The Importance of Sports Massage

Many patients and friends that I’ve treated over the years as a physiotherapist almost always asked what was wrong with them and when it came to treatment how was it going to help or what should they do, which made perfect sense and again when using Acupuncture for example, they often asked in an inquisitive way what it was meant to do? But what has often surprised me was that no such question arised when it came to soft tissue therapy or massage as it is often called. But why?

Do patients really know how soft tissue therapy works? And do they think it is going to help? I haven’t really spent much time trying to find the answers to these questions (perhaps I should) but for the former, most people probably won’t know the answer to, but for the latter probably many will believe that perhaps it will help. In fact, in the private sector more so than in the NHS, some forms of soft tissue therapy are often used to meet and satisfy a certain amount of clients’ expectations, but this is very different in the NHS where there is a move to use manual therapy only when it is required resulting in many patients’ disappointment when they were expecting and seeking massage.

What many patients coming to see physiotherapists fail to realise is that massage, in most physiotherapy training at undergraduate level, are generally poorly taught. I cannot speak for all training in this country or abroad but in my four years of training at undergraduate level, I received only 3 hours of theory and practical training in massage! This may surprise a lot of patients but physiotherapy training is very complex covering a wide range of medical subjects. It would be difficult to put in a few sentences the rigour and amount of work required to get through such training!

I just want to write a brief account of some techniques used which may help patients understand why we use it and also to the therapists a refresher as to why we are using it. 

As with other manual treatments, soft tissue therapy is traditionally directed at subjective clinical examination findings such as reduced quantity and quality of joint movement, increased muscle tone/tension, soft tissue thickening, sensitive muscle bands that may refer pain such as trigger points.

Various techniques exist including the use include digital ischaemic pressure which is the application direct pressure to the skin towards the centre of a muscle to evoke a temporary ischaemic reaction to stimulate the mechanoreceptors within muscle and fascia to reduce resting muscle tone, to provide an analgesic response through a release of pain-mediating substances and to deactivate symptomatic trigger points which may optimise muscle activation patterns.

Another technique is sustained myofascial tension which is performed by applying a tensile force with the thumb, braced digits or forearm to an assessed site of fascial thickening or reduced fascial glide in the direction of greatest restriction or in the direction of elongation necessary for normal function.

Friction massage is applied selectively to localised area palpated as abnormal tissue thickening for example scar formation following acute injury. Sufficient pressure are applied by the clinician’s thumb/finger and must work deeply enough to impart a friction movement to target tissue. Pressure should be increased gradually to reach required level within the patient’s pain tolerance.

Soft tissue techniques are often used in combined treatment including stretching and exercises to maximise effects. 

Self -treatment such as use of spiky balls and foam rollers have become more and more popular in recent years and they are a form of soft tissue therapy. Patients need to understand that presenting symptoms, soft tissue characteristics and patients’ responses vary and therefore clinicians need to individualise dosage in relation to time and repetition to achieve optimal results when using self-treatment modalities. 

When it comes to soft tissue therapy, after my undergrad, I have furthered my training in sports massage and several other CPD courses (discovering a whole host of various techniques and applications). Over the years and after hours and hours of practice I have become more appreciative of manual and soft tissue therapy. The therapeutic value and benefit of such treatment when used appropriately cannot be underestimated.