In my last article I discussed a new paper looking at Massage and Exercise Induced Muscle Damage. At the end of the article I discussed some of the ways massage can be thought of as a modality to use within the recovery process from competition or during intense training phases. I thought it would be good to put together some more formal thoughts on the topic as recovery is different for everyone and athletes often have individual complaints or needs that have to be met. By altering your treatment approach you may have a better chance of meeting these needs and helping to play a more significant role in the recovery process.
In the left hand column we see a variety of different complaints that an athlete may have and reasons that they may be seeking out massage. In the right hand column there are a few different options for treatment. This is by no means and absolute list. It is just a few ideas to get the therapist thinking of potential treatment effects. Unfortunately, most therapists have a one-size-fits-all approach to therapy and, no matter what your complaint or need is, you are going to come in, lie on the table and get a deep tissue massage (oftentimes leaving the individual more sore the next day). By trying to vary our treatment approach and be aware of the athlete’s complaint, we can (a) meet the athlete’s needs and (b) alter our soft tissue inputs from treatment to treatment, preventing the body from adapting to the exact same thing every time.
Briefly looking at the different types of complaints:
- In the first group, we are dealing with athletes who have a high level of fatigue and exhaustion. This may come from a period of overreaching or overtraining. Additionally, within this bucket are athletes that have a high level of anxiety (and perhaps may show a higher amount of sympathetic dominance). For the athletes with these complaints our treatment options are to help them attain a more relaxed state. For this, I favor longer massage sessions (60-90min) with a lot of slow compression and long holds of skin stretching. These techniques tend to be very relaxing and provide a therapeutic effect. The suggestion of placing the athlete prone is to decrease the amount of visual input (as well as the urge to talk or speak) and to attempt to get them to shut down for a moment and maybe even fall asleep on the table. Additionally, working on the neck and paraspinals in this prone position seems to evoke a sense of relaxation and have a calming effect on the system. The therapist should resist the urge of trying to go too deep with their compressions, to a point where the athlete becomes very engaged in the session and is trying to fight against your pressure. Work to the athlete’s tolerance level. Much of the ideas in this section came from some of the research I have discussed a few years ago on Massage and HRV and Massage and Stress as well as some of the concepts I took from Robert Schleip’s text, Fascia: The Tensional Network of the Human Body, which I discussed in THIS article.
- In the second group we see one of the most common reasons why athletes seek out massage – soreness. The massage technique suggestions for this complaint come from some of the research discussed on my last article as well as the research I discussed in an article two years ago from Crane et al. Both articles explained a massage approach for muscle damage dealing with 5-10min of gliding strokes to the affected muscle region. I also put into this section things like contract relax stretching or pin and stretch modalities as method to engage the athlete, get them to move around a little bit, and, in the process of creating movement with human touch, allow them to perceive themselves as “less sore”.
- The final group is one of mobility or “tightness” as well as treatments geared towards maintenance of mobility and tissue quality. The aim of dealing with the athletes in this group is to have a good understanding of where their movement system is currently (what is their baseline) and then determining when they are below their norm (oftentimes, following intense competition or training, the individual may tighten up or stiffen up and lose some of their normal movement). Also, knowing what is normal for the athlete in the sense of tissue quality (tone) and what is abnormal, for that individual, can be extremely important and helpful in guiding your treatment approach. Within this group the modalities selected are more active, engaging the athlete to move and be a participant in the treatment. Thus, things like pin and stretch techniques or active stretching/mobility techniques can be very valuable. Additionally, Dr. Andreo Spina’s work, Functional Range Release, can be extremely helpful for engaging the resistance barrier, applying tension to the tissue, and using things such as PAILs and RAILs to actively engage the athlete with movements into and out of their limited range (Dr. Spina also has an approach called Functional Range Conditioning, which is a nice follow up to the hands on treatment as it is a movement based approach to re-teach the system how to move into certain ranges of motion). Other ideas for the treatment approaches in this group came from articles and sources on Foam Rolling and increases in joint ROM, muscle stripping with eccentric contraction (gliding techniques with active movement), ischemic compression (trigger point compression) and increases in joint ROM, the work for Travell and Simons, as well as others discussing trigger point theories, and the fascial manipulation work of Stecco.
As I stated earlier, the treatment approach/modalities in the right column are by no means an exhaustive list. The goal of this article was to provide a framework for therapists to begin to think about and consider how their treatment techniques impact the athlete/client and perhaps can (and should) be modulated based on what the athlete’s symptoms/complaints are. In this way, the therapist can approach treatment with the athlete and hopefully better meet their needs and facilitate a positive recovery outcome.