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. 2017, Qaseem et al. 2017) now recommend massage therapy and exercise as part of a multi-modal approach for patients suffering from low back 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. 2016, Nahin 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. 2016, Randhawa et al. 2015).
There are a number of papers supporting the use of massage for 'tennis elbow' (Piper et al. 2016, Sutton 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).
A number of papers have demonstrated the effects of soft tissue mobilization and stretching for a number of shoulder injuries (Hawk et al. 2017, Steuri, 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.
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).
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).
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).
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).
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
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