With the longer days of spring, people are getting outside and stepping up their activity level. While we see plenty of injuries year round just from the amount of sitting and lack of movement in our society, we see different kinds of injuries cropping up when there are more runners on the road.

Muscles provide propulsion, but from the standpoint of injury resistance, their function as the body’s own natural shock absorption system is extremely important. Muscles, tendons and ligaments should absorb the shock of impact –bones are not designed to do so.

Many bodies lack the ideal positioning of the hip, knee and foot within the running form to get maximum leverage and power from each stride. Flaws in positioning often translate into a higher chance for suffering injury. Some muscles are used for purposes they shouldn’t be, and in conditions of overuse they shorten and their fascial bags glue together. Other muscles are weak or misfiring, and recruit help from neighboring muscles that were not designed to do that task. Some muscle groups have forgotten how to “turn on” and “shut off” in proper task sequence.

Running with a balanced and aligned body involves proper maintenance of the stiff springs that protect your bones and joints from impact, and that achieve power from elastic recoil (storing energy at foot strike and releasing it during push off). Muscles must be capable of quick contractions to achieve best alignment when the ground is contacted, as well as maintaining relaxation when contractions are unnecessary. The flexing and unfurling of the lower leg during the swing cycle, the stiffening and stabilization of the knee at the right time, maintaining shape in the arch and foot at the right time – all of these functions play a critical role.

Running with a body out of alignment, where adhesions are preventing relaxation of particular muscles, where improper muscle recruitment is creating chronic stress in other muscles, tendons and ligaments, where overstriding increases impact stress – all of these can eventually result in injury. Movement and posture at the knee, foot and ankle are all influenced by greater strength and control at the hips. Lack of such control can mean excessive compressive or torsional forces that strain important tendons and ligaments, or compress fatty pads beneath them. Tendons and ligaments are also asked to perform more of the energy return when critical muscles are weak. Tightness is a loss of flexibility. Poor range of motion in a joint requires the muscles to work harder to move the joint

Overuse injuries develop when repetitive stress to bone and musculotendinous structures damages tissue at a greater rate than that at which the body can repair itself. The “big five” most common running injuries are plantar fasciitis, Achilles tendonitis, medial tibial stress syndrome (shin splints), chrondromalacia or patellar tendonitis, and iliotibial band syndrome.

Solving any of these problems is best accomplished with a combination of targeted exercise and bodywork. Customized exercise programs developed by a skilled trainer or exercise therapist are the best way to address the areas of weakness and incorrect firing patterns. Properly designed eccentric exercise can induce collagen remodeling in injured tendons. Tightness represents a loss of flexibility. Appropriate bodywork can break down scar tissue and clear muscle adhesions and thereby improve range of motion. Bodywork can also assist the healing of tendon injuries (or bursa irritations) by working tissues farther from the site of injury – feeding it length by clearing issues at the other end of the structure.

Bodywork is also great awareness training. When you go from couch to marathon, it is easy to push through the body changes too quickly for you to be aware of them. But get on the table and you will feel the areas you need to pay more attention to.

Finally, massage is helpful for recovery – limiting the damage after a workout ends. Most strategies for decreasing muscular fatigue attempt to decrease inflammation and increase the efflux of fluids from the muscles back into the blood and the rest of the body.

As John Davis summarizes, “Inflammation occurs for two reasons: 1) the damaged muscles leak their contents out into their surroundings and 2) the body rushes blood and lymph fluid to the damaged areas to repair them. Repair may seem like a good thing, but the combination of the cellular fluids leaking out from the damaged muscles and the fluids rushing in from elsewhere in the body can increase pressure to the point where further damage and internal fluid leakage occurs.“

In a study by Mark Tarnopolsky’s group at McMaster, massage was used after exercise to exhaustion to induce muscle damage. Comparison of muscle biopsies (at rest, immediately after, and 2.5 hours after) showed that “[W]hen administered to skeletal muscle that has been acutely damaged through exercise, massage therapy appears to be clinically beneficial by reducing inflammation and promoting mitochondrial biogenesis.”

The kind of massage done in Russia and Eastern Europe, which uses a wide range of kneading techniques, a particular speed of massage strokes, and work within the inhibitory regime (massaging while gradually increasing pressure, and avoiding activating the pain analyzing system), is also used to decrease peripheral vascular resistance and normalize resting muscle tone. A study by Dr. LL Smith at East Carolina University “showed that, yes indeed, the muscle soreness and fatigue is dramatically reduced by sports massage when it is conducted correctly. One of the critical components is time of massage application. If massage is conducted less than 2 hours and later than 3 hours after the intense exercise it doesn’t affect the muscle soreness or fatigue.’” (Turchaninov/Prilutsky)

Adding regular sports massages to your routine can be of considerable benefit. It can help you prevent injury, improve body awareness, and recover from workouts and events.


Brian Martin, Running Technique (2011)

John Davis’ excellent blog Running Writings, inflammation quote

Oleg Bouimer, Russian (With an American Accent) Sports Massage

Ross Turchaninov and Boris Prilutsky, A response to the New York Times interview with Prof M. Tschakovsky

Michelle Shoup, Speeding Recovery through Sports Massage

About Sports Massage in Russia and Eastern Europe

I took a workshop with Oleg Bouimer last March. He had this to say about Russian Sports Massage:

“Russian Sports Massage is the most advanced system of sports massage in the world. It was regarded as an integrative part of sports training and competition in the former Soviet Union. Massage therapists were highly respected, sharing the spotlight with athletes and coaches. When an athlete would bring home a gold Olympic medal, he or she would get a medal of honor and recognition from the Soviet Government. However, his or her massage therapist would get official recognition from the Government as well as a part of the team who helped the athlete to win the Olympic competition.

“Essentially, massage therapy was used as a ‘secret weapon’ at the time of the Cold War, when winning at the top international competitions had become a political statement about supremacy of the socialist system over the West. It is empowering to learn, based on the historical facts, that sports massage therapy played great role in giving the edge, to the Eastern Bloc Olympic Teams needed to dominate Games.”

Oleg Bouimer