Using Soft Tissue Therapy To Enhance Stress Resistance

How an athlete tolerates a particular stressor – be it a resistance training or conditioning program, a change to their nutrition plan, or whatever life throws at them – is called stress resistance.  A stress is placed on the body (alarm stage) and the body then attempts to resist that stressor (resistance stage) in an effort to improve its overall state (supercompensation stage).

I talked about recovery from training/competition in a previous blog article and stressed the importance of making sure the athlete gets into shape so that they do not need to use as many recovery strategies (a higher level of overall fitness will allow the athlete to recover more easily) and that there will be periods of training where training under residual fatigue from previous training sessions/weeks may be desirable as this will lead to a greater rise in fitness in the long run when the athlete finally backs off the training volume/intensity and allows their new level of fitness to manifest itself (delayed training effect).

Recovery

Recovery methods may be employed at different periods during the training block and/or competitive season:

1. Assisting in recovery during the training week at times, although not relying on it after every single hard workout, can be helpful in allowing the athlete to perform greater intensities/volumes of training and may additionally help to carry out a training phase a little longer than normal if the athlete is still able to recover and squeeze out some more gains.
2. During the season athletes are often required to compete in multiple games per week with only a day or two of rest between them.  Helping the athlete recover following a competition is critical as it will ensure that the athlete is primed and ready to compete in top shape for the next game.

Massage and Recovery

It is not uncommon for professional sports teams or collegiate sports teams to bring a massage therapist in to perform massage on athletes during these ‘recovery days’ with most of the massages being brief (10min in length) in order to allow every athlete on the team to receive some bodywork. 

While this approach may seem great on paper as every athlete gets something (and of course coaches want to be fair and give every athlete the same thing so that some of them don’t feel like their missing out on something that may be beneficial) it is probably not the best way to attack the situation.

A better approach would be to figure out exactly who needs what, in terms of soft tissue therapy, and then make sure that the appropriate approach is carried out for each athlete.

Some athletes will require more focal attention to a region of the body that is/was injured or needs enhancement in mobility, while other athletes may require a more general approach to help the body relax and recover.  I talked a bit about this in two previous articles, Classifications of Massage and The Bucket List.  It is important to remember that choosing the right method is what will get you the appropriate result. 

An athlete that needs more focal attention cannot receive only a general treatment and expect a favorable outcome and an athlete that is in need of a more general approach cannot receive only a focal treatment and expect to get what they want (which is one of the reasons why the blanket statement of, “Just go get ART” is not a good one as 5-10min of ART may be beneficial for one athlete and not as beneficial for another.  I discussed this previously in the article, “I need (insert acronym of popular technique)…”).

Improving Stress Resistance With Massage

Taking everything above into consideration we can now shift our focus and look at how massage can be used as part of the training process to potentially improve stress resistance.

In a previous article, Massage, Stress, and HRV, I wrote about a study by Arroyo-Morales and colleagues on the effects of myofascial release massage following a high intensity wingate test as a means of restoring heart rate variability and autonomic state to the subjects.  This study may be used to highlight the beneficial role that massage may play in assisting an athlete to recover following a bout of high intensity exercise.

Helping to restore heart rate variability and improve the athlete’s autonomic state, bringing them back into a parasympathetic state, can be a very powerful strategy when using massage to support the training program to enhance the stress resistance of the athlete.  Understanding how massage and training can work together, rather than just having the athlete lift and then referring them out for massage, every once in a while, to someone who doesn’t understand training, can be a great way to get the most of the athlete.  This is probably also one of the reasons why you see many track coaches have therapists available for their athletes (Charlie Francis and Dan Pfaff come to mind), to help support the training program.

Trigger Point Therapy and Parasympathetic Function

There have been two studies that have looked at the utilization of trigger point therapy and its role in enhancing autonomic function.

A 2002 paper by Delaney et al., looked at the short-term effects of trigger point therapy on cardiac autonomic tone and, more recently (2009), a paper by Takamoto and colleagues looked at trigger point therapy to the lower extremity as a means of increasing parasympathetic nervous system activity.

Both studies used healthy subjects and quantified their results using heart rate variability.  The massage treatments in the studies were approximately 20min in length.  The Delaney study used a variety of massage techniques to the upper extremity – effleurage, petrissage, cross-fiber stroking, and tapotement – and then used a more focused pressure when a trigger point (a hypertonic and hyperirritable region of a muscle which, when compressed or provoked, elicits a characteristic referral pattern) was encountered.   The method in the Takamoto study used manual pressure (‘ischemic compression’ as described by Travell and Simons) over trigger points in the lower-limb muscles where the subjects felt fatigue and discomfort.

Regarding pressure

Many individuals think that trigger point therapy is very “deep work” and that it needs to be extremely “painful” as the therapist attempts to “dig out” the trigger point (as if there was something to actually dig out in the first place!).  This sort of mentality can be a big problem as working extremely deep (just for the sake of working extremely deep) and making therapy very painful can actually push the body into more of a sympathetic state and can even provoke a greater response of hypertonicity and hyperirritability as the muscle(s) you are beating into submission begin to fight back.  It is better to work an appropriate depth and an appropriate level of tolerance, which is specific and different for each client.  In these two studies the approach to massage was gentle and trigger point therapy was applied at a pressure which was “comfortable” to the subject.

Results

In both papers, the 20min therapy session helped to decrease heart rate and blood pressure and helped to increase heart rate variability (an indication of a shift towards a parasympathetic state).

Practical application

There are many recovery modalities available to the modern athlete.  Massage and manual therapy is one modality that, when utilized properly, can be a nice addition to the training process to help enhance the athletes level of stress resistance, allowing them to tolerate greater amounts of training/intensity or to assist them in a quicker recovery following competition.  Additionally, these two papers show us that, when used correctly, some mild compression over, eliciting low levels of tolerable discomfort, can help to influence the autonomic state.  Thus, some discomfort (I hesitate to use the word “pain” here) may be a window into the parasympathetic nervous system.

It is important that, if used, soft tissue therapy – whether it is with the hands, foam rollers, tennis balls, or massage sticks – be thought of as an adjunct to the training program rather than “just something the athletes do” as a separate entity.  Taken together, training and soft tissue therapy can be helpful for improving an athletes functional state.

Patrick
patrick@optimumsportsperformance.com

References

Delaney JP, Leong KS, Watkins A, Brodie D. The short-term effects of myofascial trigger point massage therapy on cardiac autonomic tone in healthy subjects. Journal of Advanced Nursing 2002; 37(4): 364-71.

Takamoto K, Sakai S, Hori E, Urakawa S, Umeno K, Ono T, Hisao N. Compression on trigger points in the leg muscle increases parasympathetic nervous activity based on heart rate variability. Journal of Physiological Science 2009; 59: 191-197.