14 Massage
Massag e is a popular therapy for athletes and one of the modalities that first springs to mind when you consider recovery. But how, exactly, does it work? What is the right kind of massage to get? When is the right time for a massage? How can you find the best therapist for you? In this chapter, I’ll answer these questions and more.
Physiological benefits
Does massage work for recovery? If you’ve had a massage, you’ll probably answer yes. Many of the benefits of massage are unquantifiable but directly related to your recovery. Massage gives you time away from training, work, family demands, and the technical devices that tether you to training, work, and family. It helps you reach a state of deep relaxation, and in this way it carries some of the benefits of meditation: lowered blood pressure, emotional stability, a sense of holistic well-being.
As Pornratshanee Weerapong, Patria Hume, and Gregory Kolt (2005) point out, massage has a positive effect on the parasympathetic nervous system and thereby enhances recovery. When your parasympathetic nervous system is dominant, you have a better sense of relaxation and well-being, and your body is in an optimal state for recovery. Scientific research reaches various conclusions about massage’s effectiveness. A study on NCAA Division I basketball and volleyball players (Mancinelli et al. 2006) showed that massage was effective in reduction of delayed-onset muscle soreness (DOMS). Subjects were able to perform better on the vertical jump and agility tests after massage to alleviate their soreness. But as Anthony Barnett (2006) points out, this could be a negative, because the effects of DOMS linger even after muscle soreness has faded. An athlete might be tempted to return to intense training too soon and wind up injured. A comprehensive 2008 review (Best et al.) included the studies testing whether massage is useful for muscle recovery after exercise. It says that while there are many variables that have not been measured—the technique and intensity of the touch, for example—randomized controlled trials do point to massage aiding in recovery. Because the research studies don’t prescribe an ideal timing or frequency of massage, you’ll need to work from your own experience.
Effect on Circulation
Scientific studies have found differing effects of massage on circulation. Recently, a study conducted at Queen’s University in Kingston, Ontario (Wiltshire et al. 2010), showed that massage actually decreased the blood flow to the muscles. In that study, subjects who received massage after exercise showed less blood circulation than those who simply rested (passive recovery) and those who practiced active recovery.s
But massage therapists argue that massage aids in circulation (see Figure 14.1), and older studies support them. Massage therapist Leah Kangas, who does a lot of work with runners, explains, “Blood carries nutrients throughout the body to heal and repair, and carries away waste products. Massage can help speed up this process by increasing circulation to given muscles or tendons.” Massage can also help with movement of lymph through the body; the manual work toward recirculation of blood and lymph may speed recovery. Think of the long strokes from the distal parts of your body—your feet and calves, for example—toward the center.
Older thinking blamed lactic acid produced during exercise for postexercise soreness. Under that paradigm, massage helped to remove the lactic acid from the muscles. Newer research shows that lactic acid leaves the muscles fairly quickly after exercise, so it’s not the villain it has been painted to be. In fact, Wiltshire’s study shows that massage actually slowed the clearance of lactic acid from the muscles after exercise, by reducing circulation. When you hear the phrase “flushing toxins” in conjunction with massage, think less about moving out any residual waste products and more about bringing in the reparative cells that will aid in your adaptation and recovery. Toxins are a bugaboo. Many therapists use the term to describe the natural waste products in the body, often with an admonishment to “drink plenty of water to flush the toxins.” Drinking water is generally good advice, especially for athletes, so take that part and ignore the rest.
Exactly what massage does is still unclear. Pat Archer, an athletic trainer and massage therapist and the author of Therapeutic Massage in Athletics, explains that massage works, though she admits the precise reasons aren’t clear. “It’s effective,” she said. “We know it helps. We just don’t know exactly the full mechanism. They seem to be related to reducing muscle tension and managing the inflammatory process related to microtrauma created by the activity—it’s not about circulation, and it’s not about lactic acid. It is about reducing tension in the muscles after exercise.” Archer suggests using specific lymphatic facilitation techniques, strokes with pressure designed to drain the lymphatic system, in conjunction with massage to reduce athletes’ recovery time.
Removal of Adhesions
Regular massage can alleviate trigger points and reduce cramping and spasm
in the muscles (Figure 14.2). It can also help with the placement of collagen,
preventing adhesions that can cause problems in the muscle and allowing for
fuller lengthening and contraction in the fibers.
Adhesions form in the connective tissue, including the fascia, as a result
of both tissue breakdown in training and injury, where they set as scar tissue.
Massage therapist Leah Kangas uses the orange as an illustration for the fascia and muscle in the human body. “Each muscle fiber has its own little fascial casing, just like the tiny little pulp sections of an orange. Then just like the orange is sectioned, individual muscles are sectioned in the same way. And finally just how an orange is all cased together in the thicker, white section under the peel, so are all of our muscles and organs. Adhesions are when some of these fascial layers get stuck to each other, or adhered.” In the case of an acute injury, adhesions
are a positive thing, as they provide some structural integrity around the injury site. But scar tissue that doesn’t behave like muscle tissue can become problematic, hampering range of motion. Massage helps the scar tissue work more like the muscles or tendons it is repairing.
Ben Benjamin, a sports massage specialist, concurs. “If you’re healing and you’re moving at the same time, your body heals in the presence of a full range of motion,” he explains. Massage can help by encouraging scar tissue to form in appropriate patterns and then to disappear when it is no longer needed for structural support.
Personal Attention
An experienced massage therapist will be able to address your specific issues in ways you won’t be able to do alone, which allows for a more targeted approach to your own physiological needs. Carolyn Levy, a massage therapist who works with the USA track team and many players at the University of North Carolina, says her work is more direct than self-massage: “I’m very aware of how I need to approach the tissue, the level of pressure needed. We can get lazy when we do it ourselves. You can’t get in specific places.” While self-massage is useful—see Chapter 15—it can sometimes be too broad a brush. The roller and other self-massage implements can’t trace the muscle fibers in the same way the hands of a skilled massage therapist can.
With regular visits, your massage therapist will get to know your body and can let you know when things are changing. If a muscle feels particularly tense or taxed, it may be a sign of incipient injury. Listen to your therapist. Bernard Condevaux, a soigneur (massage therapist, among other things) for USA Cycling, says massage therapists can be useful sources of outside feedback. “They can tell you things you’re denying to yourself,” he explains—things like the development of an overuse injury.
Two-time Hawaii Ironman winner Tim DeBoom swears by the power of consistent massage:
In 1994, I was hit by a car and broke my back. During my rehab I started working with a massage therapist/physical therapist who basically brought me back from the dead. I have now been working with the same therapist for 16 years. She is a vital part of my recovery from training and racing. I go one to two times a week for a pretty deep tissue massage. I also go in for spot work whenever I have any little niggles. Being religious in getting work on my body and the consistency of using the same therapist has kept me from any real debilitating injuries.
Before his win in Kona in 2001, DeBoom got the go-ahead from his massage therapist, who observed that he was “ready to win.” And indeed he did. Such observations can instill that extra drop of self-confidence needed for a breakthrough performance—they’re an example of not only the physiological benefits of massage but the psychological benefits as well.
Psychological Benefits
Relaxation
A group of British researchers (Hemmings et al. 2000) studied the effect of massage on boxers’ recovery between workouts. The fighters who received massage reported a significantly higher perception of recovery, though the physical testing did not back them up. Regardless of any direct physical link, this perception of recovery is important. Massage confers feelings of relaxation and well-being, which has a direct, positive effect on athletes’perceived recovery.
You’ll almost assuredly feel better after any massage, and perception is a big part of recovery. Reducing both muscular and mental tension will certainly help your recovery and your training. Taking time out to focus on your body, to focus on your breath, and to do something that can directly enhance your recovery is well worth the money. In fact, you may achieve deeper relaxation because you’re paying for it. The massage table is a great place to really let go, away from your smart phone and computer screen, away from the demands of work and family. It echoes training in this way because it allows you a space apart, even as it requires no effort from you at all.
Massage as Therapy
The relationship between massage therapist and athlete can be a positive, supportive one that nurtures the athlete. This happens both through compassionate touch and through the conversation between an athlete and his or her bodyworker—evidence DeBoom’s experience. Personally, I spend a good half hour talking to my massage therapist, Pat Kosdan, at our monthly visits before I even get on the table. She asks me what’s going on in my body, which usually becomes a conversation about what’s going on in my life. When I’m spending more time writing, my body has different issues than when I am deep in a focused training cycle. When I’m stressed with other work or have been teaching yoga intensives, I have different needs. I truly think of Pat as my therapist, with no need to qualify her as my “massage” therapist, and she is a valued adviser.
This interpersonal relationship is important in cycling, where there is a long tradition of traveling with a soigneur for support. Condevaux traveled to Beijing in just this role for the 2008 Summer Olympics. He recounts counseling a female mountain biker who needed someone to talk to about her frustrations when her husband wasn’t allowed access to the Olympic Village. “When someone’s on the table, they’ll talk a lot. [Not having her husband around] threw her off. Yes, we did massage, but so much was working her through the issue.” On the table, Condevaux says, athletes “can clear their chests and know it stops there.”
Ultimately, the number of professional athletes who routinely use and frequently even travel with massage therapists speaks to the importance of massage in training and recovery. Elite running coach Greg McMillan says, “If I had unlimited money, I’d hire a masseuse to be with us all the time. People who are well paid have a masseuse who stretches them out before and after every run. Deena Kastor was really smart, because she married her massage therapist!”
Types of Massag e
The two main types of massage therapy offered in the United States are Swedish massage and deep tissue massage. These terms can overlap, naturally. Other, complementary approaches to bodywork include myofascial release; Structural Integration; assisted stretching; and Eastern modalities such as acupuncture, acupressure, and Reiki.
Swedish
Swedish massage generally uses lighter pressure than deep tissue massage. The primary actions in Swedish massage are long, gliding strokes; kneading; tapping; cross-fiber motions; and gentle rocking of the limbs. The strokes generally work from the body’s outer edges in toward the heart, following the path of blood flow.
Because Swedish massage is less intense than very deep tissue work, it’s acceptable through most, if not all, of the training cycle. Massage therapist Kangas explains, “It’s easy to receive a lot of [Swedish massage] while in intense training, and even leading up to and immediately following hard efforts or events, if someone’s been receiving the work already.”
Deep Tissue
Deep tissue massage works the deeper tissues of the muscles and their interface with fascia, the connective tissue binding the body in every direction. (Remember the orange analogy used above.) The pressure of deep tissue massage will vary not only based on the therapist’s approach but also on the needs of the athlete receiving the massage.
Deep tissue work can be uncomfortable to receive, and it can lead to more soreness in the muscles. For this reason, you should schedule it far enough from your peak workouts and races that it will not negatively affect your performance. Five days or more should do. Be sure to communicate openly with your massage therapist about your experience during deep tissue massage. Athletes are used to enduring discomfort; it is not in your best interest here. If you are fighting not to gasp, speak up! My one experience with couples massage came during a trip to a spa in the Napa Valley with my husband. My mother-in-law generously sent us a gift certificate, and we headed into the therapy room together. Afterward, we looked across the room at each other and both confessed that the massages were much deeper than we’re used to receiving. Because of each other’s presence, neither one of us was willing to look like a wimp asking for a slightly lighter touch!
You may find therapists who specialize in deep tissue or in Swedish massage; most will be trained and comfortable in both, so you need not feel that you have to commit to one or the other. A good massage therapist will draw on his or her experience to deliver what your body most needs. And as a good massage recipient, you’ll let them know about your experience—what’s working, what is not. Don’t hold back.
Other Bodywork Modalities
Other bodywork modalities can complement your massage therapy work and your training. These techniques can have profound impact on your body, and thus should be slotted in the off-season or when an injury needs to be addressed.
Assisted Stretching
In assisted stretching, a practitioner aids the athlete in stretching through the full range of motion. An experienced practitioner will recognize imbalances and faulty movement patterns in the body and will work with the athlete in hands-on stretching, engaging and releasing the muscles, to bring the body into better balance. The Mattes method and the Whartons’ approach, both versions of Active Isolated Stretching, are two examples. Thai yoga massage is another.
Myofascial Release
In myofascial release, the practitioner targets the fascia through gentle, targeted touch over long holds, with the goal of helping restructure the body from the fascia outward. This system can be helpful in addressing overuse injuries but is more therapeutic than recovery-based, used to treat an injury or imbalance instead of simply working to help the body recover as a whole.
Structural Integration (Rolfing)
Structural Integration, like myofascial release, aims to restructure the body toward better alignment, but it uses a deeper touch. Massage therapist Leah Kangas explains, “This work is deep, often with big changes in the body. If someone is able to prioritize it, I would have this work done in the off-season or during a long recovery phase. This way as the body changes, time can be allowed for these changes to become familiar to the body without having to continue in an intense training cycle. However, if this work seems particularly helpful for someone, I won’t hold off because they are in an intense cycle of training.”
Depending on the practitioner, you may be advised to follow the round of 10 treatments designed by Ida Rolf, who popularized this modality, or you may be able to work directly on your individual needs. Either way, deep work like Structural Integration is best scheduled in the off-season, far from peak events.
Eastern Modalities
Other modalities, such as acupressure, acupuncture, and Reiki (a Japanese form of energy work) may or may not be effective for recovery; these Eastern modalities are not well studied in the Western scientific literature. If you have the means and access to a practitioner, consider trying them out. Simply going through the motions of making time to focus on your wellbeing can, in and of itself, enhance your recovery.
When to Schedule Massage
I have the good fortune of coaching an athlete, Suzanna Dupee, who’s a massage therapist. In researching this book, I’ve been receiving massages weekly for the past two months, sometimes more than one a week. While it’s fantastic, especially during periods of work stress, it feels overly indulgent, and I suspect my standard one or two massages a month would probably serve the same purpose for me. Many athletes wonder about the timing of massage. How frequently should one get a massage, and if regular massage is not an option, when would be a good time to schedule one as an occasional treat? Timing depends on the point you have reached in the season
and the proximity of key workouts and races.
Throughout the Season
How frequently you enjoy a massage will probably be dictated by your budget. While once a week would be nice, once a month is probably fine. This massage can go somewhere during your rest week or during a period of slightly reduced load. Since you might feel sore or slower the next day, be sure to schedule it away from long or hard workouts.
During my pregnancies, I enjoyed regular massages, scheduled to align with the frequency of my visits to my obstetrician-gynecologist. In the early stages, monthly visits and massages were appropriate; as I came closer to term, I went every third week, then biweekly, and then once a week until delivery. While I was preparing for an endurance event of a different kind, the frequency of my massages might give you an idea of how you can increase your visits but decrease their intensity as you approach your peak event. This works best if you are a massage regular and aware of how massage affects your body. And just as a pregnant woman would seek a therapist familiar with her special needs, you should look for a therapist familiar with athletes’ needs.
If you are not getting regular massages, be careful scheduling it too close to your peak event. Kangas explains, “I see people coming in the week before their race never having received a massage before. It might be helpful, but usually there is so much to work through so many layers, and of course you wouldn’t want to make too much change at this point.” Better to schedule the occasional massage farther from a race, ideally during a quiet period in your training. It will also avoid aggravating tissue that is already stressed.
Before and After a Race
As you approach your goal race or event, the type of massage should vary according to your competition schedule. In other words, when you’re still farther from the race, you can receive deeper work; as you get closer to the event, a lighter touch is key.
Massage therapist Carolyn Levy divides the timeline around a peak event into a few stages. First, three weeks from competition, she suggests a thorough, therapeutic massage to, in her words, “work all the kinks out.” This massage, “deep and slow,” as Levy describes it, can go in the two or three days after your peak workout of the preceding cycle. Levy will prescribe an ice bath later that evening, before bed. She warns her athletes that they will feel a little sluggish the next day but promises, “the body will swing back within 48 to 72 hours.”
Three days before the event, Levy will massage the athlete using a lighter touch at a faster pace. The goal in this lighter massage is to pass through the muscle tissues, helping them flush and refresh. If you take a day of rest in your race week, the massage could go on that day or precede it. Just keep it a day or two removed from your event itself—farther if it’s a very big event. Tim DeBoom says, “Before an Ironman, I’ll get my last body work done about four days before the race. I always feel pretty crappy the day after body work, so I try to have plenty of time to absorb it before a big race.”
Immediately after the event itself, Levy suggests a brief massage, “a good ten-minute flush-out, and some stretching,” which she feels signals the body to begin its repair work. If you visit the massage tent after a race, be sure that your experience is a relaxing one. This is not the time to add aggravation to already inflamed tissue.
A few days after the event, another light massage is in order to bookend the one scheduled a few days before the event. Levy says the intention is “flushing, not terribly deep. You don’t want to traumatize the tissue, but again to deliver the message that you can open up.”
Finally, within a week or so, the body will be ready for a return to its normal massage schedule.
You may find that a different protocol works for you. Professional triathlete Alex McDonald will schedule a Monday massage before a Saturday race. This gives him time to rebound. If he has a deep massage on Monday, he says, “I’ll be sore on Monday and Tuesday, but by the end of the week I feel like a spring chicken!”
In a Day
Whenever possible, schedule your massage for later in the day, after your workout. It can be especially restful—if not financially practical—to have your therapist travel to your home, so that you don’t have to drive after your treatment and can instead continue relaxing.
If you must schedule a massage before a workout, try to make it an easy workout, and assume that you will feel different from usual. It’s probably
not the best time to go out and run technical trail.
When Not to Schedule Massag e
A quick word of caution: Massage may be palliative care for an injury, as
it helps you feel better all over. But booking a massage is not the same as
scheduling an appointment with a sports-medicine specialist or physical
therapist. If you have pain related to training, be sure you are addressing the
cause of the trouble by having your symptoms and biomechanics evaluated.
Be honest with yourself; take a good, hard look at your training and recovery.
Don’t use massage as a Band-Aid.
How to Find a Massag e Therapist
Massage licensure laws vary among countries, and within countries, they vary
among states and provinces. In the United States, not all states regulate massage therapists. Most states require state licensure; a few require state certification; a few are unregulated. A quick search online will explain the law in your area and unearth a few directories to help you find a local practitioner. Don’t be shy about asking for a potential therapist’s credentials. Look at the amount of hours the therapist has trained. Six hundred hours or more of training are a good sign; a weekend certification is not. Better still is a therapist with additional training in working with athletes.
Beyond licensure and certification, you are looking for a massage therapist who understands your body and needs as an athlete. Ideally, he or she is not only experienced in working with athletes of your sport but also actively engaging in that sport. Such a person will be sympathetic and will understand not only the athlete’s body but also the athlete’s psyche. Kangas cautions, “Many therapists don’t understand athletes and their drive, and will often develop a mindset: ‘Well, if you just didn’t do so much (insert activity here).’ Also, a therapist with experience working with athletes of your particular activity will have that much more experience in working with similar injuries and imbalances.”
The best way to locate a therapist in your area is through referrals. Ask your training partners, local running and bike store workers, and local sports-medicine practitioners for their recommendations. But remember, tastes are very individual, so you’ll want to try the therapist for yourself and to communicate clearly about your needs, including the type of pressure you prefer. One person’s torture hour is another person’s deep release.
Prices for massage vary, depending on area and venue. Expect to pay more at a luxury spa and less at a franchise such as Massage Envy. And remember, price doesn’t always correlate to quality.
The Bott om Line
Massage can be a productive, relaxing, and enjoyable part of your training regimen. Depending on your budget and needs, it might be an occasional treat or an important routine. As with the other modalities described here, find what works for you and your budget. Personally, I suggest a monthly massage, with more frequent massages during peak volume weeks and closer to the race. Committing to self-care and relaxation through massage is a good first step toward building in more time for recovery and restoration.

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