Sports Massage for Tibialis Posterior Tendinopathy

The following sports massage guide is intended for information purposes only. We recommend seeking professional advice before attempting any self help treatment.

IMPORTANT: Before starting any massage treatment the therapist will check for contraindications (if any apply to you, then massage is not allowed).

How can sports massage benefit rehabilitation?

Sports massage can be beneficial in healing this injury and preventing it from recurring by reducing tension in the muscles at the back of the lower leg. By improving the condition of the muscles they will stretch more easily, reducing the tension on the tendon. In addition muscles are likely to respond better to strengthening exercises with regular sports massage.

Friction massage can also be applied to the tendon itself on the inside of the ankle. Frictioning is useful in tendinopathy injuries as it massive increases the blood flow to the tendon to aid healing, as well as stimulating a healing response which has so far failed.

What equipment is required?

A lubricant is needed to allow the hands to glide smoothly. A number of massage oils are available to buy. A cheap but effective alternative is simple baby oil. Do not use too much oil. Enough to allow for smooth, controlled movement is required but too much will mean a lack of control.

A firm, flat surface to lie on in order to apply pressure.

Technique 1: Effleurage

Aim - light stroking to warm up the area in preparation for deeper techniques.

• With the hands stroke lightly but firmly upwards from just above the heel to the knee.
• Always stroke upwards towards the heart as this is the direction of blood flow. The other way can damage veins.
• Then lightly bring the hands down the outside of the leg keeping them in contact but do not apply pressure.
• Repeat the whole movement using slow stroking techniques, trying to cover as much of the leg as possible.
• Repeat this technique for about 5 minutes, gradually applying deeper pressure on the up strokes.

Technique 2: Petrissage

Aim - kneading movements to manipulate and loosen the muscle fibres more.

• With the hands apply a firm, kneading technique.
• Try to pull half the muscle towards you with the fingers of one hand whilst pushing half the muscle away with the thumb of the other hand.
• Then reverse to manipulate the muscle in the other direction.
• Work your way up and down the muscle, trying to cover as much of the surface as possible.
• Apply this technique for around 5 minutes, alternating with effleurage (above) occasionally.

Technique 3 and 4: Stripping the muscle

Aim - to apply sustained pressure to the muscle, ironing out any lumps, bumps and knots.

• With both thumbs together, apply deep pressure up the middle of the calf muscle aiming to separate the heads (sides) of the big Gastrocnemius muscle.
• This technique should be slow and deliberate to 'feel' the muscle underneath.
• Repeat this 3 to 5 times in a row, alternating with petrissage for 5 minutes.
• This similar technique is applied with a single thumb, which can be reinforced with a couple of fingers from the other hand if more pressure is required.
• Massage should be deep but not so deep that the athlete tightens up with pain.

Techniques 5 and 6: Circular frictions and Trigger points

With either a single thumb or a reinforced thumb as shown, apply pressure in a circular pattern to any tight spots, lumps or bumps.

• Apply 10 to 20 circular frictions at a time and alternate with stripping and petrissage techniques.
• If the therapist finds any lumps and bumps or particularly sensitive spots then apply deep, sustained pressure to these points using the thumbs. A trigger point is a localized, highly sensitive point in the muscle.
• Increase the pressure on the trigger point until it ranks 7/10 on the pain scale (10 being painful). Hold this pressure until it eases off to 4/10 on the pain scale (usually about 5 seconds).
• Without easing off with the pressure, increase again until it reaches 7/10 on the pain scale once more. Hold until it eases, repeat once more.

This technique is very hard on the thumbs. It is important to keep the thumb slightly bent (flexed) when applying pressure to avoid damaging the joints.

Finishing off

The therapist can finish off with more petrissage techniques and then finally effleurage again. The whole process should not last more than half an hour.

Massage therapy can be applied every day if it is performed lightly however deeper techniques may result in a days recovery period to allow tissues to 'recover'.

For rehabilitation of muscle strains, sports massage is very important in softening / preventing scar tissue forming at the site of injury and re-aligning the new healing fibres in the direction of the muscle fibres. This will help prevent re-injury.