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# Sports Massage
**Sports massage** is not a specific technique, but the application of several methods for achieving a sport specific goals. It can be used to recover after a competition or big workout, to treat or prevent an injury, as well as increase athletic performance.
*Sports massage* involves soft tissue manipulation that is done with the intent to improve the athlete’s body. There is no doubt that when done properly, massage is a very enjoyable experience that can keep us on a positive track toward a healthy, active lifestyle. This can mean different things to different people depending on their specific activity. Sports massage can be a 90 minute, full body, deep tissue massage scheduled a couple days after a long run or a quick 15 minute calf massage just before practice.
## Sports Massage Techniques
Sports massage techniques are broad due to the wide focus included in the goal of improved performance and providing pain free movement:
##### Deep Tissue Massage
This is done with the intent to affect the deeper soft tissue structures of the body. It’s more intense than a salt scrub, fluff-and-buff at the spa, which is intended for exfoliation and a healthy appearance. Deep tissue work may be a little uncomfortable but should not be very painful. Although some people may disagree, I am not a believer in “pain equals progress.” Each person has their own tolerance and a good therapist knows they are helping and not fixing the client’s problems. As a person becomes more familiar with deep tissue treatments they learn to relax more, enabling deeper and more effective work.
##### Cross Fiber Friction
Includes deep, non gliding movements, done across muscle, tendon and ligament fibers. This broadening technique is usually done to break up scar tissue and adhesions to help restore proper tissue alignment. This technique is uncomfortable at first but pain should diminish as the treatment continues.
##### Direct Pressure
Force is applied to a particular spot usually done with a thumb or braced finger. The spot is held for up to 3 minutes with moderate pressure and is best used to help release spasm in stress points of muscle tissue.
##### Active Movement
This is a technique that has the client move a particular body part through ranges of motion while the therapist holds, presses or pins some parts of the muscle to cause resistance. This produces a deep stretching sensation which is mostly controlled by the client.
##### Facilitated Stretching
Includes a stretch or series of stretches assisted by the therapist.
##### Proprioceptive Neuromuscular Facilitation (PNF)
PNF is a physical therapy technique of sports massage that involves muscle contractions and assisted stretching for increased flexibility.
### Sports Massage: Who Can Benefit?
Many professional athletes take advantage of sports massage on a daily basis. For pro athletes, their sport is their life and their bodies are the vehicle of their sport. Proper maintenance and care for the vehicle is of utmost importance. Ice bags, ice baths, chiropractic adjustments, e-stim and massage are all part of their daily activities. Successful professional athletes employ sports massage to help them stay in tune.
Runners are perfect candidates for regular sports massage. Runners participate in their sport every day with only slight variations of long runs, speed work, tempo, and so on. This sets them up for stress related injuries like: Petellofemoral Pain Syndrome, Tibial Stress Syndrome (a/k/a “shin splints”), Achilles Tendonitis, Stress Fractures, Plantar Fascitis, and Iliotibial Band Syndrome. While there is no guarantee sports massage can prevent these conditions, having regular therapy sessions can assist in body awareness to distinguish between muscle fatigue and body malfunction. A good MT can help encourage clients to seek appropriate medical care for injuries or potential injuries sooner than they might otherwise.
Recreational and competitive athletes can all benefit from regular massage treatments. You don’t have to be an Olympian or Boston qualifier — just caring about you body is reason enough to utilize massage.
The most basic thing about sports massage is that it allows the body to regain proper alignment and function. There can be some pain, but if done correctly, it can be a good pain you want to work through. Sports massage has an immeasurable psychological effect that should not be underestimated.
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# Massage Benefits
There are many **massage benefits** that come with massage therapy. Its is one of the simplest healthcare practices available, and essentially stimulates the body’s natural healing abilities. Massage therapy is most commonly used for relaxation and stress-related issues, muscle and joint pain, high blood pressure, depression and digestive problems. Many athletes also use massage therapy to keep their bodies in peak conditions.
All massage techniques involve touch, which is an important sensation linked to comfort, love and emotion. Children and young animals require touch to thrive and grow, and touch has been linked to stress-relief and relaxation in adults as well.
When a soothing touch is applied to the skin, messages are sent to the brain to relax the body and release endorphins, the body’s natural painkillers. Rubbing the muscles and tissues of the body also help to work out any stiffness or tension that is stored in the body to improve flexibility and movement.
## What is Massage Good For?
Massage is believed to support healing, boost energy, reduce recovery time after an injury, ease pain, and enhance relaxation, mood, and well being. It is useful for many musculoskeletal problems, such as low back pain, osteoarthritis, fibromyalgia, and sprains and strains. Massage may also relieve depression in people with chronic fatigue syndrome, ease chronic constipation (when the technique is performed in the abdominal area), decrease swelling, alleviate sleep disorders, and improve self image. In the workplace, massage has been shown to melt away stress and enhance mental alertness. One study found that deep tissue massage reduced blood pressure levels (an average reduction of 10.4 mm Hg in systolic pressure and a diastolic pressure reduction of 5.3 mm Hg). Other studies show that massage may have immediate beneficial effects on pain and mood among patients with advanced cancer.
Massage is also useful for stimulating the lymphatic system to boost the immune system and get rid of toxins in the body. Many people report a sense of improved perspective and clarity after receiving a massage. The emotional balance massage provides can often be just as important and valuable as the more tangible physical benefits.
Getting a massage can do you a world of good; with our fast paced schedules, and the highly stressful world that we live in today, massage therapy is one of the best ways to relax and promote overall wellness, both physically and mentally! Getting a massage frequently by means of regularly scheduled appointments can play a huge part in your health. Consider **massage therapy** a necessary piece of your wellness plan!
## Massage Benefits
* Increases Circulation and Flexibility
* Enhances Sleep Quality
* Greater Energy
* Improves Concentration
* Reduces Fatigue and Stress
* Decreases Anxiety
* Enhances Immunity
* Improves Body Motion
* Relieves Tension Related Headaches
* Reduces Heart Rate
* Helps With Injury Rehabilitation
### Alternative Massage Benefits
* **Autism**: Autistic children, who usually don’t like being touched, show less autistic behavior and are more social and attentive after receiving massage therapy from their parents.
* **Atopic dermatitis/eczema**: Children with this scaly, itchy skin problem seem to experience less redness, scaling, and other symptoms if receiving massage between flares. Massage should not be used when this skin condition is actively inflamed.
* **Attention deficit hyperactivity disorder (ADHD):** Massage may improve mood in children with ADHD and help them feel less fidgety and hyperactive.
* **Bulimia:** Studies show that adolescents with this eating disorder feel less depressed and anxious after receiving massage therapy.
* **Cystic fibrosis:** Massage may reduce anxiety and improve respiration in children with this lung condition.
* **Diabetes**: Massage may help regulate blood sugar levels and reduce anxiety and depression in children with diabetes.
* **Rheumatoid arthritis:** Children with juvenile rheumatoid arthritis (JRA) have been shown to experience less pain, morning stiffness, and anxiety as a result of massage therapy.
### References
Anderson PG, Cutshall SM. Massage therapy: a comfort intervention for cardiac surgery patients. *Clin Nurse Spec*. 2007;21(3):161-5; quiz 166-7.
Barlow A, Clarke R, Johnson N, Seabourne B, Thomas D, Gal J. Effect of massage of the hamstring muscles on selected electromyographic characteristics of biceps femoris during sub-maximal isometric contraction. *Int J Sports Med*. 2007;28(3):253-6.
Beider S, Mahrer N, Gold J. Pediatric Massage Therapy: An Overview for Clinicians. *Pediatric Clinics of North America.* 2007;54(6).
# Acute Low Back Pain
**Acute Low Back Pain** is a condition of pain in the lower (lumbar-sacral) back region, with or without radiation of symptoms to the buttocks or lower extremities, of less than 6 weeks duration, in the non-pregnant patient.
## Acute Low Back Pain: Initial Diagnosis and Management
* Elicitation of history and performance of physical examination. Special attention to presence or absence of “red flags” to include: age <18 or >55; history of malignancy, steroid use, or HIV positivity; weight loss or constitutional symptoms; structural deformity; anal or urethral sphincter disturbance; saddle anesthesia; gait disturbance; or widespread neurologic deficit.
* If red flags are present, diagnostic testing may include plain radiographs; CBC; ESR; bone scan; CT scan and/or MRI scan and electrodiagnosis as indicated.
* If red flags are absent a diagnostic workup is generally not necessary.
* Initial treatment for the first 2 weeks consists of: reassurance that most episodes resolve uneventfully within 6 weeks; encouragement to maintain as close to normal activity as is tolerable; avoidance of bed rest greater than 24 hours; NSAIDS (unless contraindicated); muscle relaxants for up to one week; acetaminophen as needed; weak opiates (codeine; propoxyphene) unless contraindicated; passive modalities (e.g. ice, heat) for symptomatic relief.
### Acute Low Back Pain: Ongoing Management and Objectives
If *acute low back pain* has not improved in 2 weeks: re-evaluate for “red flags”, change NSAID, and refer to Physical Therapy for evaluation and treatment while continuing to follow patient.
### Acute Low Back Pain: Indications for Specialty Care Referral
1. Focal neurologic signs with abnormal imaging studies (urgent consult if worsening) – Orthopedics Spine referral. MRI prior to referral (without contrast unless tumor suspected).
2. Focal neurologic signs with normal imaging studies (urgent if worsening) – Physical medicine and rehabilitation referral.
3. Incapacitating radiculopathy unresponsive to therapy – Orthopedic Spine referral. MRI of lumbar spine prior to referral (without contrast usually).
4. Abnormal plain radiographs associated with red flags – Orthopedics Spine referral. MRI of lumbar spine prior to referral (without contrast usually).
5. Loss of bladder or bowel control – (urgent) Orthopedic Spine referral.
6. If pain has not improved within 6 weeks, refer to Physical Medicine and Rehabilitation for evaluation and management.
#### Specialty Care Referral (Physical Therapy)
* No improvement after 7-10 days of initial primary care management.
* If the patient has radicular symptoms.
#### Specialty Care Referral (Orthopedic Spine referral)
* If the patient has neurological findings (motor, sensory, or reflex deficits) and/or has positive MRI findings.
#### Criteria for Return to Primary Care
* Resolution of symptoms or implementation of continuing treatment program that can be managed in primary care portal with periodic subspecialty follow-up.
* Chronic conditions with a stable neurologic exam in patients that have been evaluated by Orthopedics Spine physician are not surgical candidates.
You may feel a variety of symptoms if you’ve hurt your back. You may have a tingling or burning sensation, a dull achy feeling, or sharp pain. Depending on the cause and severity, you also may have weakness in your legs or feet.
Acute low back pain is most often caused by a sudden injury to the muscles and ligaments supporting the back. The pain may be caused by muscle spasms or a strain or tear in the muscles and ligaments.