Sports Massage

NJD Sports Injury Clinic located in Clitheroe Lancashire, provide sports massage - using both manual and mechanical techniques. Our highly qualified graduate Sports Therapists deliver safe and effective Sports Massage to a wide range of athletes in the Ribble Valley, Lancashire and Manchester area. We have worked with Great Britain Cycling Teams, Manchester Wheelers and England Fell Running Teams. Our experience can help you be successful and achieve that extra-edge over your competitors.

The aim of Sports Massage

The aim of Sports Massage is to enhance athletic performance and can be used in almost any sport. The modern athlete is always in search of that extra edge (marginal gains) to overcome their competitors. Although Sports Massage can be used anytime, its mainly used for;

•  Pre-event massage

•  Post-event massage

•  Injury prevention

•  Assist tissue healing following sports injuries

Pre-event massage is used to stimulate you mentally and physically prior to competition. Post-event massage is performed after hard training or an event to ease the tired aching muscles,remove waste products, and enhance recovery following demanding exercise. Injury prevention massage is rpresents regular massage used to identify and eliminate potential injurious tissues. Tissue healing massage techniques can be used at various stages of healing to enhance the natural healing process.

Optimum recovery enables optimum training  

As training loads increase, a point is reached where the body is no longer able to fully recover between sessions, and performance may level off and eventually decline. The symptoms of incomplete recovery of the musculoskeletal system are muscle pain, joint pain, tendon and bursa inflammation. Sports Massage can help speed-up recovery.

Sport Massage is in demand

The demand for Sports Massage continues to grow as today’s athletes, both recreational and professional, recognise its potential benefits as an important component in their quest to enhance performance and recover quicker from their training and competition schedules. However, like all therapeutic interventions, the choice of massage must be appropriate, and the delivery must be safe and effective.

Benefits of Sports Massage

The consensus of literature clearly states the benefit of Sports Massage is to enhance athletic performance. The benefits can be broadly categorised into Physiological and Psychological processes and the interaction between the two. For more details on the benefits and effects.

The Role of the Sports Massage Therapist   

Our Therapists have both practical & theoretical ability Father and daughter team have practical experience in providing Sports Massage to professional athletes, rugby teams, Great Britain cycling and English Fell running teams. NJD Sports Injury Clinic have demonstrated that they have the academic capabilities to support their practical skills in Sports Massage. Please refer to our published areticles on Evidence-Based Massage journal articles.

Benefits and effects of Sports Massage    

Sports Massage has a high profile and is more and more widely recognised by recreational and professional athletes alike. The consensus of literature clearly states that the primary benefit of Sports Massage is to enhance athletic performance. Simplified, the benefits and effects can be broadly categorised into Physiological and Psychological processes and the interaction between the two. The mind and body are inextricably interconnected, meaning that what impacts people physically can also impact them psychologically. Although many of the purported benefits and effects are anecdotal, there is a steady growth in research evidence to support and justify its continued use in sport.

Pre-event massage 

Although athletes use pre-event massage to prepare for training or competition, there are complete contrasting needs and reasons as to why. Pre-event massage can be used psychologically, to positively psych-up the athlete, or in direct contrast used to induce relaxation, reduce mental stress and anxiety levels of the athlete. Studies have demonstrated that athletes who receive pre-event massage believe they have performed better on physical exertion tests than those who didn't undergo the therapy. Psychologically, some athletes establish a habit and consider pre-event massage as part of their normal routine when preparing for an event. Regardless, the psychological effects of massage must not be underestimated. Alternatively, pre-event massage can be used to physiologically stimulate and excite the athlete’s bodily systems in preparation for vigorous activity. The type and nature of the event will dictate the need, and thereby the types of stroke used their speed, depth and intensity.

Post-event massage

While there are psychological benefits, post-event massage is primarily used for its physiological benefits in helping the athlete to recover more quickly after intense periods of training or competition. Many authors claim that post-event massage can provide benefits and effects such as increased circulation and nutrition to damaged tissues with increased removal of wastes and toxins, i.e. improved fluid exchange. Other reported benefits and effects include, reduced muscle tension, increased range of joint motion, decreased neurological excitability, an increased sense of well being and deactivation of symptomatic trigger points.

A very important benefit of post-event massage is that a quicker and more complete recovery enables the athlete to undertake training sooner. Subsequently, this means that increased training loads are possible, thereby potentially offering that extra edge or marginal gains over their competitors. Whereas, failure to fully recover can often lead to over-training and result in reduced performance and increased susceptibility to soft tissue injury. Some studies have demonstrated post-event massage to reduce the symptoms of delayed-onset muscle soreness (DOMS) which is predominately attributed to eccentric muscle activity. Many athletes claim that post-event massage, through the removal of wastes, reduced muscle tension, and an improved feeling of relaxation, which often leads to an improved sleep patterns – thereby further enhancing the recovery process. However, optimum recovery relies on post-event massage being complimented by appropriate stretching exercises and the rapid restoration of fluid and muscle glycogen stores – which should be strenuously encouraged by the Sports Massage therapist.

Injury prevention

Regular, routine massage can help injury prevention in various ways. Firstly, regular massage facilitates ongoing dialogue between athlete and therapist to discuss potential problems. It is claimed that regular massage improves the general condition of soft tissues, through enhancing tissue elasticity and pliability. Furthermore, regular massage may help prevent formation of adhesion and improve mobility of scar-tissue.

Crucially, regular massage offers the therapist a very important opportunity to identify any soft tissue abnormalities, signs of overtraining, which – if left untreated – could progress to injury and loss in performance. Typical symptoms of incomplete recovery (overtraining) of the musculoskeletal system are muscle pain, joint pain, tendon and bursa inflammation – accompanied by a decline in athletic performance. As most appropriately once described by a prominent therapist; “the hands-on sensitivity and touch become very powerful tools in diagnosis….to recognise those conditions which may need appropriate and immediate action”. On occasions, this may necessitate early referral to other professionals.

Repair & rehabilitation

	Therapeutic massage can be used to assist the natural healing and rehabilitation of various soft tissues (muscles, tendons, ligaments) at each successive phase of tissue healing following an induced sports injury.The phases of healing are universally known as; bleeding, inflammation, proliferation and remodeling.Clinically, the condition of the tissue should drive and dictate when and how to deliver massage. Therefore, it is understandable that a practicing Sports Massage Therapist should possess a sound knowledge of human anatomy, physiology and pathology and the ability to apply it when dealing with sports injuries. The research literature unequivocally states that the phases of tissues healing should guide clinical reasoning and decision-making with respect to what, when and how to deliver safe and effective massage.    Phases of Tissue Healing Adapted from Watson (2009). www.electrotherapy.org
	Practically, this means that not only does the tissue condition dictate when and when not to apply massage; but dictates the type of stroke applied, the depth and intensity and duration of massage. Failure comply, thus risk exceeding the tensile strength of the newly healing tissue is likely to result in further tissue damage, potentially leading to prolonged recovery. Modern sports medicine encourages a wider multidimensional and integrated approach (interdisciplinary) in the treatment and rehabilitation of sports injuries. Research has demonstrated treatment outcomes can be enhanced by complimenting sports massage with other suitable interventions when appropriately applied to embrace the scientific principles underlying the successive phases of tissue healing.

The aim of Sports Massage in more detail

The aim of Sports Massage is to enhance athletic performance and it can be adapted for use in almost any sport. The modern athlete is always searching for that extra edge, known as marginal gains, to overcome their competitors. Massage can help the athlete to achieve that extra edge, known as marginal gains. Sports Massage can be used at anytime and is often an integral part of the athlete’s overall training plan. However, its main benefits are when used, before events (pre-event), during events, and after events (post-event), routinely for injury prevention, and to assist with the repair and rehabilitation of sport injuries.

The Sports Massage Therapist’s role in more detail

The competitive athlete, whether amateur or professional, presents specific needs to the Sports Massage therapist. To treat these individuals, the therapist should have a background in sport specific activities, be aware of the effects of training (exercise physiology), understand the different injury types, understand the phases of tissue healing, and deliver appropriate treatment and rehabilitation applications.

As discussed earlier, in a nutshell, the role of the Sports Massage Therapist is to "deliver appropriate, safe and effective massage to meet the athlete’s specific needs". These specific needs will be best represented through the delivery of; pre-event & post-event massage, routine massage for injury prevention, or massage in the treatment and rehabilitation of sports injuries. However, in order to satisfy these specific needs, and thus fulfill the role safely and effectively, the therapist must remain competent and professional at all times. Although not exhaustive, listed below are some key areas for consideration.

Professionalism – can sometimes be difficult to define and will mean different things to different people. With regard to the role of the Sports Massage Therapist, professionalism encompasses many aspects, including  those listed below.

Membership – therapists should be members of a recognised professional organisation or lead body in sports medicine / sports massage / sports therapy etc., thereafter, at all times comply with the lead body's rules, regulations and standards, in addition to legal requirements.

Qualifications – hold a valid and appropriate professional qualification

Continued Professional Development – therapists should engage in ongoing personal and professional development to keep abreast of new skills, research, technological advances and changes in practice.

Knowledge of the Human Body – a therapist must have a reasonable knowledge of the human body, physiology and pathology, especially when dealing with injuries.

Understanding of the Effects of Exercise – additionally to understanding the benefits and effects of massage, the therapist should have a good understanding of exercise physiology, i.e. what happens in the tissue following strenuous exercise.

Understanding of Tissue Healing – the key to safe and effective treatment of sports injuries - is to know what is happening in the body’s soft tissues at each stage of the healing process.

Multi-disciplinary Approach - when necessary the therapist should liaise and corroborate with other team officials (manager, coach, doctor etc.) to acquire a full and more comprehensive picture, hence adopt a multi-disciplinary approach.

Personal Standards & Behaviour – at all times, maintain high standards of personal conduct and professional relationships. Learn to listen to your athletes and team members and communicate effectively. Always remember, first impressions often count.

Health & Safety Issues – always carryout risk-assessments, check that equipment is suitable and fit for purpose. Check that the floor surface for trip and slip hazards and that the surrounding area / environment are free from dangers. Consider any contraindications that may exist and allergies / reactions to oils and creams. Keep oils and creams in sealed non-glass containers.

Hygiene – always wash your hands before delivering massage, remove loose jewelry, wear clean clothing, ensure your towels and couch covers are clean. Screen the patient’s skin for cuts, abrasions, rashes, infections, varicose veins – be careful not to pass risk-infections – always dispose of waste correctly.

Patient Care & Ethics – always obtain consent from the athlete; explain what you are going to do. Always work to a ‘Code of Ethics’ – usually defined by a professional organisation or lead body. Always take care of the athlete, respect their confidentially, and keep accurate records of your findings and details of the massage delivered. Always work within the scope / remit of your training and/or professional qualification(s).
 

What does the Research Literature say?

Although massage is frowned upon by some professions for its poor evidence base, the lack of robust evidence is not just confined to the profession of massage. According to Watson (6), if one looks critically at the full range of physiotherapy treatments, there is insufficient evidence to support or reject many of them in all known circumstances. While research into Sports Massage may raise more questions than answers (7) and many claims are anecdotal, there remains a clear belief in its benefits (1, 3, 4, 8, 9, 10, 11).

  Conclusion     

The current state of the Sports Massage research literature is confusing and difficult to navigate. One of the reasons for this difficulty is the lack of methodological clarity, both within individual studies, and among them for comparison to each other. Regardless of the research findings, the delivery of massage must be clinically safe. Therefore, when evidence is lacking, massage should be guided by experience, sound clinical reasoning, and when applicable, to embrace the scientific principles underlying tissue healing.
 

Evidence-Based Massage articles

NJD Sports Injury Clinic  have the academic capabilities to support their practical skills and experience in Sports Massage.  Nick and Nicola jointly set-up and delivered the BTEC National Diploma, Sport and Exercise Massage Module for a local school. They are joint authors of the popular two part article on ‘Evidence-Based Massage’, published in the Journal of sportEX dynamic, details and Abstracts can be found below. The leading independent professional body for Sports Massage in the UK, The Sports Massage Association (SMA) used the above article as an example on their website: - http://thesma.org/
 

Contraindications for Sports Massage 

Prior to delivery of any form of Sports Massage, the athlete should be screened for contraindications. This involves asking questions, taking a medical history, followed by an examination and assessment of the athlete. The therapist has a duty-of-care, legal and ethical obligation to rule out any problems or conditions (contraindications) whereby massage may be detrimental and harmful rather than beneficial to the athlete.

A contraindication is something that should not be massaged. If you do, then further injury may be caused or very, very rarely even death. Usually, contra-indications are taken to mean no massage to the patient and are often termed as absolute contraindication, i.e. no massage whatsoever. Some conditions may have partial contraindications where the Sports Massage Therapist must exercise caution. In these cases massage may be delivered, but the therapist must exercise great caution. However, if there are any doubts, massage should be avoided until consent has been given by a suitably trained medical person. Although not exhaustive, below is a list of conditions considered to be absolute contraindications to massage;

• directly over areas of acute injuries - during the first few days following injury
• over an open wound
• over recent bone fractures, or potential fractures (undiagnosed)
• over foreign bodies - e.g. glass, grit, etc
• infectious skin conditions - e.g. rashes, impetigo, ringworm, fungal infection, psoriasis, etc
• over damaged skin - e.g. cuts, abrasions, haematomas, recent surgery, recent wounds, etc
• circulatory problems – e.g. varicose veins, thrombosis, and other vascular conditions
• active/acute inflammatory conditions - e.g. rheumatoid arthritis
• cancer patients

Although not exhaustive, below is a list of conditions considered to be partial contraindications to massage;

• patients with heart problems
• patients with blood pressure problems (high and/or low pressure)
• pregnancy, especially during the first three months
 

References

1. Galloway, S. & Hunter, A. (2005). Mind or body? Research into sports massage. sportEX dynamics, 4:12–14.
2. Robertson, A., Watt, J. M. & Galloway, S. D. (2004). Effects of massage on recovery from high intensity cycling exercise. British Journal of Sports Medicine, 38:173–176.
3. Heymanson, N. & Hiskins, B. (2006). Delayed onset muscle soreness and soft tissue therapy: what makes good research? sportEX dynamics, 10:8–11
4. Hilbert, J., Sforzo, G. & Swensen, T. (2003). The effects of massage on delayed onset muscle soreness. British Journal of Sports Medicine, 37:72–75
5. Dixon, M. W., Sherman, K. J., Thompson, D., & Cherkin, D. C. (2007). Massage terminology: it’s all in the name. sportEX dynamics, 11:14–21
6. Watson, T. (2000). The role of electrotherapy in contemporary physiotherapy practice. Manual Therapy, 5:132–141
7. Holey, E. & Cook, E. (2003). Evidence-based therapeutic massage. Churchill-Livingstone ISBN 978-0443072307
8. Caldwell, E. (2001). Remedial massage therapy. Corpus Publishing ISBN 978-1903333020
9. Moraska A. (2007). Therapist education impacts the massage effect on post-race muscle recovery. Medicine & Science in Sports & Exercise, 39 (1), 34-37.
10. Tiidus, P. & Shoemaker, J. (1995). Effleurage massage, muscle blood flow and long term post-exercise strength recovery. International Journal of Sports Medicine, 16:478–483
11. Mancinelli, C., Davis, D. & Aboulhosn, L. et al. (2006). The effects of massage on delayed onset muscle soreness and physical performance in female collegiate athletes. Physical Therapy in Sport, 7:5–13