Category Archives: Performance Enhancing Massage

The Benefits of Massage

Massages feels amazing, especially after a grueling workout—and their benefits aren’t just skin deep. Soft tissue massage is exceptionally good for bone-weary athletes and people with inflammation-related chronic conditions like arthritis and muscular dystrophy, according to research from McMaster University. Vigorous exercise causes small tears in your muscle fibers, and your body’s natural repair process naturally leads to inflammation and soreness.

To see if massage truly aids recovery, the researchers biopsied volunteers’ legs over the course of three sessions—once while at rest, a second time after they’d vigorously exercised on a stationary bike and received a 10-minute massage on one thigh, and a third biopsy two and a half hours after the second to track the repair processes between the massaged and un-massaged legs.

Unsurprisingly, massage reduced the production of cytokines, which play a critical role in inflammation, and stimulated mitochondria—the tiny powerhouses inside your cells that convert glucose into energy for cell function and repair. So make sure to schedule regular massages; your muscles will adapt better to the demands of increased exercise.

Why Ice and Anti-inflammatory Medication is NOT the Answer

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This is a reprint from Stone Athletic Medicine:

In July I posted a blog discussing The Overuse of Cryotherapy. The controversy surrounding the topic made it one of the most popular blogs I’ve written. What is surprising to me is that a controversy exists at all. Why, where, and when did this notion of anti-inflammation start? Ice, compression, elevation and NSAIDs are so commonplace that suggesting otherwise is laughable to most. Enter an Athletic Training Room or Physical Therapy Clinic nearly all clients are receiving some type of anti-inflammatory treatment (ice, compression, massage, NSAIDs, biophysical modalities, etc). I evaluated a client the other day and asked what are you doing currently – “Well, I am taking anti-inflammatories and icing.” Why do you want to get rid of inflammation and swelling? I ask this question for both chronic and acute injury!

The Stigma of Inflammation:

Editor in Chief of The Physician and Sports Medicine Journal (Dr. Nick DiNubile) once posed this question: “Seriously, do you honestly believe that your body’s natural inflammatory response is a mistake?” Much like a fever increases body temperature to kill off foreign invaders; inflammation is the first physiological process to the repair and remodeling of tissue. Inflammation, repair, and remodel. You cannot have tissue repair or remodeling without inflammation. In a healthy healing process, a proliferative phase consisting of a mixture of inflammatory cells and fibroblasts naturally follows the inflammatory phase (1). Researchers headed by Lan Zhou, MD, PhD, at the Cleveland Clinic, found that in response to acute muscle injury, inflammatory cells within the damaged muscle conduct phagocytosis, contribute to accumulation of intramuscular macrophages, and produce a high-level of Insulin-like growth factor 1, (IGF-1) which is required for muscle regeneration (3). IGF-1 is a primary mediator of the effects of growth hormone and a stimulator of cell growth and proliferation, and a potent inhibitor of programmed cell death. Similarly, in 2010, Cottrell and O’Conner stated “overwhelmingly, NSAIDs inhibit or delay fracture healing” (2). And you want to stop this critical process of healing by applying ice, because inflammation is “bad”?

The Anecdotal Rationale for Ice:

Somewhere along the line the concept that ice facilitates healing became conventional wisdom. Sorry, that wisdom is wrong. I had someone tell me the other day, “We need to ice, because we need to get the swelling out.” Really? Does ice facilitate movement of fluid out of the injured area? No, it does not. The lymphatic system removes swelling. The Textbook of Medical Physiology says it best: “The lymphatic system is a ‘scavenger’ system that removes excess fluid, protein molecules, debris, and other matter from the tissue spaces. When fluid enters the terminal lymphatic capillaries, any motion in the tissues that intermittently compresses the lymphatic capillaries propels the lymph forward through the lymphatic system, eventually emptying the lymph back into the circulation.” Lymphatic drainage is facilitated by contraction of surrounding muscle and changes in compressive forces that push the fluid back to the cardiovascular system. This is why ankle pumps work so well at removing swelling.

Inflammation is a necessary component in the first phase of phase of the healing process. Swelling is controlled by the body’s internal systems to attain homeostasis. If swelling is accumulated it is not because there is excessive swelling, rather it is because lymphatic drainage is slowed. The thought that ice application increases lymphatic flow to remove debris makes no sense. Gary Reinl, author of “Iced! The Illusionary Treatment option gave me a good analogy. Take two tubes of toothpaste, one is under ice for 20 minutes, the other is warmed to 99 degrees. In which tube will the toothpaste flow fastest? It does not take an advanced physics degree to know that answer.

What might surprise you is that ice actually reverses lymphatic drainage and pushes fluid back to interstitial space. A study published in 1986 (yes, 1986, is old, but this is a foundational study) found when ice is applied to a body part for a prolonged period of time; lymphatic vessels begin to dramatically increase permeability. As lymphatic permeability increases fluid will pour from the lymphatics into the injured area, increasing the amount of local swelling (5). Ice can increase swelling and retard debris removal!

The Acronym RICE is Bogus:

The acronym RICE is bogus in my opinion. First, Rest is not the answer. Rest does not stimulate tissue repair. In fact rest causes tissue to waste and can cause abnormal gene transcription of collagen tissue. Evidence has shown that tissue loading through exercise or other mechanical means stimulates gene transcription, proteogenesis, and formation of type I collagen fibers (See studies by Karim Khan, Durieux, Mick Joseph, and Craig Denegar). Our body has all types of cells. When a cell is born it has no clue what type of cell it will eventually become. This infancy cell – for lack of a better term – is called a progenitor cell. Progenitor cells can be changed to a specific cell type. Load in tendon tells our body to turn a progenitor cell in to a tenocyte. Load in bone tells a progenitor cell to become an osteocyte. Ever wonder why myositis ossificans (calcification or bone growth in muscle) develops? The direct, repeated trauma turns progenitor cell currently living within muscle to an osteocyte. Subsequently, we develop bone growth within muscle.

The other reason RICE is bogus is obvious; Ice. Ice does nothing to facilitate collagen formation. Ice will not influence progenitor cell development. Ice does not regenerate tissue. Ice does not facilitate healing – it inhibits natural healing process from occurring. Ice does not remove swelling; it increases swelling and lymphatic backflow.

Closing thoughts:

Bottom line, ice and NSAIDs are over utilized. I am not saying never, but I am saying ice is not a magical cure all that fixes everything and is required for healing. It is not the gold standard that it has come to be. My goal with this blog is to get individuals to stop and think before immediately turning to ice and NSAIDs. Is it really the best option? Is it necessary for this injury at this stage? I understand it is not the only form of treatment clinicians use, but ice certainly is the most heavily used. Go ahead, I will wait while you look at your treatment logs.

My goal is to get this trend reversed one clinician and one patient at a time. Have you seen the video discussion between Kelly Starrett, DPT and Gary Reinl? If not I recommend you watch it. It’s fascinating. I am glad to have expert minds like Kelly and Gary in this fight with me.

I ask health care professionals to do one thing, just try it. Pick one client with chronic musculoskeletal pain, skip the ice, skip the NSAIDs and try to use light exercise as a repair stimulus. Then, try skipping the ice on a client with an acute mild injury. The outcomes might surprise you.

Could Your Horse Do Better at Shows?

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If your horse has squeaky clean X-rays and MRI’s, does that mean the horse is pain free? You can ask the same question about your own body. The answer is, of course, no. If you play tennis or ski or ride or dance or even garden, you know you can hurt without being injured. The same goes for your horse. What surrounds the skeleton is of more importance than the skeleton itself. Until fairly recently, the fascia has been largely ignored by most health care professionals, and cannot be seen in standard tests such as X-rays and MRIs.

The body work that I do on horses is meant to alleviate the pain and stress of horse sport. If the body is balanced and symmetrical, then the body can move gracefully, without distortion. This restoration of the body can be done gently and thoroughly with a combination of myofascial release, stress point, and trigger point therapy,

Strains, due to injuries and accidents, get lodged in the body when a horse compensates movement during the healing process. Unless these compensations are fully released and realigned, they eventually become chronic strains that limit coordinated movement and cause pain. Horses need massage just as much, if not more, than any human athlete, since they have to carry someone on their back! The benefits of massage are the same for horse or human, with increased suppleness, better range of motion, and quicker recovery from injury. This therapy is so much more than a relaxation massage. It improves performance and longevity in whatever sport or casual use they are involved in.

My biggest thrill is to help an animal become pain free. They behave and perform differently. Their whole personality and energy can change. And the results of the massage can be long lasting.

The Body Remembers

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The nervous system remembers the pain and trauma of an injury. With your horse, you might see this as stiffness at the beginning of a workout, or extreme caution. When a rider tells me their horse just “doesn’t want to jump anymore”, I suspect muscle pain and get to work looking for it.

Trauma accumulates in the body, starting at birth. Have you considered how much trauma there is for a foal during the birth process? The results can set up tight muscle patterns that last a lifetime, unless manually removed.

Myofascial release aims to relax contracted muscles, improve blood and lymphatic circulation, and stimulate the stretch reflex in muscles. Often I stand back after just one bodywork session and see that the body is already reorganizing itself. The body looks less chopped up into sections and more of one flowing form. During a session the body of the horse is educated in the process to move the way it is supposed to: in balance and without restrictions. If the connective tissue that covers every muscle, bone, nerve, blood vessel, and organ in the body is free of restriction, the horse will move and behave in a completely different way.

Myofascial therapy relieves soft tissue restrictions that cause pain. Some causes of chronic muscle pain are easier to diagnose than others: trauma from birth or a fall, cumulative posture misalignment , a compressed nerve from poor saddle fit, etc.

When pain is caused by Myofascial tightness the diagnosis can be difficult, as fascia restrictions do not show up on MRI scans or X-rays. Yet, those restrictions can play a significant role in creating pain and malfunction in the structure of the back and legs. Every horse (and dog and human!!) should experience pain free movement that can result from having restrictions removed.

Preventing Injury in Your Riding Horse

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What would your horse be like if all his muscles were in a state of relaxation, free from tension? Deep tissue massage, stress and trigger point therapy, and myofascial release
will help the connective tissue become more elastic, thereby allowing the muscle to return to its natural shape.

It is very important for horses to maintain a comfortable and free range of motion. If certain muscles are tight, other muscles in the body will compensate and take up the extra workload. They may be ridden like this for weeks, months or years, until the body can no longer call on extra resources because it does not have them. This ultimately leads to ruptures of soft tissues and thickening of the tendon and ligaments, which eventually can cause permanent dysfunction of the affected area.

Muscles attach to bones in pairs of opposites, and cross one joint or more. Muscles free from tension will carry out the function of keeping joints in alignment. This allows joint fluid to flow evenly within the joint, and this reduces unnatural wear and tear of joints.

Each muscle is attached to bone by tendons. Muscles are designed to take 90% of workload and tendons the other 10% The muscle is where the elasticity is. If the muscle is not functioning properly then the tendons will take more load and can eventually tear.

Equine massage therapy is a very powerful tool in injury prevention for horses.

How the Body Regulates Muscle Tension

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Tendons connect muscles to bone. There are groups of cells within a tendon, where the fibers of the muscle meet the tendon, called Golgi tendon bodies. Made up of strands of collagen, the Golgi organ also contains nerve tissue. The major function of this organ is to sense muscle tension when a muscle is contracted, sending signals to the brain about how much force is being exerted.

Golgi tendon organs and muscle spindle cells work together to prevent injury to muscles. The more the muscle tries to stretch and the faster it tries to stretch, the more the Golgi tendon organs cause it to contract.

These nerve cells and fibers can be influenced by massage. Golgi tendon organs react to sustained pressure such as trigger point therapy and stress point therapy, by telling the muscle to relax.

The Importance of a Gentle Warm Up

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Probably the biggest problem I observe is riders demanding a “frame” from their horse within moments of mounting. Using hands to force the head and neck into a fixed shape causes damage that is difficult to reverse. Without a good period of time that allows the horse to stretch, warm up muscles, and find their balance under the rider, muscles and fascia tend to get stuck into adhesions.

Superficial fascia is the connective tissue that is found beneath the skin. This tissue links and covers blood vessels, nerves, muscles, and bones. The fascia and muscle combine to form the mysofascial system. Adhesions limit muscle movement which interferes with performance. Adhesions can also cause severe pain, reduced flexibility, and tender trigger points.

To release adhesions, I use a technique called ‘myofascial release.’ This technique involves applying gentle but sustained pressure on the soft tissue. During this technique, it is also important to target the fascia. This helps to lengthen and soften the fascia and break up the adhesions and any scar tissue that is present between the bones, muscles, and skin. Scientific evidence shows that myofascial release offers relief from different types of joint and muscle pains. Flexibility and movement is then restored.

Care of Your Equine Athlete

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People often make comments to me like “You must have really strong hands” or “Your arms must have big muscles”, but Trigger Point Therapy, Myofascial Release, Stress Point Therapy are all fairly gentle practices. Accuracy, through knowledge of anatomy, reduces the need for brute strength. The massage is deep, with firm pressure, stimulating endorphins, and the horse often helps me by leaning into my hands.

Trigger Point therapy targets areas of stress where muscle attaches to bone. The treatment specifically targets areas of constriction that refer pain signals to other parts of the body. Myofascial release is related to trigger point therapy, but focuses on tightness , or other disorders afflicting the fascia, a membrane that surrounds the muscles and may restrict their motion. What makes my work so exciting is that I can switch methods as I move around the horse, using what is needed for each area of the body.

All animals need to have their bodies in balance to live long and active lives. For show horses it makes the difference between winning and being withdrawn from the competition Tight muscles can affect posture, and poor posture can cause spinal misalignments. The reverse is also true — spinal alignments can lead to muscle strain.

Massage therapy should also be part of the process of rehabilitating from injuries, regaining lost range of motion, or coping with chronic pain conditions. Body work for your horse can produce dramatic results in a short period of time: one of the many reasons it is so exciting for me to go to work!

My Detective Work

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I often say that doing body work on animals is detective work. I get a medical history from the owner, but not from the client himself. The horse or dog can’t point out where they might be feeling pain, so I have to tune in to all their subtle signals (and you would be amazed how stoic some animals can be!).

About 75% of trigger points are not where the pain is, so a thorough knowledge of anatomy, stress, and trigger points is essential. I worked on a young mare that was expressing discomfort in her neck. She tossed her head a lot, especially during transitions. When her rider picked up the reins, she curled her nose to her chest. She was showing discomfort, but after examining her, I found her pelvis was very uneven. Her right pelvic crest (what some people might call the hip) was a good two inches higher than the left. It took three adjustments during the session to finally get her body level, but she was very focused on helping during the work. She walked off showing a fluid movement that we had not seen before, and she kept stretching her neck out. Reports from the rider have been very positive: the mare continues to improve, stretch, move forward, and seek contact.

Trigger point referral patterns from multiple trigger points can overlap, causing a composite referral pattern. This has been the case with the young and green mare. As one problem gets resolved, it leads me to the next. Instead of resorting to gadgets to fix her head tossing, the wise owner had an inkling that the mare was feeling pain. If I only work on the area where the pain is presenting, there will not be relief.

This mare is competing very well at her first show as I write this. I will continue to help her keep her body balanced and pain free. I’m expecting great things from this wonderful athlete who just needed a little help to take off!

Extend The Career of Your Equine Athlete

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Many riders tell me their horse feels off when they first get on, but works out of it. In some cases, this could be the sign of something serious needing further investigation. Soreness can disappear as the horse warms up, and then reappear a few hours after the work out. The reason is that soft tissue injuries almost always cause more pain when they are cold, because that is when the muscles are tightest. As the muscles warm up, they stretch out and send fewer pain signals. After the work out, all the soft tissue cools down and tightens again, often adding a few more muscle fibers to the tight area. You can see how, over time, this scenario can turn into more pain and escalate into an injury requiring a long lay-up.

Just because an injured area feels better after it warms up doesn’t mean that everything is okay. Stiffness and pain mean something, especially if they create a pattern over time. That is not to say that all muscle soreness is bad. Some aches are inevitable in becoming fit.

Sports massage for your horse can help ease soreness and pinpoint areas that are prone to tightness. Massage is helpful both before and after (after the horse has cooled down; I never massage right after a workout) exercise.

Massage therapy benefits the body in ways that most warm-up routines fail to do. Over time, select muscles may tighten and shorten. This greatly endangers the body, and unfortunately, an athlete is rarely aware of it until after an injury has occurred. A further benefit of regular sessions is that oxygen flow is naturally improved, which creates healthier conditions for muscles, optimizing body tissue. Increasing the flexibility in soft tissue can greatly reduce the incidence of injury.