Massage for Sports Injuries: Choosing Techniques by Recovery Stage

Post-workout soreness and a sports injury are not the same thing.

Delayed-onset muscle soreness, or DOMS, usually develops gradually after unfamiliar or demanding exercise. The affected muscles may feel tender, stiff or fatigued, but there was not necessarily a specific moment when something went wrong.

Massage may reduce the perception of soreness for some people, but DOMS does not usually require injury-specific treatment.

For a closer discussion of exercise-related soreness, read Can Sports Massage Help Post-Workout Soreness and Mobility?

An injury may begin with a specific incident, such as a twist, fall, collision or sudden pull. It may also develop gradually when a tendon, joint or other structure becomes increasingly sensitive under repeated load.

Sharp pain, substantial swelling, bruising, sudden weakness, joint instability or difficulty bearing weight should not automatically be treated as ordinary muscular tightness.

When the nature or severity of the injury is unclear, assessment may be required before direct massage is performed.

There is no universal rule stating that every injury should receive massage after a particular number of hours or days. Treatment depends more on the injury’s presentation than on the calendar alone.

A recently injured area may be painful, swollen, bruised, warm or sensitive to movement. Aggressive pressure directly over that area may be inappropriate.

The RMT may decide to postpone direct treatment, use a gentler approach in surrounding areas or recommend assessment by another healthcare professional. The decision depends on the suspected injury, the severity of the symptoms and the therapist’s scope and competence.

This is not the stage for attempting to “break up” tissue or testing how much pressure the area can tolerate.

If you are uncertain whether you have injured a muscle, tendon or ligament, read:

Sprain vs Strain: How to Tell the Difference

As swelling and sensitivity decrease and movement becomes more comfortable, treatment options may expand.

Massage might include gentle-to-moderate work around the injured region, treatment of nearby muscles that have become guarded or a gradual introduction of movement during the appointment.

The therapist should continue to monitor how the area responds. A technique that feels tolerable during treatment should not produce a substantial flare-up later that day or the following morning.

Massage at this stage is often used alongside progressive exercise or rehabilitation rather than as a substitute for it.

A persistent tendon complaint, old muscle strain or recurring area of sensitivity may tolerate more focused treatment than a new injury.

However, a long-standing problem does not automatically require maximum pressure. Treatment intensity should still reflect the irritability of the condition, the client’s previous response and what the person needs to do afterward.

Persistent pain may also involve factors that massage cannot resolve on its own, including training load, strength, movement tolerance or an incomplete return-to-activity progression.

Feeling better after massage is encouraging, but temporary symptom relief does not prove that an injury is ready for full training.

Return-to-activity decisions may also depend on strength, range of motion, balance, confidence, coordination and the ability to tolerate sport-specific loading.

When structured rehabilitation or return-to-sport testing is needed, Athletic Therapy may be considered.

There is no single best massage technique for every athletic injury.

Technique selection should reflect the affected structure, stage of recovery, current sensitivity and treatment goal. Several approaches may be combined, but using more techniques does not necessarily produce a better result.

For a complete explanation of the techniques used in sports massage, read: Sports Massage Techniques: What RMTs Use and Why

The following considerations are particularly relevant when an injury is involved.

Broad, moderate techniques may be used when an area is sensitive or when surrounding muscles have become tense from protecting the injury.

The purpose may be to make the area feel more comfortable and determine how the client responds to touch and pressure. Gentle treatment should not be interpreted as ineffective treatment. In an irritable condition, it may be more appropriate than attempting focused work immediately.

Cyriax-style friction involves applying small, repeated transverse movements across a specific tendon, ligament or other soft-tissue structure.

It is sometimes considered for persistent tendon or ligament complaints. Proposed explanations have included influencing pain, tissue mobility or local response to mechanical input. However, research has not consistently shown that friction massage improves tendinopathy outcomes when compared with other approaches.

It should therefore be considered a possible adjunct—not a method for mechanically breaking apart scar tissue or replacing progressive tendon loading.

External source: Deep Friction Massage for Tendinopathy—Systematic Review [PubMed]

Instrument-assisted soft-tissue mobilization—often called IASTM, scraping or blading—uses a handheld tool to apply pressure and movement across the skin.

It may be used to explore tissue sensitivity or provide a different form of mechanical input. Some research reports short-term improvements in pain or movement, while other reviews have found that the clinical effects are small or inconsistent.

IASTM does not literally scrape away adhesions or realign tissue fibres. Bruising is not required for the technique to be effective, and aggressive instrument work may be inappropriate over an acute injury, irritated tendon, broken skin or area with altered sensation.

External source: IASTM Systematic Review and Meta-Analysis [PubMed]

Myofascial or trigger-point techniques may be used when muscular tension or localized sensitivity is contributing to discomfort around an injury.

These techniques may help modify symptoms temporarily, but they should not be described as permanently releasing fascia, correcting joint mechanics or eliminating the cause of an injury.

The RMT should reassess movement or symptoms afterward to determine whether the chosen approach was useful.

Slower, focused pressure may be appropriate for persistent muscular tension or areas that tolerate treatment well.

Deep tissue massage should not be applied simply because an injury is old or because the client is an athlete. Excessive pressure can aggravate a sensitive tendon, recently strained muscle or bruised area.

The goal is to apply enough pressure to address the treatment objective without provoking an unnecessary flare-up.

Gentle active movement, assisted stretching or joint movement may be included when appropriate.

Stretching should not be forced into sharp pain or used to test a newly injured structure. In later recovery, it may help the therapist assess tolerance and make movement feel more comfortable, but lasting improvements usually require active use of the available range.

Different injuries present different treatment considerations. The following examples illustrate why the same technique should not be applied automatically.

A muscle strain may range from a mild overstretch to a more substantial tear.

Direct, aggressive massage may be inappropriate when the strain is new, bruised or painful during contraction. Early treatment decisions should be based on severity and symptoms rather than an automatic timetable.

As the strain settles, massage may be used for comfort in the surrounding muscles or as one part of a broader return-to-loading plan. Readiness to return to sport should be based on function—not simply on whether the area feels looser after treatment.

A sprain affects a ligament rather than a muscle. Swelling, instability and difficulty bearing weight may require assessment before direct treatment.

Massage cannot restore ligament stability. During recovery, it may be used to address muscular guarding or discomfort in nearby tissues, while strength, balance and proprioceptive exercises address functional recovery.

Tendinopathy usually involves changes in how a tendon responds to repeated load. It is not always accurately described as inflammation.

Massage may help manage pain or tension in surrounding muscles, but the tendon usually also needs appropriate load management and progressive strengthening.

Friction massage or IASTM may be included when indicated, but neither should be presented as a standalone cure.

Pain near a joint does not always identify which structure is responsible.

For example, knee pain may arise from a tendon, ligament, joint surface, bursa or referred symptoms from another region. Shoulder pain may involve several tissues that produce similar symptoms.

An RMT can assess soft tissues and joints within the massage-therapy scope, but unclear, severe or persistent joint symptoms may require additional assessment.

For information about iliotibial-band-related symptoms, read: Iliotibial Band Syndrome: What May Contribute to Lateral Knee Pain

Massage therapy may help reduce pain, manage muscular tension and make movement more comfortable. Its role should not be exaggerated.

Massage cannot:

• Confirm the severity of a tear without appropriate assessment.
• Reattach torn muscle, tendon or ligament fibres.

• Mechanically break apart or perfectly realign scar tissue.
• Correct every compensation or biomechanical issue through hands-on treatment alone.
• Guarantee faster healing or prevent another injury.
• Determine return-to-sport readiness based only on how the area feels after treatment.

These limits do not make massage unhelpful. They define where massage fits best: as one possible component of a larger recovery plan.

Arrange appropriate medical or rehabilitation assessment when an injury involves substantial swelling, extensive bruising, visible deformity, inability to bear weight or a major loss of function.

Assessment is also important for persistent numbness, tingling, unexplained weakness, severe night pain, fever, redness that continues to spread or symptoms that are worsening rather than settling.

Head, neck or spinal injuries and suspected fractures should not be treated as ordinary muscular soreness.

Sudden calf swelling or pain accompanied by shortness of breath or chest pain requires urgent medical attention.

Before treatment, tell the RMT:

• How and when the injury happened.
• Whether there was a sudden sound, pull, twist or impact.
• Which movements currently reproduce the symptoms.
• Whether swelling, bruising, weakness or instability is present.
• Whether the injury has been medically assessed or imaged.
• What treatment or rehabilitation you are already receiving.
• Which medications may affect pain, bleeding, sensation or tissue response.
• What training or competition you expect to resume.

Ontario RMTs are expected to obtain a relevant health history, assess whether massage is indicated, develop an individualized treatment plan and refer when another professional’s expertise is more appropriate.

CMTO Standard of Practice: Client-Centred Care

https://www.cmto.com/rules/client-centred-care/

The best massage for a sports injury is not necessarily the deepest or most complicated treatment. It is the approach that matches the affected tissue, the stage of recovery, the person’s current sensitivity and the activities they are trying to resume.

A new, swollen or unstable injury may need assessment before direct treatment. As symptoms settle, massage may be introduced or adapted to or help manage pain, muscular guarding and movement discomfort. Persistent conditions may tolerate more focused work, but pressure and technique should still be guided by the client’s response rather than the age of the injury alone.

Massage is most useful when it has a clearly defined role within recovery. It may make movement more comfortable and help manage symptoms while healing, progressive loading and rehabilitation continue. It does not need to replace exercise-based care to be valuable.

A thoughtful RMT should be able to determine when treatment is appropriate, when it should be modified and when another form of assessment or rehabilitation would better address the problem.