing the plantar itself.
A key part of our responsibility as sports massage therapists and healers is empowering clients with knowledge and the ability to treat themselves as effectively as possible. Use of a foam roller and other home self-massage devices is a tremendous supplement to the work we perform in the clinic and makes our sessions even more beneficial. Below (pictures 10-17) are a few key home self-massage techniques that are particularly effective for runners.
Keep Clients in the Race
By understanding the needs of your running clients and giving them targeted treatment and self-care suggestions, you can help them prevent injury, recover more quickly and enhance their performance.
About the Author
Mark Fadil is the co-founder of Sports Medicine Institute, a performance center which focuses on sports and orthopedic massage, in Palo Alto, California. He is also the founder of PHLX, a comprehensive foam roller system that empowers the user to recreate hands-on techniques utilized by skilled massage therapists. He wrote “Massage for Golfers: Keep Your Clients on the Course” for MASSAGE Magazine.