The first priority of every massage therapist who works with athletes should be to understand the biomechanics of each sport, along with where the eccentric and concentric loads are put on the joints and muscles. If you don’t understand what or how the joints of an athlete are loading and unloading during that particular sport, lasting results will be very difficult to achieve.

Following, you’ll learn more about how to assess for three of the most common types of injuries you may see in your athlete clients: shoulder injuries, plantar fasciitis, and lumbar-related injuries.

Shoulder-Heavy Sports: Assessing for Injury

Athletes who participate in sports that heavily depend on the shoulder joint, such as baseball, football, tennis, volleyball or even shot put, are susceptible to shoulder injury. For example, the posterior cuff in a pitcher’s arm, responsible for the deceleration that keeps their arm from crossing home plate with the ball, can put anywhere from 78 mph to 100 mph of force on the rotator cuff—per pitch!

Similarly, the tennis player’s shoulder must decelerate a forward swing that sometimes tops 150 mph. For the quarterback, injury during acceleration is the problem, especially if they get caught and tackled with their arm cocked back into external rotation. An athlete who plays volleyball puts their shoulder joint in one of the worst possible positions. To spike the ball, their arm is first above 90 degrees and then goes into internal rotation, which sets them up for impingement of the supraspinatus tendon and misalignment of the humerus.

Assessing for potential shoulder injury requires massage therapists look at the position of the shoulder and range of motion of the shoulder in and out of gravity. In a baseball player, for example, the eccentric load on the posterior cuff decelerating a pitcher’s arm may cause palpable myofascial nodules in the tissues, and a scratch test might show decreased internal rotation.

The Neer Impingement Test, designed to reproduce symptoms of rotator cuff impingement, is another good assessment tool because symptoms will be reproduced if the supraspinatus tendon or the bicep brachii are involved. Evaluating a client in gravity and out of gravity is necessary to differentiate between myofascial restrictions and possible misalignment of the joint.

Out of gravity—when your client is on the massage table—takes most of the myofascial restrictions away and allows you to observe joint function. If a client has restrictions or limited range of motion in gravity that are no longer present out of gravity, then it’s probably safe to say myofascial release will help you restore function to them. Alternatively, if the restrictions you see in gravity remain when the client is out of gravity, a joint issue is likely the cause. Referring out to a medical health professional is a good idea because calcium deposits can lead to tears.

Runners & Plantar Fasciitis: Assessing the Foot

In runners, the function of the foot usually determines the type of injuries that the lower leg will suffer. A foot that is overpronated or stays in pronation during the run will cause a cascade of different problems for the foot and calf, for example.

In my own work, the most common injury of this type I see is plantar fasciitis. This condition causes heel pain and often radiating pain in the arch of the foot. The client will complain of pain when they take their first steps in the morning.

Assessment includes determining what caused the injury by feeling the inside of the arch as the client moves forward and backward to see how the arch of the foot is recovering. Next, massage therapists should look at how the body is accepting its own body weight down through the femur to the foot in a squat.

Looking at the loads on the foot while performing a squat is the closest thing you can do to duplicate the loads the foot undergoes in the run. A manual resistance test to the anterior tibialis is also helpful. If the calf muscles have been chronically tight, this assessment will decrease the function of the anterior tibialis muscle.

The tug of war on the calcaneous leads to misalignment of the calcaneous and hypertonicity of the plantar surface. Myofascial release on the gastrocnemius and soleus muscle can help restore the functioning of the anterior tibialis. Working on the anterior tibialis can also help relieve myofascial nodules that develop due to the stress of the posterior tightness.

The longer a client has suffered with plantar facsciitis, however, the more you want to refer them to their primary care physician for an MRI to determine if the plantar surface has separated from the calcaneous. You  don’t want to beat up the plantar surface of the foot if there is a possibility the plantar tissue has torn away from the calcaneous.

Lumbar-Related Injuries: What You Need To Know

Lumbar pain in an athlete who participates in a sport that requires rotations, such as golf, can be blamed on many things, so the easiest thing for a massage therapist to rule out is if the pain and dysfunction are being caused by a hip dysfunction. The hips are what hold up the pelvis and directly affect the sacroiliac joints.

Perform the FABER test to see if they have a positive impingement sign of the femur. Evaluate the client supine and prone, rotating the femur into internal and external rotation and noting the myofascial restrictions. When the client is in prone position, you will be able to see how the fascial restrictions are crossing over the SI joint when there is lack of range of motion and alignment of the femur. The range of motion of the femur should be similar when performing internal and external range of motion. Compare the sides bilaterally as well. The side of the most restriction almost always correlates to the side of lumbar complaint.

Understanding your clients’ habits and their athletic interests will further help you to understand how to help address certain conditions. Not every client is the same just as not every sport is the same. Whether it’s a serve, a putt, or a kick, you can help your client feel better both on and off the sports field.

Learn More About How Massage Therapists Can Work With Athletes:

Two trainers talk about how massage therapy works with their professional sports teams

Learn assessment techniques for three of the most common athletic injuries