As athletes from professionals and Olympians to high schoolers and weekend warriors seek to recover from training, many turn to massage therapy. Sports massage, however, is not a specific technique but the concept of applying massage to active individuals.
There is a variety of research on massage and sports massage available to help massage therapists improve their practices with this population if you know how to incorporate research into practice.
Where do you look for the research? Do you understand how to make the connection from research to practice? Making that connection from research to practice is a skill that can be used by every clinician. If you consider yourself a sports massage therapist or are just looking to add another dimension to your clinical practice, understanding how to apply the current research to the skills you already have can transform your practice and benefit your clients or patients.
What an Evidence-Informed Practice Looks Like
It is one thing to know about research and yet another to understand how to put research into practice in creating your own evidence-informed approach. To start this approach, look at a variety of research articles from various levels of the research pyramid, from case reports and observational studies to clinical trials, systematic reviews and meta-analyses for information that can be applied to sports massage.
Start by using keywords, but don’t limit the search to just sports massage; try other keywords—such as manual therapy, recovery from exercise, pre-event or post-event massage— the possibilities are endless. Once you find an article, especially a systematic review, look at the other keywords from the article to aid your search and use the reference list for more potential articles.
Examples of good systematic reviews on sports massage include “The mechanisms of massage and effects on performance, muscle recovery and injury prevention,” which outlines the benefits of massage on physiological, neurological and psychological outcomes and inconclusive results on performance measures.1 While this article is a bit older in research terms, it is a good place to start.
More recent articles include a meta-analysis and systematic review of massage on delayed onset muscle soreness (DOMS)2 as well as a meta-analytical review of massage and performance recovery.3 Interestingly, the review on DOMS included both Western and Chinese-based massage protocols with the evidence suggesting massage is effective in reducing muscle pain and serum creatine kinase levels while increasing performance outcomes, with the highest efficacy of massage being 48 hours post-exercise.2 In terms of recovery, about five to 12 minutes of massage per area has a large effect size, which can help identify treatment dose.3
A systematic review typically examines a number of randomized, controlled trials, which will be listed in the article and in the reference list. This is another way to generate your article search. Once you find the articles, you can begin examining for relevance in all of the parts of the study, from the introduction and methods through the results and discussion, looking for any clinical application to your own practice.
Do not expect every research article to give you all the information you need or even one article to drive your practice. Titles can sometimes be misleading, which means you cannot start or stop there. Read the abstract for a quick overview of the purpose of the study, the methods, the most prominent results and a summation. Does this article have some promise to your clinical practice or to a specific clinical question you have? Great! Let’s move to examine the parts of the article for relevance to clinical practice.
The Introduction
A good introduction is like a funnel, starting broad and narrowing the focus by the end of the section. The introduction outlines current research, shows what has been done already, and creates gaps in the literature as it narrows to the purpose statement which will tell the research question the author is answering. While the purpose statement is an important piece to the literature, not every article will answer your exact question. Even if the questions don’t match, the article may have a few points that can help in your practice. Also, if there was an interesting point in the introduction, look at the reference article for another source.
The Methodology
Now the methods: Who is the population? Gender; age range; athlete type or just an active individual? What are the inclusion and exclusion criteria? Does this population match your clients, or could you extrapolate information from that group? What are the massage protocols used? How are they being tested?
The Protocols
One of the reasons it is important to examine all different types of methodology for research is because the research protocols are often stringent, unlike clinical application. The massage protocol for research must be reproduced the exact same way for every intervention, down to the order and number of the massage strokes applied.
An example protocol for a five-minute pre-competition massage on the triceps surae included one minute of high-frequency effleurage, one minute of high-frequency petrissage, one minute of high-frequency vibrations, one minute of high-frequency petrissage and one minute of high-frequency effleurage.4 This protocol was developed based on previous research protocols, not client goals. Practitioners tend to shy away from using stringent protocols; however, comparing research across studies, as occurs in a meta-analysis, is optimal when the same protocol is applied.
By reviewing a wide range of studies, including case reports, case series or cohort models, it is easier to develop a unique protocol to match client goals based on the available research as opposed to relying on one study to provide the therapeutic protocol.
The Results
Quantitative research includes a p value, which we use to determine statistical significance, indicating the intervention caused the change and not by chance. And while this is necessary in a research study, it does not take into account individual differences which may be clinically significant to your client/patient while not statistically significant in research.
For example, performance measures are not often statistically significant after massage treatment; however, they are also not statistically significant.1 Alternately, smallest worthwhile enhancement (the minimum improvement making massage worthwhile) evaluates the potential for individual improvements in performance, results that are relevant for a competitive athlete.3
The results section will often feature quantitative statistical measures, although some subjective measures may also be included. For purposes of this article, I am going to focus on quantitative studies. Results will include such participant demographics as age, height, body mass, and (perhaps) years participating in sport.
The Discussion
Looking deeper into the results through the discussion can reveal more than just the statistics. It can be tough to go through the results section until you have a better handle on research, but the discussion section should explain what the results mean to the researcher and how they compare with the other literature in the field.
The discussion should be a reverse of the introduction, starting narrowly and ending broadly. The first paragraph of a good discussion will tell the reader the most interesting finding, according to the researchers, and how these findings relate to the current research. However, make sure to consider the entire discussion and how the context feeds into your own research question.
For example, a study that is termed as evaluating pre-competition massage protocol examines tensiomyography and myotonometry with the variables of contraction time, delay time and sustained time, the mean values of which are not familiar to most clinicians.4 The discussion is where the results can be explained and tied to the literature. The discussion can be very expansive in a systematic review or meta-analysis, as it often covers a variety of protocols.
Your Clinical Eye
Just as with the methodology and results, what is stated is in a research context and needs to be applied using a clinical eye. Do the findings match your research question, even if the actual study did not find significant results? Is there something there that can be applied to your own practice?
Using the study mentioned above as our example, it seems that pre-competition massage might not have the desired effects on the muscles; however, if this is a protocol you might use in other areas of practice, the results would be applicable.4
Pay attention to the study limitations that are listed as well as the direction for future study. Do either of these give you any ideas for research questions? Some journals also add a clinical application section. This is a good place to get ideas as to how the researcher intends the research to be used.
Now that you understand the basics and have a few articles for reference, you can begin to formulate your own plan for creating evidence-informed sports massage treatments.
About the Author
Portia Resnick, PhD, ATC, BCTMB, LMT, has over 20 years of experience in sports medicine. She was educated at the Somerset School of Massage Therapy and taught at the school until 2010. In 2017 she completed her PhD in Kinesiology at the University of Hawaii, Manoa. She is an assistant professor at California State University, Long Beach.
Footnotes
3. Poppendieck et al; Massage and Performance Recovery: A Meta-Analytic Review; Sports Med; (46); 2016