Massage Therapy and Sports Related Aches

/
crossfit workout

Due to doping regulations, athletes have strict restrictions of what they can put in their bodies, so naturally they look for alternative ways to ease the pain of overexertion.

For sports injuries, massage therapy has been shown to be a safe, non-pharmacological therapeutic intervention that is simple to carry out, economical, and has very few side effects.

Massage Therapy for Sports Related Aches & Pain

Massage therapy as a therapeutic intervention is being embraced by the medical community. A recent recommendations from The American College of Physicians (Chou et al. 2017, Qaseem et al. 2017) and Center for Disease Control (Frieden et al. 2016) represent a monumental shift in pain management. 

Physicians, now more than ever are recommending conservative treatment including massage, acupuncture and exercise for patients suffering from pain.

Does Massage Therapy Work?

The responses to massage therapy are complex and multifactorial - physiological and psychological factors interplay in a complex manner. Treatments may benefit athletes with the following conditions.

Low Back Pain
Studies have demonstrated that compression at myofascial triggerpoints (MTrPs) significantly improved subjective pain scores compared with compression at Non-MTrPs and the control treatments for patients suffering for back pain (Takamoto et al. 2015). Other systematic reviews clearly support the use of massage therapy for back pain (Chou et al. 2017, Nahin et al. 2016, Wong et al. 2017, Qaseem et al. 2017).

Neck Pain
For athletes who suffer a whiplash injury or ongoing neck pain, there are a number of systematic reviews that support the use of soft tissue based manual therapy treatment (Bussières et al. 2016, Côté et al. 2016, Nahin et al. 2016, Sutton et al. 2016, Wong et al. 2016).

Tension Type Headaches
There is good supporting literature for the use of massage therapy for patients who suffer headaches. With manual therapy the goal is to decrease the individual’s headache frequency, intensity, headache duration and acute medication requirements (Ferragut-Garcías et al. 2016, Nahin et al. 2016).

Temporomandibular Dysfunction (TMD)
Therapeutic effects of intra-oral and extra-oral massage, and self-care management of temporomandibular dysfunction has been demonstrated in a number of randomized control trials and systematic reviews. (Martins et al. 2016, Randhawa et al. 2015)

Lateral Epicondylitis
There are a number of papers supporting the use of massage for 'tennis elbow' (Piper et al. 2016, Sutton et al. 2016)

Carpal Tunnel Syndrome
Randomized clinical trials have demonstrated that for some patients who suffer from carpal tunnel syndrome there is no significant differences in pain and functional outcomes at six and twelve months when surgical and conservative care are tested (Fernández-de-Las Peñas et al. 2015, Fernández-de-Las Peñas et al. 2017).

Plantar Heel Pain
Plantar heel pain  is particularly common in runners, it is generally described as sharp or stabbing, and worse in the morning. The pain can decrease with activity, but can return after long periods of standing or after getting up from a seated position. There is evidence that joint mobilisation, calf massage stretching and eccentric loading helpful in improving function and reducing plantar heel pain (Piper et al. 2016, Sutton et al. 2016).

Post-Operative Care
One recent paper published in the journal PM&R, looked at the use of fascial manipulation following total hip arthroplasty (Busato et al. 2016). In this study 2 treatment sessions were are able to significantly improve functional outcomes in patients when used in addition to usual treatment. 

Another recent study published in The Journal of Knee Surgery looked at the effect that soft-tissue treatments with hand-held instruments have on post-surgical knee stiffness (Chunghtai et al. 2016). In the study soft-tissue treatments was shown to improve knee flexion deficits by 35° and knee flexion contractures by 12° in a small cohort of individuals who had failed to respond to traditional rehabilitation and manipulation under anesthesia. 

Why Does Massage Therapy Work?

The mechanism by which massage therapy alleviates localized pain is not clear, biological factors (physiology), psychological (i.e. thoughts, emotions, and behaviors) and social (i.e. culture, and religion) factors play a significant role in the experience and reduction of pain. In terms of clinical responses to massage therapy there are a couple of proposed mechanisms of action:

  • Endogenous neuromodulation: Massage has a modulatory affect on peripheral and central processes via input from large sensory neurons that prevents the spinal cord from amplifying the nociceptive signal. This anti-nociceptive effect of massage therapy can help ease aches and pain. (Bishop et al. 2015, Vigotsky et al. 2015).
  • Attenuating intraneural edema: Massage therapy may diminish intraneural edema and/or pressure by mobilizing neural tubes (Gilbert et al. 2015).
  • Improved blood flow: Researchers demonstrated that compression and its release improves localized blood flow. It is proposed that improved perfusion and oxygen delivery to the muscle, encourages the removal of cellular exudates and drainage of metabolic waste (Moraska et al. 2013).
  • An increase in parasympathetic activity: Studies have demonstrated an increase in parasympathetic activity following local compression of myofascial triggerpoints. This alteration within the autonomic nervous system result in changes to regional perfusion (Takamoto et al. 2009, Morikawa et al. 2017 ).
  • Contextual responses: This is likely to play a role in any therapeutic intervention, the way we present ourselves and present our techniques has influence on the treatment. The magnitude of a response may be influenced by mood, expectation, and conditioning (Bialosky et al. 2017).
  • Immunomodulation: One interesting paper suggests that the application of massage induces a phenotype change, prompting the transition of M1 macrophages into the M2 macrophages (Waters-Banker et al. 2014).

Food For Thought

As the body of knowledge to support the use of massage therapy continues to grow, understanding the basic science behind what we do and the guiding principles of adaptability enable us to apply this work to a number of conditions including, but not limited to:
• Carpal Tunnel Syndrome 
• Post-Operative Patients
• Compartment Syndrome
• Dupuytren's Disease
• Low Back Pain 
• Post-Concussion Syndrome

More to Explore

Arvinen-Barrow, M., Massey, W.V., Hemmings, B. (2014). Role of sport medicine professionals in addressing psychosocial aspects of sport-injury rehabilitation: professional athletes' views. J Athl Train.
https://www.ncbi.nlm.nih.gov/pubmed/25243737

Bialosky, J.E., Bishop, M.D., Penza, C.W. (2017). Placebo Mechanisms of Manual Therapy: A Sheep in Wolf's Clothing? J Orthop Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/28459190

Bishop, M. D., Torres-Cueco, R., Gay, C. W., Lluch-Girbés, E., Beneciuk, J. M., & Bialosky, J. E. (2015). What effect can manual therapy have on a patient's pain experience? Pain Management.
https://www.ncbi.nlm.nih.gov/pubmed/26401979 (OPEN ACCESS)

Best, T. M., & Crawford, S. K. (2017). Massage and postexercise recovery: The science is emerging. British Journal of Sports Medicine.
https://www.ncbi.nlm.nih.gov/pubmed/27797730

Chen, L., Michalsen, A. (2017). Management of chronic pain using complementary and integrative medicine. BMJ.
https://www.ncbi.nlm.nih.gov/pubmed/28438745

Chou, R., Deyo, R., Friedly, J., Skelly, A., Hashimoto, R., ... Brodt, E.D. (2017). Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med.
https://www.ncbi.nlm.nih.gov/pubmed/28192793

Forsdyke, D., Smith, A., Jones, M., Gledhill, A. (2016). Psychosocial factors associated with outcomes of sports injury rehabilitation in competitive athletes: a mixed studies systematic review. Br J Sports Med.
https://www.ncbi.nlm.nih.gov/pubmed/26887414

Frieden, T. R., & Houry, D. (2016). Reducing the Risks of Relief — The CDC Opioid-Prescribing Guideline. New England Journal of Medicine.
https://www.ncbi.nlm.nih.gov/pubmed/26977701

Ivarsson, A., Johnson, U., Andersen, M. B., Tranaeus, U., Stenling, A., & Lindwall, M. (2017). Psychosocial Factors and Sport Injuries: Meta-analyses for Prediction and Prevention. Sports Medicine.
https://www.ncbi.nlm.nih.gov/pubmed/27406221

Louw, A., Zimney, K., Puentedura, E.J., Diener, I. (2016). The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiother Theory Pract.
https://www.ncbi.nlm.nih.gov/pubmed/27351541

Morikawa, Y., Takamoto, K., Nishimaru, H., Taguchi, T., Urakawa, S., Sakai, S., Ono, T., Nishijo, H. (2017). Compression at Myofascial Trigger Point on Chronic Neck Pain Provides  Pain Relief through the Prefrontal Cortex and Autonomic Nervous System: A Pilot Study. Front Neurosci.
https://www.ncbi.nlm.nih.gov/pubmed/28442987 (OPEN ACCESS)

Nahin, R. L., Boineau, R., Khalsa, P. S., Stussman, B. J., & Weber, W. J. (2016). Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States. Mayo Clinic Proceedings.
https://www.ncbi.nlm.nih.gov/pubmed/27594189

Nijs, J., Daenen, L., Cras, P., Struyf, F., Roussel, N., & Oostendorp, R. A. (2012). Nociception Affects Motor Output. The Clinical Journal of Pain.
http://www.ncbi.nlm.nih.gov/pubmed/21712714

Quintner, J., Bove, G., & Cohen, M. (2015). A critical evaluation of the trigger point phenomenon. Rheumatology.
https://www.ncbi.nlm.nih.gov/pubmed/25477053

Qaseem, A., Wilt, T.J., McLean, R.M., Forciea, M.A. (2017). Clinical Guidelines Committee of the American College of Physicians.. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med.
https://www.ncbi.nlm.nih.gov/pubmed/28192789 

Rabey, M., Hall, T., Hebron, C., Palsson, T.S., Christensen, S.W., Moloney, N. (2017). Reconceptualising manual therapy skills in contemporary practice. Musculoskeletal Science and Practice.
https://www.ncbi.nlm.nih.gov/pubmed/2828624

Shah, J., Thaker, N., Heimur, J., Aredo, J., Sikdar, S., & Gerber, L. (2015). Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. Pm&r.
https://www.ncbi.nlm.nih.gov/pubmed/25724849 (OPEN ACCESS)

Timpka, T., Jacobsson, J., ... Alonso, J.M. (2017). Preparticipation predictors for championship injury and illness: cohort study at the Beijing 2015  International Association of Athletics Federations World Championships. Br J Sports Med.
https://www.ncbi.nlm.nih.gov/pubmed/27827793

Vigotsky, A. D., & Bruhns, R. P. (2015). The Role of Descending Modulation in Manual Therapy and Its Analgesic Implications: A Narrative Review. Pain Research and Treatment. 
https://www.ncbi.nlm.nih.gov/pubmed/26788367 (OPEN ACCESS)

Waters-Banker, C., Dupont-Versteegden, E. E., Kitzman, P. H., & Butterfield, T. A. (2014). Investigating the Mechanisms of Massage Efficacy: The Role of Mechanical Immunomodulation. Journal of Athletic Training.
https://www.ncbi.nlm.nih.gov/pubmed/24641083 (OPEN ACCESS)