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In late 1999, I had a serious illness followed by surgery and I came out of hospital with a back and a left shoulder that were almost in a state of rigor mortis. What to do? The answer was to go to my sports massage therapist and have regular treatments. After six months of intermittent treatment I was virtually back to normal and I was informed that, in the circumstances, this was extremely fast going. She had pushed me and pulled me, dug her fingers into me and mobilized me using mainly a technique called soft tissue release. Well, release me it did.

I mention this as an example of the versatility of sports massage, which came of age in the 1990s as a method of massage therapy in its own right. On this occasion I was not an athlete or a dancer or a fitness fanatic but, rather, just a Joe Bloggs with an extremely dysfunctional soft tissue condition. And my therapist, who is one of the tutors at the London School of Sports Massage, just treated what she found with some of the wide range of techniques that the true sports massage therapist has at her fingertips. Sports massage is for anyone's benefit, not just the athlete.

The Evolution of Sports Massage

Sports massage grew out of the work done by soigneurs who kept those professional cyclists on the road grinding away mile after mile, although of course massage itself is as old as Mr and Mrs Caveman. In 1989, the London School of Sports Massage started up to fill a gap that was missing in the professional treatment of sportspeople and dancers, particularly at the preventative level. Other schools followed.

Neuromuscular Technique (NMT) being applied to the rhomboid muscle

At first, sports massage was seen as an incursion into the territory of the sports physiotherapist who asked what these funny little people were doing standing round the track sides giving the athletes a quick once over before they placed their feet in the blocks.

However, with time, and with the expertise of some of the 1990s-trained practitioners, most of the sports medics came to realize that sports massage had a role to play, especially in keeping athletes and professional dancers free from injury. Now the work is well accepted by the British Olympic Association medical committee and even more so by the professional performers. And if you go to the Olympic Games today, there will be the sports massage therapists working alongside the physios and doctors. But, it is not just for athletes.

Treating the Performers

The training for true sports massage is intense. It involves learning a whole range of techniques that make for a flexible approach when treating, particularly important when working with athletes or dancers, as occasionally you have no idea of the circumstances under which you might need to administer your skills if working pre- or post-event. It may be between events at the Olympic Games, or backstage before the first act of Giselle, or treating a group of gutsy charity fun runners after the London Marathon. The point is you need to be flexible in your approach, pragmatic about location and equipment, and armed with a full kitbag of techniques. You learn to treat what you find with whatever tools you have.

The athlete or dancer of whatever standard can benefit from sports massage therapy in a number of ways. It is of enormous benefit preventatively, having regular treatment to keep the performer on the road of soft tissue health. Microtrauma can be picked up and treated before it becomes inhibiting, even before the performer his/herself knows there is something not quite right. Injury is the dread of the serious (or obsessed!) performer and can affect him or her not just physically but psychologically as well.

Event massage is used both to help the athlete prepare before performance and also, in the post-event situation, to deal with any wear or tear that might have occurred during the action. Once again, dealing with things before they become serious can save much heartache: fanatical, injured athletes can be like wounded tigers! On the other hand, if some soft tissue condition does come about, then the practitioner can normally treat or, if necessary, refer on for more intense treatment from the physiotherapist or doctor. Sports massage therapists are trained to recognize what they can or cannot treat. They are also trained not to treat where there are contraindications such as oedema, cancer or thrombosis.

If there is soft tissue injury, then the sports massage therapist has a clinical role to play. This can also include a post-operative condition, such as a repaired Achilles tendon, where there is scar tissue to be broken down; or perhaps a postural holding pattern to be corrected as a result of an original increase in muscle tension around the site of a trauma, the peripheral nervous system's way of protecting an injury. These are conditions that can be helped by skilfully applied sports massage.

What's Good for the Athlete can be Good for Everyone

What is good in the way of treatment for the athlete or the dancer can also be helpful for any one of us who may develop a soft tissue condition, whether chronic, acute or post-operative. The ability of the practitioner to act physically and think laterally can often bring about dramatic improvements in an inhibiting condition that may not be responding to other forms of treatment. The very nature of some of the techniques, being both actively and passively physical, enables the patients to play a part in their own treatment, and this can be an empowering factor that encourages their recovery, provided they are self-motivated. The only trouble is that, at present, there aren't enough truly skilled sports massage therapists around. And the medical profession as a whole is not yet aware of how valuable this type of therapy can be.

The Variety of Techniques

So what's in that kitbag that the sports massage therapist carries around in his/her hands? First, there are the familiar general strokes of massage, starting with effleurage, which is "the principal diagnostic and treatment technique used in massage".[1] It is made up of sweeping, probing strokes performed with the palms of the hands or the arms or fingers. The direction of the sweep can be either longitudinally up the muscle fibres towards the heart or transversely across the fibres, deep or superficial, whatever is appropriate.

Then, there is friction, which is performed with a thumb or fingertip rather deep across fibres, for example in specific areas where there is scar tissue or adhesion. This is sometimes painful and needs to be worked subtly, often in conjunction with some deep breathing. Even if it's a good option, sports massage is not always painless. But there is good pain and bad pain and, if it gets you better, then it's the good sort!

Finally, in the realm of general massage, you have petrissage, a form of kneading, cam and spindle, rocking and shaking, muscle squeezing, and percussion. All these have a role to play and are strokes used by most massage therapists, although not always clinically.

The more specialized techniques have books written about them, although very often they have evolved out of more indigenous methods of bodywork. For example, there is the neuromuscular technique (NMT), which works on the nervous system and has similarities with acupressure. At the time of an injury, the peripheral nervous system often sets up a wall of muscular hypertension to protect the traumatized area. After recovery of the initial injury, that area of hypertension sometimes remains, causing an inconveniencing holding pattern that is sometimes difficult to break. By applying deep but subtle pressure into the painful spot for up to 90 seconds, after preparing the area for treatment with general massage, you can release the tension and break down the reflex pattern that has developed. This then needs to be followed up with stretching exercises, and probably more treatments, if the corrected condition is to be maintained. Subtle work, this, requiring skilled practice.

NMT is a passive technique but there are a number of active techniques in which the patient's relevant muscle groups are actively worked either by the practitioner or by the patient himself. These include the muscle energy technique (MET), strain counterstrain (SCS) and soft tissue release (STR). STR is a relatively new, hybrid technique that has developed at least partially out of Thai traditional massage. It combines pressure and stretch and is an excellent way of breaking down soft tissue adhesions. Once you have located the area of tension, you shorten, and so relax, the offending muscle by moving the relevant joint. Then you apply deep pressure with the thumb, palm or fist, as appropriate, on the area of adhesion and open out the joint with the other hand to stretch the fibres away from the point of fixed pressure. The friction created breaks apart the adhesions binding the fibres, and the art lies in guiding this prising apart in exactly the right direction to bring about fully restored function. As Mary Sanderson writes, "The basic principle behind STR is that congested fibres can be targeted more accurately. In some instances, the stretch may involve only the tiniest of movements".[2] So, subtlety and skill are required.

It becomes clear that the training for sports massage involves not just the learning of a whole range of skills and techniques but also the ways in which they can be applied in any given situation, using innovation and a deep, practical understanding of how the body functions. You will find examples of this in the following case studies presented by Chris Salvary and Mary Sanderson, who do a lot of work with both athletes and the general public.

Patient Case Studies

Case Study 1 - Whiplash and Thoracic Kyphosis

Mr R, a 66-year-old curtain/blind track fitter, had longstanding back and neck problems caused by a whiplash injury and often exacerbated by his occupation. Two months ago he sensed pain in his right buttock and leg and, on examination, it was discovered that he had a pronounced thoracic kyphosis.

Mr R received treatment on his back, neck, shoulders, buttocks and chest. This consisted of deep stroking and kneading to loosen up the tight tissues, with STR techniques applied to the trapezius, levator scapula, rhomboids and pectoralis major to release specific areas of tension and adhesion. MET techniques were also used to stretch these areas and 'reset' the normal resting length of the muscles. In addition, NMT was used to treat active and latent trigger points in the upper trapezius. The piriformis was treated with STR, and the buttock pain had reduced considerably after just two treatments. The patient was also given relevant remedial and stretching exercises to improve spinal mobility and general posture.

After four treatments, he found that his back was pain free and "felt brilliant" and his thoracic kyphosis was noticeably reduced. He now continues to have a maintenance treatment once a month.

Case Study 2 - Neck and Shoulder Pain

Mrs T, an active 46-year-old housewife, had suffered from neck and shoulder pain for the last four years, which she felt was originally caused by using a garden leaf collector. She had a 'Type A' personality, tense and anxious, leading a hectic lifestyle with little relaxation. After three treatments on her back, neck and shoulders, Mrs T felt that her discomfort had reduced by about 60%. Treatment had consisted of effleurage and petrissage, gradually deepening but within her pain tolerance, as well as STR and MET for her upper trapezius and levator scapula to reduce the high level of tension. She was also given general lifestyle advice aimed at encouraging her to make time for rest and relaxation. This was all followed up with regular maintenance treatment.

At the end of 1999, she was diagnosed with breast cancer. Following a lumpectomy, and chemo- and radiotherapy, she requested massage as she knew that, "I need it and it will help me feel better". With her consultant's permission, she was treated with general massage, mainly effleurage and petrissage. After just one session, her posture improved and her complexion looked brighter. Her prognosis is now good and she has resumed exercising at the gym and playing tennis. She continues to have massage treatments for maintenance and for dealing with stress and tension.

Case Study 3 - Frozen Shoulder

Mrs R, a 57-year-old housewife, accompanied her husband for a treatment and ended up having a treatment herself. She was suffering the effects of a frozen shoulder: she was unable to abduct or rotate her right (dominant) arm and she was also kyphotic, with her shoulders hunched forward. She was unable to sleep properly, stir custard or brush her hair. This was a chronic condition due to overuse over a long period of time, combined with some lifestyle stress. The treatment consisted mainly of general massage and some STR techniques applied around the shoulder, with special attention paid to the rotator cuffs. It took four treatments to make a significant change, which included loosening holding patterns and readjusting her posture. Now, Mrs R is continuing with treatment - and she has become a sports massage addict!

Case Study 4 - Knee Injury

Mr S, a 26-year-old long-distance club runner had suffered for two years with sharp pain in the outside left knee diagnosed as being caused by damage to the iliotibial band (IT), having had a range of treatments including physiotherapy and chiropractic. One treatment of mainly deep tissue massage (DTM) into the tensor fascia lata (TFL) muscle took tension off the knee and enabled him to restart his running. Further treatments of DTM and STR into the lateral side of the thigh and on the border of the IT band by the knee and "it was almost like a little miracle". After three or four treatments, the condition was repaired. Thereafter it was a question of aiding the strengthening and stretching to confirm the repair, and also of breaking down the chronic holding patterns (e.g. his pelvis had got a bit out of alignment) that had developed over the two years. The TFL had been the root cause as it was scarred up and needed deep hands-on treatment. He had seven treatments in all.

Conclusion, and a Caveat

So, you see, what's learned for the athlete is also valuable for you and me. In each of the above case studies, the subject was an ordinary person who was suffering from an inhibiting physical condition that was righted with the help of sports massage. What is learned at the cutting edge of extreme physical activity can benefit us all. However, practitioners with this level of skill are hard to find as there are few training schools teaching to the requisite standards. Also, the medical profession itself is not generally aware of this sort of work and therefore does not refer on.

So, if you want treatment of this calibre, seek out a well-qualified sports massage therapist and ask the right questions first. There is a lot of sports massage that is little more than a rubdown. However, that said, the UK Sports Massage Association is having its inaugural meeting on 18 January 2002 and then a national register will be set up. A new era will begin. And that should provide a much needed boost to the profession so that there can be many more 'little miracles' in the future.

References

1. Cash Mel. Sport and Remedial Massage Therapy. Ebury Press. London. 1996.
2. Sanderson Mary. Soft Tissue Release. Otter Publications. Chichester. 1998.

Acknowledgements

I wish to thank Chris Salvary and Mary Sanderson for their case studies; also, Alex Selby who patiently allowed me to photograph her work.

Further Information

The London School of Sports Massage offers a register of its therapists:
tel: 01424-774459; website: www.lssm.com
(c) Wrio Russell