Sport Massage – what you didn’t know

DSCN0009Few doubt the benefit of massage in the sport medicine domain. Evidence is largely anecdotal, however there is an evolving body of evidence which suggests that massage, executed properly, is of tremendous benefit to the athlete.

The primary thrust of this discussion is to differentiated clearly between “Sport Massage” and “Generic/Spa” massage. This pertains to both in the type of soft tissue work, and the knowledge base required.

Massage has evolved beyond the generic and hence is not monolithic. Various sub-specialties have emerged, particularly Sport Massage.

Expectations of members of the athletic health care team are high, and this includes Sport Massage Therapy. Unfortunately examples exist wherein an inadequately trained therapist has performed inappropriate work. At best this compromises the athlete’s performance, at worst injury is possible. Importantly, this denigrates the reputation of the professional in question, and arguably the profession as well. Massage, while one of the oldest of all health care modalities, is ironically one which today is among those which require the greatest effort to achieve the recognition it deserves. It is also one employed with minimal equipment and by any member of the health care team.

Sport Massage

In the spa environment the use of lotion, pressure depth, rate, manipulations, treatment length within the principles of massage therapy, are largely dependent on client and therapist preference – in the sport massage scenario, these parameters are more defined.

Firstly, pre event:

Pre event massage: the objective being to stimulate the body’s systems, increase blood flow, loosen body tissues, lubricate joints. Also, not well known is that the pre event rub down facilitates the athlete’s need to focus mentally on the task at hand while keeping their body “ticking over” so to speak. Conversation is left to the athlete’s discretion.

Temporate is brisk. Depth is moderate to light, rarely deep. Treatment duration does not exceed 20 min. Given the option, err on the side of doing too little rather than too much. You can always “do more.” should the athlete so request. Manipulations are, typically kneading, compressions, picking up, tapotement, shaking, rocking out of synch with the body’s natural movement, joint vibrations/light mobs. Avoid longitudinal stokes except with very light pressure. Experience suggests this may reinforce holding patterns. Compressions serve to assist “flushing” of the tissues given the anatomy of veins with their one way valves.

Avoid “out there” techniques. Unless you know your athlete and their needs well, work within the scope of general Swedish massage (as per the prementioned manipulations). This is about the athlete, not the therapist’s ego.

Minimal or preferably no lotion/oil is used, which applies to all phases of Sport Massage. Not only does this lighten your luggage, but there are other considerations

  1. The athlete’s perspiration pores are not clogged
  2. Lotion may affect how the athlete engages with their equipment, exercise medium.
    I.e. holding an oar/javelin, levering the hand through the water
  3. Athlete does not feel sticky/oily, especially when perspiring

It is incumbent on you, as a therapist, to be versatile enough to treat without lotion. Also, to afford athlete privacy away from sport fans etc. The pre event rub down does not replace the normal warm up, but augments it.

Post event:

The objective here is to bring the body down to a resting physiological state, hasten recovery, minimise delayed onset muscle soreness, reduce tissue holding patterns and flush out waste products. Psychologically this is an opportunity to enhance the athlete’s need to tune in to the required “headspace” after competing while being physically passive. One again, the therapist leaves conversation entirely up the athlete.

As per the pre event warm up massage, the post event rub down augments rather than replaces the active physiological cool down. However, for an exhausting event, the skilled hands of a therapist will serve well to replace the cool down under those extremecircumstances.

Treatment duration depends on the number of athletes who require your attention and the needs of the athlete. There is no physiological time limitation. Rate/tempo is slow; though some therapists do choose to begin faster and slow down as they proceed. The depth is largely determined by the athlete’s status – more strenuous the event, the lighter the pressure. Manipulations are as for pre event. Rocking this time will be in synchrony
with the body. Once again compressions will serve to flush the tissue of waste products
so longitudinal strokes are unnecessary.

Rules of orthopaedics apply. Be alert for possible injuries. Your client and/or your palpations may forewarn you as much. Massaging an acute injury is tantamount to gross negligence.

Massage between events

This typically occurs for events such as Decathlon, or between quarters/sets in some sports. The physics of warming up and cooling down require energy expenditure and wear and tear on the body – valuable commodities best left for the competition. Hence the therapist can, by doing massage between events, minimise this excess “expenditure”
and “wear and tear” by the athlete, while keeping the athlete’s body “ticking over”. Objectives once again are to minimise holding patterns, flush out waste products, and reduce stiffening. Parameters are as for pre event. The therapist should be cautious not to over stimulate before an event such as “high jump” which requires precision and co-ordination. The tempo must be adjusted accordingly.

In clinic/training Sport Massage

This involves treating the athlete during their training phase rather than at the event. Here you will familiarise yourself with your athlete’s needs and work with them as their training progresses.

Objectives: enhance recovery between training sessions, decrease delayed onset muscle soreness – everything typical of pre/post/between event massage. Added objectives include the prevention and treatment of injuries, vigilance for and the treatment of holding patterns that may be precursors to injury & /or that may compromise
performance, ensure flexibility, joint health & other specific concerns of the athlete.

Note, imbalances in the athlete’s skeletal /muscular systems may be corrected at this time. Unlike game day, in this setting it is appropriate to be aggressive clinically and the therapist can at this time use a variety of techniques to achieve the objective. The changes in the body positioning and proprioception can be incorporated into the body’s biomechanics as they train. There is greater risk of injury but during training, the risk is
sustainable, the athlete will expect and incorporate the changes & in the long term will
benefit. This luxury does not exist on game day.

Epilogue

The large number of health care disciplines in sport medicine indicates the vastness of the domain. Hence all have to acknowledge and respect one another’s specialities & assist with shared knowledge. A team of highly trained professionals with diverse & shared skills that work synergistically make for an ideal environment.

By Jonathan Maister B Soc Sci (Uni. of Cape Town) RMT, CAT(C).
Jonathan has been a certified Athletic Therapist since 1996 & Massage Therapist since
1997. He is integrally involved with the Canadian Sport Massage Therapists Assn & has
written & presented on their behalf on numerous occasions.

He may be reached @ (905) 477 8900 or mrj.tor.can@sympatico.ca

Acknowledgements:
Milton Bingham RMT CSMT, Vikki Crane RMT CSMT, Ed Ratz RMT CSMT

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