Massage is the most recognized soft tissue modality in the world dating from the beginning of recorded time; Hippocrates himself said no physician was truly worthy without being able to give a “good rubbing” or massage.
That having been said, much has transpired since Hippocrates’ time, particularly in the world of massage for the modern athlete. Understanding of anatomy and physiology, focused techniques, and specific stretching make massage more effective than ever.
The therapeutic sports massage therapist will begin a session with an evaluation. The evaluation is a combination of:
- what the patient says or complains of,
- the therapist’s visual evaluation of the patient,
- and lastly hands-on examination and treatment.
Types of Massage
There are a number of techniques the therapist can use during a session, such as:
- Structural Integration (SI) – a modality that involves both deep global and specific myofascial release with or without range of motion on the part of the patient. SI typically done in a series of 10 sessions with the intention of being the body into free movement and balance.
- Neuromuscular Therapy (NMR)– a modality that is very technical in nature, often referred to as “Medical Massage” or “Deep Tissue” designed to restore balance in the body. Typically one “receives” the massage without active engagement though the massage. NMR is typically considered deep (heavy pressure) massage and does involve myofascial release and stretching techniques as well.
- Active Isolated Stretching (AIS) – also known as the “Mattes Method” is a soft tissue modality that isolates the muscles to be stretched by contracting the oppositional muscles there too. This technique greatly enhances flexibility which helps prevent injury as well as promotes wellbeing.
These modalities are just the tip of the iceberg regarding the range and breadth of techniques available to the athlete for rehabbing injury and/or enhancing performance in his given sport.
Active Release Technique
Now we’ll specifically discuss Active Release Technique, a patented, state-of-the-art soft tissue modality that really works. ART can treat a variety of conditions such as shoulder, knee or hip, back pain, etc. The list of treatable conditions is very long with over 500 protocols to pull from.
Let’s look at athletes in general.
When addressing athletes, be they cyclists, runners, tennis players, or any extreme athlete, they all have one thing in common: Passion. When passion is involved, whatever the sport may be, in order to be done well, it is done often. When something is done often or to excess, extreme things happen such as muscle fatigue and eventually injury. That’s where ART comes in, often partnered with massage.
The Cumulative Injury Cycle
ART addresses a phenomena called the Cumulative Injury Cycle (CIC), a series of events that are directly related to whatever the patient is complaining of.
It goes like this:
- Acute injury/trauma (tearing, crushing or extreme pressure), or
- Repetitive injury (overworking)
Muscle becomes weak and tight regardless of origin of injury.
- It creates friction, pressure and tension therein
- Inflammation ensues
- Adhesion/ fibrosis develops
- Condition now affects the localized area causing decreased circulation and edema
- The injury is now chronic
The injury is in the chronic stage once it becomes part of the feedback cycle (CIC) that is self-perpetuating. When in this stage it becomes difficult for the athlete to recover without assistance.
Typically this is when we, the practitioners, see the patient.
Treating CIC
The approach to defining if not diagnosing the injury (practitioner must be careful here!) may vary according to scope of practice, but the overall conclusion should be similar.
In regard to the athlete’s response to treatment, the expectations should be that:
- Chances are the symptoms you came in with will be experienced again on the table during treatment. At no time should you experience true pain but expect mild to moderate discomfort during the process. The challenge with athletic folks is that very high threshold to pain. Know that no one expects you to endure on the table!
- We want and expect for performance to improve within the first few visits and we (the practitioners) expect you (the athlete) to test the waters within the first few visits unless we tell you not to because of obvious contraindications.
- If improvement is not produced within a reasonable amount of time, it’s time to reassess a few things. Has the patient been compliant? Was the correct conclusion reached regarding the injury? Was the injury treated ineffectually? Does the patient need to specifically strengthen the affected area? And lastly, was a nerve impaired with the injury? If so, the recovery could be weeks to months before the patient reaches total recovery.
One thing is certain, if the injury is truly resolved, the range of motion, comfort level, and strength will return unless the athlete/patient injures it again.
The follow-up program should include direction in posture and position when participating in future activities, core exercise, stretching, and body mechanics as a preventive measure.
Massage and ART should be essential part of any athletic endeavor, be it to recover from injury or improve and empower performance. Once massage, stretching, and core-strengthening becomes part of one’s regimen, the possibilities can be limitless!