Massage Therapy for Athletes

massage therapy for athletes

Growing up I was involved with hockey, soccer and distance running, so I had my fair share of injuries. Most of these were minor muscle strains, but whenever I was injured I was interested in the rehabilitation process and how I could speed up my recovery and return to play quickly. This is what got me interested in the concept of performance support for athletes.

Massage Therapy and Performance Support

The goal of performance support is ensuring that athletes possess the health, physical and mental capacities necessary to compete at the top level. Which can be a challenge, due to the number of variables can effect athletic performance (eg. fatigue, recovery, training status, health and well-being).

One of the reasons athletes look for non-pharmacological ways to support health and wellness is because athlete competing at a high level are often subjected to strict doping regulations. In this post we will be examining the basic science behind massage therapy and the guiding principles of adaptability to help highlight the numerous ways that massage therapy can support athletic performance.

Massage Therapy Can Ease The Pain of Overexertion

As a non-pharmacological intervention massage therapy has been shown to be an effective way to relieve pain, decrease stress and promote overall well-being. 

The responses to massage therapy are multifactorial - physiological and psychological factors interplay in a complex manner. A biopsychosocial framework is a practical approach for investigating the complex interplay between massage therapy and the determinants of health, athletic performance and pain. In terms of optimizing athletic performance treatments may benefit athletes with the following conditions.

Low Back Pain
New recommendations from The Canadian Medical Association (Traeger et al. 2017) and The American College of Physicians (Chou et al. 2017Qaseem et al. 2017) now recommend massage therapy and exercise as part of a multi-modal approach for patients suffering from low back pain.

Neck Pain
For athletes who suffer a whiplash injury or ongoing neck pain, there is an increasing amount of research that supports the use of soft tissue based manual therapy treatment (Bussières et al. 2016, Cohen et al. 2017 Nahin et al. 2016)

Tension Type Headaches
There is good supporting literature for patients who suffer headaches. With massage therapy the goal is to decrease the individual’s headache frequency, intensity, headache duration and acute medication requirements (Ferragut-Garcías et al. 2016Nahin et al. 2016).

Temporomandibular Dysfunction (TMD)
Therapeutic effects of intra-oral and extra-oral massage, and self-care management of temporomandibular dysfunction has been demonstrated in a number of randomized control trials and systematic reviews (Martins et al. 2016Randhawa et al. 2015).

Lateral Epicondylitis
There are a number of papers supporting the use of massage for 'tennis elbow' (Piper et al. 2016Sutton et al. 2016). A massage therapy treatment plan should be implemented based on patient-specific assessment findings and patient tolerance. There may be times that focal irritability (ie. nerve irritation, triggerpoints, nervous system sensitization) co-exists with common extensor tendinopathy.

Carpal Tunnel Syndrome
Conservative treatments have shown to improve symptoms, decrease disability and improve function (Huisstede et al. 2018). For some patients there is no significant differences in pain and functional outcomes at 6 and 12 months between surgery and conservative treatments (Fernández-de-Las Peñas et al. 2017).

Shoulder Pain
A number of papers have demonstrated the effects of soft tissue mobilization and stretching for a number of shoulder injuries (Hawk et al. 2017Steuri, et al. 2017). In terms of athletic performance, an understanding of neurological increases in stretch tolerance AND changes in passive properties of muscle may help design rehabilitation programs for overhead athletes.

Hip Osteoarthritis
Osteoarthritis of the hip is common in the general population, manual therapy and oscillatory joint mobilization has an effect on supraspinal processes which influence nociceptive processing and therefore OA-related pain (Cibulka et al. 2017).

Knee Osteoarthritis
Like hip osteoarthritis, degenerative meniscus and osteoarthritis of the knee is common in the general population. Sensitization of nociceptive pathways may result in patients with OA perceiving relatively low level stimuli as being overtly painful. Manual therapy and oscillatory joint mobilization has an effect on supraspinal processes which influence nociceptive processing and therefore OA-related pain (Newberry et al. 2017, Salamh et al. 2017, Xu et al. 2017).

Patellofemoral Pain
A recent systematic review published in Journal of Orthopaedic & Sports Physical Therapy suggests that treatment of the patellofemoral joint, surrounding soft tissues, and/or lumbospelvic region may help ease pain associated with petellofemoral syndrome (Eckenrode et al. 2018).

Plantar Heel Pain
Plantar heel pain (aka. plantar fasciitis) is particularly common in runners, it is generally described as sharp or stabbing, and worse in the morning. The pain can decrease with activity, but can return after long periods of standing or after getting up from a seated position. There is evidence that joint mobilization, calf massage stretching and eccentric loading is helpful in improving function and reducing plantar heel pain (Fraser et al. 2018).

Ankle Sprain
Following initial injury there is a risk of re-injury, this is dependent on a combination of factors, including: sensorimotor deficits and changes in ankle biomechanics. There is evidence that plantar massage & joint mobilization enhance motor control in patients (Mckeon et al. 2016). Evidence also supports a protocol involving proprioceptive and strengthening exercises as well as manual therapy (mobilizations to influence joint and nerve structures) for pain, swelling and function (Doherty et al. 2017). 

Delayed Onset Muscle Soreness
Recent systematic reviews suggest that massage therapy is effective for delayed onset muscle soreness (Dupuy et al. 2018Guo et al. 2017).

Rehabilitation for Acute Muscle Strains
A recent article published in the New England Journal of Medicine highlights the role of early rehabilitation for acute muscle strains (Bayer et al. 2017), this study used a combination of loads including:
• Static stretching (Three times a day 30 seconds)
• Isometric exercises
• Dynamic resistance exercises
• Heavy slow resistance exercises

More to Explore

Arvinen-Barrow et al. (2014). Role of sport medicine professionals in addressing psychosocial aspects of sport-injury rehabilitation: professional athletes' views. J Athl Train.

Bayer et al. (2017). Early versus Delayed Rehabilitation after Acute Muscle Injury. N Engl J Med.

Best & Crawford (2017). Massage and postexercise recovery: The science is emerging. Br J Sports Med.

Cholok et al. (2017). Traumatic muscle fibrosis: From pathway to prevention. J Trauma Acute Care Surg.

Duchesne et al. (2017). Impact of Inflammation and Anti-inflammatory Modalities on Skeletal Muscle Healing: From Fundamental Research to the Clinic. Phys Ther.

Dupuy et al. (2018). An Evidence-Based Approach for Choosing Post-exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis. Front Physiol.

Forsdyke et al. (2016). Psychosocial factors associated with outcomes of sports injury rehabilitation in competitive athletes: a mixed studies systematic review. Br J Sports Med.

Freitas et al. (2017). Can chronic stretching change the muscle-tendon mechanical properties? A review. Scand J Med Sci Sports.

Guo et al. (2017). Massage Alleviates Delayed Onset Muscle Soreness after Strenuous Exercise: A Systematic Review and Meta-Analysis. Front Physiol.

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Kennedy et al. (2018).  ‘Recover quicker, train harder, and increase flexibility’: massage therapy for elite paracyclists, a mixedmethods study. BMJ Open Sport & Exercise Medicine.

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Wallwork et al. (2017). Applying Current Concepts in Pain-Related Brain Science to Dance Rehabilitation. J Dance Med Sci.

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