Originally published in Massage & Bodywork magazine, October/November 2003.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.
In June of this year, a medical team traded in their lab jackets for bicycle shorts to embark on the grueling Race Across America, a 2,922-mile course from San Diego, Calif., to Atlantic City, N.J. The goal of the team, representing Florida Orthopaedic Institute (FOI) in Tampa was to raise money for the Arthritis Foundation. The goal of their team massage therapist, Clinton Wynn, was to keep them racing at peak performance. Providing massage in the back of a rolling motor home, Wynn worked all hours of the day and night. He didn't sleep much. But his efforts were rewarded when the team placed sixth in the race.
Although Wynn's "day" job involves working with pre- and post-surgical patients (mostly weekend warriors) at FOI, this was not his first foray into the arena of team sports. From 1998 to 2000, he traveled with the U.S. women's soccer team, massaging them on their way to victory in the 1999 World Cup.
"I think massage gives you a good kick in the pants," Wynn says, speaking of the psychological benefit. The amateur cycle team, including three physicians, had little previous experience with massage. In fact, one 53-year-old surgeon had never been on the table, but Wynn's expert hands soon turned him into a convert.
"Four days into the race, the fatigue factor started coming in and they were starting to feel the effects of delayed onset muscle soreness," Wynn says. "They constantly needed to be refreshed. They were dying. I worked all aspects of their legs to keep them flushed. Afterward they would get up and say, "Wow, I feel so great. My legs feel awesome." Although a continuous rotation gave them periods of rest, the team members were sometimes on the road up to six hours a stint.
Massage, along with stretching, Wynn says, played a major role in keeping them going. He bought each of them a stretching rope and provided instruction for proper use, noting that each had a commitment to keep up with the stretching program on their own.
Wynn sees injury prevention as a primary factor in using massage for performance enhancement. "Massage is going to help you be more aware of your body and of what limitations you have. Massage and stretching help get some muscle lengthening and keep you from injuring yourself." He also points to the psychological aspect. "I ask them to feel what's going on in the muscle, to feel what kind of process is going on." In addition to decreasing soreness during training, massage gives the athlete a time to "relax and chill out."
While this cross-country race may be a little too intense for some weekend warriors, Wynn's participation is but one indication of how massage has become an integral part of sports enhancement, whether for amateur or professional athletes. Massage, delivered with the proper technique and timing, can be a means of giving athletes the edge, both physically and psychologically, in their sport. Mind, Body Parts and Massage
Exactly how does massage enhance sports performance? That question was posed to Robert King, president and co-founder of Chicago School of Massage Therapy. "It's a debatable subject in terms of actual research that substantiates it. Some research indicates massage can enhance performance as an adjunct to a total program."
King says athletes feel a competitive edge when massage is a part of their ritual. "There are some scientific studies showing that massage does elongate some muscles, but I think a large component is psychological. It's tied in with issues of confidence, self-esteem and body awareness. The feeling of getting massage expertly is a profoundly integrative experience. And if they are overly psyched out, it can assist in general relaxation.
"Massage is one of the marvelous ways of enhancing body awareness, in addition to the obvious benefits like increasing circulation. Stretching will have a normalizing effect on the balance of key muscle groups. The massage therapist, like a good detective, is looking for clues. While working on an athlete or doing a series of stretches, you can detect one hamstring tighter than the other or feel a certain tension or trigger point. You can track down areas of resistance."
King says a pre-event massage is usually 15-20 minutes. "It tends to be shorter and quicker. It can be more up-tempo depending on the sport being performed, but also on the disposition of the athlete. There's an emphasis on the techniques of light shaking, stretching and compression, and then trying to create an integrated sense for the athlete's body." King stresses the importance of creating a feeling of wholeness rather than focusing on one specific body part.
"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."
Athletes sometimes say they feel as though they reached peak performance or that everything "came together," although King says this phenomenon is highly subjective. "Optimal output is where there is a coming together of all body parts, where motion itself becomes relaxed, integrated and effortless. It's like watching a symphony of the human body. With massage there's always an 'X' factor of putting it together, of rising to the occasion and having that great integrative effect."
But can the athlete become too relaxed? While relaxation might be helpful for an athlete who is too hyper, according to James Waslaski, an educator on deep, pain-free medical and sports massage, "the majority of athletes don't want a one-hour relaxation. Ideally, pre-event massage is designed to stimulate muscle activity, but being too relaxed can throw off timing and decrease performance." Waslaski concurs that pre-event massage needs to be short, even limited to 10 minutes.
The therapist should know the difference between pre- and post-event massage as opposed to injury treatment. While providing services at the 1996 Summer Olympics in Atlanta, Ga., Waslaski notes, one would find 33 different massages at 33 different Olympic events. "Sports massage that addresses injuries is not appropriate for performance. A massage that is too deep and too long is counterproductive. Getting a deep tissue massage is the equivalent to fatiguing muscles," he says, recounting his own personal experience. A deep neuromuscular massage he received the night before a running event threw off his timing and he ended up dropping out of the race.
"The weekend warrior will get a greater benefit (from massage) than the athlete," Waslaski says, "because they're not in as good shape." And for the amateur, an entry-level sports massage therapist is OK, but the client should also consider the quality of that training.
Wynn, like many experienced sports therapists, says he can read his client's body and interpret what's going on by feel. But those not so well-versed may be reaching beyond their training to assume they can pinpoint problems at the outset. Zhenya Kurashova Wine, who teaches the Kurashova Method of Russian Massage, says, "You have to be a very good therapist to do that. It takes a lot of experience." You need to see someone several times a week and you have to be well-trained. "Any patient I work with, I remember what their normal tissue feels like," she adds. But Wine has been in the business for many years, having originally worked with Russian athletes before coming to the United States to establish her training program. Pros Working with Pros
As massage therapist for the Los Angeles Dodgers, William LeSuer sees baseball players up close and personal when he travels with the team eight months out of the year. With 25 players rotating through his door, he says his hands get pretty sore during the season. "But it's definitely not about me, it's about them. And they've come to respect me."
LeSuer traded in a fireman's hat for a profession in massage, and once he started working on athletes his career really took off. Previously with the Anaheim Angels for four years, he is now in his third year with the Dodgers (they play about 200 games a year). "There's only one other massage therapist traveling with a major ball club," he says, "and that's the Yankees."
As part of the Dodgers' support team, LeSuer attends daily meetings with medical staff prior to night games.
He provides detailed information on the condition of the players' muscles, which the medical staff then uses in their assessments. LeSuer says he has completed many athletic training courses to enhance his hands-on treatment. "I've devised a preventive program with the doctors. We're very proactive. We don't want to see a player injured.
"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."
At times, LeSuer may send a player to the trainer for help. "I don't do it immediately. If it's a tight adductor, I'll continue to treat, trying to release it. We play every single night so there's not a lot of margin for error. I have to release the tissue quickly." If the player comes back the next day with the same problem, he is sent to the physical therapist or trainer. "Then we sit and talk. We hit him with a three-prong approach using all the therapists, so the problem doesn't happen again," he says.
"It's all about being preventive. Once they've got an injury, it's there for life. It's easier to break a bone, and any deep tearing in the gross tissue will leave scarring. They'll lose pliability, continue to have stresses and injuries, and it will eventually affect their performance."
LeSuer says any time a player can link up his brain with his central nervous system, he is going to know his body better. "He'll know where all his limbs are in space and time and he'll be more instinctive about his body. For a lot of people who don't have bodywork done, injuries tend to sneak up on them quicker. When they have it every day, they're more in tune with the muscle tissue.
"The greatest thing one of our players can do is say, 'It doesn't hurt, but it just feels a little bit different.' I think it gives them a great sense of their bodies. They're aware of any little subtleties that someone not having bodywork doesn't pick up on." Professional athletes are accustomed to daily soreness and might pass off an emerging problem as an ordinary pain or cramp. With bodywork, LeSuer says, "They're more likely to catch things early before it starts hurting."
LeSuer describes his work not only in terms of keeping the players loose, but also keeping tabs on them. "It's all palpation skills. When you have a therapist with good palpation skills, that's invaluable to an athlete. It's not just a rub," he says, referring to relaxation massage or spa treatments. "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."
And it's about education. "It bothers me that athletes think they're supposed to be sore. Your body is what you make it. Ignore your muscles and they'll go away. I tell my players that a lot of them are only using 70 percent to 80 percent of their muscle tissue. Tight muscle tissue doesn't happen all at once; it's a gradual process.
"In our game, speed is crucial. If they're not throwing as fast, it starts creating doubts in the mind of the player. Well, their tissues have gotten tighter, limiting flexibility and the first thing to go is the performance. One of my main things is education. When they're on the table for the first time, I talk to them for 30 minutes about how to take care of their muscle tissue."
As simple as it sounds, LeSuer says, the most important part of muscle care is hydration. "I try to put it to the players in terms that are easy to digest. Think of your biceps like a kitchen sponge. We all know what a sponge looks like in the sink in the morning -- half the size and brittle. This is what a dehydrated bicep looks like. It's going to tear that tissue. My mantra is 'Pliable tissue does not tear.'"The Word is Out
In addition to providing services at the Olympics, Waslaski has also worked with the New York Yankees in spring training. He notes a recent trend of massage crossing over to many other sports, including hockey. "This is really for performance enhancement." But this trend has also embraced professional dance companies, such as River Dance. "These are still athletes," Waslaski says, and pre-event and maintenance massage is an essential piece to quality performance and injury prevention.
In a recent Massage Today
column, Keith Eric Grant cites a conceptual model of training developed by Russian sports scientist N. Yakovlev. The head of sports and deep tissue massage at McKinnon Institute in Oakland, Calif., Grant is also a devotee of Scottish country dancing and frequently makes reference to the art of dance in his Ramblemuse columns. Yakovlev's training model has to do with intensity, in that overtraining for the current condition of the athlete and propensity for recovery can result in breakdown, whereas waiting too long to resume training (repetitive timing) can result in a loss of previous benefit. The optimal model is to engage in a level of intensity that allows full recovery and resume training during a "super-compensation period" in which the greatest effect will be obtained.1
Grant states, "The benefits of massage come partly, I believe, in shortening the recovery time in Yakovlev's model. When recovery capacity is increased, exercise capacity can increase, yet stay in balance," thus facilitating "the gains of super-compensation." Grant goes on to note the importance of neurological-psychological interaction, and the role that stress and anxiety play in performance, specifically that of the dancer.2
In the field of dance, muscular tension is a major cause of injury associated with psychogenic factors. As with any athlete, anxiety can affect flexibility and make the muscles overly tense. In light of this, Grant speaks directly to therapists regarding the impact of massage: "We become part of the lifestyle structures of support to which an athlete and kinesthetic artist can turn when viewing massage as an interaction and communication. Beyond this, we can address the tension to which they might unconsciously cling."3
When it comes to dancers, anxiety and injury are not the only potential blocks to a healthy and successful career. James Clay, co-author of Basic Clinical Massage Therapy, provides preventive and remedial bodywork for dancers and gymnasts. Included in his clientele are students and faculty members of the North Carolina School of the Arts. Building on his study of Rolfing, he developed his own approach to postural work.
"Dancers and gymnasts," Clay says, "are pretty similar in that they both are distinguished from the rest of the population by having extraordinary flexibility, which can be quite challenging. I do a lot of work with stretching, but it's very hard when they've stretched beyond imagination.
"The funny thing is we think of dancers and gymnasts as having extraordinarily good posture. What they have is good dancer's or gymnast's posture, but not necessarily healthy posture overall. They don't have the same kinds of postural problems most of us generally have. They tend to stand straighter. But, for example, ballet dancers tend to walk turned out all the time, which is not really balanced on the feet. If you're not balanced on your feet then the whole rest of the alignment is thrown off. What they need to learn is they can certainly turn out when they need to, but they don't need to turn out all the time."
The primary muscle used to turn out is the piriformis. Constantly turning out affects all the leg and postural muscles above the hips. "You have to treat the piriformis muscles directly to enable them to stand with their feet straight, and then work with everything above that to bring the body into balance." Without this structural work, the dancer may be facing a lifetime of pain or even early retirement. Some, Clay says, continue to dance in spite of the pain. The Right Touch
No matter what the athletic specialty, the approach of Russian massage for performance enhancement is based on a specific protocol, dependent on each individual situation. Included in the variables are the type of sport, the needs and goals of the athlete, and the athlete's physical and emotional condition.4
Wine says Russian sports massage is somewhat unique. "What separates Russian from other forms of sports massage I know of," she explains, "is it doesn't have sports massage moves, but rather sports massage goals. It is completely goal-oriented and there are situations that play into that goal."
When the athlete is not in training, massage is focused on maintaining the muscle's ability to perform. "We lighten it up and change the ratio of strokes." Wine tells her students, "It's kind of like making a good soup. You have all these ingredients but you have to know how to mix them together and when. Deeper does not mean better. The point I always make is what you're looking for is 'just right.'"
A common assumption she encounters in the massage field is that athletes want to be hurt. Instead, she explains, "I say they want to be helped. They are willing to experience pain if they know it is going to help them. But one of the biggest mistakes sports massage therapists make is they try to go deep. They need to evaluate the conditions and problem they're dealing with and know how to address it. I know it sounds simplistic but it's not. Each athlete has certain specific needs and if they're not paid attention to, the therapist is going to fail.
"If you want to get great results in very few treatments, forget about techniques and concentrate on why. That's one of the things probably missing the most." By using this approach, she says she has altered some clients' performance in a single treatment.
Wine also cautions therapists about prescribing and instructing clients in stretching, noting many are not adequately trained in this area. "Stretching really is not taught in any massage schools. They need to go to someone who knows it inside out." Picking up the techniques from a book, video or weekend workshop won't suffice.
Even Wine, with all her experience, refers out to the experts. "Physical therapists have quite a lot of education on stretching. When done properly, it can be very effective. The reason it's a good idea is that it provides us with a very specific exercise. It brings blood to the tissue, and the muscle is then ready to work. It can be done in a very unforceful way. It all depends on what people expect to gain from it, but I don't see it aiding in preventing injury."The Athletic Therapist
After decades of working with athletes, King acknowledges massage therapists as part of that group.
"I work with a lot of massage therapists," he says. "Anyone doing massage therapy for a living is an athlete. I teach a system of using the body in a nonstressful way so they can add longevity to their career and avoid injury." It's important to do warm-ups, stretching or activities like tai chi for core stabilization. "The therapist is doing repetitive movements the same as an athlete in a competitive sport. There's a consistency to training a massage therapist to perform in a stress-free, integrative fashion and looking at an athlete in a similar mode." Shirley Vanderbilt is a staff writer for Massage & Bodywork magazine.References
1 Grant, Keith Eric. Training Effects. Available at www.massagetoday.com/archives/2003/06/08.html. Accessed June 16, 2003.
4 Wine, Zhenja Kurshova. "Russian Sports Massage: Enhancing performance."
Massage & Bodywork 1999 Feb/Mar:132.