Massage Therapy and Marathon Preparation – A Case Study

Dear Matt,

I wanted to thank for all you have done to get me back to running
pain free.  The marathon went very well today with me finishing 5th overall
in about 2:46:10.  The course was pretty hilly, especially the first half,
so I was quite happy with that time.  I know the results are due in no
small part to your efforts!

Mark M. – Raining Faith Sports Massage Client

I received the above email the evening after Mark participated in the Denver Rock and Roll Marathon.  Mark was a new client of mine who began seeing me in early August.  Mark is a seasoned marathoner and has been running for the last twelve years.  He has completed over 28 marathons in his career and considers himself a slightly above average runner.

When I first met Mark I took him at his word on being an “above average runner” but over time I realized he was being quite humble and has had some pretty good success running both marathons and races of shorter distances.

Mark’s initial goals were focused toward recovery in his training and staying healthy as he approached race day.  This was refreshing because quite often a marathoner will show up in my office a few weeks out from an event with a problem or injury that is hard to resolve before race day.  Quite often they literally limp across the finish line with a less than satisfactory experience.  Mark did, however, mention almost on an aside that he had been having a chronic issue with his ankle that had become stiff over time and was somewhat aggravating, especially in the morning upon waking and taking his first steps out of bed.

In the first few sessions we were able to indentify that Mark had a problem with a ligament called the Inferior Extensor Retinaculum (IER) of the foot, pictured below.

Inferior Extensor Retinaculum
Inferior Extensor Retinaculum

The IER is the band of opaque tissue in the middle of the image to the left. It is important because there are a number of muscles and tendons that run underneath that ligament; in Mark’s case, muscles that lift the toes and ankle up and out as he ran.  Mark had developed adhesions in this ligament that were making it difficult for him to push off as he ran and thereby affected his gait during his runs.  Basically, the tendons were like cables in housing that needed lubricating and were restricting his ankle movement.  Typically, as he warmed up, the ankle and foot function would improve but Mark was experiencing nagging, stiff ankles primarily first thing in the morning and also when getting up from his desk at work.  In addition to the adhesions (the tendons not gliding smoothly under the ligament), Mark had tightness in the muscle bellies on the front of his shin and to the outside part of his lower leg.

I performed some techniques where I had Mark move his ankle and foot while I glided over the affected muscles in his lower leg and I also did some firmer work directly on the IER.  I showed Mark how to do the same kind of work at home and to let me know if it made a difference.

Over subsequent sessions Mark noticed the ankle improving.  He had less stiffness in the morning and also when he got up from his desk.  The first time we worked on the ankle it felt good for about three days.  With each subsequent session and Mark addressing it on his own it began to function better for a longer period of time.  Mark commented that he felt like his gait was smoother and there was a better firing sequence in the lower leg when he was training.  Mark also realized that if he sat on the floor with his ankle underneath him or under him as he sat on a chair that it contributed to the problem.  So his awareness in his body increased as well.

I saw Mark a total of six times before his marathon.  I probably never spent more than ten to twelve minutes addressing his ankle during the course of his session as we worked through the kinetic chain from low back and hips to his feet to ensure that all systems were staying healthy and firing properly.

I only worked on him a total of six hours. As he was training up to 12 hours and 90 miles per week you can see that is a pretty small percentage of his treatment to training time.  I really felt that Mark was on his way to another fine marathon performance and downplayed the role that the massage therapy had on his result.  However, when I remarked about this Mark replied with the comments below.

To be honest, I’m not sure I was on my way to another great race.  This summer I was starting to think about how much longer I wanted to keep doing this as the discomfort from my ankle was becoming such an annoyance throughout the day that I questioned if it was worth it.  Although the pain went away once I got moving, my running wasn’t going well due to the flexibility limitations my ankle imposed.  I just couldn’t get the push-off I was accustomed to with that leg.  I thought I might try a fall marathon and then give myself a break over the winter to see if it seemed to heal itself.

Now I’m so thankful and happy to be running smoothly again.  And the pain and soreness that had become part of my regular daily activity is essentially gone.  Instead of thinking how much longer I want to race, my thoughts have turned to what I want to run next.  It has been a complete change in mentality all due to fact that your techniques relieved the pain.

I wish I could say that all of my clients get these kinds of results.  This was an ideal case where things worked out really well.  But there is something that Mark mentions above that is rarely true.  With soft tissue dysfunction, especially in my experience with lower leg conditions, things rarely get better on their own with just rest.  It is necessary to resolve the soft tissue dysfunction first and then follow a sequence of healing.  Typically this involves restoring flexibility, restoring normal movement patterns (his push off) and then gaining strength back as the final phase of healing.  It quite often requires some patience and time but it is time well spent.  Congratulations Mark on a great race at the Denver Rock n Roll marathon!

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