Sports Massage Gains Popularity among Amateur Athletes

from New York Times:

By Christopher Percy Collier

WHEN Jessi Stensland, a professional triathlete, enters the Athletes’ Performance training center in Tempe, Ariz., she usually goes through the door labeled “Work” and into the wing of the building filled with treadmills, elliptical trainers and free weights.

But once a week, Ms. Stensland, 22, carries her gym-worn body through a door labeled “Rest.” As soothing music plays, she lies face down between two sheets atop a cushioned massage table to await her treatment.

But the session that usually follows is far from a coddling.

Ms. Stensland’s muscles and tendons may be kneaded, pummeled, poked or scraped. Thumbs and elbows may be forcefully pushed into pressure points on her body. Clear plastic instruments, some the thickness of a pencil eraser, are used to deeply penetrate soft tissue that may be tender and tight.

Once the session is over, Jeremy Hassler, the on-site soft tissue specialist, often hears a similar quip as subjects rise from the table. “Thanks.” And then, after a pause, “I think.”

So-called sports massages have become a common facet of training for professional athletes of all kinds. And because of their increasing presence on spa menus (beside facial exfoliations, body wraps and hot stone treatments) and at health clubs (down the hall from Pilates, step aerobics and yoga classes), this sometimes painful procedure — which can cost $45 to $150 an hour — appears to be gaining in popularity among a growing segment of amateur athletes.

“It hurts,” said Tara McGinness Murdock, a runner in Lookout Mountain, Tenn., who recently used deep-tissue massage while training for a marathon. “But, as crazy as this sounds, it’s a good hurt.”

But as more amateur athletes have chosen sports massages in an effort to improve performance and avoid injury, they have been confronted by an increasingly varied combination of massage styles under this heading.

Asking about the predominant techniques used in the advertised sports massage can be enlightening, said Terri Schneider, an ultra-endurance athlete and coach.

“If it’s all Swedish massage, then it will probably be less of the kind of deep-tissue work that’s beneficial for athletes while training,” she said. But even exclusive use of the deep-tissue approach has limitations, as many massage therapists have numerous techniques at their disposal.

Sports massage, Mr. Hassler explained, has become something of an umbrella term.

Light pressure Swedish-style sports massages (which are often less intense) are typically used to prime muscle tissue before a heavy bout of exertion or to flush the system after a race or sporting event.

Deeper, more intense work, not unlike the massage therapy one might normally associate with rehabilitation from an injury, is undertaken at fitness centers as a weekly general maintenance measure, often as part of a broader training plan.

Categorically, a deep-tissue sports massage is part of a training philosophy that hinges on the belief that a succession of heavy workouts can take an athlete only so far. Additionally, what is (or isn’t) accomplished in so-called down time is also significant.

In other words, rather than working out ad nauseam, setting aside time for the body to bounce back has some intrinsic benefit. But advocates of deep-tissue work contend that such treatments take this thinking a step further: they don’t just allow the body proper time for recovery, they also actually accelerate the rebuilding process.

Using a technique known as Augmented Soft Tissue Mobilization, for instance, Mr. Hassler’s goal is to facilitate muscle regeneration. “We are intentionally inflaming the tissue to kick-start the body’s own natural healing cycle,” he said. He also uses active release, which breaks up fascial adhesions (connective tissue buildup created by exertion) to lengthen muscles and better prepare them for continued high intensity training.

Despite the anecdotal evidence from athletes and massage therapists, hard data that soundly quantifies the extent of this phenomenon is hard to come by. In broad terms, however, according to the American Massage Therapy Association, about 20 to 22 percent of the United States population reported receiving some form of massage in the previous 12 months, compared with 8 percent in 1997.

Ron Precht, spokesman for the association, estimated that these types of massages that are directed at athletes have been growing in popularity in this country for 10 to 15 years. Colleen Casey, massage director at ZUM, a boutique health club in downtown Seattle, said she averaged 30 sports massages a month in 2007. So far in 2008, she has averaged 40 a month.

All the while, research has uncovered varying results.

For instance, a study in the October issue of the British Journal of Sports Medicine found that cyclists who received massages after intensive pedaling showed improved performance.

But a study in a 2005 edition of the Journal of Athletic Training found that while subjects who received a 10-minute arm massage three hours after exercise had about a 30-percent reduction in muscle soreness and swelling, there was no change in muscle strength or function. Furthermore, a study in the September issue of the Clinical Journal of Sport Medicine by Dr. Thomas Best of Ohio State University assessed that, of 27 studies reviewed that tested sports massages after exercise, only “moderate evidence” as to their effectiveness was found. The problem, in part, involved the inability to create an objective environment for measurement.

“Massage therapists use different amounts of pressure, so there’s tremendous variability,” said Dr. Best, who conducted a related study to try to address this very problem.

That trial, reported on in the July edition of Medicine & Science in Sports & Exercise, used a mechanical device to deliver a massage with consistent pressure. When this treatment was delivered to the legs of rabbits after exercise, they showed a significant increase in muscle recovery and reduced inflammation as opposed to rabbits that received no massage. “The machine gave us a basis to see how much force was supplied,” Dr. Best said.

To the trained eye of a massage therapist, it is not difficult to identify the problem areas of different athletes. “Usually, all I have to do is look at your body and I can tell what type of athlete you are,” said Muriel Hattori, a massage therapist at the Spa at Sawgrass in Ponte Vedra Beach, Fla.

Beyond the physiology of how a massage alters the state of an athlete’s body, some massage therapists try to identify measured improvements to performance. “I tell serious golfers that I may be able to add 20 yards to their golf swing,” Ms. Hattori said. She boasted of helping one marathon runner shave eight minutes off a previous best time after the woman visited her once a week for about six to eight weeks as part of her training.

Ms. Hattori typically starts with two Swedish techniques: effleurage (smooth, long strokes) and petrisage (a kneading motion). After that, she may use Shiatsu, a Japanese method involving pressure from fingers and palms.

At times, should Ms. Hattori need more leverage, she will have her subjects lie on the floor so that she can put almost the entire weight of her body on a specific area. She is adamant that not every treatment she doles out to elite athletes requires some measure of pain.

“A really good therapist knows exactly when to pull back,” she said.