Sports Massage - Sample Manual by HealthFitnessEducation

Sports Massage Level 3 Student Manual

Contents

Table of Contents Section Page

The History and Development of Massage

Sports Massage Environments and Equipment

Fundamentals of Sports Massage Techniques

Effects of Sports Massage

Health, Safety and Professional Practice

Soft Tissue Injury and Dysfunction

Assessment and Screening Techniques

Postural Considerations for Sports Massage

104

Planning and Evaluating Sports Massage

114

Massage Techniques for Specific Muscles

119

Stretching for Sports Massage

138

Acknowledgement We would like to express our sincere appreciation to Lorna Malcolm for her invaluable writing and consultancy services throughout the development of this resource. Without her unwavering commitment and sheer professionalism, this resource could never have come to being.

© Copyright Statement © Health and Fitness Education (HFE) retains all intellectual property rights to the material that appears in this manual or ANY other learning materials supplied. No part of this manual (text, graphics or data) may be reproduced, transmitted or stored in an electronic format without the prior written permission of HFE. Most of the artwork has been produced specifically for HFE but where commercial images have been used, the appropriate royalties have been paid. We therefore remind you that reproduction of these images in any form is strictly prohibited under the international laws of Copyright.

Section 01

History and Development of Sports Massage

Sports Massage Level 3

Section 01

The History and Development of Massage The Origins of Massage Massage is an action that is based on a universal and intuitive instinct to rub an area of the body that hurts. Serving to reduce pain and provide comfort, research seems to suggest that when a painful area of the body is rubbed, the sensation or perception of pain is reduced. The word ‘massage’ has Arabic roots from the word ‘massa’ which means ‘to touch, feel, knead or squeeze’. It also has French origins where it was used to describe “friction or kneading”. In Latin, massa means “mass, lump, kneaded dough”, and the Greek verb means “to handle, touch, to work with the hands, to knead dough.” The earliest written records of massage therapy were discovered in Egypt and China somewhere between 2500-2700 BC, with the first Chinese text titled “The Yellow Emperor’s Classic Book of Internal Medicine”. First published in English in 1949, this has become a standard reference in many massage therapy, acupuncture, acupressure, and herbology training programs of the modern day. Written references were also discovered in India around 1500BC, although the practice is thought to have originated much earlier (circa 3000BC). In 2500 BC, paintings on Egyptian tombs revealed that not only was massage therapy part of their medical practices, but, that they also pioneered reflexology, which also had cultural influences on the medicinal practices of the Greeks and Romans. The development of Chinese massage therapy grew from a wide-variety of skills and expertise. This included traditional Chinese medicine doctors, practitioners of martial arts, Buddhists and Taoists for whom touch was essential to their spiritual yoga teachings, and laymen, who offered massages for relaxation purposes. Chinese massage therapy techniques originated from the theory that diseases and illnesses arise from a deficiency or imbalance of energy in specific energetic pathways, also known as ‘meridians’. The Chinese practice of acupuncture and massage is based on the belief that these energetic meridians correlate closely with the body’s physiological systems. Within the practice of this traditional medicine, it is believed that massage restores balance and harmonious energy flow along these pathways thus allowing and encouraging the body to heal itself naturally. Chinese techniques were eventually taken to Japan and formed 2

the basis from which Japanese Shiatsu massage was derived. In 400BC, Hippocrates is believed to have said that physicians should be experienced in rubbing (massage), “for things that have the same name have not always the same effect. For rubbing can bind a joint that is loose and loosen a joint that is too rigid” and “Rubbing can make flesh, and cause parts to waste.” He outlined four principal guidelines in terms of results from different types of massage: • • • •

Vigorous massage constricts and firms up the body Gentle massage relaxes the body Much (frequent) massage thins and lightens the body Moderate massage thickens the body, and increases the flesh

Historically, there are numerous accounts across many cultures in which the most revered medical practitioners boast of the therapeutic health value of massage in some form or another. For example, in the 16th century, Ambroise Paré, a french surgeon and doctor to 4 French kings, adopted a more anatomical and physiological approach to massage therapy because he recognised the function and critical role that the circulatory system served within the healing process. Using massage, he was able to aid and expedite the recovery process for many of the patients he served, all of whom were suffering from a wide variety of ailments. Credit for the Swedish massage techniques used today is a bit controversial. Some historians give credit to a Swedish physician of the early 1800’s named Per Henrik Ling, who is often cited as being the father of physical therapy and the developer of the Swedish Gymnastic Movement System. Ling’s Swedish Gymnastic Movement System was a movement program designed to induce medical/health benefits for those that participated. Within this system of movement however, Ling did not prescribe specific strokes or methods of “rubbing” the body in a way that could be argued that he was developing specific massage techniques. Ironically, Swedish massage is neither Swedish nor was it developed by Ling (a Swede), nor does it have any roots in Swedish medicine. Massage isn’t even called “Swedish Massage” in Sweden. In the majority

Section 01

History and Development of Sports Massage

Sports Massage Level 3

China

Tui na, an ancient form of Chinese manipulative therapy is developed, bringing rise to Anma, which eventually became Shiatsu.

India

Believed to be the divine origin of massage, although no written records exist.

3,000 BC

2,500 BC

Egyptians

Tomb paintings in ancient Egypt and China illustrate people being massaged and kneaded. The Egyptians are credited with creating reflexology.

1300 BC

Worldwide

Rome

The romans received massage treatments for relaxation purposes in public baths.

400 BC

1800 AD

200 BC

Greece

Hippocrates had a high regard for massage and believed it to be one of the arts all good physicians should be familiar with.

New techniques developed from ancient methods, documented, formularised and adopted wordwide.

20th Century

Europe

Swedish physician, Per Henrik Ling is credited with the creation of Swedish Gymnastic Movement System, incorporating massage with medicine and physiology.

of European countries, it is almost universally referred to as “classical massage” however, in the UK, the term “Swedish Massage” is the name used when referencing the classical techniques of massage therapy. The very strokes that define massage (effleurage, petrissage, tapotement, and friction) are French terms assigned in the mid 1800’s by the late Dutch practitioner Johann Mezger, to systemise the practice as we know it today. Somehow, Ling’s work, called “the Swedish Gymnastic Movement System” was transposed into “The Swedish Massage System” sometime during the mid1900’s and Mezger’s massage terminology was credited to Ling. To this day, it is argued that Ling’s work set the stage for massage therapy, however it was Mezger’s systematic approach to organising the therapeutic stroke techniques that are taught in massage schools around the world today (Calvert, 2014).

Swedish Massage consists of various techniques, including:

Regardless of its origin, “Swedish” massage techniques are the basis from which all other forms of massage are derived. Using firm but gentle strokes, a flat palm, the heel of the hand, or by grouping the fingers to apply targeted pressure to specific tight spots, the practitioner delivers a variety of stroke techniques that are of therapeutic and potentially remedial benefit to the recipient. The primary objectives of Swedish Massage are similar to those of the Chinese techniques, with emphasis being given to loosening and lengthening the muscles while increasing blood circulation, particularly to the larger muscles.

• • • •

• • • • •

Effleurage - long, gliding strokes Petrissage - lifting and kneading the muscles Friction - firm, deep, circular rubbing movements Tapotement - brisk tapping or percussive movements Vibration - rapidly shaking or vibrating specific muscles

All of these techniques can be used in sports massage. The physical benefits of receiving classical, ‘Swedish’, massage are numerous and plentiful. However, the physiological and neurological benefits are equally as important as the mechanical attributes. Research has demonstrated for years that some of the non-mechanical benefits of regular massage therapy include:

• • • •

reduction in the sensation of pain lowering of blood pressure boost the function of the immune system decrease in depression, anxiety, fatigue and/or other mood related disorders reduce headaches mitigate symptoms of fibromyalgia alleviate “phantom pain” experienced by amputees increase the overall sense of wellness and wellbeing

Sports Massage Level 3

Fundamentals of Sports Massage

Section 03

Effleurage Effleurage is a French word that literally means ‘to stroke’ or ‘to skim’ and is considered to be the most basic of all massage strokes. However, this “basic” stroke is where the initial contact with a client’s tissues is made and it serves as an invaluable assessment and communication tool to determine the most appropriate treatment plan for that client and how this should be executed. It is within these “basic” strokes that massage therapists learn to recognise subtle differences in tissue tension in the fascia and underlying musculature. Hilton’s Law dictates that ‘the nerve supplying a joint also supplies both the muscles that move the joint and the skin covering the articular insertion of those muscles’. Therefore, massage therapists need to be acutely aware that their treatments do not create a surface level effect on the tissue being massaged, but instead are capable of eliciting both a parasympathetic and sympathetic nervous system response deep within the massaged tissues. This ultimately dictates physiological reaction and tone within the tissue being treated as well as the surrounding areas. Effleurage consists of long, smooth, rhythmical strokes typically on the larger muscle groups, such as the legs, arms, and back. Small, circular strokes are sometimes more appropriate in areas such as the hands, posterior cervical spine, anterior and lateral neck musculature, and in some cases, the back. However, gliding strokes can still be used in the treatment of these areas and will be presented later in this section. Effleurage is applied with varying levels of pressure (light, firm or deep) and speed, depending on the condition of the client’s tissues and desired outcome. Ultimately, it is the client’s tolerance and feedback that dictates how these variables are applied. The speed of stroke varies based on whether the intended result is to relax the tissues or create a warming and priming effect. Light effleurage stimulates the receptors of the parasympathetic nervous system, creating a reflexive and relaxing response. This causes vasodilation of the blood vessels (inhibiting vasoconstriction) thereby helping to improve blood flow and circulation. In addition to the relaxation response, effleurage also helps in the process of removing waste products created as a by-product of normal cellular metabolism. With effleurage, the more superficial the stroke, the more reflexive the effect. Slow, superficial strokes are very soothing, while fast, superficial strokes are stimulating. If a deeper stroke pressure with a slower rate of application is used, the effect will be more mechanical. © Copyright Health and Fitness Education 2017. All Rights Reserved.

Purpose: •

• • • •

Introduce the sports massage therapist’s touch to the client, developing the client’s trust and putting them at ease Apply oil or other massage medium Warm-up superficial tissues Relax muscles and the surrounding tissues Allow the therapist to palpate and sense the condition of the tissue and identify any problem areas that may need specific attention in the treatment session Stimulate peripheral nerves either to excite or to relax muscle Increase lymph and venous blood flow, aiding the removal of waste products Assist in stretching tissues Relax a client as the massage is coming to an end

Effects: Neurological Effects: • • • •

•

Elicits a parasympathetic response, lowering blood pressure, breathing rate, and heart rate Reduces the sensation of pain by affecting the pain sensors (nociceptors) and the release of endorphins Stimulation of nerves in the tissues being treated as well as the related joint space Decreases sympathetic contraction of the muscles in the walls of the blood vessels resulting in vasodilation and an increase in capillary space Relaxation of soft tissues and reduced muscle tension, based on the client’s neural response to the applied touch

Section 03

Fundamentals of Sports Massage

Mechanical Effects: • • • •

•

Removal of cellular waste products Increased circulation of blood and lymph at the level of application (i.e. superficial or deep) Can help improve the condition of the skin due to the increased circulation Provides compression and stretching to the fascial layer between the muscle tissue and subcutaneous skin layer (often causing the tissue to turn red) Reduction of edema (also spelled oedema) by increasing the exchange of fluids at the capillary level and stretching the lymphatic vessels

Contraindications: Generally, effleurage is a safe technique that can be used in almost any situation, although there are a few precautions and considerations to be aware of. These include: • •

Avoid using the method over a recent injury site, an open wound or over skin irritations (e.g. a rash) Deep contact with the backs of knees, the areas over the kidneys and the front of the neck because the tissues in these areas can be easily injured

Application(s): Direction: Effleurage combines strokes that are longitudinal and/or transverse to the direction of the muscle fibres being treated. The palm, flat of the hand and fingers, and in some instances, the forearm, are used to deliver this technique over a wide or large area. Contact with the skin is maintained at all times. When applying the technique, the hands should be relaxed and follow the natural lines of the body. Strokes should cover the full length of the muscle, from attachment-to-attachment, starting at the bottom of the limb or body part and working towards the heart. Transverse strokes can either be applied by grasping the belly of the muscle and, using the thumb as an anchor, drawing the fingers through the tissues towards the thumb, or the other way round, with the thumb being drawn toward the fingers.

Pressure: The treatment always starts with light, superficial pressure, applied through the edges of the palms and the pad below the thumb. The pressure can then gradually build into deeper and firmer strokes according to the needs of the client and their response to such pressure. The return stroke should be much lighter and more superficial to avoid disrupting venous and lymph flow toward the heart. Deeper pressure can 16

Sports Massage Level 3

be achieved by placing one hand on top of the other and covering a smaller area, or if appropriate, using the forearm. Deep effleurage requires smaller contact points to press deeper into the muscle. The pad or tip of the thumb/ fingers can be used, or the forearm/elbow. These deeper strokes can be used with some clients to assist with the stretching of the muscle tissue; this will however be dependent on the client’s neural response and the therapists perception to this. For example, a nervous system that perceives touch as a threat (e.g. too much pressure or too much pain) will result in more tension and tone in the tissue. This is the opposite of its intended effect.

Rhythm/Speed: The strokes should be smooth, rhythmical and applied in a relaxed and flowing manner so that each stroke moves continuously into the next. Position: As a massage therapist, it is important to understand that a safe, effective application of this stroke is achieved by transferring force from the core and legs and maintaining proper postural alignment. The arms should be long, shoulders stabilised by not allowing them to elevate toward the ears, maintaining a tall and supported torso throughout. The stance will normally be split to achieve this, with one foot forward. As the treatment stroke is applied, the core provides stability to the spine and the bodyweight is used to transfers power through the arms so that the required amount of force is applied to the tissues. This also helps to prevent the therapist from becoming unnecessarily fatigued. With regard to a therapist’s self care, being mindful and aware of one’s own body position is crucial. Additionally, when using the thumb and fingers, it’s important not to overstress the hands by using the hands and arms to create the pressure; this should be created indirectly from the therapist’s bodyweight. In some cases, one hand can be positioned over the other, allowing the thumb and fingers of the treatment hand to be passive while the pressure is applied in a more supportive manner from the hand directly above it.

Sports Massage Level 3

Fundamentals of Sports Massage

Section 03

Effleurage Strokes

Superficial strokes: A light touch that is primarily

Fanning strokes: Stroking outward in a three-stroke

used at the start and end of the massage as a form of preparation and restoration, although it can be performed between other strokes for soothing purposes.

fan shape from a single point often used for draining after friction massage.

Alternating strokes: Used primarily with longitudinal and more superficial strokes, the hands pass each other moving in the opposite direction while treating the area/ muscle.

Reinforced hands: The hand is reinforced for a greater depth and the bodyweight is used to generate the force. This technique is more effective for large and thin sheets of muscle (e.g. back) where squeezing is difficult.

Reinforced fingers: The finger is also reinforced for

Guided elbow: Used for deeper effleurage. The

more depth. This technique is typically used for shorter/ thicker muscles (e.g. upper trapezius) where it is difficult to obtain depth with the hand.

therapist can flex the elbow to make the technique deeper. Note the therapist uses the hand to guide and stabilise the elbow and pressure.

Section 10

Massage Techniques for Specific Muscles

Cervical section of the erector spinae, multifidus, scalene and sternocleidomastoid

Sports Massage Level 3

•

Client Position(s): Prone, supine, seated and side lying

Therapist Position(s): Standing to the side of the couch at the head end, or, at the head of the couch looking down the client’s body

Thoracic, lumbar and sacral sections of the erector spinae, multifidus and deep spinal muscles and ligaments

Prop(s): • • •

Scalenes - for these muscles, deep strokes can be applied from the insertion around the mastoid process, down towards the ribs to release tension. Light friction can also be used ‘with care’ so as not to compress the carotid artery or jugular vein that lie underneath Sternocleidomastoid - deep stroking and friction can be applied to this muscle by grasping and pinching the fibres using the fingers and the thumb along the whole length of the muscle, lifting it away from underlying structures. Again, care needs to be taken not to compress underlying blood vessels. Working around the throat can be uncomfortable for many clients. It is not uncommon for treatment of this muscle group to cause coughing. Therapists should be particularly mindful of the client’s body language or verbal feedback when treating this area. In addition to being physically uncomfortable, it can also cause emotional or psychological distress

Small pillow a towel under the head in prone if there is no head hole a towel/pillow under head/neck in side lying

Stroke(s): • •

•

• •

Long strokes can be applied with thumbs, fingers or the heel of the hand up or down the neck muscles Upstrokes - the shoulder should be anchored down with one hand while the other executes the stroke towards the occiput to stretch the muscles Downstrokes - one hand gently holds the base of the skull to put the muscles in a slight stretch, while the other hand executes the stroke Transverse stroking - the thumb can be used to identify and treat any tense bands of muscle Deep friction - standing at the head or to the side of the couch, deep friction can be applied with fingertips to the occipital region

Notes: •

120

In supine with the therapist at head of the couch, one hand may be used to lift and support the head, or to turn it to one side while the strokes are applied to the back or side of the neck with the fingertips or thumb of the other hand. Passive stretching can also be performed in this position by gently pulling the base of the occipital bone to stretch the neck extensors, rotating the head and nodding the chin to the client’s armpit or moving the head laterally so the ear is moved towards the same shoulder to target extensors and lateral flexors

Client Position(s): Prone with the head in the couch/face hole

Therapist Position(s): Standing to the side of the couch facing toward the client’s head, or, standing at the head of the couch looking toward the client’s feet

Prop(s): Towel under hips; if no couch hole, rest forehead on small rolled up towel; cushion/towel under shoulders

Stroke(s): • •

Generally, most strokes will be applied to the back in a direction toward the head Long upwards strokes using the whole hand can be performed; these strokes should be returned to after any particularly deep or painful work to relax the muscles and the client

Sports Massage Level 3

Stretching for Sports Massage

Specific Stretch Techniques

Lower Back - child’s Pose

Section 11

The following examples of stretching techniques are provided to illustrate a range of simple techniques that can be used by massage therapists to compliment and support their massage treatments. These stretches are provided for illustrative purposes only and are by no means exhaustive. Massage therapists should therefore select stretches that are most suited to their client’s individual needs and circumstances.

Neck and shoulders- seated The client places themselves into the ‘child’s pose’ position. The therapist applies gentle pressure with their hands or body weight, to the lower back from behind.

Serratus anterior and arm adductors supine

The client places their head on their forearms or a towel/ pillow and the therapist stands behind. The client nods their chin to flex the neck while the therapist applies downward pressure to the shoulders. Alternatively, in a supine position the therapist can support the head in one hand, lift and flex the neck taking the head to one side or rotating the head and flexing the neck, while applying gentle downward pressure to the opposite shoulder.

Back - seated

The therapist can link their elbow into the client’s elbow with the client’s arm positioned overhead, and support the lower arm by holding on to the client’s wrist, applying pull away from the client and down, to stretch serratus anterior and the arm adductors.

Chest/anterior deltoids - seated

The therapist can guide the client into a variety of flexed and rotated positions and then use pressure through their hands, arms or body weight to assist the stretch. The client may also be able to move themselves more into the position, so enhancing the stretch, once they have a sense of the position required. © Copyright Health and Fitness Education 2017. All Rights Reserved.

The client sits on the couch with legs over one side. They place their fingers lightly on the back of their head. The therapist stands behind, placing their forearms on

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Section 11

Stretching for Sports Massage

the front of the client’s arms. They then apply gentle pressure against the client’s arms to open the chest and anterior shoulder.

Sports Massage Level 3

Gluteus medius/minimus - supine

QL and lateral muscles - seated

The therapist places one hand on the pelvis (iliac crest) to stabilise that side while the other hand guides the client into a side bend. The client’s arm on the stretching side is placed overhead in a tricep stretch position.

The therapist uses their body weight along the length of the client’s thigh, while supporting the knee and stretching in a diagonal position toward the opposite shoulder. The other hand is used to stabilise the opposite shoulder. By moving the position and direction of the knee different aspects of the muscles can be targeted.

Leg adductors - supine

TFL/abductors - side lying

The client flexes the hip and knee on the side to be stretched, placing their foot on the couch. The therapist uses their hand and arm to abduct the leg at various angles and apply pressure using their body weight to stretch the muscles.

The client lies with their top leg over and in front of the bottom leg with both knees bent. The therapist places one hand on the pelvis to stabilise it while lifting the bottom leg off the couch.

If the client lies with both legs straight and apart, the therapist can stabilise one leg while abducting the other with their hand or their body. Rotating the leg while abducting it will target different parts of the muscles.

144

Section 11

Sports Massage Level 3

Stretching for Sports Massage

ITB/abductors - side lying

Hip extensor/rotator muscles - supine

The client is positioned right on the edge of the couch. They can bend their bottom leg to aid stabilisation while the therapist applies gentle pressure to the top leg that is straight and hanging over the side of the couch.

The therapist supports and guides the client’s bent knee and through various flexed, adducted and abducted positions to effect a stretch.

Rectus femoris - supine

Iliopsoas - supine

The client lies with their bottom at the bottom end of the couch with one knee drawn into the chest and the other leg hanging over the edge toward the floor. The foot of the bent leg can be placed on the therapist’s chest to give support and ensure the hip stays flexed to protect the lower back. The therapist applies pressure with their hand on the thigh of the hanging leg, just above the knee.

The client is in the position described for the iliopsoas stretch. The therapist can use their shin or knee to press against the client’s lower leg. The stretch at the hip (iliopsoas) should be mild so as not to overstretch this muscle.

145

Section 11

Stretching for Sports Massage

Quadriceps - prone

Sports Massage Level 3

Summary Stretching can be a good way to conclude a sports massage session as it can reinforce muscle lengthening done as part of the treatment and aid relaxation. Any stretches the client is given to do at home should be demonstrated by the therapist to the client, and then by the client to the therapist, to check understanding and technique. It is good practice to review these again at the next session to ensure the client has not inadvertently adapted them and is still doing them correctly.

The therapist has one forearm across the clientâ&#x20AC;&#x2122;s lower back to support and stabilise the pelvis. The client bends their knee on the stretching side, bringing their heel toward their bottom. The therapist uses their shoulder to assist knee flexion or they can place a hand under the knee and gently lift it off the couch.

Hamstring - supine

The therapist lifts one leg up to the ceiling, fixing the knee into extension with one hand while the other hand supports the ankle as the leg is stretched. The therapist can place the stretching leg against their shoulder to effect a stretch.

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Sports Massage Level 3 Student Manual