Perceived Effectiveness of Sports Massage Therapy

Massage therapy has been used ancient times. There is evidence that the Chinese used therapeutic massage more than 3,000 years ago. Massage has fallen in and out of favour over time. One of the newest forms of massage therapy is sports massage. Famous athletes have publicly expressed their great satisfaction with sports massage. They claim that it has increased their athletic performance and helped speed their recovery after strenuous exercise.

Non-professional athletes and their trainers has also become increasingly interested in sports massage, partly because of the acclaim it has received from elite athletes. This has led to even more interest in the therapy by non-athletes. Some of the popularity of sports massage can be attributed to the increasing acceptance of all forms of alternative therapies. Despite all of the intense interest, there is a lack of accurate information about massage.

There are many widely held perceptions about the effectiveness of pre-event sports massage, including that it can prevent injury and provide an edge over the competition. However, there is no published research that suggests pre-event massage has a positive impact on performance or injury prevention. There is some evidence that massage after an athletic event can help reduce pain, but the results remain inconclusive. There has also been research that concluded that regular, or maintenance, massages can alleviate some symptoms.

In 2004, a research team published A Meta-Analysis of Massage Therapy, which provided comprehensive look at the actual effectiveness of sports massage. Among other findings, they concluded that massage may reduce pain. However, the study debunked many of the widely held perceptions about the effectiveness of sports massage. Massage therapy does seem to have an impressive ability to reduce anxiety and depression. While the exact science behind the benefits sports massage remains elusive, many athletes, coaches, and massage therapists continue to believe that it can have a tremendous positive effect if used both before and after sporting events and during periods of training.

Introduction

Massage is one of the oldest and widely used therapies in the history of mankind. The American Heritage Dictionary of the English Language defines massage as: “the rubbing or kneading of parts of the body especially to aid circulation, relax the muscles, or provide sensual stimulation.” These benefits have been enjoyed since ancient times and almost all cultures have used some version of therapeutic massage(Vickers, Zelman, 1999). However, in more recent history, massage has become an important tool for athletes. Sports massage is now considered powerful way to help maximize athletic performance (Davidson, 2001).

The prevalence of this type of massage has rapidly increased over the last two decades and the perceived effectiveness of sports massages given before and after athletic events has become widespread.
Massage may have become more en vogue recently, but it is certainly not new. The first evidence of massage can be seen in the Chinese Cong-Fou, written around 2700 B.C. The text makes references to the manipulation of soft tissue. The ancient Chinese massage techniques involved applying pressure to muscles and meridian points. There is evidence that the ancient Chinese practitioners believed their massage not only relaxed muscles, but also improved the function of internal organs(Calvert, 2001).

Ancient Indian texts also described various massage techniques that were believed to promote spiritual and physical healing (Pike, p.viii). Even Hippocrates taught a form of massage to his students around500 B.C. Another famous Greek medical practitioner, Asclepiads, was so impressed by the perceived benefits of massage that the stopped using all other medicines and treatments and only used massage therapy for healing. He believed that massage techniques could increase and restore nutritive fluids (Calvert, 2001). However, over time, Western cultures gradually abandoned the Greek beliefs about massage.

During the middle ages, massage was still used as a folk remedy, but established medical scientists discounted it and the use of massage was no longer considered part of regular medical treatment. (Calvert, 2001).
About 150 years ago, a French translation of the Cong-Four appeared. Historians believe the text served as the foundation for the development of the now-popular Swedish massage (Davidson, 2001). There is some dispute over the origins of Swedish massage, but many credit Per Hendrix Ling for its development during the early 18th century. Ling promoted the idea that massage could heal the body by boosting circulation of the blood and limp systems.

Ling’s massage technique was very vigorous and he prescribed a standardized treatment. He suffered from gout and developed the system to improve his condition and later to help others. He did not equate massage with relaxation or any other psychological benefit. In fact, he called it the “Swedish Movement Cure” (Cates, 1998). Current Swedish massage has evolved somewhat from Ling’s ideas and is now more gentle, although the focus is still on increasing the flow of oxygen in the blood and to assist the muscles in releasing toxins. In the last few decades, Swedish massage therapists have placed greater emphasis on the psychological benefits of massage and they strive to provide a sense of calmness and well-being.(Vickers, Zelman, 1999)

Historically, the interest in massage has been cyclical. Massage fallout of favour, only to once again regain acceptance, many times over the last 500 years. Currently, massage has become far less important tour culture than medical drugs and surgery, but it is again becoming more popular as an alternative therapy (Cates, 1998). There are still many forms of massage found throughout the world, including Hawaiian, deep tissue, and Tue. Na. One of the newest forms of massage is sports massage. Although it is considered a separate form of massage, it shares strong similarities with Swedish Massage and the most of the techniques employed in Swedish massage are used in sports massage(Davidson, 2001). However, sports massage also incorporates Shiatsu massage techniques.

Sports massage was largely developed by Jack Meagher. Meagher was the massage therapist for the US Olympic Equestrian Team. He developed sports massage based on the theory that there are a dozen body postures that form the axis of all athletic movement. Meagher said that because each sport requires that the athlete maintain certain postures, it is possible to identify potential overuse injuries before they occur and help prevent them through sports massage. Meagher wrote that athletic performance could be improved by 20% with the introduction of sports massage (Dion, 2001).
Although sports massage encompasses many techniques, all sports massages geared toward generating the maximum performance from an athlete.

The effects of sports massage are achieved through a combination of mechanical, physiological, and psychological processes. Research has demonstrated that the compression caused by correctly-applied sports massage can improve lymphatic and venous drainage in the body and boost circulation (Hollis, 1997). Under the general heading of sports massage, there are three distinctly different types of massage. Each has a different goal and employs different strokes. The three categories of sports massage are pre-event, post-event, and maintenance massage.

Although sports massage has recently become more sophisticated, modern athletics have been using forms of pre-event and post-event massage for decades. For example, baseball pitchers have long used massage as an attempt to extend the length of their career by maintaining range of motion and flexibility. For many decades, boxing coaches and trainers have been seen giving boxers “rubdowns” before a fight in an effort toward-up the body by boosting circulation. This is an early form fore-event massage (Pike, p.viii).

Modern sports massage first became integrated as part some teams ‘standard athletic training in the former Soviet Union, East Germany, and other Eastern European countries during the 1960s. Soviet teams were the first to employ dedicated massage therapists that traveled with them. In the 1970s, the trend became more widespread, as more European countries and teams in the United States began to take interest in sports massage (Davidson, 2001).

However, it is only since the 1980s that sports massage has become truly mainstream. Now, it is a common practice for teams to integrate sports massage as part of their standard training regimen. Certified sports massage therapists have been seen at many major sporting events, including Ironman competitions, the Goodwill and Pan-American games, marathons, the Olympics, and professional bike races (Latina, 2000).When the U.S women’s soccer team defeated China, winning the World Cup, the players publicly thanked their sports massage therapist, Wynn Clinton and Jim Fayola. Goalkeeper Tracy Ducat said, “Clinton and Jim Fayola, who worked with him during the World Cup, were invaluable in the treatment they provided for us,” testified Tracy Ducat, a goalkeeper on the team. “We could not have been at our best without their help every day.” Goalie Saki Webber agreed, saying, “Without Clinton I think that it would have been a much different story. I think that he kept us healthy and kept us together during the World Cup” (Hued, 2002).

Sports massage has also infiltrated smaller sports. For example, even some Canadian cowboys are receiving massages before and after rodeos, thanks to new mobile massage rooms are traveling with them (Visconti,p.54). Although professional sports teams have lead the way in incorporating sports massage, college, some secondary schools, and amateur teams are also exploring massage as a way to enhance performance.

The public’s perceived value of the effectiveness of sports massage has been fuelled by public statements from well-known professional athletes who say their extraordinary skills have improved after undergoing regular massage therapy. For example, tennis champion, Martina Navratilova said, “I started getting massages and realized what wonderful thing it is for your body” (Sports Massage: Taking the Field ). Former professional football quarterback, Joe Montana, has said, “I’ve been working with massage for a few years now, and I found it helps you to recover a little quicker. The bumps and bruises seem Togo away a lot faster” (Sports Massage: Taking the Field). Canadian National Swim Team member, Marianne Limpet, agrees:

“I find that massage is very beneficial in helping with a quicker recovery from hard training or racing, and it prevents me from getting tight muscles and injuring myself. I am one of few athletes at my age(30), and I’m sure that massage has played a major role in helping to keep my body in shape to continue to this level” (Warren, 2003).
Even Marjorie Album, the Chief Athletic Trainer of the 1996 Atlanta Olympic Games, once commented, “I would not provide sports medicine services for any major athletic event without massage therapists.”(Sports Massage: The Athlete’s & Trainer’s Edge ) With glowing testimonials from esteemed athletes and sports professionals, it is not surprising that more amateur and college athletes are now becoming interested in sports massage.

After all, our society places great emphasis and value on athletics, and the financial and emotional rewards can be great to those who excel in their chosen sport. It is not surprising that sports massage is popular among those searching for competitive edge.

This relatively new appreciation for sports massage has increased as part of a larger trend toward ergogenic aids to boost all types of athletic performance. Ergogenic aids include a wide variety of tools and therapies, such as visualization, meditation, and pre-event stretching. Advocates of sports massage say it is valuable ergogenic tool that can improve circulation, reduce stress, promote muscle efficiency and healing, and even prevent injuries (Pike, p. vii).

The perceived benefits of massage have also become more wide-spread as the general acceptance of alternative medicines has increased. In a1997 random sample of 1,500 households in the United States, 42% of adults reported using some type of alternative therapy in the last year. Nearly 45% said they would be willing to pay more each month for alternative care. Additionally, when choosing healthcare, nearly 70% of respondents said having access to alternative therapies is an important factor in choosing a health insurance plan (Landmark Healthcare Inc.,1997). Alternative medicine is even more popular in the United Kingdom, where in studies, nearly 47% of respondents have reported they are using alternative therapies. Also in the U.K., of those undergoing complementary medicine, nearly nine out of ten are paying for their treatment (Thomas et al. p. 2 -11 ).

Massage therapy is one of the fasting growing forms of alternative medicine. In 1999, The American Massage Therapy Association (AMTA)conducted a nationwide survey in the United States. Researchers found that 27% of adults had therapeutic massage in the last five years, compared to only 17% in a 1997 study who said they had a massage in the previous five years (Massage: Much-Kneaded Complementary Health Care). Another study conducted the previous year found that visits to massage therapists increased by nearly 36% in the years between 1990 and 1997(Eisenberg et al. p. 1569).

Furthermore, in 2004, the National Centerior Complementary and Alternative Medicine in the United States reported that massage has become the ninth most popular alternative therapy treatment. In the study, 5% of respondents said they had received massage therapy at least one time in the previous year (Boneset al.). This translates into big business for the massage industry, as American consumers are spending up to $6 billion dollars a year on massage therapy (Eisenberg et al., p. 1569). This increasing interesting massage has created a surge in massage school educational facilities and applicants. As of 2002, there were more than 950 state-licensed massage schools in the U.S., which is 14% more school than existed in2000. In 2001, massage schools turned out an estimated 30,000 new graduates (Lacombe, p. 49).

There are other significant signs that the perceived benefits of massage is having a strong effect on public policy. In the United States, The National Institutes of Health is currently sponsoring three studies in an attempt to clarify the medical benefits of massage. Additionally, a national survey of employer-sponsored healthcare plans found that 15% of HMOs cover massage therapy. Cigna and Blue Cross BlueShield also cover some forms of massage (Lacombe, p. 49).Furthermore, a 1995 study found that more than half of family doctors in the United States said they would recommend some form of massage therapy to their clients (Hedwig, p.1).

This is a concern to some researchers who wonder if the benefits of massage are worth the price of the therapy. In their meta-analysis of massage therapy research, Moyer, Rounds, and Hanno wrote, “For these trends to continue (indeed, to determine if they even should continue),what is needed is a more rigorous and quantitative examination of MT’s(massage therapy’s) effectiveness that that which currently exists”(Moyer et al.).

The perceived, yet often unexplained, effects of massage (including sports massage) have even created interested within the White House. In2004, the White House Commission on Complementary and Alternative Medicine Policy called for more research and funding for public education on massage therapy. The commission’s chairman, James Gordon, did not offer an explanation of the actual benefits of massage, but he did allude to the widespread perceived effectiveness of the alternative treatment. He said:
“We shouldn’t put too much weight on its benefits, but at the same time we should make it available to everyone. Massage does decrease anxiety, reliably. It does decrease pain in a number of people with chronic-pain syndrome. It does improve mood. Exactly how it does it, I don’t think we know” (Lacombe, p. 50).
AMTA researchers say as more people accept massage therapy as a viable treatment option, more athletes are becoming interested in sports massage.

The AMATA now recognizes sports massage as a unique specialty field within the massage industry. There has also been increased interest in sports massage among the so-called “weekend warriors”(people who only exercise on the weekends) and those do not consider themselves athletes or exercise regularly. No matter how little time they spend taking part in athletics, some people want to enjoy the perceived benefits of sports massage. Licensed massage therapist John Balletto said, “Anyone who exercises or works in an active job or even has to constantly bend down to pick up a child can benefit from sports massage. This type of massage helps muscles deal with the repetitive motions inherent to these activities” (Latina, 2000).

In the past, there was a public perception that only elite athletes and wealthy, pampered women received regular massages. As sports massage becomes more mainstream and begins to be embraced by the general public, there is an increased perception that sports massage is not only a luxury, but a new necessity. This trend can be seen in many forms of mainstream media. For example, a college newspaper in Texas, The University Daily, recently ran an article that stated that more financially strained college students were paying for massages as a way to combat stress. It also explained how deep tissue massage can help relieve pain associated with carrying heavy book bags and suggested that students ask their parents to pay for a massage session.

A massage therapist in the article was quoted as saying, “It is very therapeutic. It’s not a luxury like people think. If more people think of it as therapy, then more people could justify it that way” (Aaron).
However, despite the widespread interest in sports massage, there is a lack of reliable information on its benefits and effects. Using a search engine like Goolgle.com to search under the “benefits of sports massage” will turn up hundreds of websites offering glowing testimonials about the therapy and claims that are not backed up by current scientific research.

For instance, SportsInjuryClinic.net claims that regular sports massage treatments will “maintain the body, prevent injuries and loss of mobility, cure and restore mobility to injured muscle tissue, boost performance, and extend the overall life of your sporting career” (Sports Injury Clinic). Another website for massage centre in Connecticut bluntly states, “Massage is beneficial when starting a conditioning program because it helps you get into good shape faster” (Buckland Massage & Neuromuscular Centre). With so many websites making fantastic claims about the benefits of sports massage, it is easy to understand why the perceived benefits of sports massage currently held by the general public do not always match current scientific research.

As previously mentioned, sports massage is broken down into three main categories: pre-event, post-event, and routine maintenance. Each of these forms of sports massage uses a combination of stroke techniques. In order to understand the research and perceived benefits of sports massage, it is important to understand the various stroke styles. The most common stroke strokes are effleurage, petrissage, and cupping(Davidson, 2001). Other common strokes include friction, range of motion movements, trigger point, and compression (which some massage therapists classify as a type of petrissage) (Pike, p. 26-31).

Effleurage utilizes long, gentle strokes. This is the most basic type of stroke and warms the area for the work to come by increasing blood flow to the muscle (Pike, p. 26). This is the main stroke for creating relaxation and is often used most frequently at the start and end of massage therapy session, although it is useful throughout the therapy(Cates, 1998).
Petrissage is a firmer, two handed kneading technique that includes blows to the muscle. Both hands grab the muscle and compress it. Massage therapists use petrissage to loosen tight muscles and squeeze blood out from deeper structures (Davidson, 2001).

Cupping involves hitting the muscles with cupped hands. This stroke technique is used to break down scar tissue, relieve tension and tone the muscles (Davidson, 2001).

Friction strokes are used only during deep tissue massage to relax the muscles and reduce adhesions. These circular strokes generate heat by increasing blood flow to the area being worked on (Pike, p. 32)
Range of motion movements are assisted exercises that the massage therapist uses to increase the mobility of joints. The massage therapist moves the body while the athlete stays relaxed. Massage therapists report that this technique can extremely helpful for athletes, who usually need to have the maximum range of movement possible in order to excel at their sport (Pike, p. 34).

Trigger points are parts of the muscle that are tight and painful. When massage therapist applies pressure to a trigger point, the athlete will often cry out in pain. Correctly massaging a trigger point will help release tight muscles and “break the pain cycle so the tissue can get blood and nutrients to heal and relax itself” (Pike, p. 31)
Compression strokes are used on muscle bellies, generally in large areas, like the adductors. Massage therapists use compression, which Isa squeezing movement, to feel the tissues under the skin. Compression can stimulate and warm the tissue or relax the athlete, depending on the firmness of the stroke (Pike, p. 30).

Many people mistakenly think that sports massage is beneficial because it is somehow “deeper” than other massages. However, that is not always the case. Sports massage is any massage technique that allows “active people to stay active, to keep the body in working order, and to aid rehabilitation following injury.. Thus it can also involve gentle rubbing, or even no rubbing at all. In fact, there are times when rubbing may be harmful and in this instance, stretching may be more beneficial” (Famous Therapies).

Literature Review

Many massage therapists believe that pre-event sports massage can help prevent serious injury by warming-up the muscles and improve performance during a competition. Meagre was strong advocate for-event massages. In his book, Sports massage, he wrote:
“Whatever sport you play, Sports massage will give you 20 per cent extra—extra performance, extra protection, (and) extra time per game, per season, (and) per career…….With Sports massage you can do what you do better, longer, and more easily, raising your performance level at the same time that you lower the stress level it places on your body…. Sports massage before (problems) reach the critical stage is the only sensible way to keep your entire muscular structure in top form”(Massage Before, or After?).

Pre-event massage is not intended to replace traditional warm-up methods. It is usually performed just before the athlete’s standard warm-up. Rapid effleurage stimulates and warms the muscles andpetrissage encourages the release of tension. It is common for the massage therapist to use shaking and stretching techniques. Deep tissue and friction are avoided. The part of the body that is massaged depends on the sport, but usually includes leg and back muscles (Davidson,2001).
Pre-event massage generally only lasts about ten minutes. The goal Isa reduction in tension, but not total relaxation. Sports massage therapist, James Weslaco, says that most athlete want to feel stimulated, not overly relaxed, by a pre-event massage because being too relaxed can adversely affect performance (Vanderbilt, 2001).

“(Pre-event massage) objectives are to increase circulation, increase range of motion of the joints, decrease tightness and hyper tonicity of major joints and muscles, and to relax and then invigorate the body to get it ready for the competition” (Pike, p. 19)
The perceived benefit of fully prepared muscles is important to many athletes, who are well-aware of the many career-ending injuries that have been blamed on not properly warming-up. There is a widely-held belief that overuse injuries can be avoided if the athlete is warmed-up with a combination of massage and standard warm-up practices. However, many studies have suggested that the benefits of pre-event sports massage are mostly psychological and there is no evidence theatre-event massage can decrease the risk of injuries (Harmer, p.55).

Some athletes say they perform better on the field after receiving pre-event massage. However, again, the benefits appear to be purely psychological. Research shows that massage, which is part of passive warm-up techniques that can also include saunas and hot showers, have little positive effect on performance (Volant’s, et al., 2001).

In one study, members of a group of athletes who received pre-event massage each reported feeling that they could perform better on the field because of the therapy. Yet, their performance, heart rate and arteriovenous oxygen responses were not noticeable different than those of a control group that did not receive massage (Boone, et al., 1991).
Although there are many widely embraced perceived benefits to pre-event sports massage, there has not been enough research to back up the antidotal evidence given by athletes and their massage therapists. Some studies have indicated that there can be physiological responses that result in improved outcome for the athlete.

However, much of the research has not quantified the technique and pressure used by the massage therapist.. No study to date has examined how stroke forms and pressure (light touch versus firm) as an independent variable can affect athletic performance (Moyer et al.).

Even though the benefits of pre-event massage are still unknown, it continues to increase in popularity, not just in athletics but also another performance-driven industries. Robert King, president and-founder of Chicago School of Massage Therapy, says “It’s a debatable subject in terms of actual research that substantiates it.” Yet, he continues to see the demand for pre-event message grow. “I’ve worked on runners, actors and actresses before performances, boxers and swimmers, and again it depends on the type of muscle you’re going to encounter and the condition and goals of the athlete. The approach is geared toward the needs of that particular event” (Vanderbilt, 2001).

Unlike pre-event massage, post-event massage may have measurable benefits. Post-event massage is performed one to two hours after the athlete has finished taking part in a sporting event, in order to allow time for blood vessels dilated by exercise to return to their normal state. The goal of this type of massage is to reduce the trauma caused by strenuous exercise. Light effleurage is used to minimize swelling. Practitioners believe light petrissage will promotes cellular waste removal and clear toxins from the body. (Pike, p. 20).

“The goals are to relax tight muscles, decrease muscle soreness, facilitate faster recovery time, relieve cramping, increase lymphatic circulation and removal of post activity metabolites, and relax the nervous system” (Pike, p. 20).
Other perceived benefits of post-event massage therapy include the lessening of muscle spasms and an increase in flexibility which may prevent future injuries. Although receiving a massage after a strenuous workout can feel very pleasurable, practitioners should limit sessions to under 30 minutes because tired muscles may be more prone to injury. In fact, some therapists believe that the longer the athletic event is, the shorter the post-event massage should be (Cates, 1998).

The perceived effectiveness of post-event massage is pervasive among professional athletes. There is a strong belief that the therapy can speed recovery after extreme exertion. For example, Butch Reynolds, the400 meter world record holder was quoted as saying that because of massage, “If [a muscle pull or strain] does occur, it’s easy to heal. The healing process is cut in half.”

Professional football linebacker Al Smith has also heralded the benefits of post-event massage. He said, “It helps me quite a bit. It helps my recovery time from the game. Athletes are using it quite a bit.” (Sports Massage: Taking the Field)Perhaps the most famous advocate of post-event massage is Michael Jordan. In talking about his physical problems after a performance, the basketball player said, “I was a little concerned, because I couldn’t really walk well…and my mobility was very, very limited. But two days of electros Tim, massaging and heat treatments really loosened things up” (How Massage Aides Athletic Performance).

Despite scepticism that massage has physiological benefits, Davidson advocates the use of post-event massage to speed recovery (2001). She writes that sports massage can reduce the swelling of micro-traumas. Micro-traumas are small tears that occur in muscles during strenuous exercise. Davidson claims that post-event massage will also remove lactic acid and waste build-up in the muscles, help maintain flexibility, and reduce cramping.

However, while Davidson’s theories may be popular, there are studies that dispute the claims. For instance, the blood pressure, cardiac output, heart rate, and lactic acid levels of ten men were compared during a recent study. Lactic acid is a by-product of exercise that occurs during exercise when there is a lack of oxygen in the body’s tissues. Some massage practitioners have made the claim that massage can help the body eliminate waste products, including lactic acid.

However, the men in the study who received massage had similar levels of lactic acid to the men who were not treated with a massage(Callaghan, p. 31). Furthermore, the group that received massages performed no better than the control group.

The idea the lactic acid can (and should) be flushed from the body during post-event massage is a good example of how the perceived effectiveness of massage does not always match current scientific research. For many years, massage therapists believed that they could help athletes get rid of lactic acid. They passed this belief onto clients, including many athletes, who accepted the theory as fact. The false assumptions about lactic acid were even taught in massage schools. Even though scientific studies have debunked this belief, many athletes still think they need post-event massage to rid their bodies of lactic acid (Vanderbilt, 2001).

Despite the critics, many massage therapists are convinced of the benefits of post-event massage. They say post-event massage can help determine why an athlete did not perform up to expectations. A massage therapist for the Los Angeles Dodgers, William Leisure, said he uses post-event massage in the same way a detective might search for clues. Leisure described his work not only in terms of keeping the players ‘muscles loose and relaxed, but also keeping constant watch on their bodies.

“Even if someone’s not injured, if the performance wasn’t quite right, I do a palpation to see if any muscles are tight. It has a lot to do with how good your hands are. Your brain and your thumbs have to be as one… It’s not just a rub. It’s the information I can get from the body and turn it into something else to try to make a cohesive plan. Scanning the tissue and checking for deviations is kind of diagnostic, actually. That helps them to stay at peak performance” (Vanderbilt,2001).

The third category of sports massage, maintenance, is not administered on days of competition or performance. Instead it is done between events (Pike, p. 21). Usually, maintenance massages are given once week as part of