Classifications of Massage

“Give the body what it needs” is a quote that my friend/colleague Don Miller often says to students when teaching some of his massage therapy classes.

In a nutshell, what Don is referring to is establishing what the clients needs are based on assessment (subjective and objective) and then ensuring these needs are met with your treatment, because if they are not, then the desired outcome might not be achieved.

Some of these ideas can be further explained in my article, The Bucket List, where I took various techniques/methods and placed them into buckets based on what sort of treatment I felt like they addressed.

In a recent email exchange with a colleague, we were discussing massage therapy and the issues some coaches may have with finding local therapists as he commented:

One of my fears is that some therapists don’t know enough about training and biomechanics to give advice. Also it seems when I need hands on therapy the therapists wants to be the “diagnosis and detective” guy and after 30 minutes no therapy is done. When a coach sees the athlete every day and understands biomechanics, he or she knows what is going on, but may not have the abilities to treat.

I certainly wont disagree with this statement and, as I tell the massage students at the school where I have been doing some teaching, it really helps if you (as a therapist) can go and meet with the strength coach/athletic trainer and get a really good understanding of the sport and its demands as well as the training that is involved in the athlete’s program.  I also advise them to attend practices and games when time permits to have a good understanding of the sport.

In regard to the statement about assessment and being a “detective guy” I commonly classify soft tissue therapy in two ways:

1. Bodywork for stress reduction, fine tuning, recovery/regeneration
2. Bodywork with a specific treatment purpose/goal

Category 1

Category one is pretty self explanatory and I think this is what the above colleague is looking for and seeking out when he brings his athletes to a therapist.  Basically, you are looking for someone who can help the athlete relax and recover from the high amounts of training and/or competition they have been placed under.  In this instance, the therapist is looking to decrease tone and “turn down the volume knob”on the athlete’s nervous system.  This approach may be focused on areas of the body specific to the sport or it may be focused on more of a general whole body approach with the goal of calming the athlete down (or it might be a combination of the two depending on the allotted time for treatment).  This of course does not mean that you wont spend time working on areas of restriction or increased density (scar tissue, fascial adhesions, trigger points, etc), however, it just means that the athlete is not coming in to you with a particular complaint other than, they just want to have a massage.

Category 2

In category two, the athlete is coming with a specific complaint (e.g., “My knee is aching me and has been for a few weeks.”).  In this instance, the goal of the therapy changes from a more general approach to one which needs to be focused on specific regions that deserve the therapists attention.  These regions are determined via some form of assessment and, if the therapist is not that familiar with the athlete or the sport, should include feedback and commentary form the strength coach/athletic trainer.

Category 2b

Category two can be a bit of a touchy subject for some therapists, coaches, athletic trainers, etc, as people often think/feel that you may be stepping on their toes with a more involved assessment approach.  In this instance, Category 2b is the way to go. 

In Category 2b the goal is the same – a focused/specific soft tissue therapy approach – however the method of attaining this goal begins with a more general approach (as in Category 1) and then slowly becomes more focused as you do your work.  What you are looking to do with this approach is scan the tissue, evaluate joint play, get a sense of the state of how things feel, and gather feedback from the client/athlete, just as you would in Category 2, but you are doing so within the constructs of the massage rather than sitting there and assessing things first and developing a plan of what you want to treat and then doing so.  In reality, Category 2b resembles Category 1 from the standpoint that you are beginning with a general approach, the only difference being that you are concentrating your efforts on evaluating structures that may have a negative influence on the main area of complaint.

I don’t think Category 2b is as effective as Category 2 because you may miss some things as you are doing the massage and trying to piece together information, given the time it takes to try and treat/scan everything, rather than taking the time to make an assessment and formulate a plan of attack.  Unfortunately, given the inflated egos in the various professions, this may be the method that some therapist may have to work under in these situations.  Obviously, I am much more a fan of a multidisciplinary approach, where the strength coach, athletic trainer, and massage therapist, can all sit down and talk openly about the athlete and what the best way to help them would be, however, this doesn’t always happen.  I have been in both situations – the situation where other professionals don’t want to talk to you and the situation where there is an open sharing of ideas and methods – and I much rather prefer the latter.

Blending Categories

What I laid out above is a very black and white classification of how can approach massage.  However, in the real world, things are never so black and white and clients rarely ever fall into such specific categories.  It is important to remember that most therapy treatments will have a blending of all categories listed above.  For example, in a more treatment based approach it is not uncommon for me to do some very specific work and follow it with more general work for relaxation, as specific therapy can be thought of as a stress the body needs to adapt to, my goal is to try and balance that stress with an approach that has some influence on the parasympathetic system as well.

Conclusion

Depending on the needs of the athlete – general relaxation/therapeutic or treatment based – it is important to give the body what it needs in order to obtain the desired outcome with your treatment approach.  In a treatment based approach, assessment is a key component in helping you get an understanding of what needs to be addressed.  In some situations, however, any assessment that takes place outside of “doing massage” may be interpreted by others (typically those with large egos) as you not doing your job and this may cause you to move to plan “B” which involves soft tissue therapy starting in a general way and slowly trying hone in on what areas need the most attention.  While this approach may not be 100% optimal, sometimes it is the only way for you to get your work done.  Finally, a comphrensive treatment will often require a blending of each category discussed in an effort to positively influence the clients system to make the changes you seek.

Patrick
patrick@optimumsportsperformance.com