The National Safety Council (NSC) reports that in 2019, personal exercise, with or without exercise equipment, held the top spot for sports- and recreation-related injuries that resulted in an emergency room visit.1 That represents roughly 468,000 injuries. Bicycling took second place with about 417,000 injuries. Then came basketball and football, with 404,000 and 292,000 injuries respectively.
Numbers this strong suggest there are a lot of American athletes, from elite to amateur, following up an emergency room visit with a rehab program or even surgery that’s initiated and provided by a medical team.
Today, more than ever, a sports massage therapist is a valued member of that treatment team. There is, however, a caveat, explains Andrew Abramson, LMT, LSW, owner of Synergy Sports & Corrective Massage, LLC in Villanova, Pennsylvania. “Massage therapists can’t diagnose, and the average athlete shouldn’t self-diagnose,” Abramson says. “If someone comes to me without a proper medical evaluation and states, ‘I think I have a sprain, and maybe massage therapy would help,’ I first recommend this person get a physician diagnosis. It’s the most conservative route, but we want to make sure there’s nothing more serious or injurious going on.”
While massage therapists must never diagnose, they certainly can use their knowledge and experience to identify techniques that support an athlete’s recovery from a properly diagnosed injury or surgery, explains Diane Hood, BCMT, LMT, owner of Body Mechanix Athletics in Springfield, Missouri. “To do this, though, a massage therapist needs to know basic kinesiology terminology and principles,” Hood adds. “It’s important to know which muscles are involved in specific movements, which muscles most likely compensate for an injured muscle, and if you’re part of a team, which muscles the doctor or physical therapist is focused on.”
Studies specific to massage and the management of sports-related injuries or surgeries are sparse. That said, evidence appears to suggest that massage can be effective for patients in general who are rehabilitating from injury or recuperating from surgery.
A 2016 study divided 51 patients who had just completed hip arthroplasty into two groups.2 Both groups followed standard protocol based on two daily sessions of active exercises for 45 minutes. In the study group, two sessions were replaced with fascial manipulation (FM). The study conclusion cites significantly improved functional outcomes in patients when FM is used in addition to usual treatment.
Low back pain is a frequent issue for athletes and can lead to significant time “on the bench.” In 2017, The Kentucky Pain Research and Outcomes Study3 evaluated massage’s impact on pain, disability and health-related quality of life for primary care patients with chronic low back pain. Results describe “a meaningful signal of massage effect for primary care patients with chronic low back pain.”
A case report that followed one athlete, a 19-year-old female middle-distance runner, examines the use of massage to better manage the patient’s sports-related chronic knee pain.4 When surgery and post-operative therapy failed to produce desired results, the patient started a treatment program consisting of stretches, massage and soft tissue mobilization. After following this course of rehabilitation for 10 weeks, the athlete returned to running and completed an entire season of indoor track and field. The article authors repeatedly stress that massage was one component of the rehabilitation program, so the unique contribution any one element played in the athlete’s return to competition is unknown.
Students of the Game
Science is only beginning to investigate how massage affects an athlete’s recovery from surgery or injury, but massage therapists, trainers, physical therapists and athletes have been following the effects for decades. Following are several insights based on accumulated wisdom and professional experiences.
To specialize in helping athletes recover postsurgery or postinjury, invest in continuing education classes to build your expertise.
“With the right training, your work will eventually speak for itself,” says Jo Ann Zitzow, LMT, owner of MyPlaceWellness!, Bloomington, Minnesota.
“You want clients who are referred to you to go back to their doctor, chiropractor or physical therapist and describe your work in terms of results specific to their needs. That’s how I built up my reputation and earned a spot in other health care professionals’ care network.” A good place to begin building your knowledge is at amtamassage.org, Zitzow says. “That’s where I turned for continuing education starting years ago. Today, AMTA has even more classes.”
Become familiar with what physical therapy involves in particular, how physical therapists help athletes recover from a sports-related injury or surgery.
“It helps to know what the physical therapist’s goals are—so you can use your skills, knowledge and experience to complement what they’re doing,” says Ann E. Boone, LMT, instructor of kinesiology and ethics at the Lexington Healing Arts Academy, Lexington, Kentucky. To achieve this level of insight, Boone suggests contacting a physical therapist you know and asking to shadow them. Or, for a specific client, ask permission to contact their PT. “Some physical therapists don’t often work one-on-one with a massage therapist, so they may not understand why you’re even calling,” Boone cautions. “When that happens to me, I explain that I’m not questioning what they do; I’m questioning how I can best support what they do. That’s how to become part of a team and develop relationships that can help your client heal.”
Have referrals ready to help amateur athletes stay on a safe healing plan.
While elite athletes often have a health care network, weekend warriors typically limp through injuries on their own. So if an amateur athlete books an appointment and asks you to “correct” a self-diagnosed injury, the ethical response is to steer that client toward a proper medical diagnosis, says Mosi Blane, certified massage.
A massage therapist's connection to a client's physician is often a physical therapist.
It’s not unusual for a physician to prescribe physical therapy and it’s the PT who actually recommends massage therapy, Blane says. “When that happens, my direct connection to the medical diagnosis is the PT, and my role is to help maintain what the physical therapist is already working on— like strengthening the athlete’s muscles around a joint, increasing range of motion, decreasing scar tissue and increasing blood flow.”
Building strong working relationships with athletic trainers and physical therapists not only helps your clients—it can also help your business.
“I get a lot of client referrals from physical therapists,” Brown says. And becoming a PT’s go-to massage therapist doesn’t require a glitzy marketing campaign, Brown adds. “When I’m working with a physical therapist for the first time, I talk to them and let them know how much I value being on their team. Once a PT understands that I’m all about working in harmony with them, the referrals come.”
Whether addressing an athlete's recovery from surgery or an injury, Boone says the one bit of advice she still gives herself—despite more than 40 years of experience—is to "wait, listen and don't go rogue."
Why? As Boone emphasizes, “You always want to make sure that you’re enhancing what everyone else is doing and not working against them. If you don’t know what they’re doing, ask! It shows you’re interested, and, at least in my experience, it’s the best way to keep healthy communication going.”
If and when appropriate, do what you can to strengthen communication lines among an athlete's entire health care network.
Professional and elite athletes typically have a team that manages recovery from surgery or injury. Even college and high school athletes may have access to a health care team. But for amateur athletes, the experts involved in post-injury rehab or post-surgery recovery are often working independently. “I believe there should be a harmonious connection between all the health care professionals helping an athlete recover,” says Isaac Brown, LMT, owner of T3 Recovery in West Hempstead, New York. “We all have valuable information to share. So if there is no one in charge of connecting that team—the physician, physical therapist, trainer and myself—then it’s something I focus on.”
Massage Therapy Journal
1. National Safety Council analysis of U.S. Consumer Product Safety Commission NEISS data. National Safety Council. Injury Facts®. 2019.
2. Busato M, Quagliati C, Magri L, Filippi A, Sanna A, Branchini M, Marchand AM, Stecco A. "Fascial manipulation associated with standard care compared to only standard postsurgical care for total hip arthroplasty: A randomized controlled trial." PM&R. 2016 Dec;8(12):1142-1150.
3. Elder WG, Munk N, Love MM, Bruckner GG, Stewart KE, Pearce K. "Real-world massage therapy produces meaningful effectiveness signal for primary care patients with chronic low back pain: results of a repeated measures cohort study." Pain Medicine. 2017;18(7):1394–1405.
4. Pettitt R, Dolski A. "Corrective neuromuscular approach to the treatment of iliotibial band friction syndrome: A case report." J Athl Train. 2000;35:96–99.