Sports & Therapeutic Massage

Sports Massage | Active Release Technique | Fascial Release

I specialise in sports massage for injury management, rehabilitation, pain management, sports enhancement and exercise recovery. Sports massage is a valuable treatment in conjunction with corrective exercise programming to improve function and reduce injury risk.

I am a ‘full body’ certified Active Release Technique (ART) and fascial release practitioner and am overseen by the Complementary and Natural Healthcare Council (CNHC).

What is Massage Therapy?

Massage therapy is a technique performed whereby the therapist manipulates the soft tissues of the body in a rhythmic fashion, using varying degrees of pressure and movement.

Soft tissue refers to tissues that connect, support, or surround structures and organs of the body; these include muscles, tendons, ligaments, fascia, nerves, fibrous tissues, fat, blood vessels, and synovial membranes.

Massage therapy can be helpful to:

• Relieve chronic muscular tension, aches and pain

• Complement osteopathic/physiotherapy treatment

• Improve circulation and joint mobility

• Decrease scar tissue

• Reduce mental and physical fatigue

• Improve lymphatic drainage

• Release emotional tension and stress

• Help prevent and treat sport injuries and prevent re-injury

• Facilitate recovery and repair

• Improve training and performance

• Improve sense of well-being and bring relaxation

What is Soft Tissue Therapy?

Soft Tissue Therapy is defined as the assessment, treatment and rehabilitation of minor and chronic musculoskeletal conditions (Mel Cash 2012). To optimise your treatment, I will therefore:

• Take a medical history.

• Make note of any orthopaedic injuries or surgeries.

• Ask about current exercise habits and exercise history.

• Palpate your tissues to identify abnormality in tissue texture, tension, and movement.

• Assess muscle range of motion and muscle strength

• Perform relevant tests and assess basic movement to try and identify what may be underlying your muscle tightness, pain and dysfunction.

• Perform soft tissue release, muscle energy techniques, positional release, fascial release and neuromuscular techniques to release tight muscles.

I recognise that muscles have a 3D web of connective tissue (myofascia) running through them which connects them to other groups. Pain and dysfunction in one muscle may often create dysfunction in a muscle that it connects to, which is why I perform a thorough range of motion, strength and movement based assessment.

Sports massage, Active Release Technique, manual lymphatic drainange and Lyno method are manual therapies that involve manipulation of superficial and deep layers of muscle and connective tissue (tendons, ligaments and fascia).

To optimise your recovery, I provide a home exercise/stretching/soft tissue programme to address muscle imbalance and help prevent further soft tissue injury.

I provide sports massage in Henley-on-Thames and offer a mobile massage service in the Berkshire, Buckinghamshire and Oxfordshire area. I am a specialist in my field and charge £95 per hour for massage therapy.

Massage Therapy Techniques

I commonly use the following massage techniques:

Effleurage

Effleurage strokes involve long, rhythmic strokes of the hands over the client’s skin of varying pace and pressure. This type of stroke helps to prepare the body for massage, aids relaxation and increases blood and lymph flow and give valuable information to the condition of the tissue under their hands. This stroke is also beneficial post-injury or surgery to remove waste products and promote healing.

Petrissage

Petrissage is a deeper stroke than petrissage and is generally performed after effleurage. It involves rhythmical lifting, kneading, squeezing and rolling of the skin with the therapist’s hands, thumbs and/or fingers. This type of stroke is helpful in mobilising deeper tissues, breaking down adhesions, scar tissue and reduce post exercise muscle soreness. Caution should be used on inflamed tissue, swelling and new scar tissue.

Percussion/Tapotement

Percussion/tapotement is a stimulating style of massage stroke. It involves rhythmic hacking, pounding, beating, clapping and pounding on muscular/fleshy parts of the body with either the fingers, sides of the hands, loosely clenched fists or cupped hands. It is a stroke that is generally used at the end of a massage to ‘wake’ the body up and further increase blood flow.

Soft Tissue Therapy Techniques

Soft tissue therapy uses a skilful combination of sports massage and advanced massage techniques. These techniques include neuromuscular treatment techniques (e.g. trigger point therapy, muscle energy techniques and positional release), soft tissue release, fascial release, neuro-lymphatic reflexes and muscle activation techniques to release myofascia, muscle tension and optimise recovery and performance.

Soft Tissue Release (STR)

STR is a technique which combines manipulation of tissues and client movement to remove physical dysfunction in soft tissues (the fascia, muscles, ligaments, and tendons). It targets adhesive (tight) tissues to improve muscle flexibility, mobility, range of motion, muscle-nerve communication, muscle contractibility, strength and function by breaking down restrictions. Benefits also include the realignment of muscle/connective tissue fibres and pain reduction. Two techniques included in this category are soft tissue mobilisation and corrective transverse friction massage.

1. Soft Tissue mobilisation (STM)

The first of these is soft tissue mobilisation. STM involves the manipulation of targeted areas of soft tissue by applying direct pressure on ‘tight’ tissue whilst mobilising the related joint. Pressure is applied and maintained by the therapist to ‘lock’ an area of tissue in place, creating a temporary new muscle ‘attachment’ point. The client is then taken through a specific movement pattern to lengthen the muscle, either actively, where the client initiates and performs the movement, or passively, where the therapist facilitates the joint movement. Active Release Technique is an example of this type of therapy.

STM can be very effective in tight and adhesive tissues because of its isolated and targeted nature. The technique is useful in clients with injury, pain, scar tissue and ‘tight’ muscles.

Care should be taken on recent injury sites and avoided during the inflammatory stage of healing so as not to increase healing time. STM can have an immediate effect on pain levels and muscle length, strength and function.

2. Corrective Transverse Friction Massage

The second STR technique is called corrective transverse friction massage. It is also known as cross fibre frictions or transverse friction massage (TFM). TFM is thought to relieve pain, promote collage formation and alignment, improve scar tissue formation and break down adhesions which form within muscles, between muscles and from muscle to bone. In TFM deep pressure is applied with the balls of the fingers and/or thumb and gentle rubbing back and forth or in a circular motion on a precise area of tenderness. It is applied across the direction of the tissue’s fibres rather than along their length like in effleurage. If the sore area lies in the belly of the muscle, the muscle should be put on slack when the treatment is performed. This will promote separation of the muscle fibres during the massage. Tendons with a sheath should be put in a lengthened position to facilitate the best result.

TFM is particularly useful in tendinopathy, muscle strains, ligament injuries, adhesions and prevention of adhesions, scar tissue and for pain relief. It should not be used on clients with acute rheumatoid arthritis, broken skin, bursitis and tunnel syndrome.

Contraindications for Soft Tissue Release

Contra-indications for soft tissue release also include cancer, deep vein thrombosis, clotting disorders, pulmonary oedema, open wounds, any type of skin infection, varicose veins, acute rheumatoid arthritis, advanced diabetes, broken skin, haematoma, bursitis, severe osteoporosis, and healing fractures. These should be discussed with your practitioner prior to any treatment.

Connective Tissue Therapy

Where STR is a massage technique that primarily targets muscles and tendons; connective tissue massage targets the fascia which surrounds them.

What is connective tissue and fascia?

‘Fascia is defined as a sheet or band of fibrous connective tissue enveloping, separating, or binding together muscles, organs, and other tissues of the body’ (functionalfascia.com 2021). Fascia occupies the space between your cells (interstitial space) and surrounds muscles, groups of muscles, blood vessels, and nerves, binding some structures together, while permitting others to slide smoothly over each other. These tissues include ligaments, aponeuroses, and tendons.

Fascia is the scaffolding that holds our body together but also allows movement. The health and condition of the fascia may affect the health and function of the tissue it surrounds.

Fascia contains closely packed bundles of collagen fibres oriented in a wavy pattern parallel to the direction of pull. These wavy fibres are straightened out by a pulling force i.e. when the muscle is lengthened under a load. The fibres are flexible structures that can withstand large amounts of tension.

Fascia is divided into three layers:

1. Superficial fascia is the fascial layer directly under your skin.

2. Deep fascia is a layer of dense connective tissue that surround individual muscle fibres, individual muscles and groups of muscles to separate them into fascial compartments. This layer contains many nerve endings.

3. Visceral fascia is connective tissue that surrounds, suspends and protects our internal organs within their cavities.

Fascia contains large amounts of sensory organs and is embedded with nerve endings and mechanoreceptors. Mechanoreceptors are mechanical receptors that respond to mechanical pressure or distortion.

Whenever we change our posture or move in any way mechanoreceptors deform and activate, sending information into the spinal cord and brain. These messages are interpreted by our central nervous system, then information is relayed to our muscles. Poor movement quality, accompanied by inappropriate muscle function can in turn cause fascial dysfunction hampering movement control (physiospot.com 2021).

Sometimes injury, stress, trauma, inflammation, poor posture or repetitive actions e.g. cycling or running can cause areas of tissue to become thickened, inflamed and restricted. These tight tissues pull on adjacent areas of fascia. The less mobile fascia can then cause stiffness, fatigue, movement restriction, strain, reduced performance/function and pain.

‘Connective tissue is the tissue that connects, separates and supports all types of tissues in the body’ (Kenhub 2021).

Connective tissue is visco-elastic which means that it can lengthen if a stretch is applied to the tissue for a prolonged period. Fascial release is a type of CTM for stretching fascia, focusing on releasing specific localised fascia restrictions, restoring mobility between layers of tissue and influencing tissues distant to that area. Manipulation of the fascia helps improve the slide, glide and length of your tissues, promoting remodelling of cartilage, restoring movement, strength, function and pain relief.

CTM uses techniques such as:

• Skin rolling which involves lifting the fascia away from the body and releasing adhesive fibres.

• Slow fascial stretching, often resulting in release in areas other than the area being worked because of the connectedness of fascia throughout the body.

• Movement of limbs/body parts and manipulation of swathes of tissues to release long standing dysfunctional bodily movements/postures. Lyno method is an example of this type of treatment.

Who can benefit from CTM?

CTM can be a very light or intense treatment and helpful for:

• Athletes

• Chronic joint or muscle injuries

• Poor posture

• Fibromyalgia and Chronic Fatigue Syndrome

• Neurological Dysfuction

• Frozen Shoulder

• Sciatica

• Tunnel Syndromes

Contraindications for CTM

Contra-indications for CTM include cancer, deep vein thrombosis, clotting disorders, pulmonary oedema, open wounds, skin infection, varicose veins, acute rheumatoid arthritis, advanced diabetes and healing fractures.

Myofascial lines are considered muscular/fascial lines of pull which distribute strain, transmit force and affect the structure and function of the body. The diagram to the right shows these connections and helps explain how the body works as a whole through the interconnectedness of fascia/muscle groups rather than single muscle groups working in isolation. These suggested lines of pull help practitioners explore how one structure affects other distance structures in the body and can help to define treatment. CTM can release huge swathes of connective tissue, this treetment should then be supplemented with corrective exercise to address strength imbalances throughout the entire kinetic chain. This is why thorough assessment, treatment and corrective exercise is necessary for recovery.

Muscle Energy Techniques (MET)

A muscle that can’t be used through its full range of motion will generally be less functional, weaker and more injury prone.

MET is a form of manual therapy that uses gentle muscle contractions to relax and lengthen muscles and normalize joint motion.

‘MET is a direct manipulative procedure that uses a voluntary contraction of the patient’s muscles against a distinctly controlled counter-force from a precise position and in a specific direction’ (International Therapist 2011). It is considered an active technique, as opposed to a passive technique where only the massage therapist does the work.

Muscles contain two receptors which affect muscle stiffness. They are called muscle spindles and Golgi tendon organs (GTO). Muscle spindles detect stretch and speed of stretch. GTO detect tension and rate of tension through a muscle. If too much force is required by a muscle i.e. the load is too heavy then the GTO will prevent muscle contraction to stop muscle injury. If too much stretch is applied to a muscle, then the muscle spindle will signal for the muscle to contract to prevent overstretching and tearing. MET’s work by affecting these two muscle receptors.

How MET works

All MET’s work by producing a low intensity muscular contraction by the client which is deemed ‘safe’ by their neuro-muscular system. This is followed by a temporary relaxation response.

I use two types of MET:
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1. Post Isometric Relaxation (PIR)

PIR involves a very mild contraction (10-30%) of the clients target muscle (the one the therapist wishes to lengthen), followed by a relaxation and lengthening of the muscle.

The process is as follows:

1. The client is positioned to allow the target muscle to be lengthened to the ‘point of bind’ (the first point of tissue tension felt by the therapist).

2. The target muscle then performs a mild contraction for 7-10 seconds. This mild contraction stimulates the GTO which inhibit contraction, the inhibited target muscle becomes more relaxed and can be moved to it’s new ‘resting’ length.

3. The target muscle is then rested for 20 seconds in this new lengthened position.

4. The process can be repeated 3-5 times.

PIR technique is used with caution with muscles that are recovering from a recent trauma as it can cause re-tearing of the repairing muscles.

2, Reciprocal Inhibition (RI)

RI is based on the principle of reciprocal inhibition, a theory that explains that muscles on one side of a joint will relax to accommodate the contraction of muscles on the other side of that joint. For example if a hip flexer/thigh muscle such as the rectus femoris shortens then a hamstring muscle (on the other side of the joint) must lengthen to allow it. Muscle spindles, which monitor stretch and speed of stretch in muscle fibres allow lengthening against this gentle ‘safe’ contraction. Therefore, this technique facilitates the comfortable lengthening of a tight muscle by contracting the one opposing it.

The process is as follows:

1. To lengthen the hamstring the client is positioned to take the hamstring (the ‘tight’ muscle) passively to the point of bind by the therapist.

2. The client then contracts the front of thigh muscle (the opposing muscle or antagonist) of the hamstring gently (10-30% of their strength), for 7-10 seconds against a resistance provided by the therapist.

3. The client then relaxes the thigh muscle and the therapist promptly lengthens the muscle to the new point of bind. The client relaxes at the new resting length for 20 seconds.

4. The process can be repeated 3-5 times.

RI is useful in treating areas like the neck or when working with clients following recent injuries. With RI the client has greater control and the body’s natural preservation reflexes are likely to stop them causing any damage. IR and RI can be combined very effectively.

METs are generally considered ‘safe’ treatments to create lengthening and improve range of motion at any joint in the body. They are particularly useful for clients with asymetrical range of motion, neuromuscular conditions such as cerebral palsy, chronic muscle pain, injury and also as prehabilitation for athletes to help prevent against injury.

Contraindications for METs

Contraindications for METs include recently traumatised muscle e.g. Grade 1 to 3 strain, recent surgery or a ligament sprain. PIR technique is used with caution with muscles that are recovering from a recent trauma as it can cause the repairing muscles to re-tear, increase pain and lengthen the rehabilitation process.

Trigger Point Therapy (also known as myotherapy or ischaemic pressure)

A Trigger Point (TrP) is a palpable nodule (or what most people describe as a knot) in a tight band of muscles or fascia. They are typically the cause of muscular pain. TrP’s can cause muscle twitching, extreme local pain and referred pain (pain pattern distant to the spot e.g. a trigger point in your shoulder main refer pain down your arm). The majority of trigger points are not located in the same place the person feels symptoms, so by knowing and understanding referral pain patterns I can help you find the main source of your pain.

There are two types of trigger points, active and latent. Active trigger points produce pain constantly or during movement, and can reduce the flexibility of muscles, while latent trigger points are only painful when pressed. Both can cause referred pain.

What causes trigger points?

It is not fully understood what causes trigger point but there are a few theories:

1. They occur in area of increased metabolism and decreased circulation e.g. muscle bellies, muscle/tendon junctions, tendon/bones junctions and ligaments.

2. Active trigger points develop through muscle/tissue overuse, putting those who have repetitive movement patterns and athletic populations at risk.

3. Latent trigger points are thought to develop in underused muscle/tissue, making them more likely to occur in people who are sedentary.

Other Causes are:

• Chronic emotional stress e.g. anxiety and depression

• Inadequate diet e.g. vitamin C, D, B12, folic acid and iron deficiency

• Poor sleep quality

• Joint dysfunction e.g. osteoarthritis, rheumatoid arthritis, tendonitis, bursitis

• Poor posture

• Metabolic disease such as hypothyroidism and hypoglycaemia

• Systemic disease such as lupus erythematosus, Lyme disease, psoriatic arthritis, gout and bacterial/parasitic/viral infection,

• Ageing

• Hypermobility

• Neuralgias

Trigger points once identified are released by applying direct pressure to the triggerpoint in the direction of the muscle fibres for 7-10 seconds. This is called ischaemic therapy. The pressure applied reduces blood flow to the trigger point. There is a surge of blood flow to the tissue upon release of the pressure. This helps to restore ‘normal’ blood flow to the tissue and decreases pain sensitivity. Trigger points can be very painful so pressure is applied with feedback from the client to encourage a parasympathetic (relaxation) response.

Why you shouldn’t ignore trigger points

Painful, active trigger points tend to limit range of motion and reduce movement due to pain inhibition. The affected muscle is then underused and can become tight and weak; this can lead to compensatory use of other muscles and increase risk of injury. Latent trigger points rarely cause a person to complain of pain but often restrict or cause compensatory movement patterns and weakness.

Following treatment, I will provide a corrective exercise programme to help remedy the root cause of trigger points if they are due to poor posture/movement dysfunction and show you how to keep the muscle at its optimal length to help prevent recurrence.

Contraindications for Trigger Point Therapy

Contraindications for trigger point therapy include cancer, deep vein thrombosis, clotting disorders, open wounds, skin infection, varicose veins, acute rheumatoid arthritis, advanced diabetes, broken skin, haematoma, bursitis, acutely inflamed tissue, severe osteoporosis, and healing fractures. These should be discussed with your practitioner prior to any treatment.

Positional Release Therapy

Positional Release Therapy (PRT) also known as strain-counter strain is a form of bodywork aimed at resolving pain and tissue dysfunctions in a relatively painless manner. PRT is the opposite of stretching. It takes the tension off the tissue (shortens the muscle) to release it, unlike most other soft tissue techniques which apply tension to stretch/lengthen restricted fibres.

How PRT works

The basic principle behind this technique can be likened to untying a knot. Instead of lengthening the loose ends of the knot further by pulling them apart we shorten them towards the middle of the knot so that we can fully release them. Similarly, the therapist shortens the client’s muscle to send a signal to the nervous system to reduce the contraction, which makes the subsequent lengthening much easier. PRT unkinks the muscle fibres by decreasing their neural activation in two ways: 1) by mechanically shortening them thereby deactivating muscle spindles and 2) by manipulating the neurochemical bonding formed by pain and inflammation. This interruption of the inflammatory neural signalling further decreases activation at the spinal cord, brain stem and locally. (Martin Petkov).

The process is as follows:

1. The therapist palpates the target muscle to find a tender point (usually around the attachment site of the muscle).

2. The therapist then applies firm constant pressure to this point until the client experiences a subjective level of discomfort between 4 and 5 on a 0-10 scale. The therapist would maintain this precise level of pressure and use this tender point to monitor the effectiveness of the technique.

3. The therapist then moves the tender body part away from the restricted motion barrier towards the most comfortable position. At this stage, the point should no longer feel tender.

4. This precise position is then held for 90 seconds to several minutes until the pain is reduced or relieved and the muscle is then returned to its normal resting length.

5. The process is then repeated until pain is relieved and the muscle reset to its optimal length.

PRT works by interrupting the pain spasm cycle. PRT release can be achieved in larger areas of tender tissue by the therapist using both hands to pull larger areas of tissue towards the tender area. This process is called crowding.

PRT is suited for any patient who has a history of either acute or chronic pain caused by poor posture, emotional stress, injury and repetitive stress caused by work or exercise.

Contraindications for PRT

The contraindications for PRT include cancer and metastatic disease, abdominal or thoracic aneurysms, healing fractures, acute rheumatoid arthritis, open wounds, infected skin, sutures, healing fractures and haematoma.

Testimonials

I suffered with back pain during my pregnancy and sciatica after the delivery of my baby. Lisa provided me with an exercise programme and massage which relieved the pain within a couple of sessions. Lisa also gave helpful nutritional advice throughout and after my pregnancy which helped me lose my pregnancy weight. I would highly recommend her. 

ES

I had lived with debilitating chronic back pain for years which I was told by back specialists was sue to osteoporosis. I went to see Lisa for Pilates sessions to strengthen my back. The biggest difference came from the massage she performed on my back which gave me immense and sustained pain relief. This has since meant that I could live a pain free life. I am very grateful to her.

MM

 A year ago, my shoulder was in a bad way with a rotator cuff injury, torn ligament and bone spurs, all from playing sport at a high level. I had previously had a year of physio treatment but found it ineffectual. I was at an impasse.

In contrast, Lisa helped me immediately – her soft tissue work gave me a great deal more range of motion and some welcome pain relief. An operation was inevitable and Lisa prepared me physically for the surgical procedure and afterwards in the recuperation phase that followed, always with a smile, encouraging words, and applying her vast medical knowledge.

Lisa is extraordinarily caring but also has a sense of fun. Lisa’s understanding of the golf and tennis swing, meant she has adapted exercises and treatment, to help me in my endeavours to play at a decent level again. This, Lisa has achieved, and I am back playing and winning again! I count myself to be very fortunate indeed, to be under her care.

HJ

I had a mastectomy 18 months ago and was left with pain, weakness and heaviness in my arm from the scar tissue. Lisa performed soft tissue work which took away the pain and heaviness and has helped me strengthen my arm following the surgery. I am so pleased as I thought that I was going to have to live with the side effects of having the surgery. I thoroughly recommend her.

AT