Physical TheraPT
Clinical Wisdom
Shannon Vigil
Superbill Best Practices
The Recovery Mindset
Nina Szemis, ATC
Can You Outrun Illness?

General common sense, as well as scientific research, tells us that lifelong physical activity acts as a protecting agent against chronic illness and disease. If you’re able to consistently rack up 300 minutes of moderate intensity activity per week, you’re at much lower risk for things like cancer, cardiovascular disease and other inflammatory disorders. Regular physical activity also increases your resilience against communicable diseases, like bacteria and viral infections. However, here’s where the research starts to diverge.

The Real Reason to Drink Water After a Massage

You've probably heard you need to drink lots of water after a massage. But is that really necessary? Let's look at what the science actually says about hydration, massage, and athletic performance.

Why Water Matters for Athletes

Water makes up about 60% of your body weight and plays essential roles in nutrient transport, temperature regulation, and joint lubrication. For athletes and active individuals, staying hydrated is particularly important because it affects how your muscles and tissues function.[1]

When you're dehydrated, your tissues become stiffer and less flexible. Research shows that dehydration increases the force needed to compress soft tissues and reduces tissue thickness. Even mild dehydration (losing just 3% of your body weight in fluids) can decrease muscle endurance by about 8% and reduce strength by about 5%.[2][3]

Dehydration also creates extra stress on your muscles at the cellular level. Studies show that exercising while dehydrated increases oxidative stress and can impair muscle protein metabolism. Over time, severe dehydration may even slow down muscle recovery and glycogen (energy) storage after workouts.[4][5]

 

The Truth About Massage and "Toxins"

Here's the reality: the idea that massage releases toxins requiring extra water is a myth. There's no scientific evidence supporting this claim.[6][7][8]

Your body already has highly effective systems for removing waste products—your liver, kidneys, and lymphatic system handle this 24/7. Massage doesn't create a sudden release of toxins that needs to be flushed out with water.

What about lactic acid? This is another common misconception. Lactic acid doesn't cause muscle soreness, and it's cleared from your muscles within 30-60 minutes after exercise—long before you'd typically get a massage. Massage doesn't remove lactic acid, and you don't need extra water to flush it out.[9][10][11]

That said, massage does produce real physiological effects. Studies show it can temporarily reduce cortisol (a stress hormone), lower heart rate, and cause modest changes in inflammatory markers. But none of these effects require you to drink extra water.[12][13][14]

 

How Much Water Do You Actually Need?

For general health, aim for about 40-45 mL per kilogram of body weight per day from all beverages and food combined. For a 150-pound (68 kg) person, that's roughly 2.7-3 liters (90-100 ounces) total per day.[15][16]

If you're training hard or sweating heavily, you'll need more. A good rule of thumb: replace about 1.5 times the fluid you lose during exercise. For example, if you lose 1 pound during a workout, drink about 24 ounces of fluid.[17]

Simple ways to monitor your hydration:

  • Check your urine color—pale yellow is ideal

  • Pay attention to thirst during moderate activity

  • Weigh yourself before and after intense workouts to estimate fluid loss

  • Add 0.5-1 liter of water after high-sweat sessions


Important: Don't overdo it. Drinking excessive plain water during prolonged exercise can dilute your sodium levels and cause problems.

 

The Bottom Line

Hydration is important for athletic performance and recovery—but not because of massage. Staying well-hydrated helps maintain tissue flexibility, supports muscle function, and enables efficient recovery from training.[2][4][3]

After your next massage, feel free to drink water if you're thirsty. But don't feel pressured to chug extra water based on myths about toxins or lactic acid. Instead, focus on consistent daily hydration as part of your overall training and recovery strategy.

The real reason to stay hydrated isn't about flushing anything out—it's about keeping your body functioning at its best.

 

References

  1. Water as an Essential Nutrient: The Physiological Basis of Hydration. Jéquier E, Constant F. European Journal of Clinical Nutrition. 2010;64(2):115-23. doi:10.1038/ejcn.2009.111.

  2. Investigating the Impact of Dehydration and Hydration on in-Vivo Hip Soft Tissue Biomechanics. Khorami F, Foroutan Y, Sparrey CJ. PloS One. 2025;20(8):e0328054. doi:10.1371/journal.pone.0328054.

  3. Effect of Hypohydration on Muscle Endurance, Strength, Anaerobic Power and Capacity and Vertical Jumping Ability: A Meta-Analysis. Savoie FA, Kenefick RW, Ely BR, Cheuvront SN, Goulet ED. Sports Medicine (Auckland, N.Z.). 2015;45(8):1207-27. doi:10.1007/s40279-015-0349-0.

  4. Passive Dehydration Increases Oxidative Stress and mTOR Signalling Pathway Activation in Young Men Following Resistance Exercise. Luk HY, Jiwan NC, Appell CR, et al. The Journal of Physiology. 2025;603(12):3551-3570. doi:10.1113/JP288434.

  5. Hydration, Hyperthermia, Glycogen, and Recovery: Crucial Factors in Exercise Performance-a Systematic Review and Meta-Analysis. López-Torres O, Rodríguez-Longobardo C, Escribano-Tabernero R, Fernández-Elías VE. Nutrients. 2023;15(20):4442. doi:10.3390/nu15204442.

  6. Side-Effects of Massage Therapy: A Cross-Sectional Study of 100 Clients. Cambron JA, Dexheimer J, Coe P, Swenson R. Journal of Alternative and Complementary Medicine (New York, N.Y.). 2007;13(8):793-6. doi:10.1089/acm.2006.6401.

  7. The Safety of Massage Therapy. Ernst E. Rheumatology (Oxford, England). 2003;42(9):1101-6. doi:10.1093/rheumatology/keg306.

  8. The Mechanisms of Massage and Effects on Performance, Muscle Recovery and Injury Prevention. Weerapong P, Hume PA, Kolt GS. Sports Medicine (Auckland, N.Z.). 2005;35(3):235-56. doi:10.2165/00007256-200535030-00004.

  9. Delayed Onset Muscle Soreness : Treatment Strategies and Performance Factors. Cheung K, Hume P, Maxwell L. Sports Medicine (Auckland, N.Z.). 2003;33(2):145-64. doi:10.2165/00007256-200333020-00005.

  10. Delayed Muscle Soreness: A Review. Francis K. The Journal of Orthopaedic and Sports Physical Therapy. 1983;5(1):10-3. doi:10.2519/jospt.1983.5.1.10.

  11. Lactate: Friend or Foe. Hall MM, Rajasekaran S, Thomsen TW, Peterson AR. PM & R : The Journal of Injury, Function, and Rehabilitation. 2016;8(3 Suppl):S8-S15. doi:10.1016/j.pmrj.2015.10.018.

  12. Physiological Adjustments to Stress Measures Following Massage Therapy: A Review of the Literature. Moraska A, Pollini RA, Boulanger K, Brooks MZ, Teitlebaum L. Evidence-Based Complementary and Alternative Medicine : eCAM. 2010;7(4):409-18. doi:10.1093/ecam/nen029.

  13. Influence of Classical Massage on Biochemical Markers of Oxidative Stress in Humans: Pilot Study. Skubisz Z, Kupczyk D, Goch A, et al. BioMed Research International. 2021;2021:6647250. doi:10.1155/2021/6647250.

  14. Effect of Single Session of Swedish Massage on Circulating Levels of Interleukin-6 and Insulin-Like Growth Factor 1. Stenbäck V, Lehtonen I, Mäkelä KA, et al. International Journal of Molecular Sciences. 2024;25(17):9135. doi:10.3390/ijms25179135.

  15. Hydration for Health Hypothesis: A Narrative Review of Supporting Evidence. Perrier ET, Armstrong LE, Bottin JH, et al. European Journal of Nutrition. 2021;60(3):1167-1180. doi:10.1007/s00394-020-02296-z.

  16. Hydration and Health at Ages 40-70 Years in Salzburg Austria Is Associated With a Median Total Water Intake Over 40 mL/kg Including at Least 1 L/D Plain Drinking Water. Stookey JD, Langthaler PB, Felder TK, et al. Frontiers in Public Health. 2025;13:1668981. doi:10.3389/fpubh.2025.1668981.

  17. Selected Issues for Nutrition and the Athlete: A Team Physician Consensus Statement. Medicine and Science in Sports and Exercise. 2013;45(12):2378-86. doi:10.1249/MSS.0000000000000174.

Returning to Play for High School Athletes: Part 2

Ever watch an athlete pass every physical test with flying colors but still hesitate when it's time to compete? Or see someone who's technically cleared but just doesn't look like themselves on the field? That's the psychological side of injury recovery — and it's just as important as the physical side.

Here's what many don't realize: an athlete who returns to sport when not psychologically ready may be at increased risk for mental health crisis, physical injury, or both. Let's break down the mental obstacles high school athletes face after ACL injuries, shoulder dislocations, and ankle sprains — and what actually helps them overcome these barriers.

 

The Mind-Body Connection: Why Psychology Matters

Psychological readiness is the critical missing piece in return-to-sport decisions. After ACL reconstruction, mental health scores directly correlate with successful return to sport. In fact, a recent analysis found that psychological readiness was the most effective predictor of return-to-sport success, with an effect size of 1.55 — outperforming physical tests like hop tests and limb symmetry indices.

The numbers tell a sobering story. Despite technical surgical successes and well-designed rehabilitation programs, many athletes never reach their preinjury athletic performance level, and some never return to their primary sport at all. This gap between physical capability and actual return suggests that factors beyond muscle strength and joint stability are at play.

 

The Psychological Obstacles: What Athletes Actually Face

Fear is the biggest mental barrier — specifically, fear of reinjury and fear of movement (kinesiophobia). Research on teens and young adults after ACL reconstruction found that each one-point increase in kinesiophobia was associated with a 28% higher likelihood of reporting unacceptable psychological readiness. Greater psychological readiness was strongly associated with lower kinesiophobia in both teens and adults.

The emotional landscape of injury recovery includes several warning signs that indicate poor adjustment:

  • Unreasonable fear of reinjury

  • Loss of athletic identity

  • Continued denial of injury severity

  • General impatience and irritability

  • Rapid mood swings

  • Withdrawal from teammates and support networks

  • Extreme guilt about letting the team down

  • Dwelling on minor physical complaints

  • Obsession with the question of when they can return

Nearly half of young athletes score below acceptable thresholds for psychological readiness after ACL reconstruction, highlighting just how common these struggles are.

 

What Psychological Readiness Actually Looks Like

An athlete who is psychologically ready to play has three key characteristics: realistic expectations of performance, high self-efficacy, and low anxiety. But here's an interesting finding: perceived physical competence matters more than actual physical competence when it comes to psychological readiness.

In a study of young athletes after ACL reconstruction, meeting criteria for perceived physical competence was associated with higher psychological readiness to return to sport, while meeting actual physical competence criteria showed no association with psychological response. This suggests that how athletes feel about their abilities may be more important than objective measurements alone.

For adolescent athletes specifically, the emotional response appears more influential than confidence in performance or risk appraisal. ACL-RSI scores increased significantly between 6 and 12 months post-surgery (from 55 to 71), and the emotions factor had better predictive ability for return to play than the confidence and risk appraisal factors.

 

Evidence-Based Assessment Tools

Several validated screening tools can help identify athletes who need psychological support:

Injury-specific tools:

  • ACL-Return to Sport after Injury scale (ACL-RSI): The gold standard for assessing psychological readiness after ACL reconstruction, with a cutoff score of 77 distinguishing acceptable from unacceptable readiness

  • Injury-Psychological Readiness to Return to Sport questionnaire (I-PRRS): Psychometric test specifically designed to assess psychological readiness of injured athletes

  • Tampa Scale of Kinesiophobia (TSK-11): Measures pain-related fear of movement

  • Reinjury Anxiety Inventory (RIAI): Specifically measures reinjury anxiety

General mental health screening:

  • Patient Health Questionnaire-9 (PHQ-9): Assesses presence of depression

  • Generalized Anxiety Disorder-7 (GAD-7): Assesses anxiety symptoms

  • Athlete Sleep Screening Questionnaire (ASSQ): Evaluates sleep disturbance

  • Sport Mental Health Assessment Tool 1 (SMHAT-1): Developed by the International Olympic Committee for comprehensive mental health assessment in athletes

Serial assessments using these tools offer a continuing profile of the athlete's psychological progression throughout recovery.

 

What Actually Helps: Evidence-Based Interventions

Three psychological elements are most important for positive rehabilitation and return to preinjury level of play: autonomy, competence, and relatedness (from self-determination theory).

Specific strategies that support positive return to sport experiences include:

  1. Reducing reinjury anxieties using modeling techniques — connecting athletes with others who have successfully recovered from similar injuries

  2. Building confidence through functional testing and goal setting — establishing both short- and long-term recovery goals

  3. Providing social support — keeping athletes involved with their team, teammates, and friends throughout recovery

  4. Reducing stressors related to premature return — ensuring athletes understand realistic timelines and expectations

  5. Fostering athlete autonomy — involving athletes in decision-making about their recovery

  6. Teaching specific stress coping skills:

    • Positive self-talk and cognitive restructuring

    • Relaxation techniques (meditation, deep breathing, progressive muscle relaxation)

    • Imagery and visualization

    • Goal setting

Research shows that psychological strategies like goal setting, positive self-statements, cognitive restructuring, and imagery/visualization are associated with faster recovery.

 

Building Trust and Addressing Misinformation

The foundation of psychological support starts with the healthcare team. Critical factors include:

  • Building trust and rapport — listening not only to make a medical diagnosis but also to assess and monitor emotional state

  • Educating the athlete about the injury — providing clear explanations in terms they can understand, with opportunities to ask questions

  • Identifying misinformation — athletes may obtain inaccurate information from parents, coaches, teammates, or the internet that contributes to confusion and emotional upheaval

  • Preparing parents, coaches, and other stakeholders — with the athlete's permission, educating support networks that injury management is individualized

  • Assessing the social support network — understanding who the athlete can rely on and their perception of that support

 

When to Refer to Mental Health Professionals

Athletes with problematic emotional reactions should be referred to licensed mental health professionals, preferably those with experience working with athletes. Early intervention and referral to the mental health network is important.

The American College of Sports Medicine recommends integrating sports psychologists and other mental health professionals into the athletic care network and coordinating referrals for mental health services as needed.

 

The Unique Challenges for High School Athletes

Adolescent athletes face specific psychological challenges. Adults were twice as likely as teens to report unacceptable psychological readiness after ACL reconstruction, suggesting that younger athletes may have different psychological responses or support needs.

Additionally, athletes with moderate preinjury adversity experienced less negative psychological responses compared to those with low or high preinjury adversity, suggesting that some prior experience with challenges may build resilience.

 

TOOLS FOR BUILDING CONFIDENCE

Resistance bands, balance pads and boards, and BFR cuffs are a few of the essential tools in rehabilitation. Resistance bands safely build strength, balance pads enhance coordination and stability, and BFR cuffs accelerate recovery through low-load training.

Below are our top 5 recommended products to use as a recovering athlete.

 
 

Click the image to shop on Amazon through our affiliate links and access possible discounts!

 
 

The Bottom Line

Physical clearance is only half the battle. Psychological readiness should be evaluated and incorporated into return-to-sport decision-making for all injured high school athletes, not just those recovering from ACL injuries.

The good news? High levels of optimism and self-efficacy and lower levels of depression and stress are associated with improved recovery from injury. Athletes who maintain optimism, believe in their ability to recover, and receive strong social support while managing stress and depressive symptoms are more likely to complete rehabilitation successfully, return to sport faster, and achieve better functional outcomes.

The key is recognizing that physical healing and psychological readiness must progress together — and when they do, high school athletes have the best chance of not just returning to their sport, but thriving in it.

 

References

Returning to Play for High School Athletes: Part 1

Ever watch your star player go down with a knee injury, see a shoulder pop out during a tackle, or witness an ankle roll on the court? These moments are gut-wrenching for athletes, parents, and coaches alike. But here's the good news: most high school athletes can successfully return to their sport after these common injuries — if they follow the right roadmap for physical recovery.

Let's break down what it takes to get physically cleared for return to play after an ACL tear, shoulder dislocation, or ankle sprain.

 

The ACL Injury: A Marathon, Not a Sprint

An ACL tear is one of the most feared injuries in youth sports, and for good reason. Nearly a quarter of a million ACL injuries occur annually in the US and Canada, with rates in high school athletes reaching 5.5 per 100,000 athlete exposures. But here's what many don't realize: getting back on the field isn't just about healing — it's about meeting specific physical benchmarks.

The minimum timeline is 9 months from surgery, and that's not arbitrary. Your body needs time for the graft to incorporate biologically, and rushing back increases reinjury risk dramatically. In fact, athletes who returned before 9 months had significantly higher rates of reinjury compared to those who waited.

But time alone isn't enough. Athletes must achieve at least 90% limb symmetry index (LSI) for both quadriceps strength and hop testing before getting cleared for competition. This means the injured leg needs to perform at 90% or better compared to the uninjured leg. Athletes who met these criteria had a reinjury rate of just 4.5% within 2 years, compared to 33% in those who didn't meet the criteria.

The recovery follows a structured, mulit-phase approach:

  • Early phase (weeks 0-6): Focus on reducing swelling, restoring range of motion to 0-115 degrees, and achieving 60% quadriceps strength symmetry

  • Intermediate phase (weeks 7-9): Progress to 70% strength symmetry with full, symmetrical range of motion

  • Late phase (weeks 10-16): Reach 75-80% strength symmetry and begin running when you hit 80% and can demonstrate single leg squats, step downs and hops with good mechanics

  • Transitional phase (months 4-6): Introduce jumping, sprinting, and agility drills at 85% strength symmetry

  • Return-to-sport phase (months 6-12): Sport-specific training with final clearance requiring 90% symmetry, no pain or swelling, and adequate confidence levels

Here's the reality check: only 40-55% of athletes return to their pre-injury activity level after ACL reconstruction. Even among highly motivated European professional soccer players with excellent resources, only 65% returned to their previous level. This isn't meant to discourage — it's meant to emphasize the importance of working with a sports physical therapist and following a comprehensive plan.

 

Shoulder Dislocations: High Risk, But Quick Recovery Possible

The shoulder is the most commonly dislocated joint in the body, and it usually dislocates anteriorly (toward the front). For high school athletes, especially those in contact and collision sports, this injury comes with a sobering statistic: recurrence rates can reach up to 90% in active patients younger than 25 years.

But here's where shoulder dislocations differ from ACL injuries: return to play can happen as early as 2-3 weeks after injury for athletes who are pain-free, have symmetrical shoulder range of motion, and can perform sport-specific motions. Some athletes with recurrent dislocations who experience easy relocation, minimal pain, full range of motion, and protective strength may even return the same day.

The treatment approach depends on several factors:

Immediate management:

  • Attempted relocation on the field before muscle spasm develops

  • Neurovascular assessment before and after reduction

  • Immobilization and pain management after successful reduction

  • Post-reduction radiographs after first-time dislocation

Recovery protocol:

  • Sling use for 2-4 weeks for comfort (though current evidence doesn't mandate a specific duration)

  • Graduated rehabilitation focusing on passive and active range of motion

  • Physical therapy addressing joint range of motion, scapular control, rotator cuff strength, and sport-specific conditioning

Surgical considerations: Surgery should be considered for first-time dislocations in active patients under 25 due to the extremely high recurrence rate, or when there are complications like large bony defects.

Interestingly, research on high school athletes shows that 85% of those treated nonoperatively successfully returned to their sport and completed at least one full season without additional injury. Athletes with subluxations (partial dislocations) fared even better, with an 89% success rate compared to 26% for complete dislocations.

 

Ankle Sprains: The Most Common Culprit

Ankle sprains are the most common foot-ankle and sports-related injury for which people seek medical care. Four in every 10 first-time ankle sprains occur during sports participation. The good news? Most athletes bounce back quickly.!

High school athletes have a 75% chance of returning to sport within 3 days after a first-time , Grade I ankle sprain, and a 95% chance within 10 days. In college athletics, 44.4% of athletes returned to play in less than 24 hours. However, more severe Grade II and III sprains involving multiple ligaments can sideline athletes for more than 3 weeks.

The key to successful return involves addressing five critical domains — the PAASS framework:

  • Pain: Both during sport participation and over the last 24 hours

  • Ankle impairments: Range of motion, muscle strength, endurance, and power

  • Athlete perception: Confidence, reassurance, stability, and psychological readiness

  • Sensorimotor control: Proprioception and dynamic postural control/balance

  • Sport/functional performance: Hopping, jumping, agility, sport-specific drills, and ability to complete a full training session

Supervised exercise programs addressing strength, coordination, proprioception, and functional deficits lead to faster return to sports. Evidence also supports the use of compression stockings and anteroposterior ankle joint mobilization for quicker recovery.

General return-to-work and sport guidelines suggest:

  • Return to sedentary work: 2-6 weeks following injury

  • Return to physical occupations and sports: 6-8 weeks

These timelines should be adjusted based on injury severity, rehabilitation response, and specific task requirements. Working with a sports medicine clinician will be key for determining optimal readiness.

 

TOOLS FOR BUILDING CONFIDENCE

Resistance bands, balance pads and boards, and BFR cuffs are a few of the essential tools in rehabilitation. Resistance bands safely build strength, balance pads enhance coordination and stability, and BFR cuffs accelerate recovery through low-load training.

Below are our top 5 recommended products to use as a recovering athlete.

 
 

Click the image to shop on Amazon through our affiliate links and access possible discounts!

 
 

The Bottom Line

Physical clearance for return to play isn't one-size-fits-all. ACL injuries require the longest recovery with the most stringent criteria — minimum 9 months and 90% strength symmetry. Shoulder dislocations can allow quicker return (2-3 weeks) but carry high recurrence risk in young athletes. Ankle sprains typically resolve fastest, with most athletes back within days to weeks.

The common thread? Meeting objective physical criteria matters more than arbitrary timelines. Pain-free movement, symmetrical strength, full range of motion, and sport-specific performance capabilities aren't just checkboxes — they're your best insurance against reinjury.

In Part 2, we'll explore the mental side of return to play — because as we've learned, physical readiness is only half the battle.

 

References

From Rehab to Resilience: The Power of Maintenance Massage

If you’ve ever received massage therapy as part of your physical therapy care, you’ve likely experienced the benefits of recovery massage—decreased soreness, improved mobility, and faster healing. But what happens when you’re out of the acute phase? That’s where maintenance massage comes in—and it’s often the missing piece in staying injury-free and performing at your best.

While recovery massage gets much of the spotlight in the rehab process, maintenance massage is what keeps your system tuned and functioning well long after the initial problem has resolved. Let’s explore the distinct purposes of recovery and maintenance massage, why each matters, and why transitioning from one to the other should be part of your long-term plan.



Recovery Massage: A Tool for Healing

Recovery massage is typically prescribed during or immediately after an injury or intense physical stress. It targets soft tissues that are healing or under high demand. The goals are straightforward: reduce pain, manage inflammation, improve circulation, restore function, and help tissue recover from overload.

Studies consistently show that massage therapy can play a meaningful role in post-injury and post-exercise recovery. A meta-analysis published in Frontiers in Physiology found that massage significantly reduces delayed-onset muscle soreness (DOMS) and improves muscle performance markers such as strength and range of motion after strenuous exercise (Davis et al., 2020). Similarly, massage has been found to be effective in reducing perceived fatigue and supporting muscle recovery without impairing strength or power output (Poppendieck et al., 2016).

Massage also appears to positively impact inflammatory and healing pathways. A cellular-level study by Crane et al. (2012) found that massage downregulated genes associated with inflammation and promoted mitochondrial biogenesis in muscle tissue following exercise. This means massage doesn’t just feel good—it may help tissues repair more efficiently.

In rehab settings, recovery massage often occurs multiple times per week, especially in the early stages of healing. Sessions are more targeted, focusing on restoring mobility and reducing compensation patterns. Once pain and mobility have improved, the frequency of sessions typically decreases, paving the way for a maintenance plan.



Maintenance Massage: Investing in Resilience

In contrast to recovery massage, maintenance massage isn’t about fixing something that’s broken—it’s about keeping systems running smoothly. After you successfully recover from injury, transitioning into maintenance massage is a key strategy to prevent recurrence and improve long-term performance and body awareness.

Maintenance massage supports:

  • Circulation and metabolic exchange in muscles and fascia

  • Muscle tone balance in frequently used or overused areas

  • Joint mobility and tissue pliability

  • Stress reduction and parasympathetic nervous system activation

Although fewer studies focus exclusively on maintenance massage, the benefits are supported by broader research into regular manual therapy. For example, research published in International Journal of Therapeutic Massage & Bodywork found that regular massage over four weeks led to statistically significant decreases in reported musculoskeletal discomfort in healthy adults (Sherman et al., 2014).

Importantly, maintenance massage isn't “less important” just because it's not addressing an acute injury. For athletes or active individuals, maintenance massage becomes part of an ongoing performance strategy—much like strength training or mobility work.

Frequency can vary: for highly active individuals, once every 2–4 weeks is common. The techniques used are often broader and less intense than during the recovery phase, with a focus on tissue health and function rather than symptom relief.





The Transition: From Recovery to Maintenance

One of the most important shifts in the rehabilitation process is knowing when and how to transition from recovery massage to maintenance. That shift usually happens once:

  • Pain has decreased

  • Normal movement patterns have returned

  • The tissue is no longer in an acute inflammatory state

  • Function has improved with activity or return to sport

At this stage, the goal is no longer just healing—it’s sustainability.

Yet many patients disengage from bodywork once the acute phase ends. They “graduate” from PT and stop getting massage until the next injury arises. This stop-start cycle can lead to setbacks or recurrent issues that were preventable with consistent maintenance work.

Massage therapists working in sports and rehab settings understand this arc and can guide the timing and frequency of maintenance sessions. Maintenance massage isn’t about pampering—it’s an active part of an athletic recovery strategy.

 

Tools We Trust for Recovery

While nothing replaces the benefits of hands-on massage, there are a few tools we consistently recommend. Products like massage guns, Chirp wheels, and the VenomGo—combining targeted heat and vibration—can help boost circulation and ease muscle tension between sessions.

 
Buy on amazon
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Conclusion: Recovery Is a Phase—Maintenance Is a Mindset

Recovery massage is the hero during an injury—focused, intensive, and essential. But as tissues heal and performance returns, the work doesn’t stop there. Maintenance massage picks up the baton, helping you maintain the progress you’ve made and avoid returning to square one.

For active individuals—especially those who’ve just completed physical therapy—making maintenance massage a consistent part of your recovery strategy helps build resilience, prevent injuries, and optimize performance. Just as your training evolves with your goals, so too should your approach to bodywork.

In short: Recovery massage gets you out of trouble. Maintenance massage keeps you out of it.

 

References

  • Crane, J. D., Ogborn, D. I., Cupido, C., Melov, S., Hubbard, A., Bourgeois, J. M., ... & Tarnopolsky, M. A. (2012). Massage therapy attenuates inflammatory signaling after exercise-induced muscle damage. Science Translational Medicine, 4(119), 119ra13. https://doi.org/10.1126/scitranslmed.3002882

  • Davis, H. L., Alabed, S., & Chico, T. J. (2020). Effect of sports massage on performance and recovery: A systematic review and meta-analysis. Frontiers in Physiology, 11, 748. https://doi.org/10.3389/fphys.2020.00748

  • Poppendieck, W., Wegmann, M., Ferrauti, A., Kellmann, M., Pfeiffer, M., & Meyer, T. (2016). Massage and performance recovery: A meta-analytical review. Sports Medicine, 46(2), 183–204. https://doi.org/10.1007/s40279-015-0420-x

  • Sherman, K. J., Cherkin, D. C., Kahn, J., Erro, J. H., Hrbek, A., Deyo, R. A., & Eisenberg, D. M. (2014). A survey of training and practice patterns of massage therapists in two US states. International Journal of Therapeutic Massage & Bodywork, 7(1), 10–17. https://doi.org/10.3822/ijtmb.v7i1.202

Crepitus: The Truth About Noisy Joints

Ever hear a pop when you squat, a crack when you roll your neck, or a grind when you climb stairs? That’s crepitus — the medical term for the noises or sensations that sometimes come from your joints.

Crepitus is common, and in most cases, it’s nothing to worry about. But sometimes, it can signal that your joint mechanics aren’t working as smoothly as they should. Let’s break down why it happens, when it’s normal, and when it may be worth a closer look.


What Exactly Is Crepitus?

Crepitus refers to the popping, cracking, grating, or crunching sounds (or sensations) that occur during joint movement. It can show up in many areas of the body, including the knees, shoulders, hips, spine, and even the jaw.

It’s not a condition by itself, but more of a sign that something is happening in or around the joint. A lot of times, that “something” is completely benign. Other times, it’s a clue that the joint is under stress (Drum et al., 2023).


Why Do Joints Make Noise?

There are several reasons joints produce crepitus, most of which are harmless:

  • Gas bubble formation (cavitation): Joints are lubricated by synovial fluid. When pressure inside the joint changes quickly, gas can form or collapse in the fluid, creating a distinct popping sound (Kawchuk et al., 2015; Fryer et al., 2017).

  • Tendons or ligaments snapping over bone: Soft tissues sometimes shift slightly during movement and then snap back into place, creating a click.

  • Surface changes in cartilage: If the smooth joint surfaces become uneven (such as in arthritis), movement can cause grinding or crackling noises.

  • Internal tissue catching: Soft tissue folds inside the joint, such as plica or meniscal edges, can occasionally cause popping or clicking (Drum et al., 2023).


How Common Is Crepitus?

You’re not alone if your joints make noise — crepitus is widespread, even in healthy people.

  • About 41% of knees in the general population show crepitus.

  • Even among people with no knee pain, roughly one-third still experience it.

  • In individuals with osteoarthritis, the numbers are higher — up to 81% report crepitus (Couch et al., 2025).

The takeaway? Joint noise is very common, and by itself, it doesn’t necessarily mean damage.


When Crepitus Is Harmless

Most of the time, crepitus is simply a mechanical quirk of how your joints move. It’s usually not a concern if:

  • The noise occurs without pain.

  • There’s no swelling, stiffness, or loss of motion.

  • It hasn’t been getting worse over time.

In these cases, there’s no reason to avoid movement — in fact, staying active can keep your joints healthier.


When Crepitus Might Signal a Problem

Crepitus deserves more attention when it’s paired with other symptoms. You may want to consult a physical therapist or physician if you notice:

  • Pain with movement or weight-bearing

  • Swelling, warmth, or stiffness in the joint

  • Locking, catching, or instability

  • Persistent or worsening grinding

  • Loss of function or activity limitations

In some cases, more intense crepitus has been linked with weaker surrounding muscles (like the quadriceps in the knee). This muscle imbalance can place more stress on the joint, making symptoms worse (Jakovacz et al., 2024).

Importantly, while crepitus is more common in people with osteoarthritis, studies show that crepitus alone does not reliably predict disease progression or need for joint replacement (Pazzinatto et al., 2018).


What You Can Do About Crepitus

If your crepitus is painless:

  • Keep moving. Regular activity nourishes cartilage and prevents stiffness.

  • Strengthen muscles. For example, strong quadriceps and hamstrings help reduce stress on the knee.

  • Stretch and mobilize. Increased flexibility can improve tendon and ligament function.


Simple Tools to Keep Your Joints Moving Smoothly

Crepitus can often be eased with tools that promote muscle relaxation and joint mobility. The Hypervolt massage gun with its heated attachment helps improve circulation, reduce muscle tension, and warm up tissues around the joints. Pairing it with gentle movements using an exercise ball encourages controlled mobility and improved joint function.

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If your crepitus is painful or comes with swelling or dysfunction:

  • Check in with a physical therapist. They can identify whether the crepitus is harmless or potentially linked to a condition like arthritis, tendon overload, or a fibrocartilage injury (meniscus, labrum).

  • Follow a guided plan. Targeted exercises, joint protection strategies, and activity modifications can help reduce pain and restore confidence in movement.


Bottom Line

Joint noise by itself, even if it sounds dramatic, is usually nothing to worry about. But if crepitus shows up alongside pain, swelling, or loss of function, it’s your body’s way of telling you to pay closer attention.

The good news? Most causes of crepitus respond well to exercise, physical therapy, and healthy movement habits. So the next time your joints crack, remember: noise without pain is normal; noise with pain deserves attention.


References

  • Couch, T. A., Hall, M., Hussain, S. M., Teichtahl, A. J., Wluka, A. E., & Wang, Y. (2025). Knee crepitus: A systematic review of prevalence, incidence, and associations with knee osteoarthritis. Osteoarthritis and Cartilage Open, 7(1), 100471.

  • Drum, E. E., Jauregui, J. J., Probasco, S. K., et al. (2023). Knee crepitus: Current evidence and clinical relevance. Musculoskeletal Care, 21(3), 442–449.

  • Fryer, G., Pearce, A. J., & Herbert, J. J. (2017). Cavitation onset in the metacarpophalangeal joint: A physiological explanation of joint cracking. PLoS ONE, 12(4), e0174190.

  • Jakovacz, N., Mészáros, Z., & Farkas, J. (2024). Relationship between knee crepitus intensity and quadriceps muscle thickness. Manual Therapy, 66, 107102.

  • Kawchuk, G. N., Fryer, J., Jaremko, J. L., Zeng, H., Rowe, L., & Thompson, R. (2015). Real-time visualization of joint cavitation. PLoS ONE, 10(4), e0119470.

  • Pazzinatto, M. F., de Oliveira Silva, D., Azevedo, F. M., & Barton, C. J. (2018). Association between crepitus and progression of knee osteoarthritis: A longitudinal cohort study. Arthritis Care & Research, 70(3), 420–427.