Did you know that soft tissue manipulation or massage has been a tool for treating a wide variety of illnesses and injuries for thousands of years? This method has been used as a therapeutic modality by healthcare practitioners since early civilisation.

In fact, massage has been promoted as the treatment of choice for musculoskeletal injuries, cancer, stress, and even pregnancy, as massage can promote relaxation. Let’s take football for for an example, there are multiple roles of massages that are used by football players during competition and/or training sessions:

• Pre–competition massage is started 2 hours prior to competition before the warm up. Pre–competition massage is performed in a short period of time, quick and fast to enhance the blood flow and warm up the body. It also increases cardiovascular activity, putting all joints in full range of motion and muscles at full length of flexibility. The duration of this massage will be 20 – 30 minutes. Pre-competition massage generally helps to prepare the muscle(s) for exertion, aid in the warm up and psychologically affect the athlete to feel lighter.
• Inter–competition massage is suitable for prolonged games such as cricket and is primarily for maintenance, being performed after cool down and prior to the next warm up. Inter – competition massage helps to promote recovery, refresh the athlete and prevents muscle cramps and spasm.
• Post–competition massage is undertaken after competition, with the sports massage carried out slowly and rhythmically and is designed to achieve superior results after cooling down. It also helps the muscles relax and enhances the speed of recovery. Furthermore, it helps to carry the waste product away from the body, acts as an active cool and prevents delayed onset muscle soreness (DOMS).

In this post, we are going to share with you the top 4 types of soft tissue manipulation or massages, that are well known in the sports field.

Let’s dive right in!!

There are various types of soft tissue manipulation which involve working and acting on the body with rhythmical pressure or stroking, tension, motion or vibration, done manually or with mechanical aids. Massage can be applied with the hands, fingers, elbow, knee, forearm, feet or massage devices.

In addition, a variety of techniques are commonly employed clinically among sports professionals to enhance recovery after exercise-induced muscle damage.

1. Deep tissue massage

Deep tissue massage is a massage technique that is mainly used to treat chronic aches and pain in contracted areas such as stiff neck, upper back pain, lower back pain and leg muscle tightness. This massage targets deeper layers of the muscles and connective tissue.

Deep tissue massage involves applying sustained pressure using slow, deep strokes to target the inner layers of the muscles and connective tissue. This helps to break the scar tissue that forms following an injury and reduce tension in the muscle/tissue.

Besides that, it also promotes faster healing by increasing blood flow and flushing out the inflammation debris.Deep tissue massage benefits patients both physically and psychologically; it has the greatest effect in chronic tight muscles, repetitive strains, postural problems or recovery from injury.

Thus, it can help to relax the muscles thereby creating positive psychological effect. Deep tissue massage can sometimes cause discomfort or pain when the therapist works on the area with adhesions or tight muscle, hence the patient may experience bruising over the skin or feel sore for one to two days as a result of the massage.

2. Myofascial release /Trigger point therapy

Myofascial release is a type of massage often used to treat myofascial pain syndrome. Myofascial pain syndrome is a fancy way to describe muscle pain, simply referring to pain and inflammation of the body’s soft tissue.

Myofascial pain syndrome is a chronic condition caused by the tightness of the myofascial tissue, where the pain normally roots from a specific point within the myofascial tissue known as the “trigger point”.

But in some cases, the area where the pain is reflected may not be where the myofascial pain generator is located; this is known as “referred pain”.

Myofascial pain can be caused by, on one hand, an injury to the muscle or excessive strain on a muscle group, and on the other hand a lack of activity of the myofascial tissue.

Trigger points can be diagnosed by applying pressure to specific areas of the body. There are two types of trigger point:

• An active trigger point is an area of extreme tenderness that usually lies within the skeletal muscle and is associated by local pain.
• A latent trigger point is an inactive area that has the potential to act like a trigger point. It may cause muscle weakness or restriction of movement.

Trigger point therapy or myofascial release are specifically designed to relieve the tension and pain in an isolated area by releasing energizing endorphins and eliminating toxins within the muscle.

This myofascial release gives immediate pain relief at the affected area and is usually incorporated with other types of massage.

3. Scar tissue mobilization

Scar tissue is formed as a response to the body’s injury repairing the damaged tissue and consists of a collection cells and collagen that cover the site of the injury. Scar tissue can develop from both an injury or surgery. For instance, after a quadriceps strain, scar tissue will develop in the muscle as it heals.

Bony scar tissue, called a callus, will form on the bone after a fracture. In general, the formed scar tissue will remodel over time, and henceforth act like normal healthy tissue. Therefore, scar tissue is typically not permanent and must remodel in order to tolerate the stress the body encounters.

This is essential in ensuring that normal range of motion, strength, and mobility are restored to the injured area. Scar tissue is much stiffer and thicker than adjacent tissue, meaning if the scar tissue fails to remodel properly it can lead to a loss of mobility and joint contracture in the long run.

The deeper the scar penetrates into the body, the more layers of skin, muscle and connective tissue there are that can get stuck together.  Thus, scar tissue mobilization is incorporated as a component of any post-op rehabilitation and recovery process after an injury. Scar tissue mobilization will be done by a therapist to:

• Promote with the remodelling process by applying pressure to scars; and,
• as a technique to softening and flattening scars.

Furthermore, it also helps to reduce the itchiness and provide moisture and flexibility to the scar. The scar tissue mobilization will begin 2 – 4 weeks post-operation (depending on the surgery and after the sutures have been removed).

A variety of techniques can be used to break down the scars, the most commonly used are acupressure technique, cross friction, myofascial release and . Along with scar tissue mobilization, stretching and strengthening exercises after an injury or post-operation also help the patient to experience better rehabilitation improvement.

4. Sports Massage

Sports massage is a deep form of soft tissue manipulation and can be applied in both sporting and non-sporting contexts. This massage technique is applied for optimal performance, recovery after difficult events or to maximize potential during training.

Persons who receive this massage do not need to be sports professionals as sports massage are also commonly used among physically active people.

A physically active person tends to do repetitive intensive exercises which may cause the muscle or fascia to develop imbalances creating muscle tightness that leads to discomfort. Sports massage can be applied for conditioning or treatment purposes.

Thus, a sports massage is also suitable for people with non-sports injuries, chronic pain or restricted range of motion. In addition, sports massage can be applied prior to competition (pre-competition), during competition and after competition (post-competition).

A combination of techniques that are widely used in sports massage include effleurage, kneading, wringing, hacking and trigger pointing with varying stroke speed and pressure. Stretching will be incorporated to help loosen muscles and increase flexibility during sports massage.

The different types and goals of sports massage can be summarised as follows:

• Massage as conditioning can be performed on a daily basis and throughout the training session and will concentrate more on the muscle(s) being trained. Massage in conditioning is to promote recovery from intensive training sessions and aid cool down, in order to return the body to the pre-exercise state as quickly and painlessly as possible. This also helps to prevent delayed onset of muscle soreness and reflect positive effect to the athlete.
• Massage as treatment can begin 48 – 72 hours after a sports injury which is typically after the bleeding and swelling have settled. This massage will be done from proximal to distal ends before concentrating on the treatment area for about 10 – 30 minutes. Massage as treatment helps to stimulate blood circulation, promoter faster recovery from an injury, helps to break down the adhesions and improve the range of motion and promote flexibility.
• Pre – competition massage must be started 2 hours prior to competition before the warming up session. Pre – competition massage is performed in a short period of time, quick and fast to enhance the blood flow and wamr up the body. It also increases cardiovascular activity, putting all joints in full range of motion and muscles at full length of flexibility. The duration of this massage will be 20 – 30 minutes. Pre-competition massage generally helps to prepare the muscle(s) for exertion, aid in the warm up and psychologically affect the athlete to feel lighter.
• Inter – competition massage is suitable for prolonged games such as cricket and is primarily for maintenance, being performed after cool down and prior to the next warm up. Inter – competition massage helps to promote recovery, refresh the athlete and prevents muscle cramps and spasm.
• Post – competition massage is undertaken after competition, with the sports massage carried out slowly and rhythmically and is designed to achieve superior results after cooling down. It also helps the muscles relax and enhances the speed of recovery. Furthermore, it helps to carry the waste product away from the body, acts as an active cool and prevent delayed onset muscle soreness (DOMS).

Benefits of Massage

• Increased venous return

Venous return is the rate of blood flow returning to the heart. Increased venous return can be used to reduce venostasis and oedema by increasing blood flow to a site of injury.

• Increased skin and muscle temperature

The skin friction during the massage increases regional heating, and consequently, causes hyperaemia within the massaged area. The increase in temperature creates dilation of vessels and capillaries which allows more warm blood to flow. Temperature increases the metabolic rate, which improves the condition of the tissues. It also improves the flexibility of the tissue, muscle fibres, fascia tissue, ligaments and tendons. Warm muscles contract more efficiently thus it also helps to prevent any injury.

• Increased lymphatic drainage

Lymphatic drainage removes waste products and toxins from the body. Following exercise, waste products such as lactic acid will build up within the muscle, producing pain and stiffnessand thus interfering with the recovery process. Massage flushes out bad substances enhancing muscle recovery and helps to reduce pain and stiffness. Increased recovery allows the person/athlete to train more and improve performance.

• Increased tissue elasticity

The stretching effect from manipulation during a sports massage such as wringing and skin rolling can help the tissue to move transversely. Muscle bundles are lifted, separated and stretched which increases the flexibility and extensibility. Increased tissue elasticity will improve performance and reduce risk of injury.

• Break down of adhesions and scar tissue

Adhesions form as a result of an inflammatory healing process, making the tissue sticky and binding down the tissue. While scar tissue is formed as a result of injury remodelling. Deep friction technique helps to loosen and break down the adhesion or scar tissue. Thus, it allows movement within the muscles, ligaments, and tendons to function normally.

• Enhance relaxation

The increased temperature aids in tissue relaxation. The fast removal of waste products in the muscle will prevent pain and stiffness and promote feeling of relaxation.

• Reduced delayed onset muscle soreness

DOMS occurd after heavy training sessions, during which pain occurs in the muscle due to metabolic insufficiency where lactic acid will be formed. A massage post exercise helps to flush out the waste products formed as a result of the exercise.

• Improved recovery

Sports massage significantly aids the recovery process after an injury. When an injury happens, scar tissue forms as a part of the healing process. Massage helps to break down the scar tissue and movement can be regained. Also, increased blood circulation delivers oxygen and nutrients to thr injured area and helps in repairing damaged tissue.

• Maximise performance

A sports massage helps the body recover after exercise, psychologically prepares the patient’s mental state and increases muscle movement readinessy for exercise. The effect of recovery helps the athlete to train more and achieve a higher level of performance.

• Prevent injury

A constantly built-up tension in the muscles can lead to stresses on the joints and soft tissue. Hence, massage helps to prevent injury by relieving muscle tension and restoring muscle balance. Soft tissue manipulation is highly recommended modality to treat skeletal injuries, increase muscle condition and flexibility.

Likewise, it has both physical and psychological benefits. Ultimately, the therapist or masseur will select the appropriate massage technique to provide maximum benefits for each individual patient.

If you want to know more about what the different types of tissue manipulation or massages, feel free to give us a call at 03-50315946 or send us a Whatsapp or Make an Appointment. We at Rehamed Therapy are always here to help!