Research and Critical Evaluation of a Variety of Issues Relating to Sports Massage Methods
Knowledge of anatomy, physiology and pathology
Knowledge and an understanding of the human body and how it functions is the starting point of sports massage. The more we understand about how the body functions, what may interrupt this functioning (such as trauma and injury), and what influence increased activity has on the systems that combine to make it function, the more we can use these skills and knowledge to advise our client.
I also think it is important to know the structure of the human body and its component parts, i.e bones, muscles, ligaments, tendons etc. It is very important that we know where they are and their function so that we can effectively treat the sports injury or trauma. Moreover it is very important to know the relationship between bones and muscles, muscles and tendons and bones and ligaments with regards how they affect each other or the body if one of them is in trouble.
Prevention and management of injury
The ultimate goal for any athlete should be to improve their sporting performance and remain injury free by adopting sound preventative procedures. In this part I will talk about the best ways to prevent sports injuries that are commonly caused by any trauma or the overuse of muscles. One of the most common methods of injury prevention is regular stretching providing it is done properly. (M.J. Alter MS, 1998)
Stretching before and after physical activity can reduce muscles soreness and is known as being central to any injury prevention programme. (Bischoff C, Perrin DH. 1999, Irvin R, Iversen D, Roy S. 1998) Also, pre-activity or post-activity stretching to prevent or alleviate post-exercise muscle soreness, if effective, could have a positive effect on subsequent physical activity. That is, if stretching effectively reduces soreness, then future performance may be unaffected.(Cheung K, Hume PA, Maxwell L., 2003) In contrast, the results of a systematic review by Herbert and Gabriel do not support the role of stretching, as a method of decreasing muscle soreness after exercise. ( Herbert RD, Gabriel M. ,2002) Some studies show that stretching does not have any effect on muscle stiffness in terms of maintaining range of motion and stretch tolerance in the days after physical exercise.(LaRoche DP, Connolly DA.2006)
Injury prevention can be done by also having pre and post event massage. Both intend to increase athletes’ performance helping to overcome fatigue and aiding recovery. ( Callagan M. 1993). An increase in muscle blood flow would hasten the delivery of oxygen, increase muscle temperature and buffer blood pH, which would then aid the performance of exercise. (Cafarelli E, Flint F. 1992). Increased muscle blood flow, theoretically, should help to remove waste product after exercises and should enhance the delivery of protein and other nutrients needed for muscle repair. (Tiidus P.1999). Only one study has reported that massage treatment could increase blood lactate removal after strenuous exercise. (Bale P, James H. ,1991) Therefore, there is little empirical evidence to support the effectiveness of massage for blood lactate removal despite participants reporting less fatigue after massage application. (Hemmings B., 2000, Hemmings B, Smith M, Gradon J, et al.,2000, Monedero J, Donne B.,2000, Dolgener F, Morien A., 1993, Gupta S, Goswami A, Sadhukhan A, et al., 1996)
Warming up and cooling down is also very important to prevent injuries. A good warm up should raise your body temperature by one or two degrees Celsius. (Bradford D. Appleton 1998) The main aim of cool gown is to promote recovery and return the body too a pre exercises or pre work out level. Its helps repair any muscle fibres, tendons, and ligaments from damage and removes the waste product and helps with post exercises soreness. (Brad Walker, 2005)
Pathology used to prevent and manage injury
A lot of pathology is used to prevent and manage injuries. The common basic massage techniques like petrissage, tapotement, and effleurage are used most of the time to prevent injuries. Preventing injuries it not just about the techniques we used also how much pressure we apply to the affected area and which body part the therapist is using when applying the different massage method. Also, we have to consider what kind of massage medium we will use with the different techniques. For example CTM (Connective Tissue Manipulation) can’t perform well and is ineffective if we use oil as a massage medium. It has to be done dry without massage medium. The other pathology we can use is soft tissue manipulation. This is including a wide range of techniques. This can be NMT (Neuromuscular Technique), MET (Muscle Energy technique), STR (Soft Tissue Release) and the above mentioned CTM. (Mel Cash, 1996)
Another pathology which is relatively new is Myofascial release technique which works with the fascia which is present everywhere in the body like a 3 dimensional net.
So many other therapies combined with massage techniques can help manage the injury. For example Cryotherapy.
The relevance of nutrition and hydration
Hydration is very important area of the dietary needs of anyone undertaking any exercise activities. It is important to get enough fluid before competition and training, but also it is important to re-hydrate after exercises to replace the fluid losses from exercise and to aid recovery. Some research shows that the correct amount of fluid intake and how it affects the athletes performance. (Maughan RJ, Shirreffs SM. ,2010, Von Duvillard SP, Braun WA, Markofski M, Beneke R, Leithäuser R., 2004). One of the easiest ways to find out if we have taken enough water and we are not dehydrated is to check our own urine colour. Other scientific method used is to measure urine specific gravity using a refractometer and another way is to test sweat and hydration levels.
Nutrition is an important component of good health and for sporting performance. Optimum nutrition may help the athlete to maximize their performance by achieving their ideal weight, ensuring the right amount of vitamin intake and minerals and maintaining hydration. Nutrition also plays a crucial role in aiding recovery from intensive training. (Peter Brukner,Karim Khan, 2009) The first big group of nutrients we must mention is that of carbohydrates for athletes. Carbohydrates are a very important fuel source for exercising athletes. The main source of energy for exercising muscles is carbohydrates – some come from glucose in the blood and larger amount from the glycogen stored in the muscles. The source of all these carbohydrates ultimately comes from the dietary intake.
The second major component is fat – an important fuel source for the exercising athletes. About half of the total energy comes from free fatty acid metabolism. Trained athletes use fat much more quickly than untrained athletes. Of course too much fat is not meaning that the intake of trans fatty acids and saturated fats should be limited.
Protein in one of the three major components of food. Not only is protein used in building muscles, it can also provide fuel for exercising athletes. Ingested protein is broken down into amino acids – the building blocks of muscle tissue. Resistance training provides the stimulus for building muscle, the protein just provide the resources. Protein provides energy for the body, but not as much as carbohydrate or fats. The need for protein may increase in athletes, depending on the type and frequency of exercises. Unlike fat and carbohydrate, there is a place in the body to store protein. Any excess protein is either eliminated from the body or stored as fat. (Peter Brukner,Karim Khan, 2009, www.topendspots.com)
Massage is believed to stimulate the sensory receptors and decrease muscle tension by reducing neuromuscular excitability due to changes in the Hoffman reflex (H- reflex) amplitude. ( Morelli M, Seaborne D, Sullivan S.,1990, Morelli M, Seaborne D, Sullivan S.,1991, Morelli M, Chapman C, Sullivan S., 1999, Sullivan S, Williams L, Seaborne D, et al.,1991). In the study by Molleri et al., one-handed petrissage for 3-6 minutes decreases H-reflex amplitude, but amplitude returned to baseline levels immediately after the termination of massage (Morelli M, Seaborne D, Sullivan S.,1990).
Also massage may reduce pain by activating the neural-gating mechanism in the spinal cord. Tactile information from massage might stimulate large fast nerve fibres and then, block the smaller, slower nerve fibres that detect pain. This effects presumably result from local lateral inhibition in the spinal cord (Guyton A, Hall J., 2000) and explain why touching the painful area is an effective strategy for relieving pain. However I did not find any objective data to support this idea. Massage can increase biomechanical substances such as serotonin, (Leivadi S, Hernandez-Reif M, Field T, et al., 1999) which is a neurotransmitter that plays roles in reducing pain. (Guyton A, Hall J., 2000).
We sport massage therapists use massage to break the vicious cycle that causes muscle spasm, and consequently, muscle pain. Muscle spasm causes muscle pain directly by stimulating mechanosensitive pain receptors or indirectly by compressing the blood vessels resulting in ischemia. (Guyton A, Hall J., 2000). Also massage might help to rearrange muscle fibres and increase microcirculation. The realignment of the muscles fibres can help to reduce muscle spasm which can stimulate pain receptors and can help to reduce the pressure on the blood vessels. The increased blood microcirculation can help to increase nutrition to the damaged area. Unfortunately there is no study or scientific evidence published with regards the effect of massage on the realignment fibres.
Psychology of injury
When athletes suffer from any kind of injury there is most certainly a psychological effect as well. Some of the symptoms and signs for example of stress – and not just physical stress – but other stress factors like work, family life – all has an overall effect on the body in both a physical, emotional and mental capacity. (Brad Walker, 2007)
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- Michael J.Alter. Sport stretch 2nd ed.Human Kinetics,Leeds;1998
- Irvin R, Iversen D, Roy S. Sports Medicine: Prevention, Assessment, Management, and Rehabilitation of Athletic Injuries. Needham Heights, MA: Allyn & Bacon; 1998: 26–29.
- Cheung K, Hume PA, Maxwell L. Delayed onset muscle soreness: treatment strategies and performance factors. Sports Med. 2003;33:145–164. [PubMed]
- Herbert RD, Gabriel M. Effects of stretching before and after exercise on muscle soreness and risk of injury: systematic review. BMJ. 2002;325:468.
- LaRoche DP, Connolly DA. Effects of streching on passivemuscle tension and response to eccentric exercises. Am J Sports Med. 2006 Jun;34(6):1000-7. Epud 2006 Feb 13.
- Callagan M. The role of massage in the management of the compression effectathlete: a review. Br J Sports Med 1993; 27 (1): 28-33
- Cafarelli E, Flint F. The role of massage in preparation for and recovery from exercise. Sports Med 1992; 14 (1): 1-9
- Tiidus P. Massage and ultrasound as therapeutic modalities in exercise-induced muscle damage. Can J Appl Physiol 1999; 24 (3): 267-78
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- Hemmings B. Sports massage and psychological regeneration. Br J Ther Rehabil 2000; 7 (4): 184-8
- Monedero J, Donne B. Effect of recovery interventions on lactate removal and subsequent performance. Int J Sports Med 2000; 21: 593-7
- Dolgener F, Morien A. The effect of massage on lactate disappearance. J Strength Cond Res 1993; 7 (3): 159-62
- Gupta S, Goswami A, Sadhukhan A, et al. Comparative study of lactate removal in short term massage of extremities, active recovery and a passive recovery period after supramaximal exercise sessions. Int J Sports Med 1996; 217 (2): 106-10
- Bradford D. Appleton Stretching and Flexibility Everything you never wanted to know 1998 Chapter 4, Page 25
- Brad Walker. The sports injury handbook, Walkerbout Health Pty Ltd Australia, 2005 Page:14
- Mel Cash. Sports & Remedial massage therapy, 1996, Chapter 14; Page 199-225
- Maughhan RJ, Shirreffs SM. Development of hydration strategies to optimize performance for athletes in high-intensity sports and in sports with repeated intense efforts. Scand J Med Sci Sports. 2010 Oct;20 Suppl 2:59-69
- Von Duvillard SP, Braun WA, Markofski M, Beneke R, Leithäuser R. Fluids and hydration in prolonged endurance performance. Nutrition. 2004 Jul-Aug;20(7-8):651-6.
- Urine test pictures: www.brandoncharls.com
- Refractometer picture: www.nationalmicroscope.com
- Peter Brukner,Karim Khan, Clinical Sports medicine, 2009 Chapter 37; Page 681-707
- Morelli M, Seaborne D, Sullivan S. Changes in H-reflex amplitude during massage of triceps surae in healthy subjects. J Orthop Sports Phys Ther 1990; 12 (2): 55-9
- Morelli M, Seaborne D, Sullivan S. H-reflex modulation during manual muscle massage of human triceps surae. Arch Phys Med Rehabil 1991; 72: 915-9
- Morelli M, Chapman C, Sullivan S. Do cutaneous receptors contribute to the changes in the amplitude of the H-reflex during massage? Electromyogr Clin Neurophysiol 1999; 39:441-7
- Sullivan S, Williams L, Seaborne D, et al. Effects of massage on to reflect on alpha motoneuron excitability. Phys Ther 1991; 71 (8): 555-60
- Guyton A, Hall J. Textbook of medical physiology. 10th ed.Philadelphia (PA): WB Saunders Company, 2000
- Leivadi S, Hernandez-Reif M, Field T, et al. Massage therapy and relaxation effects on university dance students. J Dance Med Sci 1999; 3 (3): 108-12
- Brad Walker, The anatomy of Sports Injuries (2007), Lotus Publishing, Chichester, U.K. (Page 13-42)