The body encounters discomfort from stresses all day long. Eventually, when ignored for long enough, this can result in decreased function (i.e. stiffness, poor circulation, limited range of motion, slowed extension from flexed positions). This can lead to actual injury. It’s part of the game, but it’s easier if we take care of discomforts before they snowball into injuries.

The Makings of an Injury
Most people think that injuries are sudden events, surprises that they have no control over. This is not the definition of injuries, however, but of accidents. Injuries are accumulations of circumstances. For example, holding positions for long periods of time while we work can create tension, stiffness, decreased circulation, poor tissue health and later, weakness. Add wearing shoes with no support and perhaps a jerky movement from stumbling off a curb and you end up with a micro tear in a muscle, tendons or ligaments. Add a tough speed-training day, and you could end up with achilles tendonitis, low back pain, plantar fascitis or a host of other minor and major injuries.

We all have to deal with the phenomenon of injury, it’s part of life, and we all need help with it. Various tools are available to help us keep in shape to counter these stresses so that we can enjoy our lives: regular exercise, taking breaks, biofeedback, meditation, stretching, visualization, ergonomic education, a good chair at work… Yet another tool can be getting regular massage therapy. Massage helps the body combat all kinds of stresses that it encounters on a daily basis, as well as aids all the normal processes of the body. So it’s a double duo tool. One hour of massage is said to be equal to 4 hours of sleep.

One of the ways it helps the systems of the body, for example, is that massage stimulates circulation, which brings nutrients and oxygen to all the cells of the body, via the bloodstream, and aids in the elimination of wastes and toxins, via the lymphatic system and organs. Massage also helps refresh posture and stimulates more efficient and easier movement patterns by breaking down scar tissue, adhesions and muscle tension holding patterns with specific strokes, “range of motion” assisted movements, exercises and stretches. Massage can cause the body to secrete “feel good” substances (endorphin, seratonin and dopamine'), which combat prolonged states of stress, which tax and fatigue the body and our immune systems. Massage also relaxes tense muscles and calms our nerves, helping us to get to sleep and get better quality sleep.

All the aforementioned, happen to be extremely convenient for athletes. For example, athletes who have jobs in which they sit a lot, develop tight hip flexors and/or an anterior pelvic tilt (among other problems), like anyone else. Except that “shortened and/or tight hip flexors will decrease the ability of the gluteal complex to contract appropriately,"” and this leads to a weaker, slower stroke in skating, if not just back pain. Massage techniques work to release these tightnesses and stimulate circulation and movement through the stiff areas to restore proper range of motion and normal function. Then you go strength train to get back your muscle mass.

So basically, as long as you’re human, (though equine and pet massage do exist) you can benefit from massage; athletes benefit doubly. But if you still have some question about the pros and cons of massage related to specific injuries and conditions, massage therapy, with your doctor’s permission, uses specific medical techniques, protocols and strokes for helping to treat all sorts of conditions. Here is a brief list of specific conditions and how massage can assist people in coping with them.

Muscle, Tendon, Connective Tissue Problems
(Strains/ Tears/ Inflammation/Myositis/ Fibromyalgia (Fibrositis, Fibromyositis, Fibromyitis, Tension Myalgia)/ Myofascitis/ Tendinitis/ Plantar Fascitis/ Osteoperiostitis (Shin Splints)/ Epicondylitis (Golf and Tennis Elbow)/ Tenosynovitis/ Tenoperiostitis/ Repetitive Stress Injuries…)
In general, massage seeks to help break the pain-spasm-pain cycle present in most chronic physical conditions, which eventually result in emotional responses.

Note: Massage, during the acute stages of inflammation of a muscle, tendon, tendon sheath, or connective tissue (fascia), is contraindicated directly at the site of inflammation, except where your doctor may prescribe the Cyriax Technique (transverse friction massage protocol arranged by orthopedist James Cyriax, MD).

However, once a problem becomes chronic, massage therapy is used to assist in healing by breaking the cycle, treating the soft tissues (muscles, tendons, ligaments) and joints, breaking and re-educating compensatory movement and tension patterns and assisting in overcoming negative feelings which surface with chronic injury.

For instance, assisting circulation increases the availability of oxygen and other nutrients needed in tissue repair. This is especially useful when spasm (increased tension with or without shortening of a muscle due to non-voluntary motor unit potentials that cannot be terminated by voluntary relaxation''') causes ischemia (lack of adequate blood supply to an area), which can cause more pain, which leads back spasm and the cycle. Eventually, Trigger Points form (hyperirritable spots in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band… painful on compression and can give rise to characteristic referred pain, referred tenderness, motor dysfunction and autonomic phenomena'''').

Also, certain massage strokes are mechanically very helpful because they help break through and realign scar tissue and adhesions, which though necessary for healing, often outdo themselves and outlast their usefulness. For instance, muscle stripping (long thin strokes) and myofascial (slow strokes that mechanically soften and realign tissue by the use of friction) facilitate movement between muscle fibers and connective tissue (fascia) and vibration and/or friction, which can be used to facilitate movement and circulation through joints.
So, massage therapy, with your doctor’s permission, has specific medical techniques and protocols for helping to treat many aspects of injuries, accidents and conditions.

Joints/ Ligaments
(Sprains/ Synovitis/ Bursitis/ Arthritis/ Spinal Tuberculosis (Pott’s Disease)/ Ankylosing Spondylitis (Marie-Strumpell Disease/ Spondylitis Ankylopoietica/ Arthritis of Spine)/ Lupus/ TMJ/ Lyme Disease (Lyme Arthritis)
Sprains involve ligaments and joints. Ligaments (which wrap around joints) are less vascular than muscles, meaning they don’t have as great a blood supply. Therefore, when they are injured, they take longer to heal than other structures. Massage therapy specifically pushes blood around the body into all areas and therefore greatly decreases healing time. Massage therapy is thought to reduce the healing time for Sprains by as much as a third the time! Scar tissue and adhesions occur as part of the normal healing process, but often build up too much and interfere with normal movement. Friction technique actually acts as an analgesic (pain killer), breaks down adhesions and re-aligns scar tissue and therefore facilitates normal movement (so that you don’t limp around as much and cause secondary spasms, strains and pains) and therefore, healing. Manual rolling of tendon and ligament sheaths (and gentle pinching of tendon and ligament sheaths during assisted movements through affected joints) will smooth their gliding surfaces, break down adhesions and scar tissue and further increase pain free movement.

In Synovitis, (trauma induced, bacterial or secondary to arthritis) inflammation of the synovial membrane of a joint leads to a thickening of the membrane, which is roughened by fibrinous deposits and causes crepitus (grating or creaking noise during movement). Massage during chronic stages helps decrease swelling, stiffness and discomfort and increase circulation thereby helping to maintain motion. Friction strokes break up fibrous nodules, which results in better circulation and movement, which in turn accelerates their elimination.
In Bursitis, massage, after the acute stage of inflammation can increase circulation, reduce adhesions and cramping, assist lymphatic drainage to combat swelling, and provide passive range of motion exercises that can break through adhesions that may form in the joint.

Fractures
After your MD/surgeon has approved massage therapy, massage can be used to speed healing and deter complications. You can even get a massage with a cast on, provided your MD has proclaimed you have “bony union”! Massage above and below the site flushes circulation to and from the break site to keep the skin and muscle nourished under the cast. After the cast is off, add all the other benefits of massage that help inactive, injured muscles and joints. Massage can be used to increase range of motion and nutrition and decrease swelling, spasm, scar tissue and adhesions. Massage Therapists are taught how to bolster your body or limb for comfort during the massage and exercises and stretches you can do to combat muscle atrophy, weakness, cramping, stiffness and tightness, all of which are normal during the healing process.

Nervous System Disorders
(Flaccid, Spastic Paralysis/ Alzheime r’s/Cerebral Palsy/ Parkinson’s/ Multiple Sclerosis/ Ulnar, Median and Radial Paralysis/ Volkmann’s, Erb’s and Bell’s Palsy
Neuritis/ Brachial Neuralgia/ Sciatica/ Carpal Tunnel Syndrome
Injury or disease may cause lesions which cause acute inflammation or chronic degeneration within the nervous system. Scar tissue may replace neural tissue. Processes of the PNS neurons may regenerate if conditions are favorable. Massage works to restore functional ability, relieve symptoms, train replacement faculties, prevent contracture and deformity, maintain and improve motion, and help people emotionally adjust to disability.

Neuritis (nerve inflammation) and neuralgia (nerve pain), includes things like: sciatica, Brachial Neuralgia (Thoracic Outlet Syndrome), Trigeminal Neuralgia (Tic Douloureux) and Carpal Tunnel Syndrome. In these cases, massage seeks to help break the pain-spasm-pain cycle, present in most chronic physical conditions, which eventually results in emotional responses. Massage therapy helps by loosening contracture of spasmed muscles, increasing circulation, relieving trigger points, increasing range of motion, assisting in postural education, relieving pressure on nerves.

Weight Loss/ Working Out
(Delayed Muscle Onset Soreness)
Gentle massage accelerates the elimination of fluids held by the tissues, and in conjunction with appropriate and healthy lifestyle changes, like exercise, increases general and local tissue metabolism, muscle tone and caloric expenditure. The secretion of “feel good” hormones reduces the need for “comfort food” and increases sensations of well-being, both of which support positive actions toward weight loss. Massage speeds recovery from workouts and lessens delayed onset muscle soreness, which makes working out and working out more often, less painful and more palatable.

Pregnancy
Massage in pregnancy relieves fatigue, pain, tension and stiffness, promotes feelings of well-being, assists circulation, reduces swelling, energizes and helps fight stress and in general helps to create a nurturing environment for the mother and baby.

Pre-Race Massage
In general, if you’ve never had a massage before, I recommend that you don’t have one for at least one week prior to an important race (or heavy training session). This allows your body to recover from a massage and normalize tissue states and energy levels. If you can’t wait to have a massage have it after the race. If you have to have a pre-race massage, keep it short and the strokes superficial. Avoid deep, invasive, exhausting massage techniques. Don’t forget massage therapists are qualified to stretch you too. So if you feel tight, your therapist can combine gentle circulatory strokes with gentle stretching to loosen you before a race.
If you are an experienced racer and already have regular massage as part of your “workout” recovery plan, you might try having a massage closer to a race or heavy training session. Just remember that the body must “recover” from a massage, sometimes, as if it were recovering from a workout. This is because massage techniques are manual and may cause irritation for the purposes of breaking through scar tissue and adhesions and increasing circulation to wanting areas. Trust your ability to decide for yourself what works for you, but be wise. If you still have to have that deep massage prior to a race, at least ice the areas that were worked on in depth to minimize swelling, eat well, drink plenty of fluids and go right to sleep after the massage. If you got a deep massage and you feel a little stiff the morning of the race, try taking a hot shower, gently and slowly stretch in the shower and then let the water turn gradually from hot to cold. Then get a post-race massage.

Post-Race Massage
Post–race massage should also not be too invasive. Remember the punishment the tissues have endured and go easy on them. The goals of post-race massage should be to eliminate cramping, increase circulation, stretch tight areas, increase relaxation and restore normal function and range of motion.

***

'CBS News Channel 2, March, 2003.
''http://www.nasm.org/mthly_exercises/hip_flexors.htm
'''Travell & Simons: Myofascial Pain and Dysfunction, Ed. 9. Williams & Wilkins, Baltimore, 1991 (p.7)
''''Travell & Simons: Myofascial Pain and Dysfunction, Ed. 9. Williams & Wilkins, Baltimore, 1991 (p.5)
Reprinted with permission by Touch Fitness, Inc. All Rights Reserved.

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