Critically analyse the role of the sports massage therapist within a sports science team, indicating the importance of soft tissue management as part of total athletic care.
With an elite athlete in mind, discuss the link between whole body biomechanics and the use of sports massage therapy. Critically analyse the role of the sports massage therapist within a sports science team, indicating the importance of soft tissue management as part of total athletic care.
A sound knowledge of body biomechanics is essential to comprehensively understand human motion. Biomechanics within kinesiology 'involves the precise description of human movement and study of the causes of human movement' (Knudson, 1961). This area of study concerns the analysis of the function and structure of biological systems. Sports biomechanists are responsible in analysing human performance within a scientific perspective striving to achieve optimal sporting techniques, aid the enhancement of sports equipment and determine stresses imposed on the body during performance to circumvent injury.
The importance of biomechanics is prominent within many sporting occupations. This may include a coach developing the most efficient movement patterns for athletes, for example the movements of a pole-vaulter incorporating biomechanics to qualitatively analyse movement. A basic understanding of the principles of movement can help to identify and correct problems with a technique. Despite these technical developments however, the well being of the athlete undoubtedly remains a sports biomechanists primary concern.
The limits of speed, endurance and strength are pushed every day and new world records are produced every year. However, accompanied with these records is the presence of injury risk. This risk increases exceptionally when the stability of an athlete is threatened. An athlete's stability involves the level of '...difficulty required to disturb [their] equilibrium' (Hay, 1994). This stability is affected by '...the point at which the body's weight can be considered to act' (Sprunt, 1993). This point is known at the centre of gravity and is a useful concept for analysis of human movement. The centre of gravity is the point at which the entire mass or weight of the body is considered to be concentrated. An imaginary line that vertically dissects the centre of gravity is known as the line of gravity. This line always acts in the direction of gravitational force. Only when the line of gravity dissects the base of support is the body considered stable. For example, when a body is in its basic anatomical position, the centre of gravity will be just above the stomach, with the line of gravity dissecting straight through this.
However, when this line does not anatomise the base of support, the body will become unstable and susceptible to injury. The athlete can be said to be in a state of equilibrium when 'the resultant forces acting on it are zero...and their motion in not changing' (Kent, 1994). However, demands placed upon an elite athlete to succeed often require pushing the human physique to the limit. 'Forces acting on living things can create motion, be a healthy stimulus for growth and development, or overload tissues, causing injury' (Knudson, 1961). Athletes continually expose their bodies to various levels of stress and strain, inevitably resulting in tissue dysfunction and breakdown. Despite fitness levels and level of participation, the aim of the athlete is nearly always to systematically increase the level of training thus by subjecting the body to gradual and controlled overuse. It is this overuse that can create problems and imbalances in the soft tissues. These minor stresses and strains frequently become chronic if ignored and will serve to hinder the athlete's rate of improvement, level of performance and will most certainly develop into more severe conditions. The relationship between body biomechanics and sports massage therapy now becomes apparent and it becomes easy to appreciate how massage can constitute an integral part of an athlete's training programme. 'Biomechanics [can] help professionals in clinical settings to determine the extent of injury and monitor progress during rehabilitation' (Knudson, 1961).
Massage is recorded as one of the earliest forms of physical therapy and has been used by different cultures for over 3000 years. However, only in 1979 did the field of massage just begin to establish itself as a legitimate form of alternative care. It soon became apparent that this field of care could be utilised as a support for high performance within sport. Massage therapy is 'a profession in which the practitioner applies manual techniques and may apply adjunctive therapies, with the intention of positively affecting the health and well being of the client' (AMTA). The purpose of this therapy is to treat 'muscular pain and dysfunction' (http://danke.com/Orthodoc/text.html).
Massage therapy is based on the fact that the soft tissues of the body respond to touch. 'Soft tissue is connective tissue that has not hardened into bone and cartilage and includes, skins, muscles, tendons, ligaments and fascia' (Paine, 2000). This type of touch that massage therapy provides exists as a unique, therapeutic way of manipulating the body's soft tissue elements and has been proven to moderate 'the heart rate and blood flow...reduce muscle tension/spasm...and help relieve pain' (Knudson, 1961). These manipulated effects serve to prepare the athlete for peak performance by addressing both physiological and psychological concerns.
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Massage therapy is based on the fact that the soft tissues of the body respond to touch. 'Soft tissue is connective tissue that has not hardened into bone and cartilage and includes, skins, muscles, tendons, ligaments and fascia' (Paine, 2000). This type of touch that massage therapy provides exists as a unique, therapeutic way of manipulating the body's soft tissue elements and has been proven to moderate 'the heart rate and blood flow...reduce muscle tension/spasm...and help relieve pain' (Knudson, 1961). These manipulated effects serve to prepare the athlete for peak performance by addressing both physiological and psychological concerns.
As a result, this form of therapy although a relatively new concept has become a key component in the quest for performance enhancement and has successfully established itself of equal, vital importance as the role of a sports nutritionist. Minor injuries and lesions, which have traditionally depended upon rest for rehabilitation, can now be broken down quickly and effectively with the aid of massage therapy. 'An athlete who is receiving regeneration treatments regularly can increase [their] work by as much as 40% - and not so much in terms of volume but rather in the terms of the quality of high intensity work' (Francis, 1999). The rate of recovery is therefore significantly reduced and injuries that previously inhibited performance and the degree of achievement experienced by an elite athlete can be avoided at a level where every millisecond counts.
Sports massage therapists are comprehensively trained in anatomy, physiology, kinesiology and biomechanics. They also are trained in the appropriate uses of hydrotherapy and cryotherapy. The role of the sports massage therapist is to ideally predict potential injuries or diagnose and treat them effectively. The majority of elite athletes and teams appoint their own sports massage therapists to provide treatment despite the venue of competition. More often than not, qualified sports massage therapists operate within a sports science team consisting of dieticians, physicians, physiotherapists, chiropractors, biomechanists and nurses. This team of experts is responsible in providing optimum, extensive healthcare services for elite athletes. Although massage should not be substituted of other, more common medical attention, it can be used accordingly as a way to prevent injury, alleviate pain and accelerate the healing process. The cost of healthcare in the United States is estimated to reach $2.2 trillion boy 2008 and approximately $4-$6 billion is annually spent on visits to massage therapists. These are just a couple of indications that highlight the increasing acceptance and growing support experienced by massage therapy as a form of alternative care. Of all the types of alternative care available, it is thought that 80% of the American population are likely to choose massage therapy (AMTA). Not only this but this is supported by primary care physicians and family practitioners who actively encourage their patients to pursue massage therapy as a complement to medical treatment.
Contrary to this information however, the real value of sports massage is often questioned, particularly within British society where the role of a sports massage therapist is a relatively new concept. There is of course exceptional circumstances in which sports massage should not be administrated. These contraindications include open wounds, muscle and tendon ruptures, contusions, burns, chilblains and broken bones, periostitis, rheumatoid arthritis and gout, bursitis, myositis ossificans, skin/soft tissue infections, haemophilia thrombosis and tumours. It now becomes clear that a sports massage therapist should have all the necessary information and training before they practise. Misuse of massage will not only serve to deteriorate and hinder an athletes condition, but in the most extreme cases cause fatalities. Fully licensed therapists however combat this by obtaining insurance, often worth millions of pounds.
Sports massage therapists however, are establishing themselves in what is already a very competitive field. The cost of a private sports massage therapist may cause the athlete to 'prioritise' what they value as 'necessity'. For example, a long distance runner may regard a sports physiotherapist as more important, because that specific field of study has been established for much longer within a sporting context. The role of the sports massage therapist may be under threat because of the lack of information supplied to the athlete regarding the procedures involved.
Training is concept to consider when predicted future injury. Male and female athletes have similar injury rates per hour of training. Previous injuries however, are very likely to reoccur with regular and prolonged exercise. In long distance running, unique biomechanics can cause knees to be put under heavy stress when engaging in prolonged activity. After recovery, re-establishing the desired training load without modification to the biomechanics increase the likelihood of chronic injury in the knee joint.
The frequency of training in another accurate predictor of injury. Scientific studies strongly suggest that reducing the number of consecutive days of training can lower the risk of injury recovery time deduces injury rates by giving muscles and connective tissues an opportunity to restore and repair themselves between workouts. 'The difference between a performance at 95% effort and 100% (i.e. at World Record level) effort is that a 95% effort might require a recovery period of only 48 hours while a 100% effort might require up to 10 days' (Francis, 1999). Sports massage therapy can assist this process. It is realistic to expect '...up to 40 % more CNS-power training time related to the performance of high intensity training by incorporating properly executed massage and regeneration" (Francis, 1999).
Prominent injuries and debilitating conditions may be caused by over training, frequency and change of training, changing equipment such as trainers and sudden traumatic injuries. There are six main steps involved in the treatment of any complaint:
. Identify the nature of the complaint.
2. Facilitate the healing and eliminate this complaint using appropriate massage techniques.
3. The masseuse should then address any dysfunction which may be contributing to or resulting from the primary complaint.
4. Return the athlete to an optimal level of performance.
5. Consider the biomechanics of the athletic activity and other possible causes of dysfunction.
6. Recommend approaches to prevent recurrence of injury.
The benefit of massage treatment is it can be employed in each of the above stages, aswell as prevention. Sports scientists suggest that injury rates could be reduced by up to 25% if athletes took appropriate preventative action.
The massaging technique required will certainly vary amongst athletes. However, the technique incorporated frequently involves a combination of both traditional Swedish massage and Shiatsu, specifically designed to treat professional athletes.
* Deep Swedish massage involves the muscles specific applications of the standard effleurage, petrissage, vibration, and tapotement techniques.
* Compression massage requires rhythmic compression into muscles used to create a deep hypremia and softening effect in the tissues. This method is generally used as a warm-up for deeper, more specific massage work.
* Cross-Fiber massage incorporates the use of friction techniques applied in a general manner to create a stretching and broadening effect in large muscle groups; or on site-specific muscle and connective tissue, deep transverse friction applied to reduce adhesions and to help create strong, flexible repair during the healing process. In more specific cases, a deeper friction is employed to 'reduce adhesions and help create a strong, flexible repair during the healing process' (http://www.amtamassage.org/publications/sports-massage.htm -1 ).
* Trigger Point massage is perhaps on of the most popular massage types. This method of rehabilitation concerns the combined positioning and specific finger or thumb pressure into trigger/tender points in muscle and connective tissue, to reduce the hypersensitivity, muscle spasms and referred pain patterns that characterise the point. The trigger point acts as a pre warning to highlight imperfections within the biomechanical system. If these points remain untreated, a relatively minor condition can often lead to restricted and painful movement of entire body regions.
* Finally Lymphatic massage is the stimulation of specialised lymphatic-drainage pathways, which improves the body's removal of edemas and effusion.
Sports massage can be classified into three main categories: maintenance, event and clinical for the time at which massage is being distributed to athletes will vary to suit individual physiological demands. The common considerations when administrating massage includes aims to promote greater athletic endurance and performance, decrease chances of injury and reduce recovery time.
When administrating maintenance massage, the athlete's target muscles are worked. This increase in blood flow can hypothetically aid in the ensuing of warm up and activity. Maintenance, which includes modalities to enhance recovery from the stress of sport, helps athletes maintain optimal performance by keeping them injury free.
However, an overuse in the body's '...muscles from regular activity may lead to stresses on joints, ligaments, tendons as well as the muscles themselves' (http://brianmac.demon.co.uk/massage.htm). With appropriate massage therapy, such injuries will be avoided and the athlete may see '...improve[d] range of motion and muscle flexibility' designed to favour a more commodious training programme (http://www.amtamassage.org/publications/sports-massage.htm -1 ).
Event massage, before, during and after competition supplements an athlete's warm up, cool down and reduces the spasms and metabolic build up that occurs with vigorous exercise. It enhances recovery, if well designed, improves an athlete's return to high level training and reduces the risk of injury.
'Pre event massage is used as part of an athlete's warm-up to enhance circulation and reduce excess muscle and mental tension prior to competition' (Paine, 2000). This form of massage can be distributed at any moment before competition, although benefits and treatment should differ significantly according to the time scale. However, contrary to these findings, research indicates little effect of immediate pre-event massage. In a sample of ten healthy males, massage was administrated ten minutes prior to exercise. Certain factors were measured including blood pressure, cardiac output, heart rate and lactic acid, a metabolism bi-product indicating a lack of oxygen in the body's soft tissue (Callagan 31). Massage had no effect on these statistics, and the study concluded that massage has no real effect regarding an athlete's performance. In retrospect, many believe massage before a workout can make an athlete feel weaker and unmotivated because of the therapeutic nature of the treatment.
Therapy utilised after strenuous activity however has been revealed to lower the occurrence of muscle contractions due to reduced waste products (lactic and carbonic acid) that build up in muscles after exercise (http://www.amtamassage.org/publications /sports-massage.htm -1 ). In context, studies have revealed a significant decrease in the amount of delayed onset muscle soreness (DOMS) when massage is administrated after exercise (Smith 95; Callaghan 30). Muscle soreness typically arises "between eight and twenty four hours after exercise, peaks at around forty eight hours, and dissipates over the course of a few days" (Smith 93). In addition to this finding, athletes who obtained massages had fewer indicators of muscular injuries and fewer white blood cells due to less inflammation of muscle tissue through surveying the changing levels of creatine kinase and neutrophils within the body. Sports massage can be '...an adequate substitute for a warm down as it can achieve much of the same effect by removing muscle waste and stretching the tissue' (Cash, 1996).
Aspects of massage therapy, as already noted, have been developed to precipitate this course and involve a number of applications that work the weakened area. Localised muscle tension may be present after strenuous competition, which due to the range of movement permitted by some joints, the effectiveness of stretching is reduced. Massage can be directed onto these areas ensuring immediate action through appropriate rehabilitation procedures, avoiding impending injuries. In basic terms, massage ensures soft tissues are free of trigger points and adhesions, thus contributing towards the prominence of peak neuromuscular functioning.
Elite athlete Paula Radcliffe has reached the top of her sport with the aid of sports massage. 'All tissues have mechanical limits beyond which intrinsic damage can occur' (Atler, 1996). Considering the repetitive motion and jarring of the lower body in long distance running, Radcliffe is more susceptible to overload injury. This occurs when a muscle is forced to perform work at an unaccustomed intensity or duration. Although training speed has no association with injury risk, as previously noted frequency of training does play a key role. Fatigued muscles do a poor job of protecting their associated connective tissues, increasing the risk of damage to the bone, cartilage, tendons and ligaments. Therefore if you are a runner, the link between training quantity and injury means that the total mileage is an excellent indicator of your injury risk. The more miles you accrue per week, the higher the chances of injury. The importance of rehabilitation massage therefore becomes apparent.
While sports massage does not deserve sole responsibility in ridding the body of undesirable toxins, these studies do corroborate the comforting effects massage can have upon the fatigued athlete.
In conclusion, massage therapy, like many forms of alternative medicine care, has not yet provided any satisfactory explanation for the defects identified in study. There still appears to be a severe lack of research into the advantages and disadvantages concerning its use in sport. It is of the opinion of a number of critics that massage or "...the use of massage is more of an indulgence than a necessity" (Reed, 2004). However, it is obvious that the use of sports massage therapy does have benefits, and so long as this field of alternative care continues to grow, so will the research into the recuperative benefits and degree of aid, it has upon not only athletes of the elite, but at every level of sport.
References
* American Massage Therapy Association (2003) AMTA Definition of Massage Therapy [online] Available from http://www.amtamassage.org/about/definitions.html [accessed 14th December, 2003].
* Bartlett, R. (1997) Introduction to Sports Biomechanics. 1st Edition.
* Callaghan, Michael J. (1993) The Role of Massage in the Management of the Athlete: A Review. British Journal of Sports Medicine. (1) pp 27-35.
* Smith, Lucille L, PhD et al. (1994) The Effects of Athletic Massage on Delayed Onset Muscle Soreness, Creatine Kinase, and Neutrophil Count: A Preliminary Report. Journal of Orthopaedic and Sports Physical Therapy. (1) pp 93-98.
* Sports Massage (2004) http://wwww.brianmac.demon.co.uk/massage.htm [accessed 4th February, 2004].
* Wesson K, Wiggins N, Thompson G, Hartigan S (2000) Sport and PE. 2nd Edition.
