Massage Therapy for Runners By Susan S. Paul, MS, TSF Training Program Director

Massage therapy has become very popular in recent years among athletes, and in particular runners. Massage is purported to relieve muscle soreness, shorten recovery time, restore range of motion, remove adhesions, and even improve performance. Catherine Ndereba, queen of the marathon, says massage is the one thing she cannot live without and receives two massages weekly as her reward for running 90+ miles a week.

Massage most directly affects our muscular system, but it also has an impact on other systems of the body as well. Research has shown that the human body responds to pressure- no, not just any pressure- but deep, therapeutic pressure applied in a steady, even manner by a professional. Therapeutic massage elicits very specific responses, such as, increased blood circulation, increased diameter of blood vessels, and decreased blood pressure. These effects are significant for anyone, but can be of special importance to the athlete looking for ways to recover faster, prevent injuries, and improve performance.

Anatomy Review
Muscle tissue contracts; muscle contraction results in movement. Running requires sustained, repetitive muscle contraction. The greater the muscle contraction, the more shortening occurs within the muscle tissue, and the more force generated. The amount of muscle fiber recruitment determines the amount of force generated by each contraction. In running, these sustained, repetitive contractions translate into speed, power, and distance.
Fascia is a type of connective tissue that provides support; somewhat like a body stocking. Fascia wraps and separates each individual muscle, providing support and allowing greater ranges of motion. Fascia also works to absorb a portion of the physical stress from impact involved with running sustained from hitting the ground. Tendons attach muscles to bones. Tendons are located at the ends of each muscle belly. Muscle and fascia wrap together to form a tendon.

Ligaments are a highly fibrous form of connective tissue that connects bone to bone. They provide support to joints. Ligaments allow movement only within that joint’s range of motion. The cardio-respiratory system includes the heart, lungs, blood, and blood vessels. This system is responsible for oxygen transfer, nutrient delivery, and waste removal. Our circulatory system delivers blood enriched with oxygen and nutrients, like glucose and electrolytes, to muscle tissue. It then picks up and removes muscle metabolic by- products and waste. Inadequate circulation is somewhat comparable to starving and missing your garbage pick up day. Systems of the Body and Massage Susan Salvo’s textbook, Massage Therapy: Principles and Practice, lists some of the effects of massage on the body’s systems:

Massage and The Cardio-Respiratory System

• Dilates blood vessels- this promotes circulation and lowers blood pressure. Both systolic and diastolic BP readings decline following massage and remain lower for up to 40 minutes.
• Improves blood circulation by mechanically assisting venous blood flow back to the heart. Some studies have shown that massage increases local circulation up to 3 times more than at rest. This is comparable to levels of circulation during exercise. Better circulation means better delivery of nutritive materials and oxygen to surrounding cells and tissues.
• Cut down on eating from 4 p.m. on the night before the race or long run. Normal portions may be too much. It's okay to snack on toast or an energy bar. No fat or roughage.
• Promotes rapid removal of metabolic waste products; therefore improving recovery time.
• Increases red blood cell count and their oxygen-carrying capacity.
• Reduces heart rate.
• Increases oxygen saturation in blood.
• Improves pulmonary function by loosening tight respiratory muscles and fascia.
• Reduces respiration rate by activating the relaxation response.

Massage and The Muscular System

• Relieves muscle tension through improved circulation.
• Reduces muscle soreness and fatigue through enhanced circulation.
• Increases the amount of oxygen and nutrients. Increased circulation disposes of waste products and hastens recovery time.
• Increases/restores range of motion; thus improving running efficiency and performance.
• Improves flexibility- this reduces the risk of injury, improves running efficiency and performance.
• Restores posture and gait.

Massage and Connective Tissue

• Reduces excessive scar formation.
• Decreases adhesion formation.
• Releases fascial restrictions.
• Improves connective tissue healing.

Massage and The Lymphatic and Immune Systems

• Promotes lymph circulation.
• Improves connective tissue healing.
• Increases the number and function of natural killer cells; thereby boosting the immune system.

Massage and The Nervous and Endocrine Systems

• Reduces stress and anxiety and promotes relaxation by activating the parasympathetic nervous system.
• Increases dopamine and serotonin levels.
• Reduces cortisol levels; elevated cortisol levels are linked to stress.
• Reduces norepinephrine and epinephrine levels; these hormones are linked to high levels of stress.
• Decreases pain through improved circulation and by triggering the release of endorphins and other pain reducing neurochemicals.

FAQ

What are the implications of massage?
Many of the above listed effects as excerpted from Susan Salvo’s textbook, speak for themselves. However, it is important to understand the implications of some of these effects. First, the effects of massage are cumulative. This means that the effects increase with sequential, repetitive massages. Receiving one massage prior to a race will not reap the same benefits as a regular program of massage therapy. Second, massage therapy works best as a preventative program. Once an athlete sustains an actual injury, seeking medical attention comes first. Only after a proper diagnosis and treatment can physical therapy and/or massage therapy become part of the recovery and rehabilitation process. Remember, an ounce of prevention is worth a pound of cure.

What type of massage is best for athletes?
Deep tissue, therapeutic massage is required to achieve the benefits listed above. Deep tissue massage is not spa-type relaxation massage. Deep tissue massage can and will be uncomfortable at times. In addition to deep tissue massage, athletes will also benefit from a massage technique known as “myofascial release”. This technique specifically affects the connective tissue and works to restore fascia to its’ natural state. Connective tissue dehydrates as we lose fluids during training and “shrink wraps” (much like Saran Wrap does in the microwave). This “shrink wrapping” compresses muscle tissue; therefore, limiting range of motion and reducing circulation. Athletes training in hot, humid climates are especially susceptible to this phenomenon. Using a combination of deep tissue massage and myofascial release is very beneficial for runners.

How long will these benefits from massage last?
Unfortunately, most of the effects from massage are relatively short-lived. One exception to this rule is the long-term effect massage therapy has on specific injury sites and the reduction of scar tissue formation. Because running is a repetitive action, weekly mileage eventually causes muscles to shorten, fascia to bind, and restrictions to set in again and create the need for another massage. Runners can extend the life of their massage with proper hydration, good nutrition, adequate sleep, and stretching, stretching, and more stretching.

How often should runners get a massage?
Massage treatment plans are very individual. Assess your running goals and your budget when determining your treatment plan. Ask yourself the following questions: Do you have recurring injuries? Are you pushing your physical limits? Are you tackling a new distance? Are you time goal oriented? Are you competitive? Do you want to qualify for Boston? How much can you afford to spend per week or per month on massage? Then, after assessing your goals, your budget and your available time during the week, plan accordingly. The most important goal is to set a regular schedule for your massage treatments whether it’s once a week or once a month.

How will I feel after my massage?
Massage relaxes and lengthens the contractile fibers of muscles, so expect to feel different. There is a constant feedback system of communication between our muscles, joints, and our brains. Since massage impacts the muscles and the joints they cross, this feedback will be altered giving the athlete new and different post-massage messages. This can be disconcerting for some athletes so it is best to schedule massages 3-5 days before a race or a hard workout. Athletes should allow time for one or two easy runs or workouts before a hard effort after massage. This allows time for muscles, joints, and the communication system to re-adjust.

How to schedule your massage?
Look at your training schedule and note the dates of long runs, key workouts, and races. Schedule your massages around these targeted dates. For example, if you do a long run every second or third weekend, schedule your massage a day or two after these long runs to get “cleaned” up. Schedule your Pre-Race Massage 3-5 days before your race and your Post-Race Massage 3-5 days after your race. It is best to wait a few days after your race for a deep massage- wait until your muscles are no longer sore to the touch. When you are no longer sore, your regular massage therapist can work “deep” and “clean” you up for more training and races.

What about the on-site post race massages?
Many races offer on-site post-race massages. Taking advantage of this opportunity is a good idea. A post-race massage is very different from a deep tissue massage. These massages will be a light flushing treatment that will simply help re-direct blood flow up and out of your legs. This helps facilitate the post-race recovery process. The therapist’s touch should feel light compared to your usual massage treatments.

In Summary
1) Seek a Licensed Massage Therapist, they should have LMT after their name and their license number posted
2) Word-of-mouth recommendations from other athletes are a good referral source
3) Schedule regular massages throughout your training and racing period for the best results
4) Use massage therapy as preventative treatment
5) Schedule your Pre-race Massage 3-5 days prior to your event
6) Schedule your Post-race massage 3-5 days after your event
7) Drink lots of water and stretch between massage treatments