Tennis Ball self-massage techniques

The humble tennis ball is a very useful self-massage tool. Attributes of tennis balls: gets into deeper muscles and tendinous attachments, a quick focus on one pinpoint area, no need for a partner, extremely economic, can be used any time, and can prolong and enhance the work following a massage therapy session. Here are some resources, visuals and techniques to apply your own tennis ball therapy towards a few common musculoskeletal issues.

During the workshop, we’ll do a little bit of anatomy so you can locate the right area to place your tennis ball before we add a body weight load to the situation. In general, you’ll want to spend at least 60 seconds or longer working on an area before moving to the next spot. Start light and gradually deepen the pressure as the area releases/feels less sharp or uncomfortable.

You’ll need: a warm space, some comfy clothes, a mat on a firm surface, some pillows, 2 tennis balls, a long sock, a yoga block or a couple of stacked thick books.

1) Foot and Calf (common issue: Plantar Fasciitis).

Your lower leg is encased in a knee sock of connective tissue called fascia. It has been stripped off in the image to the right, revealing the muscles and tendons underneath. The posterior leg muscles are continuously connected via fascia with the bottom of the foot (plantar surface). When the calf muscles (gastrocnemius and soleus) are too tight, the tension is transmitted through both the Achilles tendon and fascia, to the foot. This tightness creates inflammation and pain on the bottom of the heel and foot, known as Plantar Fasciitis (PF). When a client presents with PF, I work on their calves primarily, and only a little on their feet.

Sit on the floor with your legs outstretched, and put your tennis ball under your calf, centrally and just below the knee. It will fall between the two heads of the gastrocnemius. Allow your leg’s weight to fall on the ball and roll a little side to side - spend at least 30 to 60 seconds in an area. Work your way down the leg similarly - if you find tender spots, stay on them and try to relax your leg to spread over the ball. You could cross your free leg overtop for more weight. Try externally rotating your leg and rolling down the outer fibularis muscles, then internally rotating and finding the medial edge of the soleus. Repeat on the other leg.

2) Lateral knee, side leg and anterior Iliac crest (common issue: Iliotibial Band Syndrome/ITBS)

If you’ve ever been to a ‘Bodies’ exhibit by Gunter Hagens (highly recommended!!), you’ll have seen an IT band (ITB), an impressive 3-inch wide piece of gristley tendon running down the outside of each leg. It originates at the top of the lateral pelvis and inserts at the outer kneecap. When the knee bends during running, the ITB moves across the lateral femur, so repeated movements can irritate the inside of the tendon causing Iliotibila Band Syndrome (ITBS) and inflammation of the surrounding muscles, such as the Vastus Laterialis. Because the ITB is a tendon, it is not meant to stretch very much along its length, so massage can be directed to the two ends and around on either side, upper and lower, for more successful relief of discomfort. To massage the distal (further from the head) portion at the lateral knee, we’ll recline on our right side and put the ball to the outside and above the right patella. You can put as much weight on the ball as you can tolerate and wiggle around. The proximal (closer to the head) end of the ITB is the Tensor Fasciae Latae (TFL), embedded in the top of the ITB and the Gluteus Medius, a little posterior to the TFL. To affect these muscles, we’ll find the iliac crest (upper hip bone) and put the tennis ball just below it as we lie on it laterally. Do not allow the ball to roll too far back at this point (save that for #3, piriformis and glute maximus). Keep it lateral and at the top of the ITB. You can roll down the ITB a little in front and behind, to massage the lateral quadriceps muscle underneath (called the Vastus Lateralis). Go easy - that’ll be sore. Repeat the series on the left leg, and hang out for about 5 min per leg exploring all the different points of sensation.

3) Piriformis/hip rotators/ Gluteus Maximus (common issue: Sciatica)

The Piriformis is one of 6 muscles deep to the Gluteus Maximus that attach fan-like from the sacrum and upper pelvis to the greater trochanter of the femur. Their function is to externally rotate the leg and stabilize the hip. The sciatic nerve initiates in the low spine from vertebrae L4 to S3, travels through the pelvis under (sometimes through) the priformis, and travels down the leg enervating all the way down to the foot. It’s huge - about the diameter of your pinky finger at the top of the leg, and diminishes in size as it travels down. If the piriformis becomes inflamed (too much sitting is the usual culprit), it can compress and irritate the Sciatic nerve, causing pain not only in the immediate gluteal and hip area, but all the way down the leg.

A good way to relieve sciatica is by stretching, and we’ll use the tennis ball to passively stretch the piriformis muscle. Lie supine with your feet flat on the floor and knees up. Place the tennis ball directly in the middle of your right glute, (imagine the location of a back pocket of a pair of jeans). Start with light pressure on the ball and roll it around a bit. You can also lift your pelvis by using your feet to push off. Try extending the right leg along the floor. The most aggressive approach would be to cross the right ankle over the left knee to lengthen the piriformis while maintaining the ball underneath. Repeat on the left to balance both sides.

4) Spine (common issues: low back pain, upper back pain)

The back is a BIG area to cover, so we’re going to focus mostly on lower back pain near the lumbar vertebrae, and upper back pain, between the shoulder blades. The lumbar area is covered by a thick wrapping of connective tissue called the thoracolumbar fascia (TLF). The most common source of lower back pain is weak core muscles not supporting this area adequately, putting discs and afferent nerves at risk. Lack of mobility and stretching will also cause the lumbar muscles and connective tissue to stiffen, becoming susceptible to injury when responding to movement. Other sources can be osteoarthritis or acute injury, among others. We’ll use the tennis balls to gently massage muscles from the TLF (bottom) to the occiput (top) on either side of the vertebral processes (knobby parts of the spine going up the back). One cannot separate the deep from the superficial muscles, so this massage tecnique will affect them together. (Also work your core - check out my class specifically for this: https://www.emmaholder.com/core-and-more, and I have lots of videos for you to try HERE.

Put two tennis balls on the sock and tie a knot above them so they are held together and do not escape. Lie supine with your feet flat and place the sock with two tennis balls just above your sacrum. The tennis balls should press into the muscles on either side of your spine, not touching the vertebral processes. Work your way up the back towards your scapulae/mid to upper back. (Step #6 will approach the back of the neck and occiput. Save that area - I promise we’ll get there with a side trip to the shoulder #5 first.) Use a pillow or yoga block, pile of books to support your head or hips as needed. Wiggle around and find the sweet spots, and spend a few minutes on each spot. Click here for a resource on spinal anatomy.

5) Shoulder (common issue: Rotator Cuff/RTC)

Each arm’s rotator cuff is made up of 4 independent muscles with different actions (internal and external rotation, plus shoulder stabilization during lower arm movements). Unlike the hip, the shoulder is a shallowly cupped joint allowing the large range of motion important for arm function. However, great flexibility has the cost of decreased stabilization and increased susceptibility to injury; dislocation, strains and tears. Using the tennis ball to massage the RTC muscles requires a little gymnastics, but it’s doable. A door frame and wall allows access to the Supraspinatus and Subscapularis and Teres Minor. Supine position will get the Infraspinatus.

Put the tennis ball on top of the shoulder (Supraspinatus) and then bend at the hips to lean the tennis ball against a door frame (your head goes past the frame). To get the subscapularis (baseball pitching muscle) use a wall or the floor. Put your right arm over your head and place the tennis ball towards the back of the axilla, then lean the ball against the wall or go to side lying on the floor. Turn supine to massage the tendons of the Infraspinatus and Teres Minor. You can hold the ball still and move your arm back and forth and in rotation to access all the attachment points and fibers. To use the wall a little more, put the ball on your sock and sling it over your shoulder then lean against the wall. Palpate the spine of the scapular to locate the ball below and on the rear face, to target the Infraspinatus. The sock will keep the ball in the right place. It will take some practice to get the wall technique. Persevere, it’s worth it.

6) Occiput, back and lateral neck, jaw (upper back and neck pain, TMJ)

We tend to feel a lot of tension in the back of the neck and along the jaw. This is primarily due to unconscious forward-head posture, stress-induced jaw clenching, and overly strong front pectoral muscles. The antidote? Relax and release all these muscles and consider what is stressing us out (I know, easier said than done…) The image to the right shows superficial (left) and deep (right) musculature, and attachments in the upper back, neck and skull area. It’s multi-layered and complex, but you don’t need to know all the names of the muscles to affect and release them.

Put two tennis balls in a sock and tie a knot to keep them together like you did for the spinal approach (#4). Lie supine with feet on the floor, knees up and put the sock with tennis balls under your occiput, just below the back of your skull. You might need a pillow or to double your yoga mat up. Roll around a bit to find good spots. You can also do a little from the prone position with a rolled yoga mat underneath one pec with the ball on top.

For TMJ, the first approach should be gentle - just roll the ball on your jawline with your hand. Hold it on the side of your face and open and close your lower jaw. You can put a yoga block or a couple of books under the top edge of the yoga mat and put the side of your sternocleidomastoid (front diagonal side of the neck) on the ball and roll gently. You could also lie with the side of your face on the ball, but this will be a more aggressive approach. less can be more in the case of your face. Get creative with pillows to support the remaining weight of your head.

7) Forearm (medial or lateral tendinitis/golfer’s or tennis elbow)

Many workers suffer from a repetitive motion issue at the elbow. Most common is Lateral Epicondylitis or “tennis elbow” on the top of the forearm and around the thumb-side of the elbow. Less common though still bothersome is inflammation on the other side of the elbow (“pinky-side”) which leads to medial epicondylitis, aka golfers elbow. An epicondyle is a protuberance at the end of a long bone where tendons attach, and your elbow has one on each side; lateral and medial.

To massage the muscles involved in lateral epicondylitis (LE), we’ll have to put the tennis ball on the outside of our forearm, then get into cobra position (yoga), and maneuver our body on top of the tennis ball. If one is suffering LE, this will feel quite sharp, so use your other arm and your torso and core muscles to lighten the load on top of the ball. We all spend a lot of time on computers now, and this maneuver will preemptively release this forearm compartment, reducing risk of LE in the future.

To massage the medial epicondyle area, lie prone with the target arm outstretched on a yoga mat and put the ball on the inner forearm. Roll it around - you wont have full body weight for this one, but it can be a rather tender area, so you probably won’t mind.

For anatomy look-ups, this is a fun site: https://www.innerbody.com/htm/body.html