Chain Of Command In Sports Massage

When I first started in the fire service, I didn’t fully understand why we had chiefs, captains and lieutenants, this thing we call “chain of command”.

All I knew was there were people telling me what to do and I’d better listen.

As I progressed it became more clear why this was necessary and how it applied to what we were doing.

I never gave it much thought outside of the fire service but have now come to understand how “chain of command” is applicable and necessary in sports and working with teams as a Massage Therapist.

While it can be a bit tough to understand (and some may find it insulting) there is a purpose and very good reason behind having chain of command in place. It is also important to understand how to work within it if you are going to be successful working with teams.

You may not always agree with how this type of organization works but if you want to work effectively and be part of the team, you have to work in accordance with the team principles.

Here’s why and how to do it.

Principles Behind This Organization Style

If you’re already working with teams you might be familiar with this, but if not it’s important to understand the structure.

Businesses, organizations and emergency services all operate under this kind of functional system in order to operate more efficiently and to work within it, you have to understand not only your role, but also the terminology behind it.

Here is some of the terminology, it may not be used extensively when working with a sport team, but the basics are the backbone of the way most organizations have things set up:

  • Chain Of Command
    • The formal line of authority, responsibility and communication.
  • Unity Of Command
    • A principle that each employee reports directly to one supervisor moving up the chain, ultimately all report to the main person in charge.
  • Span Of Control
    • The principle that establishes the maximum number of people or functions that any one supervisor can control, it’s typically three to seven but five is considered optimum.
  • Division Of Labour
    • This is the process of dividing larger jobs into small jobs to make them more manageable and efficient.

Below is how an organizational chart could look for a large team (obviously I picked hockey).

*This is just an example, not necessarily how any one team is set up.


Sport Massage Chain of Command


As you can see, the General Manager would ultimately be in charge with Logistics, Head Coach and Sport Med Doctor all reporting directly to him/her.

They would each then oversee their own group who would report to them.

In our case, the Sport Med Doctor would oversee the healthcare of the athletes with Massage, Strength, Chiro and AT all reporting directly to them, they would then convey the necessary information the the General Manager.

Remember, the above is just an example. It may be set up where the Massage Therapist reports to the Physio, who reports to the Doctor.

These lines of communication are essential in the function of any organization, since each person can only effectively manage five people (according to span of control).

Having things organized this way also gives the organization room to expand (or decrease) if necessary. For instance, the General Manager can add assistant GM’s as the organization expands giving them new branches of responsibilities and groups operating under them.

Understanding how you fit into these lines is essential, not only to your success, but to the teams success as well.

Know Your Role Jabroni!

Okay, so you’re not a jabroni, but it’s a good headline to get the point across.

If you’re selected to work in this kind of team environment, knowing your role is crucial.

The team probably even has a job description prepared for each person on the medical team, outlining each persons specific role. Not all the roles will be specifically medical.

Depending on your past relationship with a team or whether you’re brand new can define what your role will be, or how you can function within the role they define and the scope that is laid out for you.

Initially you may have a very minor role. The A.T, Physio or Sport Doctor may be the ones who do all of the assessment and refer athletes to you only when they deem necessary.

Don’t take this as a slight against you if this is how things start out!

The team may have things designed that way because of insurance concerns, or because of past experiences which are totally beyond your control. Don’t forget, there is a broad spectrum of massage therapy certifications out there in addition to the broad spectrum of experience these other healthcare professionals in working with Massage Therapists.

The job description given to you may have you assisting equipment managers, helping with video, filling water bottles, or just cleaning up the dressing room.

Again, it’s not a slight against you or the profession, it’s just a role the team needs filled, so they might get you to help out by filling that role.

Now, the rest is up to you.

Personalities play a massive role in team sports. When you’re starting out be happy to fill whatever role it is they have designated for you. Leave the ego at the door. As you start to work more regularly with the team, your role can expand, it’s all about building that relationship (where have I heard that before?). As the trust builds between you and the other healthcare professionals in the group, so will your role and what you can do. It’s all part of being a team, not all jobs on the team are going to revolve around you doing soft tissue work on athletes. Nor is all the work for the other healthcare professionals going to solely revolve around healthcare for the athletes, it’s about pulling together for the greater good of the team. Like it or not there is still a hierarchy, these other therapists have more education than we do and may assume that we report to them, even though the team chain of command doesn’t display that. Back to those personalities, while some people will bring their ego and put it on display, that usually gets weeded out. You may just have to change your approach in dealing with people for the greater good of the team. If someones ego is getting in the way, it may be something you have to work around temporarily, but trust me it will be temporary.


Should Massage Therapists Stretch Athletes Pre-Performance?

Hey, can you stretch me out a little before the game?

Well, no but we can after the game, it’s best to not stretch before the game but I can help you with your warm up.

Teachers had told me that doing any kind of stretching on athletes pre-event can actually mess up their stride and make things worse (if you’re stretching out the lower body).

Recent research has shown that stretching doesn’t really do what we thought it did and has been argued that it may be a feel good thing as opposed to a therapeutic intervention.

So what about when your athletes want you to stretch them out, especially pre-event?

What Actually Happens During A Stretch

As new research develops we have come to learn that stretches aren’t actually lengthening a muscle, but rather it is the nervous system reacting to the tension placed on the muscle that causes the change.

I always thought that doing a stretch actually elongated a muscle but upon further reading, have come to understand things a little differently.

When we do a stretch and reach that point of feeling tension in the muscle, the GTO (Golgi Tendon Organ) monitors what’s happening and reports back to the central nervous system which then affect’s the muscles response to a stretch.

The nervous system feels the tension and then regulates how far it will allow the stretch to go.

While I used to believe that we were actually lengthening muscle fiber, I’ve come to learn it’s all up to the nervous system.

So then, if I stretch an athlete out before competition, am I actually messing up their stride?

Static Stretching

Static stretches are probably the most commonly used stretch, especially among amateur athletes and weekend warriors.

It’s the type where you place tension on the muscle for 10-30 seconds without much movement involved.

When it comes to athletes and their performance a few studies have shown whether this is helpful to do before competition.

One study  compared 12 college baseball players having stretching done as part of a warm up before throwing pitches. The results showed that doing static stretches as part of the warmup made no difference whatsoever.(1)

Another study done on 16 NCAA track athletes over four weeks showed that static stretching before doing 20 m sprints actually added time to their sprint, showing that stretching had a negative impact on performance. (2)

In an effort to mix things up, thirty teenage athletes were tested on doing dynamic exercise combined with static stretching as a pre-event routine. They were tested on vertical jump, medicine ball toss, 10 yard sprint and an agility shuttle run. The test showed that it might be more beneficial to combine the dynamic exercise with the static stretch in athletes performing power activities.(3)

It’s interesting to see that between the three studies there is a combination of upper body and lower body tests as well as a difference in muscle groups being tested.

Also, the tests were done on very different activities but all came back with either no effect or a negative effect.

So maybe my sport massage teacher was right!?

Not so fast.

Photo by: Ryan McGuire

Photo by: Ryan McGuire

Dynamic Stretching

Dynamic stretching is when there is movement and resistance applied during the stretch.

Commonly known as PNF (proprioceptive neuromuscular facilitation) which has a few other titles under it like:

  • Contract Relax
  • Antagonist Contraction
  • Hold Relax with Agonist Contraction

Essentially you passively stretch the patient, then they contract the muscle against your resistance for a short count and you’re able to passively move the limb or joint into a greater range of motion after they resist.

This is where things change up a little bit with your athletes.

A study on 12 track athletes (yes I know these are small numbers) who train for explosive power, showed that dynamic stretching of the hamstrings increased jump height, yet decreased after static         stretching.(4)

It doesn’t just have an effect on explosive power either.

A study was done to see how it would effect balance, agility and reaction times on the upper limbs. 31 female high school athletes were tested by doing 3 min jogging, then either dynamic stretching, static stretching or rest. Again dynamic stretching won. (5)

Two more studies show that dynamic stretches are a benefit.

One was on female basketball players and their bicep brachii muscle, which recommended dynamic stretches for explosive maximal exercise. (6) The other showed that dynamic stretches for 20 seconds prior to a vertical jump improved not only height, but hip and knee range of motion. (7)

So apparently not all stretching is created equal.

However, the question is why?

There was a study done where heart rate and electromyography (EMG) data were collected and it showed via the EMG that a fast dynamic stretch is linked to greater nervous system activation and prepares an athlete better. (8)

It always goes back to the nervous system.

However now that I have written this post I also have a caveat to the whole thing. After years of working in hockey, one thing I know for sure is: athletes know what they like. They also know their bodies and performance routines better than your average weekend warrior. Before every game or competition athletes like routine, don’t mess it up. If they regularly have you stretch them before a game and want it, then explain why a dynamic stretch is better and ease them into it if they’re not used to it. Also important is to know your sport. Most of the studies listed in this post were very specific for certain movement. Warming up Usian Bolt before a 400m sprint is vastly different than taking care of Sidney Crosby. A sprinter has under 10 seconds to perform, whereas you can help a hockey player warm up, then he goes out for a 10 minute pre-game skate and warm up before the actual game. Your warm up is not going to have the same effect in two drastically different sports. Either way, try to educate and don’t screw with their routine, they really don’t like that.



  1. Haag S, Wright G, Gillette C, Greany J. Effects of acute static stretching of the throwing shoulder on pitching performance of national collegiate athletic association division III baseball players. Journal Of Strength And Conditioning Research / National Strength & Conditioning Association [serial on the Internet]. (2010, Feb), [cited July 18, 2016]; 24(2): 452-457. Available from: MEDLINE with Full Text.
  2. Nelson A, Driscoll N, Landin D, Young M, Schexnayder I. Acute effects of passive muscle stretching on sprint performance. Journal Of Sports Sciences [serial on the Internet]. (2005, May), [cited July 18, 2016]; 23(5): 449-454. Available from: MEDLINE with Full Text.
  3. Faigenbaum A, Kang J, McFarland J, Bloom J, Magnatta J, Hoffman J, et al. Acute Effects of Different Warm-Up Protocols on Anaerobic Performance in Teenage Athletes. Pediatric Exercise Science [serial on the Internet]. (2006, Mar), [cited July 18, 2016]; 18(1): 64. Available from: SPORTDiscus with Full Text.
  5. Chatzopoulos D, Galazoulas C, Patikas D, Kotzamanidis C. Acute Effects of Static and Dynamic Stretching on Balance, Agility, Reaction Time and Movement Time. Journal Of Sports Science & Medicine [serial on the Internet]. (2014, June), [cited July 18, 2016]; 13(2): 403-409. Available from: SPORTDiscus with Full Text
  6. VEEVO M, ERELINE J, RISO E, GAPEYEVA H, PÄÄSUKE M. THE ACUTE EFFECTS OF WARM-UP, STATIC AND DYNAMIC STRETCHING EXERCISES ON BICEPS BRACHII MUSCLE FUNCTION IN FEMALE BASKETBALL PLAYERS. Acta Kinesiologiae Universitatis Tartuensis [serial on the Internet]. (2012, Dec), [cited July 18, 2016]; 1839-46. Available from: SPORTDiscus with Full Text.
  7. Murphy J, Nagle E, Robertson R, McCrory J. Effect of Single Set Dynamic and Static Stretching Exercise on Jump Height in College Age Recreational Athletes. International Journal Of Exercise Science [serial on the Internet]. (2010, Oct), [cited July 18, 2016]; 3(4): 214-224. Available from: SPORTDiscus with Full Text.
  8. Fletcher I. The effect of different dynamic stretch velocities on jump performance. European Journal Of Applied Physiology [serial on the Internet]. (2010, June), [cited July 18, 2016]; 109(3): 491-498. Available from: MEDLINE with Full Text.

Is Volunteering Massage Therapy Worth The R.O.I?

“Contact us and we’ll get you to the first page on Google”

We’ve all seen the emails come into our clinics (and maybe even personal accounts).

Then there’s the other emails. You know the ones.

“Our organization is doing a fundraising event and would like to give you the opportunity to donate some gift certificates to help raise money for our charity”.

Every year as business owners Massage Therapists must decide how they are going to spend their marketing dollars.

Where is the best place to spend money and what will the Return On Investment be?

Is volunteering our time really worth the effort it takes to provide free treatments?

As it is with any marketing venture, you have to ask “is there a return on investment of my time if I donate”?

Well it depends.

Donating Massage Therapy Gift Certificates

This can be a bumpy road.

Every year our clinic gets several requests via email, phone and our regular patients that come in, to donate a gift certificate to some sort of cause or function.

One of the interesting things about this (and I know from doing fundraising with the fire dept) is that once you say yes, the same organization is coming at you next year to ask again. While there is nothing wrong with them doing that, just make sure that wherever you are donating gift certificates is worthwhile.

Make sure to check that your donation is going to something you can actually help with.

I’m always more than happy to donate to local hockey teams, or different events that I can at least relate to. If there is a request to donate to an organization where I know the recipients are people who actually use massage therapy, then yeah I’ll donate.

For instance in our community, hospital workers (ie: nurses, pharmacy tech’s etc.) have amazing benefits when it comes to massage. So if I can manage to get one of them in the door, where there’s a really good chance they’ll rebook, I’m happy to help.

If the request comes from one of my current patients, again I’m happy to help. They support me in my business, so the least I can do is help them out with whatever endeavor they are putting their efforts toward.

If the request comes from someone or something that I don’t connect with, I’ll be far more reluctant to donate anything. Although from being involved in fundraising on the other side of the table, there’s something I’ve learned from making requests for donations.

Most of the time when we’re fundraising and ask stores for donations (especially the big box stores) they’ll donate just enough that it requires the recipient to spend more money.

Rarely do they donate a material prize, it will be a gift card for say $25-$50 so that the person will buy a bigger ticket item and just put the gift card toward the cost. It ends up being a win-win for both parties.

The other thing most of these places do, is ask for a tax receipt. At least this way, they are not losing out on the money, they will actually get a tax deduction at the end of the year which lowers their bottom line.

Before you just randomly donate to the next charity that calls, ask yourself (and the person asking) a few questions first:

  • What is my possible return on investment?
  • Can I get a proper tax receipt?
  • Is it better to give a discount rather than a full treatment, so I at least make some money?
  • Is the charity or cause something I actually believe in and can connect with?
  • Does my clinic schedule actually allow for someone to book in?

Gift certificates can be a great way to promote your business and be a great marketing tool, just make sure you donate wisely so it is still profitable for you in the end.

Volunteering With Sport Massage

When it comes to working in sports this is a bit of a vicious cycle.

So many sports organizations don’t have the funding or the money to be able to pay for the services of a Massage Therapist. Depending on the size of the community you live in this can be almost painful if you want to get involved.

Your average high school basketball team obviously can’t afford full, or even part time therapy and if there aren’t any teams in the area that can afford it and you want sport experience, what do you do?

One of the other issues with sport, is that if you do volunteer and decide that the organization should start to pay for your services and put up a hard stance with the team, there is someone around the corner who is willing to take your spot and start volunteering, just to get an opportunity.

Most teams are going to do whatever they can to save money, so if you’re not willing to volunteer your time anymore the general attitude can be (and I’ve heard this from team managers) “no biggie, we’ll just get someone else”.

While there are teams that can afford to hire a full or part time therapist, those spots are tougher and tougher to get into. It also completely depends on where a team gets their funding from or if the team is privately owned. Usually if a Massage Therapist gets one of these spots, they’re reluctant to give it up and they hold onto it like Donald Trump grabbing his hair in a windstorm.

I’ve debated giving up one of my sports volunteer positions but hesitate because I always wonder if I’ll get the chance again.

If you decide you’re going to volunteer your time, make sure it’s worth your while.

At a minimum, make sure the team is willing to promote you. In return for your donated time, the athletes should be willing to come and see you in your clinic as well. If the athletes are minors, their parents should be made aware of who you are and that if they need treatment, your clinic is where they should go.

Check to see what kind of insurance the athlete or team carries.

I used to do one day a week at the rink with the hockey team where I would bill hockey canada. If a player was injured, the team doctor would sign off on the insurance form recommending massage therapy so I could then fill out the form and submit it for payment from the insurer.

Find out what other healthcare practitioners the team uses and see if you can set them up as a referral base. I still have a steady stream of people who come in from the team chiropractor and we refer back and forth for each other regularly.

Just make sure that if you’re volunteering your time with sports you get more from it than just experience.

Photo by: Elvert Barnes

Photo by: Elvert Barnes

Fundraising Massage Therapy Outreaches

Every year in our city there are charity 10K’s, Run For The Cure’s, Goddess Run’s and various other charity events looking for Massage Therapists to volunteer.

They can all be great events to volunteer at and hopefully generate some business for you.

Just like the gift certificates, if you volunteer one year you can bet the event is going to call you next year to see if you’ll come out again.

But choose wisely.

I have done some volunteer work for events like this in the past, both as a student and as a registered therapist. I’m much more likely to spend my time at a half ironman or a 10K because most of the people involved in these are going to look for more therapy after the race day.

If they have spent enough time training to get ready, they’re more likely to keep exercising as a regular habit, thus needing more therapy. This is where I’m more confident that I can turn a couple of them into a regular patient with a little education and discussion on race day.

I’m far less likely to volunteer at a Run For The Cure, or a Goddess run. Not because I don’t think they’re great causes or that the athletes won’t need further therapy. It’s because it’s harder for me to connect with the participants (which is my own issue). I worked a couple of these kinds of events as a student and had a tough time watching people crying as they crossed the finish line. I hate seeing women cry!

If you decide to volunteer at one of these events for the first time, keep track for the rest of the year and see how many people come to your clinic as a result of your attendance. If you get a few new people, then you’re getting a return on your time investment.

I’m not saying that volunteering your time is a bad thing. I volunteer hundreds of hours a year between the fire department and sports. Both have their own set of rewards and both have given me some great opportunities. However our time is valuable, maybe the most valuable thing we have. While volunteering can help give you better community engagement as a business person your time shouldn’t be given away randomly. As you should with any marketing you do, track how successful the marketing strategy was. Track how much business comes your way from your volunteer time and weigh out whether it was worth the investment. I mean you paid a lot of money to go to school and learn how to be a therapist, you should at least get paid for it!

6 Tips For Getting Involved In Sport Massage

I was so excited to get my first chance to work in sport.

Walking through the staff entrance to the rink, players were running around getting equipment, doing their warm ups and reporting to medical staff. I remember it like it was yesterday.

I stood in awe.

One by one, the training staff introduced themselves to me. Chiropractor, Sport Med Doctors and equipment managers all welcomed me to the team.

Then it was time to get to work.

Sport Med Doc was assessing a player with a concussion, the AT was doing some taping and players were popping in to get some work done from the Chiro. As the Chiropractor was getting ready to do some manipulation, he introduced me to another player and asked me to work through his low back before he did any work with him.

Player after player worked their way through before the game started. There was almost a pageantry to it in my mind. Watching each health care person work together in combination with the equipment managers to get everything and everyone ready before the game.

It felt so amazing being around the team and seeing what happens behind the scenes. As a student, sitting there watching and listening to those healthcare professionals doing their assessments and talking about what was going on with each player (and actually understanding them) made it that much more amazing.

This is why I wanted to be a Massage Therapist.

Getting Into Working With A Team As A Massage Therapist

When I decided to become a Massage Therapist, one of my main goals was to work with athletes and be involved in sport.

I talked to a few of my teachers in college about their experience. Some had been to olympics, some worked with specific teams and some worked with everyday athletes in their clinics.

While in term two of college, a buddy from my hometown was playing on the local Junior A hockey team. So, I gave him a call to see if they had a Massage Therapist on the team, he said they had an Athletic Therapist, Chiropractor and Sport Med Doctors, but no Massage.

Maybe I had an in.

Talking with one of my teachers who works in sports and is heavily involved in the X games, I asked for his advice on how to approach the team. The advice he gave, helped me to have a better outlook on how different Athletic Therapists look at roles on teams and where everyone should fit in.

His advice was to find out what kind of work the A.T. was doing with the team. Some like to do their own massage and don’t want to outsource it or have someone else do it for them. “Find out if he does his own massage, so that you’re not going to step on his toes or take something away from him by getting involved”. He told me to use my First Responder background as another manner in which I could help the team, in case he did his own massage.

Armed with his advice I approached the team A.T. one night after their game was over.

I explained that I was a student looking to get some experience. He was pretty happy to hear about my First Responder background and was gracious enough to have me start coming to games and helping out.

6 Tips For Working In Sport Massage

Working in sport can be a tough scene to get into.

Some people have to work their but off to get into it and others can end up just falling into it. Either way, if it’s something you’re interested in, here’s a few tips to help you get started.

  1. Get your First Responder license. It is almost worth its weight in gold. Not only do most teams need someone to act as a First Responder, it will add to your clinic experience as well. Being able to recognize and deal with medical emergencies in a confident manner not only adds to a patients confidence in you, but can literally be a life saver in the clinic or in the sport environment. In fact some leagues require teams to have a certain number of First Responders at every game, it could be one of the things that gets you in the door. Over the years I have done far more First Responder work than Massage Therapy working with the team. 
  2. Volunteer in a sport you’re passionate about. If you’re passionate about the sport, you won’t even feel like you’re working when you go there, you will actually look forward to it. There is also a reward in knowing that you are one of the people who contributed to the athletes and team success.
  3. When approaching a team, go directly to the head trainer. Little did I know (until someone else on the team told me), the biggest reason the A.T. welcomed me to the team is because I approached him directly and not the front office staff. The head trainer is in charge of all medical and therapy issues with the team and they are in control. Having someone come in the back door because another team person brought you in isn’t going to go over very well. Always try to contact the head trainer and talk to them.
  4. Look to see if you have any local Sport Massage organizations you can join up with. Once I joined CSMTA (Canadian Sport Massage Therapy Association) I was given the chance to work with the Rugby Canada National Men’s 7’s team because their main Massage Therapist wanted to use therapists from that organization. Here in BC we recently started a Sport Professional Practice Group that is focusing on Massage Therapists becoming more recognized in sport. Reach out to these types of organizations to see if there are opportunities in your area to get involved.
  5. Be willing to help with things other than massage. Need water bottles filled?, towels for the athletes?, equipment issues? Be there to help out with all aspects of what happens behind the scenes. As much as the athletes are a team, so is the background staff, make sure you’re an important part of the team.
  6. Always be willing to learn from the other medical professionals you’re working with, you will learn a lot which will add to your experience and make it more positive.

If you’re interested in sport massage, get out in your community and see what’s available. It doesn’t matter what level the team is, it will be a way to get experience, build your network and help increase business.

Photo By: Brian Cribb

Photo By: Brian Cribb

The Benefits Of Volunteering In Sport Massage

This is where some therapists have a hard time.

Getting paid in Sport Massage can take some time. There are some organizations out there that are willing to pay and others that are regulated by governing bodies who decide on funding and what gets paid for.

For instance, in Canada OTP (Own The Podium) decides on funding for Olympic athletes and organizations as well as where the funding is spent. So some teams may be bound by whatever funding is given as far as therapy.

In private teams, the team will typically have a budget they work in and will decide whether having a Massage Therapist is something they can afford.

As difficult as it may be to find the time to volunteer, there are other benefits.

In the past I have taken days at the rink to work on players where the team doctor signed insurance documents for whenever a player needed some Massage Therapy. I would then fill out the signed document, submit it and get paid via the league’s insurance policy. The turn around to get paid is a little slow but hey, I was working in the sport I love.

The team Chiropractor sends me more referrals to the clinic than any other source the clinic uses, or any marketing I have ever done. I counted up one week a little while ago and in a five day period, half of the patients I saw, came from that Chiropractor. So even though the majority of my work with the team is on a volunteer basis, he has sent me a lot of business over the years.

Being able to say you work with a local team changes the way patients look at you, especially new ones. A number of times I have had people book in with me because they see that I work with the team and they want a therapist that can help with athletic injuries. The hockey team’s front office even tries their best to refer people to me and some even bring family members in.

I get asked several times a year by other therapists interested in working in sport if I know of opportunities for them. I still think the best way to get in is just by marketing yourself to different teams and volunteering your time to get started. The paid positions will come, but they don’t always come easy. By taking continuing ed courses based around sport (like First Responder), making sure to approach team head trainers, joining Sport Massage organizations, volunteering where you’re passionate and having a great work ethic are all steps that will get you closer to being able to work in sport. But whatever sport you’re passionate about and decide to get into, (keep in mind I’m Canadian) it’s just not as cool as hockey.

Emergency Action Planning For Sport Massage Therapists

I felt like a deer in the headlights when she asked me.

“Can I get a copy of your Emergency Plan to give to the other team’s trainer?”

My what?

“Your Emergency Plan, you’re supposed to have one ready, or on file before each game to give to the other trainer.”

I had NO idea.

I had volunteered with the team for the previous five years and had never heard of this. However this time I was the head trainer, which came with a whole group of responsibilities I didn’t yet know about.

Part of the league rules were that each team head trainer had to have an Emergency Plan in place in the event that a player was badly injured and needed medical attention beyond what we could provide.

I had yet to do my first road trip and receive one of these documents from another trainer.

All I could do was apologize and promise to have one ready for the next game.

I felt like an idiot.

Massage Therapists As Part Of The Team Within A Team

Even though I felt like an idiot, I was fortunate.

I’ve had to do this kind of thing before and have some experience with it.

There is more to this than just printing up a document. It designates you as a leader, a professional, an expert and a damn good communicator.

When it comes to working in sport, your athletes are your responsibility, but there are times when trainers of opposing teams must work together (actually most of the time it’s important to work together).

I won’t go so far as to speak for other sports (although I’d assume it’s much the same), but in hockey the trainers are almost like their own little team, within the teams. On road trips, it’s not uncommon to forget equipment and have to borrow tools or get help with injuries from the other team’s medical staff. There are constant favors being done back and forth to help each other, whether it’s laundry, equipment trades or holding coaches back from attacking each other (yes it happens).

The same applies when someone is hurt in a game. While your athletes are your responsibility, if they get hurt bad enough that you have to go out on the field, ice or playing surface to help, everyone is on edge.

If the trainer puts their fist up into the air, that’s typically the signal they need more help. At this point, what team you’re on doesn’t matter, it’s all about THAT athletes safety. When it’s done right, it can be seamless, when it’s done wrong it can be a complete cluster…well you know.

There has to be one person in charge and it’s not a time to start second guessing things. When the trainers are working together as a team, in the best interest of the athlete, there can’t be any ego’s. If the athlete is on the other trainers team, they have started first aid protocols before you get there and you may get assigned a somewhat menial task.

If all you are asked to do is call 9-1-1 or go and direct paramedics to the scene, that’s all you need to do.

Why You Need To Develop An EAP

The preparation for these kinds of emergencies starts long before the injury or the game even starts.

Making sure you have a well prepared Emergency Action Plan will give the proper steps to ensure a positive outcome for both trainers and athlete. Also making sure your medical equipment is in good working order and properly stocked prior to game time is crucial.

Like I mentioned before when it’s done properly it can be seamless almost like watching an orchestra of movement. The people who are really good at it, can direct with confidence, which in turn instills confidence in the people they are directing.

I’ve been fortunate to watch several people who excel at it and watch how seamlessly they can direct people to do what they need while still tending to injuries and dealing with a patient.

Being able to direct one person to help deal with injuries, one to lead paramedics in and others to get extra equipment doesn’t come naturally, or easily and it must be practiced.

Part of the reason why it’s important to develop an Emergency Action Plan is because of your knowledge of your environment. When teams come from other towns or cities they don’t have the intricate knowledge of the area like you do. Nor do they have the knowledge of the idiosyncracies of your building or area of play.

Every little thing you know that could possibly delay more advanced medical help arriving is crucial information to be able to share with the other trainer.

For instance:

  • Is there a preferred entrance for paramedics to use?
  • Is there a better entrance/exit to take the athlete away from the playing surface?
  • Are there gates or doors that would have to be unlocked for paramedics to gain access?
  • Where do you keep extra medical equipment stored?
  • Are there more staff/people on hand trained for medical emergencies that can help?
  • Is there an AED stored close by?
  • Where is the closest hospital or medical clinic?
  • Are there any slang names that are used for common areas of the building/sport area?

While these things might seem simple, to someone who isn’t familiar with the area, it can be crucial.

Having a face-to-face with the other trainer before game time to review your Emergency Action Plan is not only beneficial but can be life saving.


Photo by: Jon Candy

Setting Up An Emergency Action Plan For Sport Massage Therapists

I’ll never forget the first time I was in command of an accident scene with the fire department.

I was beyond nervous.

On the way a senior officer was driving and giving me tips on what to do before we got there. But I had never been in command before and was totally unsure of myself.

Midway through the call, one of the chiefs arrived on scene. He calmly came up, grabbed me and pulled me out of the accident. We walked up a hill about 15 feet from the accident and he told me “here is where you need to start”.

His point was to take a deep breath, take a step back and look at the entire scene, not just the middle of it. Look at what things could possibly go wrong, take a broader view to make sure everything is safe.

Undoubtedly, you will be in the middle of the emergency if this is your scene. Before anything ever happens, take a step back. When you’re making up your Emergency Action Plan, try to envision everything that could possibly go wrong when your athlete has to be taken off the playing surface, or is seriously hurt on it. Anticipate as much as possible. While you will never be able to come up with everything, it’s a good start. If an emergency does happen and something you didn’t think of occurs, go back, review and update your EAP.

There are several things that need to be included on your Emergency Action Plan. Remember, this should be shared with the visiting trainer before game time:

  • Level of First Aid that is available during the game (team doctors, first responders, paramedics, and how many of each).
  • Location of any First Aid equipment and supplies (AED, spine board, clamshell).
  • How to get more help if needed (the fist in the air is fairly common).
  • How you will respond if needed.
  • Methods of transport if needed.
  • Any prearranged routes out of the area and to medical treatment (you can just copy and paste in a picture from google maps).
  • The role you want the trainer to follow.
  • The roles other team members will follow (ie: equipment managers, coaches)

If possible, make this a one page plan that can be handed off to anyone. You can make it as detailed or as simple as you want, but the above points should all be included. I’ve heard some trainers say theirs is a 4-5 page document. It’s fine if you want to be that detailed, but in an emergency situation, it’s not practical to have to review something that long.

You can download the one I made up by clicking here, if you want to see a simple example of one.

Whether you’re the head trainer or there strictly as the team Massage Therapist, you should have a working knowledge of the EAP. If you’re not the head trainer, ask if you can review it and ask what role you can play if there is an emergency. More importantly ask if you can be part of a practice to make sure things run smoothly if you are going to be part of the emergency medical team. If you are the main medical person for a team, make sure you conduct a practice every once in a while to make sure all staff members are familiar with their role in the case of an emergency. Go back and review your EAP every once in awhile. Every year, equipment needs, First Responder protocols and athlete medical conditions will change. Make sure the EAP reflects everyone of those changes. Just try to avoid being like me and feeling like an idiot!


Acute Quadricep Contusion Management For Massage Therapists

He was a little slow getting up.

An opposing player tripped him, he fell to his knees and slid into the boards.

I was following the rest of the play and the student working with me pointed out he was hurt.

Looking down at the end of the bench, he was standing and shifting his weight back and forth from leg to leg and was bearing weight on the leg no problem. The whistle blew, so he went out for a quick skate to test it while there was a stop in play.

When he came back to the bench he was wincing and gave me a look that said he wanted some help.

As we walked into the dressing room, he had a bit of a limp.

Once he sat down, I started taking his gear off and there wasn’t much of an issue pain wise.

There was some tenderness just above the knee cap and his range of motion was pretty good, a bit of pain with muscle testing and some minor swelling in the area. We pulled him from the game and had him ice the quadriceps.

After the game he came into the treatment room and asked what he should do that night? Since we had a game the next night, I advised him to ice the quad, elevate it and take some ibuprofen.

Then the discussion started.

The student I was working with thought it was better to get inflammation to the area rather than prevent it.

After we discussed it, we still decided to go with ice and anti-inflammatories.

Treatment for Acute Quadriceps Contusion

There has been so much debate over this for the last while, it’s no wonder there was some confusion for treatment protocol.

I think Paul Ingraham explained it better than I could with his article titled “The Great Ice vs Heat Confusion Debacle”.

We use ice as a treatment application to reduce pain with acute injuries as well as reduce inflammation. While there is much debate on whether to reduce inflammation, the body has a tendency to over do it, so in the acute stages (in order to manage pain and mobility) ice is a good thing.

As with any other injury, you want to make sure you do a thorough assessment to determine its severity.

If you’re working on the sidelines in sport, your assessment happens immediately on impact or collision that causes the contusion.

Running through a quick checklist in your head can help:

  • Was the collision severe enough to cause a fracture?
  • Can the player bear weight?
  • Did they need help to get off the ice or playing surface?
  • If they can bear weight, are they walking with a limp?
  • Are they able to bend the knee?

Once you get them into your treatment room, or away from play, your more concise assessment can start.

In the case of a Quad contusion, they are divided into three grades:

  • Grade I (mild)
    • Mild swelling and pain and able to walk without a limp.
    • Passive movement beyond 90° may cause pain.
    • A muscle test for knee extension may cause minimal discomfort.
  • Grade II (moderate)
    • Walks with a limp.
    • Can bend the knee between 45°-90°.
    • Swelling prevents full knee flexion.
  • Grade III (severe)
    • Progressive bleeding and swelling occur within 24 hours.
    • Swelling won’t allow knee flexion past 45°.
    • Flexing the quads is also painful or not possible.
    • They will need to see a doctor.

The easiest way to do this is just by having the person lay prone on your treatment table (if possible) and you’re essentially going to perform an Ely’s test.

Once they are face down on the table just passively flex the knee (within pain tolerance) as much as possible to see what grade you get. Anything past 90° is mild, anything less than 90° is moderate to severe, the person should not bear weight and should be given crutches.

In order to treat a mild contusion an application of ice while the knee is braced in full flexion (this can be done using a large tensor bandage), puts a stretch on the muscle and helps maintain range of motion but the bracing should not be done for extended periods of time because it can weaken the tissues. One study showed that bracing for 24 hours immediately after injury (in addition to stretching and strengthening exercises after brace removal) had people back to full athletic function in 3.5 days.

For the first day or two continue with ice and anti-inflammatories to keep the swelling down. Use passive and active range of motion to keep the surrounding joints moving as well as preventing tissue changes.

With any hip or thigh injury, if the person can’t bear weight (grade II or III) they should be sent for more advanced medical care.


Photo by: The US Army


Return To Play For Massage Therapists

Once past that initial 24-48 hours and swelling has started to go down you can look at getting your athlete involved in their sport again.

Massage Therapy treatments can start in addition to functional exercises. As long as the athlete can do the functional movements associated with their sport, pass all functional tests, and range of motion is within 10° of the other leg, they should be good to go.

In the case of a Grade I, this could be the next day, Grades II-III will take longer and if the athlete has been sent for more advanced medical care, their return to play should be coordinated with feedback from the doctor.

There are a couple of complications that should be ruled out with Grade II-III (possible compartment syndrome and myositis ossificans) and this requires a doctor’s care.

It will be rare to see an acute quadricep contusion in a clinical setting, but if you are interested in or are already working in sport, there is the potential to see this all the time. While there are many guidelines that can be used, good clinical reasoning on your part will be the best guideline for whether an athlete can return to play again. The player treated in this story was back on the ice and in the game the next night. Using some ice and anti-inflammatories helped manage his pain when he got home that night, so that he could get a decent sleep. The next day, the swelling had gone down, he was functioning well and we put a bit of extra padding in place for protection. Athletes are a bit of a different breed compared to the general population in cases like this, they will do whatever they can to get back in the game and sometimes to their own detriment. In his most recent book Ron MacLean tells a story about Trent McCleary, a former NHL player who repeatedly used his body to block shots which meant constant swollen and bruised ankles and knees, and the odd charley horse that took him out of a game or two. But he didn’t like to get out of the way because he thought that was putting himself ahead of the team. Besides, he was getting good at managing contusions with ice and flexing.