This Sunday the 34th London Marathon will be taking place. Over 170,000 applied with an expected 36,000 at the start line. At First Physio each year we meet new and existing patients who are training for the event who are experiencing niggles or are injured which is impacting on their training. We have seen increasing numbers of recreational athletes who may be training for a 10km, half marathon or the couch to 5km challenge alongside the London Marathon for sports massage in the hope to optimise the training they are doing and/ or to assist in their recovery. The commitment of training that goes alongside the goal of completing a marathon is quite incredible often squeezed between people’s already hectic lives. The number of applications for the London Marathon is staggering and people often find obtaining charity places easier to obtain although with a commitment to fundraise. As a reward for this many charities have tents that provide post event massage and support for their runners at the end of the marathon. The use of sports massage post event is not uncommon in many sports and the queue for such services is never short!
Sports massage is something that makes up part of my hands-on skills as a physiotherapist. Not all physiotherapists have extra training in sports massage (we all do at First Physio) and you may be suprised to know that massage skills only make up a very small part of the physiotherapy degree. Hence in my opinion the extra training and courses are important to develop your massage skills as a physiotherapist. At First Physio we have two dedicated sports massuses who provide sports massage to athletes and non-athetes every day of the week – some come for a block of treatment, some like clockwork at regular intervals and some as a one off! The benefit of having both physiotherapists with sports massage skills and specific sports massuses is that we can cross refer to each other as needed and we have an excellent understanding of each others roles. I often get enquiries where the patient doesn’t actually know what is needed, and with sensitive probing questions on the phone or via email can usually direct the patient appropriately to the right professional.
So, should you or shouldn’t you as an aspiring marathon runner or a couch to 5km runner have sports massages... below I hope to help answer this for you.
What is a sports massage?
Sports massage is the management, manipulation and rehabilitation of soft tissues of the body including muscle, ligament and tendons (SMA: Sports Massage Association, 2009). Perhaps more simply it’s the conscious manipulation of the soft tissues of the body for therapeutic purposes.
The confusion comes from terminology – you will see advertised ‘deep tissue massage’ and ‘relaxation massage’ alongside many others. Unfortunately ‘Sports masseuse’ is not a protected title unlike physiotherapist hence anyone can claim to deliver sport massage. All I can recommend is you find out where the person has trained. Sports massage qualifications require a good level of understanding of the body and how their techniques can impact on it.
What are the benefits of a sports massage?
- Performance enhancement: optimise and support training program
Sports massage can increase general circulation and local circulation (micro-circulation within the muscle), lymphatic flow, and tissue extensibility. There is thought to be a mechanical, chemical and reflexive response from massage. All these things do not however replace good stretching or a good training plan. Sports massage can complement a balanced and focussed training plan.
All forms of massage use external sensory information that can either stimulate or inhibit body processes depending on how they are delivered. Consequently, this is why different massage skills will be used depending on where you are in your training program: whether pre-event, post event, during an event or injured. This is where the expertise of the skilled sports masseuse is so important
If I have one, when should I or shouldn’t I have a sports massage?
Soft tissue integrity is influenced by life stresses (sports, work, training etc), tissue history (injuries before, training volume etc) and genetics. Sports massage has a role in injury management, pre-event preparation, post event preparation and during some events.
There is much research done into improving sports performance, however, the difficulty is that no athlete does only one thing in isolation and therefore sports massage will only make up a small part of the process required to achieve your goal. Nevertheless, there is research that points towards its value and the interesting work related to cortisol release (stress chemical) is fascinating as it is suggested that the cortisol levels drop as a result of sports massage, having a most dramatic impact on those who are injured or stressed (Moyer, et al, 2010).
Sports massage when injured can be a really good idea. BUT... the injury must be properly diagnosed with a treatment plan in place. For example – tear a muscle, have a few sports massages on it and do no strengthening or staged return rehab plan and the potential to re-injure is high. Likewise a deep sports massage over a recently torn muscle could just aggravate the damaged tissue delaying the recovery. However, a sports massage at the right time with the right treatment plan could help optimise the recovery and rehabilitation plan.
There are absolute contraindications to sports massage, hence questions should be asked before massage is delivered. Please note the examples are not exhaustive and are only illustrating my point. The obvious ones are: open wounds, where bleeding is occurring and infection. Also, in the early stages of healing or in acute inflammation or with suspicion of undiagnosed cancers are absolute contraindications. Therefore, the importance of the specific qualification of sports masseuses who are taught to question whether sports massage is appropriate and the value of the close working relationship with the physiotherapist to seek clinical guidance.
There are potential contraindications which take specific judgements at the time. For example, heart conditions, fragile skin, malignant disease. Again these are just a few examples. I am not writing this to scare anyone but am hopefully highlighting my point that you may be able to get a ‘cheap massage’ but there are potential consequences and like any qualification they are in place for a reason.
Specifically in the athletic population it is important to know that sports massage does not impact on the re-absorption of lactic acid as it was once reported to do. Of course it helps, but an active recovery (light session post the event getting the heart rate up for 20 minutes) is much more effective and this is now strongly supported with evidence. Sports massage will help recovery but should go hand in hand with active recovery (Hemmings, 2001).
How often should I have a sports massage?
There is no ‘one size fits all’ answer to this question and it depends on various factors such as: your sport, your training levels, your injury history and status, your tissue type etc.
Of course cost is a factor and so if you have a specific training target in mind and you are looking to use sports massage to compliment your training then this discussion is worth having with us.
The important message is don’t suddenly get a sports massage a week or so before a big event, keep your routine the same. Certainly, athletes normally have tightness when the soft tissues are manipulated and therefore repeat sessions should reduce this tension over time.
Do I need to have an injury or pain to have a sports massage?
In a word no, sports massage can be used for a number of reasons. It can improve performance, help you achieve training and competition goals, reduce tension in the muscles and increase flexibility (alongside stretching). Our sports masseuses give massages regularly to non-athletes and again the frequency really does vary depending on what it is for. Sports massages use various techniques and can be just for relaxation if this is the desired goal.
However, if you are injured, sports massage can make up part of a physiotherapy appointment or be recommended in response to an injury or pain. If an injury or pain is present this is where the skill and knowledge of the sports masseuse or physiotherapist is essential to promote optimal recovery and not impede recovery.
Finally, good luck to all those running on Sunday but especially to the First Physio patients who are taking on this challenge for the first time. We are looking forward to hearing about your personal successes next week.
Chartered Physiotherapist MSc, BSc (Hons), MCSP, MHCPC
Owner First Physio
Disclaimer: The opinions expressed are those of First Physio only and do not constitute medical advice.