Updated Post: Massage Therapy and Sport Related Aches

massage and sports injuries

Sports Massage

An Updated Post

Due to doping regulations, athletes have strict restrictions of what they can put in their bodies, so naturally they look for alternative ways to ease the pain of overexertion.

For sports injuries, massage therapy has been shown to be a non-pharmacological therapeutic intervention that is simple to carry out, economical, and has very few side effects.

Does Massage Therapy Work?

The responses to massage therapy are complex and multifactorial - physiological and psychological factors interplay in a complex manner. Treatments may benefit athletes with the following conditions.

Low Back Pain
Recommendations from The Canadian Medical Association (Busse et al. 2017), The American College of Physicians (Chou et al. 2017, Qaseem et al. 2017), Ontario Protocol for Traffic Injury Management (OPTIMa) (Wong et al. 2017) and The Mayo Clinic (Nahin et al. 2016) represent a monumental shift in pain management. Physicians, now more than ever are recommending 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 are a number of systematic reviews that support the use of soft tissue based manual therapy treatment (Bussières et al. 2016Côté et al. 2016Nahin et al. 2016Sutton et al. 2016Wong et al. 2016).

Tension Type Headaches
There is good supporting literature for the use of massage therapy for patients who suffer headaches. With manual 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).

Carpal Tunnel Syndrome
Conservative treatments have shown to improve symptoms, decrease disability and improve function (Huisstede et al. 2017). 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. 2015Fernández-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. 2017, Steuri, et al. 2017). 

In terms of performance care, an understanding of neurological increases in stretch tolerance AND changes in passive properties of muscle may help design rehabilitation programs for overhead athletes.

Mild to Moderate 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 (Busse et al. 2017Xu et al. 2017Salamh et al. 2017).

Plantar Heel Pain
Plantar heel pain 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 (Piper et al. 2016Sutton et al. 2016).

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). 

Post-Operative Care
One recent paper published in the journal PM&R, looked at the use of fascial manipulation following total hip arthroplasty (Busato et al. 2016). In this study 2 treatment sessions were are able to significantly improve functional outcomes in patients when used in addition to usual treatment. 

Another recent study published in The Journal of Knee Surgery looked at the effect that soft-tissue treatments with hand-held instruments have on post-surgical knee stiffness (Chunghtai et al. 2016). In the study soft-tissue treatments was shown to improve knee flexion deficits by 35° and knee flexion contractures by 12° in a small cohort of individuals who had failed to respond to traditional rehabilitation and manipulation under anesthesia. 

Why Does Massage Therapy Work?

A biopsychosocial framework helps put into context the interconnected and multidirectional interaction between: physiology, thoughts, emotions, behaviors, culture, and beliefs.

In terms of clinical responses to massage therapy there are a couple of proposed mechanisms of action, including but not limited to:

• Neurodynamics - “A clinical concept that uses movement (1) to assess increased mechanosensitivity of the nervous system; and (2) to restore the altered homeostasis in and around the nervous system.” (Grieve's Modern Musculoskeletal Physiotherapy).

• Neuroplasticity - Touch can help sharpen the image of the self in our body maps.

• Contextually Aided Recovery - The way we present ourselves and present our techniques is tied to clinical outcomes, the magnitude of a response may be influenced by mood, expectation, and conditioning.

• Neuromodulation - Massage has an affect on peripheral and central processes - input from large sensory neurons may prevent the spinal cord from amplifying nociceptive signaling.

• Social Grooming - Nervous system regulated by touch (social grooming) helps modulate the activity of neural circuits important for maintaining resting state. This reduced physiological and behavioural reactivity to stressors results in improved mood/affect.

• Mechanotherapy - "Any intervention that introduces mechanical forces with the goal of altering molecular pathways and inducing a cellular response that enhances tissue growth, modeling, remodeling, or repair.” (Thompson et al. 2016).

More to Explore

Related Links
• Myofascial Techniques
• Sports Massage
• Active Release Treatments
• Medical Acupuncture
• Cupping
• Taping

Massage Therapy: Injury Specific Treatments
As the body of knowledge to support the use of massage therapy continues to grow, understanding the basic science behind what we do and the guiding principles of adaptability enable us to apply this work to a number of conditions including, but not limited to:
• Sports Related Aches and Pain
• Shoulder Injuries
• Carpal Tunnel Syndrome 
• Post-Operative Patients
• Compartment Syndrome
• Dupuytren's Disease
• Low Back Pain 
• Neck Pain
• Post-Concussion Syndrome
• Temporal Mandibular Disorder (TMD)
• Scar Management 

Research Links

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Bishop, M. D., Torres-Cueco, R., Gay, C. W., Lluch-Girbés, E., Beneciuk, J. M., & Bialosky, J. E. (2015). What effect can manual therapy have on a patient's pain experience? Pain Management.
https://www.ncbi.nlm.nih.gov/pubmed/26401979 (OPEN ACCESS)

Bove, G., Harris, M., Zhao, H., & Barbe, M. (2016). Manual therapy as an effective treatment for fibrosis in a rat model of upper extremity overuse injury. Journal of the Neurological Sciences.
http://www.ncbi.nlm.nih.gov/pubmed/26810536 (OPEN ACCESS)

Bove, G.M., Chapelle, S.L., Hanlon, K.E., Diamond, M.P., Mokler, D.J. (2017). Attenuation of postoperative adhesions using a modeled manual therapy. PLoS One.
https://www.ncbi.nlm.nih.gov/pubmed/28574997/ (OPEN ACCESS)

Chaitow, L. (2016). Dosage and manual therapies – Can we translate science into practice? Journal of Bodywork and Movement Therapies.

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Crane, J., Ogborn, D., Cupido, C., Melov, S., Hubbard, A., Bourgeois, J., & Tarnopolsky, M. (2012). Massage Therapy Attenuates Inflammatory Signaling After Exercise-Induced Muscle Damage. Science Translational Medicine.

Ellingsen, D., Leknes, S., Løseth, G., Wessberg, J., & Olausson, H. (2016). The Neurobiology Shaping Affective Touch: Expectation, Motivation, and Meaning in the Multisensory Context. Frontiers in Psychology.

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Fryer, G. (2017). Integrating osteopathic approaches based on biopsychosocial therapeutic mechanisms. Part 2: Clinical approach. International Journal of Osteopathic Medicine.

Gilbert, K. K., James, C. R., Apte, G., Brown, C., Sizer, P. S., Brismée, J., & Smith, M. P. (2015). Effects of simulated neural mobilization on fluid movement in cadaveric peripheral nerve sections: Implications for the treatment of neuropathic pain and dysfunction. Journal of Manual & Manipulative Therapy.
http://www.ncbi.nlm.nih.gov/pubmed/26917940 (OPEN ACCESS)

Ivarsson, A., Johnson, U., Andersen, M. B., Tranaeus, U., Stenling, A., & Lindwall, M. (2017). Psychosocial Factors and Sport Injuries: Meta-analyses for Prediction and Prevention. Sports Medicine.

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Morikawa, Y., Takamoto, K., Nishimaru, H., Taguchi, T., Urakawa, S., Sakai, S., Ono, T., Nishijo, H. (2017). Compression at Myofascial Trigger Point on Chronic Neck Pain Provides  Pain Relief through the Prefrontal Cortex and Autonomic Nervous System: A Pilot Study. Front Neurosci.
https://www.ncbi.nlm.nih.gov/pubmed/28442987 (OPEN ACCESS)

Newell, D., Lothe, L.R., Raven, T.J. (2017). Contextually Aided Recovery (CARe): a scientific theory for innate healing. Chiropr Man Therap.
https://www.ncbi.nlm.nih.gov/pubmed/28289539 (OPEN ACCESS)

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