Heat Treatment

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Heat treatment is used as a therapy for many sports related musculoskeletal injuries. There are many forms of heat treatment, with the most effective often depending on the injury in question. Time scale is also an important factor when deciding whether to use heat therapy.

What Are The Benefits Of Heat?

Heat acts to:

  • Reduce pain
  • Reduce stiffness
  • Decrease muscle spasm
  • Increase blood flow to the area which promotes healing

When Should I Use Heat Treatments?

Heat therapy should be used on chronic injuries and late stage acute injuries. A chronic injury is one that has persisted for a length of time and is usually due to overuse and biomechanical issues, as opposed to a traumatic incident. Heat can be used before exercise to warm the muscles, but should be avoided after exercise.

At home the easiest way of applying heat to an injury is by using a widely available heat pack. These can be made of varying materials, often gel or wheat based which either require heating in a microwave or submerging in hot water. Wrapping such an item in a towel and applying it to the injuy is perfectly suitable. This should be applied be 15-20 minutes at a time. Warm, damp towels, warm baths and heat rubs can also be easily used at home although may not be as effective at warming deeper tissues.

What Are The Contraindications To Using Heat?

The following are contraindications (times when heat treatment is not suitable) which apply to heat therapy:

  • Sensory changes (cannot feel if it is too hot)
  • Heat injury
  • Hyper or hypo-sensitive to heat
  • Circulatory problems
  • During the acute phase of injury
  • DVT
  • Infections
  • Malignant tumours

Most of these are due to the massive increase in blood flow to the area. With conditons such as infection or malignant tumours, heat would increase the risk of spreading the infected or cancerous cells in the much increased blood flow.

Smooth Moves: Massage for Your Golf Game

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Bodywork and Your Golf Game

By: Michelle Schneider

 You're standing over an easy 3-foot putt on the 18th green, $20 riding on dropping the ball in the cup. And yet all you can think about is that sharp twinge in your lower back, that pesky crick in your neck and the growing tension in your hands--which have a death grip on the putter.

How did this happen? Didn't you take up this game to relax?

"We Type-A personalities all seem to be attracted to golf--then we get out on the course and tense our muscles and stress out," says Marilyn McAffee of Ponte Vedra Beach, Fla.

Massage--and her massage therapist Muriel Hattori, in particular--have been godsends, McAffee says. "I consider massage a joy not just for my golf game but for my whole life." McAffee, 63, is a former U.S. ambassador to Guatemala who now is president of the Jacksonville, Fla., chapter of the nonprofit World Affairs Councils. She reluctantly admits that her handicap is closer to a 23 than the 19 she once carried. "I tend to work hard, and I tend to play hard. I tense up, grip the club too tightly, swing too hard, punish myself by hitting the ball as hard as I can even though my muscles are tense."

 Hattori works that tension out, loosening McAffee's muscles and allowing her to relax, and to take deep, calming breaths. "So, of course, the ball goes farther because my swing is more effortless."

McAffee is one of a growing number of golfers--especially those who wield their clubs only on the weekend--who have seen how massage can improve not just their game, but their lives.

 "People love this game so much that they just have to play, even though they're hurting," Hattori says. She's one of northern Florida's massage masters, based at the famous Marriott at Sawgrass golf resort in Ponte Vedra, home to the PGA headquarters. "Try to tell a golfer to hang up their clubs and take up chess. No way. They're going to play until their body finally gives out on them."

Hattori--whose client list includes an impressive lineup of pro football players and PGA tour golfers--says her approach to massage is the same no matter who's on the table.

"I have to get to know your body so I can fine-tune it," she says. "The best thing a golfer, or anyone who's in pain, can do is find a massage therapist who they're comfortable with, and one that they can work with on a regular basis. It's the consistency that will give you the best results." 

Golfers routinely report pain in their lower backs and hips, tight hamstrings and stiff necks. "One major cause of injury among the golfers I see at the resort is that they've saved up for months to come play, and they're so eager to get out there, they just start whacking the ball as hard as they can, without warming up," Hattori says. And, many tourists have crammed so much work into the week before their vacation "that they're even more tense and stressed than they normally would be."

Hattori knows that not everyone can afford a massage every week, but that doesn't mean they can't start immediately to improve their flexibility and begin to lessen their chronic pain. 

"Those weekend golfers must get into a daily stretching routine at home," Hattori says. "It is one of the most effective ways to start getting your body in shape. I tell them to stretch for just one minute every morning and every evening--just one minute. While you're brushing your teeth, put one leg at a time up on the counter by the sink and stretch it. You can incorporate stretching into your daily routine without it adding extra time."

This stretching takes the pressure off, Hattori says. "If you tell them they have to stretch 15 minutes twice a day, and they only get 10 minutes in, they feel guilty, or like a failure. But if you tell them they only have to do one minute twice a day, and they end up doing 10, then they feel better about themselves." 

For golfers, Hattori suggests a massage therapist who not only knows your body's specific aches and pains, but who also knows the sport. That way, he or she can design a stretching routine tailored just for you and your game.

"Freddy Couples (14-time PGA tour winner) always had trouble with his back, so I recommended he do a classic cat stretch on a regular basis." (In the cat stretch, you are on your hands and knees and then alternately arch your back, then make it concave.)

Hattori and other massage therapists agree it's also critical to stretch not only at home, but before teeing the ball up on the first hole.

Lynn Teachworth, a massage therapist from Orlando, Fla., whose clients include pro golfers Annika Sorenstam, Se Ri Pak and Ernie Els, says the best approach is to stretch until you feel your muscles are warm, play your round of golf and then stretch again--longer and deeper. That's when you'll get the most benefit from stretching, and there's no risk fatigue will dent your game. "A little stretch before and a lot after -- that's the winning formula," Teachworth says.

If you have a major tournament just around the corner, massage therapists recommend you come in for a tune-up before the big event. Ideally you should get a massage 10 days before, and then again three days before the tournament.

Pre-event massage involves a lot of intense stretching, not gentle, soothing strokes, Hattori says. "Before a game, I'll use strong, aggressive stretching. You leave the soothing massage for afterwards, because then you want your client to feel like they're in la-la land. Beforehand, you don't want la-la land, you want them to be loose and limber but focused."

Hattori says it's important to keep the game in perspective. "The whole idea of golf is to have a good time. That's the secret," she says. "If you feel good physically, it's easier for you to have a good time, and I can help with that. If you go out with the right frame of mind--that you're going to have fun--then you'll relax and play better."

 McAffee agrees. "I can't imagine not having my Muriel massage every two weeks. Sure, it helps me with my golf game, but it also just makes me feel so much healthier. She doesn't just get all the aches and pains out, she takes all the tension away. It's so relaxing that I feel I'm connecting my body with my mind. I'm becoming fully integrated--it's such a wonderful feeling."

Originally published in Body Sense magazine, Spring 2003.

Massage and Cycling

A Winning Combination
By: Doug Freedcycline

Whether it's the Tour de France or Ride the Rockies, cyclists -- world-class and otherwise -- are learning the lessons of massage for injury prevention, enhanced performance and faster recovery.

Cycling is a demanding activity, a sport that puts the athlete in stress for prolonged periods, sometimes for several hours at a time. While it is the legs that endure the greatest burden, many muscle groups are involved on a long ride. For these endurance machines, it isn't enough to ride long one day then give the body plenty of time to recover. Often the rider is back on the saddle again the next day for another prolonged ride. The results can range from fatigued to damaged muscle tissues. 

World-class cyclists include massage in their daily routines, often traveling with a private massage therapist. Citizen riders in races and tours across the country have available to them massage therapists. Colorado's Ride the Rockies tour, one of America's most popular multi-day rides, provides more than 20 massage therapists to help cyclists through the difficult stages of riding through the Rocky Mountains.

Benefits of massage don't end with road races and tours. Mountain bike enthusiasts will net the same positive results as will a variety of other athletes. Massage tents at cycling events are commonplace, but don't be surprised if you're helicopter or snowcat skiing in Canada to see exhausted skiers returning to the lodge and clamoring for an evening massage. It improves performance for any athlete and that translates to a safer and more enjoyable outing.

Injury Prevention
The Baby Boomer generation remains active, but it is not remaining young. According to a Wall Street Journal analysis of injury statistics, injuries to Americans in the 35- to 54-year-old age group are climbing much faster than the group's population. Injuries to the Boomers are up 40 percent over the last decade, according to U.S. Consumer Product Safety Commission estimates. This figure doesn't include so-called minor injuries that still required more than 1 million doctor visits and accounted for a national medical bill of $22 billion.

No middle-aged basketball player would be surprised to learn basketball, with an injury rate of 8.8 per 1,000 participants, tops the Wall Street Journal list of sports most apt to cause an injury. But cyclists might be surprised to learn their sport, with 4.1 injuries per 1,000 riders, clocks in at No. 4 on the ouch list behind only basketball, soccer and softball. That puts cycling well ahead of in-line skating (3.4 injuries per 1,000) and running (0.5 injuries per 1,000).

 The most common cycling injuries are crash-related: shoulder and trunk fractures and dislocations. Sitting too long on a bicycle also has its problems. Temporary impotence among riders is not unheard of, while overuse injuries to joints and muscle stress is common.

Massage therapist Michael Hargesheimer, who specializes in work with cycling athletes, offers these injury and pain-prevention tips to his clients:
-Make sure the bicycle fits the body. Have a bicycle expert provide a proper frame size, and make proper seat and handlebar adjustments.
-Implement a proper, graduated training schedule. Increase time in the saddle gradually as terrain difficulty increases. To avoid knee and back problems, get base mileage in on the flats before riding any long, steep roads or trails. Base riding should include about 500 miles of spin at 90 rpm with anaerobic threshold work added. Other conditioning should include attention to the core muscles -- abs, erectors and obliques -- as a means of keeping back problems at bay.

 Other essential modalities are proper stretching, nutrition, hydration, active recovery activities such as swimming, cryotherapy to problem areas and self-massage.

Self-Massage
The goal of pre-ride massage is to manually warm the muscles and tendons, helping to eliminate a cold start. It makes the warm-up time on the bike more efficient and decreases the time it takes to warm up to difficult efforts. When a therapist is available pre-ride, certainly take advantage of it. For most, that will be only a distant luxury. The pre-ride self-massage will be advantageous as well, improving circulation to tendons and ligaments and breaking adhesions in the muscles. Adhesions are muscle fibers that bundle up and need to be separated to improve freedom of movement. A proper pre-ride self-massage leaves the legs warm and invigorated.

Plan on spending about 10 minutes on the pre-ride massage, roughly one minute per muscle group.

 Post-Ride Massage

After a long, sometimes grueling ride, the body begs for recovery. Legs take the brunt of the punishment -- cramping and general soreness is the most common result. The upper body also takes a beating because of the unnatural posture required for serious cycling.

"The most common problem area during the ride is probably the quads," said Julie Arrowood, a Colorado therapist who has worked on the multi-day Ride the Rockies tour for many years. "The pedaling motion, especially during the steep climbs, puts tremendous strain on that area. The upper back and shoulders also require a lot of attention. If it's a head-wind day with a lot of climbing, the lower back and gluts are the most common complaint. The climbs can lead to a lot of cramping. Some people need work on their knees. We don't get a lot of injuries, just a lot of sore muscles. Most participants in Ride the Rockies are in pretty good shape. They know their bodies pretty well. They also realize getting worked on regularly by a therapist can really help them make it through the week in better shape." 

A post-activity massage for almost any athlete improves recovery time by allowing fluids and toxins to be moved out of the interstitial spaces between muscle fibers, and allowing blood flow, oxygen and nutrients an opportunity to get back in. An increase of blood flow and nutrient to the muscles naturally translates to better recovery. 

In the case of more serious injuries, massage can have the same effect. Swelling caused by an injury, and the production of non-flexible scar tissue, can "pinch" the flow of blood to the injured area. Athletes suffering ankle sprains or other joint strains will find massage can speed recovery by sending more blood and nutrients to the injured area.

 Swelling is the evil anti-recovery agent. Whether it is caused by traumatic injury or micro-trauma to the muscle fibers during exertion, it should be treated with cold (cryotherapy), not heat. Heat increases swelling, cold decreases swelling. Therefore, no matter how inviting that hot tub looks, or how good it may feel, stay away from it. The heat will slow recovery.

Hot versus Cold Therapy

There is often confusion following an injury concerning whether to apply cold therapy or whether to warm the area. The answer depends on the type of injury you have sustained.

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Acute Injuries

Acute injuries are those which result from traumatic incidents (a fall, twisting movement or direct blow for example) and are immediately painful.

When an acute injury first occurs, bleeding, inflammation, swelling and pain must all be controlled. Ice should be applied as soon as possible in order to cool the tissues, reduce their metabolic rate and nerve conduction velocity and cause vasoconstriction of the surrounding blood vessels.

Ice should remain in contact for up to 20 minutes at a time (dependant on the size of the area being treated and the depth of the injured structure) and be re-applied regularly, every 2-3 hours.

Following approximately the first 3-5 days of an acute injury, once bleeding has stopped and there are no signs of inflammation, you may wish to alternate cold and heat treatments. That is apply cold for 10 minutes, followed immediately by 10 minutes of heat. Doing this causes massive increases in blood flow to the area as the vasoconstriction caused by cooling reverses when heat is applied, resulting in an influx of blood to the damaged tissues. Ensure all bleeding has stopped before applying this technique. Blood is vitally important in providing all of the energy and nutrients that the body needs for repair.

Chronic Injuries

Chronic injuries usually do not present with a sudden onset. They tend to gradually build up over a period of days, weeks or longer and are often caused by overuse or biomechanical abnormality. A chronic injury can also be caused by an acute injury which fails to heal due to a lack of, or inappropriate treatment.

Heat therapy should be applied for 15-20 minutes in the form of hot water bottles, a warm damp towel, heat rub or commercially available heat pads. If using something such as a hot water bottle, ensure a suitable layer of protection is placed over the skin to prevent burns.

In general heat should be used to treat chronic injuries, to help relax tight, aching muscles and joints, increase elasticity of ligaments and tendons and increase the blood flow to the area. Heat therapy can also be used prior to exercise in chronic injuries to warm the muscles and increase flexibility.

The only time ice should be used on chronic injuries is after exercise, to reduce any residual swelling.

Massage Therapy for Those Who Exercise

Research findings from American Massage Therapy Association (AMTAMassage.org)

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Sports massage can be used to improve athletic performance, speed recovery, and can be utilized by all individuals who participate in any athletic and/or exercise program to help improve conditioning and maintain peak performance. Many professional and collegiate athletic programs employ or contract with massage therapists, and sports massage has been sought for many years by athletes of differing backgrounds for multiple reasons.With the 2008 Physical Activity Guidelines being very clear that activity is essential for people to be healthy, sports massage can be recommended to those individuals who participate in exercise programs as well as professional and collegiate athletes.

Research has shown that in relation to exercise and athletic participation massage can:

  • Reduce muscle tension
  • Help athletes monitor muscle tone
  • Promote relaxation
  • Reduce muscle hypertonicity
  • Increase range of motion
  • Improve soft tissue function
  • Support recovery from the transient immunosuppression state
  • Support the recovery of heart rate variability and diastolic blood pressure after high-intensity exercise.
  • Decrease muscle stiffness and fatigue after exercise
  • Improve exercise performance
  • Decrease delayed onset muscle soreness
  • Be the most efficient intervention for maintaining maximal performance time in subsequent exercise tests when combined with active recovery from maximal exercise
  • Reduce serum creatine kinase post exercise
  • Reduce swelling
  • Reduce breathing pattern disorders
  • Enhance athletic performance
  • May help prevent injuries when massage is received regularly

Individuals who participate in exercise and athletic programs who seek enhanced performance, improved conditioning, faster recovery, injury prevention, and assistance in maintaining peek fitness can benefit from massage therapy given by professional massage therapists working within their scope of practice.

Click here to read this article in full, along with Research References.

How Massage Heals Sore Muscles

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A massage after vigorous exercise unquestionably feels good, and it seems to reduce pain and help muscles recover. Many people — both athletes and health professionals – have long contended it eases inflammation, improves blood flow and reduces muscle tightness. But until now no one has understood why massage has this apparently beneficial effect.

Now researchers have found what happens to muscles when a masseur goes to work on them.

 Their experiment required having people exercise to exhaustion and undergo five incisions in their legs in order to obtain muscle tissue for analysis. Despite the hurdles, the scientists still managed to find 11 brave young male volunteers. The study was published in the Feb. 1 issue of Science Translational Medicine.

On a first visit, they biopsied one leg of each subject at rest. At a second session, they had them vigorously exercise on a stationary bicycle for more than an hour until they could go no further. Then they massaged one thigh of each subject for 10 minutes, leaving the other to recover on its own. Immediately after the massage, they biopsied the thigh muscle in each leg again. After allowing another two-and-a-half hours of rest, they did a third biopsy to track the process of muscle injury and repair.

Vigorous exercise causes tiny tears in muscle fibers, leading to an immune reaction — inflammation — as the body gets to work repairing the injured cells. So the researchers screened the tissue from the massaged and unmassaged legs to compare their repair processes, and find out what difference massage would make.

They found that massage reduced the production of compounds called cytokines, which play a critical role in inflammation. Massage also stimulated mitochondria, the tiny powerhouses inside cells that convert glucose into the energy essential for cell function and repair. “The bottom line is that there appears to be a suppression of pathways in inflammation and an increase in mitochondrial biogenesis,” helping the muscle adapt to the demands of increased exercise, said the senior author, Dr. Mark A. Tarnopolsky.

Dr. Tarnopolsky, a professor of pediatrics and medicine at McMaster University in Hamilton, Ontario, said that massage works quite differently from Nsaids and other anti-inflammatory drugs, which reduce inflammation and pain but may actually retard healing. Many people, for instance, pop an aspirin or Aleve at the first sign of muscle soreness. “There’s some theoretical concern that there is a maladaptive response in the long run if you’re constantly suppressing inflammation with drugs,” he said. “With massage, you can have your cake and eat it too—massage can suppress inflammation and actually enhance cell recovery.” 

“This is important research, because it is the first to show that massage can reduce pro-inflammatory cytokines which may be involved in pain,” said Tiffany Field, director of the Touch Research Institute at the University of Miami Medical School. She was not involved in the study. “We have known from many studies that pain can be reduced by massage based on self-report, but this is the first demonstration that the pain-related pro-inflammatory cytokines can be reduced.” she said.

Getting a massage from a professional masseur is obviously more expensive than taking an aspirin. But, as Dr. Field points out, massage techniques can be taught. “People within families can learn to massage each other,” she said. “If you can teach parents to massage kids, couples to massage each other. This can be cost effective.”

Dr. Tarnopolsky suggests that, in the long run, a professional massage may even be a better bargain than a pill. “If someone says “This is free and it might make you feel better, but it may slow down your recovery, do you still want it?” he asked. “Or would you rather spend the 50 bucks for a post-exercise massage that also might enhance your recovery?”