Practicing Sports Massage

May 16, 2011

There's a lot of opportunity for massage therapists, from health care environments to spas to opening their own practice—or some combination of all of these. When considering your options, it's helpful to have an idea of what you need to know, as well as what you can expect, in a particular work setting.

Following is a snapshot of how massage therapy is used in the athletic environment. From modalities and techniques used to how massage therapy is scheduled to the importance of research, you’ll find a variety of information that can help you decide if sports massage is a good fit for you, and your professional goals.

What You Need to Know About Sports Massage

Education. When thinking about pursuing sports massage, you need to be aware that a better-than-average understanding of anatomy and physiology—along with kinesiology, pathology and orthopedic assessment— is expected. “Therapists have to be able to communicate with the other team members using the correct anatomic terminology and descriptions,” explains Pat Archer, a licensed massage therapist and certified athletic trainer in Seattle, Washington. “We also have to understand the difference between sprain and strain, severity and stage of healing, treatment and rehabilitation, as well as what structures are implicated with a positive Kernig’s or Speed’s test.”

Stay current with sports massage research. Archer believes strongly that keeping up-to-date with research is an important aspect of sports massage, particularly because establishing credibility is key when hoping to develop professional relationships in this setting. “We need to be careful, more precise with our language, when explaining the physiologic effects of massage,” explains Archer, “especially because a few of the most commonly touted beliefs have not been supported with research.”

For example, talking about massage therapy removing or breaking up lactic acid to prevent muscle soreness is a mistake, according to Archer. “These claims aren’t supported in the research, and we’ve known for decades that lactic acid has nothing to do with muscle soreness,” Archer explains. “We lose credibility when we continue to make claims that other sports health care professionals know to be erroneous or misleading.”

What to do, then? Archer suggests reading the research and journals that other sports health care professionals read, and focus your attention on the well-supported benefits and structural effects of massage therapy that can help athletes. Improved sleep patterns, for example, and identifying areas of tension and soreness and addressing them before an injury occurs.

You should also mention structural effects, such as improved tissue flexibility and muscle relaxation, improved range of motion, reduction of muscle spasms and cramps, relief of myofascial trigger points and neuromuscular tender points, as well as the reduction of adhesions and enhanced collagen remodeling during a healing cycle.

PRO TIP: Get involved in the sports medicine scene by subscribing to the journal that athletic trainers and physical therapists read, including: Training & Conditioning, Athletic Therapy Today and The Physician and SportsMedicine, for example. Or, consider becoming an associate member of the National Athletic Trainer’s Association. “These things not only get you name and face recognition, but really help bolster your education on current research, modalities and rehabilitation techniques,” says Archer.

Massage-specific skills. “Currently, many athletic trainers and physical therapists use some type of myofascial or active release, positional release, trigger point or lymphatic techniques,” Archer says. “So, being certified or having advanced training in one or more of these areas is important.” More generally, too, being proficient in massage therapy skills that are easily integrated into standard treatment protocols already used in the athletic clinic is a good idea. For example, you should understand the basic effects of heat and cold, as well as the purpose and general use of other techniques, such as ultrasound, TENS units, diathermy and muscle stim.

Understand the sport. Along with a solid understanding of anatomy and physiology, massage therapists must also have a thorough understanding of the sport they want to work within. “Therapists need to know enough about the training regimen and competitive practices of the sport so they can ask relevant questions,” Archer says. “You need to know the different stresses placed on the plant leg versus the drive leg of a pole vaulter, for example, or the difference between classic and modern Nordic skiing.”

Additionally, Archer suggests that massage therapists familiarize themselves with the athletes’ training schedules. When do they do weights? What do the aerobic workouts look like, and when do the athletes taper or intensify training? Knowing this information, according to Archer, helps massage therapists decide the optimal time for massage therapy. “You don’t have to be an expert or compete in the sport to be a good therapist,” Archer adds. “But, you do have to have some understanding of how it’s done.”

Related: AMTA/NCBTMB Sports Massage Specialty Certificate Program

Getting The Sports Massage Job

Making contact. When thinking about working in sports massage, knowing who makes the hiring decisions, as well as the other members of the sports health care team and their qualifications, roles and responsibilities, is important. “Most often, the sports health care team is made up of a team physician, certified athletic trainer(s) and physical therapists,” Archer says, “although the athletic trainer and physical therapist may be the same person because they’re dual credentialed.”

And assuming the coach is who you should approach about a position would be misguided. “Coaches are generally not considered members of this team, and so as tempting as it may be, you don’t really want to approach the coach for the job,” Archer recommends. “Most often, especially in professional and collegiate athletics, the head athletic trainer would make the decisions on whether to hire a massage therapist and how the therapist will function within the team.”

PRO TIP: Massage therapists just starting in sports massage need to understand that an athletic trainer is not the  same thing as a personal trainer or fitness coach. “There is a huge push in the athletic training profession to emphasize this distinction, and massage therapists can really get off on the wrong foot by not knowing this,” Archer explains. “You need to be very careful to not use the term athletic trainer when referring to a personal trainer or fitness coach.”

What to do. Consider contacting the head athletic trainer with your introductory phone call and letter of introduction. If you know the coach or an athlete and they want to work with you, ask them to introduce you to the head athletic trainer. “Make sure you let the athletic trainer know your intention and desire to consult and work under their guidance,” Archer encourages.

When drafting a proposal for the head athletic trainer, emphasize the therapeutic nature of massage therapy. “Make sure you’re clear about the fact that the massage you are offering is therapeutic, not ‘feel good’ or a reward for the star athletes,” Archer says. Massage therapists should also be prepared to demonstrate their techniques, as well as discuss the physiologic rationale for every massage modality they use.

Additionally, remember that you’re building a professional relationship, so try to avoid sounding too much like a fan—even if you may very well be a loyal fan of the team you’re hoping to work with. “You want to develop a professional proposal for how you can work within their already established system,” Archer says. “You’ll want to discuss how you want to work in the same manner as their team physicians and other subcontractors.”

What's Expected of You in Sports Massage

Massage sessions. Remember that athletes are going to be using techniques and modalities other than massage therapy, so your work is going to happen in shorter sessions. “The massage treatment can only be 15 to 20 minutes long,” Archer says. “The goals of each session are very limited, such as reduce spasm, pain or edema in a particular muscle group.” So, you’re going to have to adjust how you think about your work, moving from the holistic nature of massage therapy to a more targeted perspective, like loosening up a tight spot instead of correcting posture. “You also need to be comfortable with the idea that an athlete will be practicing and competing even though there still is some pain,” Archer adds.

Schedule. Massage therapists do have some control over their schedule, but will likely be expected to establish regular times, like every Tuesday and Thursday after practice for three hours, for example, or everyday in the training room from 1 p.m. to 6 p.m. The athletic trainer or physical therapist will be who fi ll the schedule with the athletes they want the massage therapist to see, however. “In other words, I may have appointments set up on a 30-minute schedule over a four-hour period of time, so I can see eight athletes,” adds Archer. “But, it’s the athletic trainer or physical therapist who determines who the eight athletes will be."

Archer also recommends that the massage therapist ask for a “referral” from the athletic trainer or physical therapist outlining the goals for the massage session. “You need to educate the sports health care team about the kinds of injuries and conditions that will benefi t most from the different massage therapy modalities you practice,” Archer explains. “Then, the athletic trainer or physical therapist will specify treatment goals, like‘decrease muscle spasms in the right hamstrings’ or ‘assess right shoulder for soft tissue restrictions and treat as needed.’”

Documentation. Proper documentation of your work is essential in this environment. “In general, therapists want their documentation to match what is being used in the clinic or training room,” Archer says. “So, taking a look at their treatment logs is the best guideline.”

An abbreviated form giving the basic information is sufficient most of the time. “You can use one-half page that has the athletes name, sport, referring athletic trainer, injury or area of focus and any contraindications,” Archer adds. “There should be open space on the form for the massage therapist to record session goals, specific techniques used, areas treated and duration of the session.”

As with most work environments, there are going to be things that are familiar in sports massage, as well as practices that you might not be as familiar with. Getting to know what you can expect from various work settings, however, is a good first step in deciding if a particular environment fits both your personal and professional goals.