Sports Massage for Runners

Mark Fadil

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 cant 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 clients goals.

Pre-Event Massage

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 dont 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.

Post-Event Massage

Goal: To expedite recovery from a race and decrease post-exercise

soreness.

When administering a post-event massagegenerally within 36 hours of a

race or competitionkeep 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.

Injury Massage

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.

Picture 1: Tool for scraping tendons

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.)
Picture 2: IT band work

Picture 3: Abductor strengthening exercise

Achilles Tendinopathy

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.
Picture 4: Achilles tendon work

Picture 5: Side-lying work

Runners Knee

Runners 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.
Picture 6: Cross-fiber friction on supra-patellar and infra-patellar tendons

Picture 7: Stretch the quad

Picture 8: VMO strengthening start position

Picture 9: VMO strengthening finish position: Focus on locking out the
knee

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.

Home Treatments

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.
Picture 10: Iliopsoas

Picture 11: Glutes

Picture 12: Piriformis

Picture 13: Iliotibial Band

Picture 14: Hamstrings

Picture 15: Quad

Picture 16: Calf

Picture 17: Shins

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.

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