Technique 1: Effleurage to front of the whole leg

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

• With the hands stroke lightly but firmly upwards from the ankle up the whole leg to the hip (image 1) and then down the side of the leg.
• Try to cover as much of the surface as possible with the hands but avoid going directly over the patella.
• Apply this technique 5 to 10 times before moving on to concentrate just on the thigh area (image 2).

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Technique 2: Deep effleurage to thigh

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 patella to to the top of the thigh. Try to cover as much of the surface as possible with the hands (image 1).
• Always stroke upwards towards the heart in the direction of blood flow. Veins have valves which prevent blood from flowing back the wrong way. Forcing it through with massage can damage the veins.
• Then lightly bring the hands down the outside of the leg (image 2) keeping them in contact but do not apply pressure.
• Use slow, smooth movements. Many beginners tend to rush the massage techniques.
• Repeat the whole movement using slow stroking techniques, trying to cover as much of the leg as possible.
• Repeat this technique for about 2 to 5 minutes, gradually applying deeper pressure on the up strokes.

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Technique 2: Petrissage

Aim - kneading movements which mobilise and manipulate muscle tissue. There are a number of different types or methods of petrissage massage techniques but it is not the quantity of techniques but the quality of how they are performed. A couple of simple ones are described below:

• With the hands apply a firm, circular kneading technique. Try to pull half the muscle group towards you with the fingers of one hand whilst pushing half the muscle away with the thumb of the other hand (image 4).
• Then reverse to manipulate the muscle in the other direction (image 5).
• Work your way up and down the muscle, trying to cover as much of the surface as possible.
• Apply this technique for around 2 to 5 minutes. This technique can be alternated with light stroking or effleurage (above) occasionally to add variety.

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• Another slight variation on the above technique is a forwards and backwards type technique rather than circular movements.
• The overall aim of these techniques is to mobilise and manipulate the muscle tissues making them soft, supple and easy to work with.
• Aim to keep as much of the hand in contact with the skin at all times.

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Techniques 3 and 4: Stripping the muscle and Circular frictions.

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

• With the thumb of the right hand (for the left leg), apply deep sustained pressure along the full length of the muscle (image 5).
• This technique should be slow and deliberate to 'feel' the muscle underneath. A good therapist will gradually build up a mental picture of exactly where the tension and scar tissue is in the muscle.
• Repeat this 3 to 5 times in a row, alternating with petrissage for 5 to 10 minutes.

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• If the therapist comes across and tight, tender knots in the muscle (usually at the point of strain or rupture), these can be worked out with deep circular frictions to the knot (image 6).
• Massage should be deep but not so deep that the athlete tightens up with pain.

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Technique 4: Stripping the Iliotibial Band

Apply sustained pressure with the heel of the hand along the length of the iliotibial band. This technique can be uncomfortable or even painful so start gently.

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Technique 5: Trigger points

Any lumps and bumps or particularly sensitive spots can be treated with deep, sustained pressure to these points using the thumbs. Increase the pressure on the spot 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. Finger nails need to be short to apply this technique correctly.

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Finishing off

The therapist can finish off with more petrissage techniques and then finally effleurage again. The whole process need 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' just like they would after a training session.

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.

THE KNEE