As a practitioner working in the field of Specific Injury since 2010, certain therapeutic massage techniques have been found to help speed the process of recovery. Acute injury is a sudden, sharp, traumatic injury that causes pain, such as a fall, strain, sprain or collision. When the body experiences an acute injury, there is an acute period of healing, generally lasting 48-72 hours, which typically involves pain and inflammation.
The four cardinal signs of inflammation are known as redness, swelling, local heat, and swelling. During this time, massage would be contraindicated as an effective technique while the body's own immune response is stimulated and begins its job of healing.
R.I.C.E. is a well known methodology to treating the injury for the first 48 hours, consisting of Rest, Ice, Compression, and Elevation. If the pain or swelling has not decreased after two full days, a visit to a physician would be the next step. H.A.R.M. is another acronym known for Heat, Alcohol consumption, Running, and Massage that should be avoided as not to exacerbate the symptoms or make the injury worse. Once this time period has passed, some therapies would be acceptable depending on the individual nature of the injury and the patient being treated.
In Workers' Comp, for example, it's common for the patients to begin with physical therapy, and then massage, chiropractic, and acupuncture may be gradually incorporated along with the continuing physical therapy.
I'm often asked what kind of massage do I look for to treat injuries? For the most part, I believe massage therapy to be an integrative modality, although there are certainly therapists who specialize in a singlular technique. Most massage therapists tend to be trained in many modalities in massage school, and then specialize with time and experience in the field. It's beneficial to become acquainted with some well known techniques so you can better choose the best massage therapist for you.
Neuromuscular therapy is an approach to soft tissue manual therapy commonly used in injury work by massage therapists, physical therapists, among many other healthcare professionals. Manual pressure and friction techniques are used to release tender or trigger points. Its goal is to help relieve the pain and dysfunction by understanding and alleviating the underlying cause. Often the client actively participates by breathing deeply and communicating with the therapist as the referral patterns subside (15-30 seconds generally, sometimes more) and become more localized to the manual pressure being applied.
Trigger points are defined as tender, small contraction knots that typically refer pain, called "active" trigger points. Active trigger points are often caused by injury, muscular strain, and overuse. Travell and Simons define a trigger point as "a highly irritable localized spot of exquisite tenderness in a nodule in a palpable taut band of muscle tissue." Common massage techniques include effleurage, gliding, petrissage, grasping, and friction. Over time, the "active" trigger points will relax and refer less pain, tingling, and numbness. They will become "latent" and perhaps only tender locally to the touch. Although myofascial trigger points may be found in the muscle tissue or muscle fascia, trigger points in general may also be present in cutaneous, ligamentous, periosteal, and non-muscular fascial tissues.
Trigger points can be so intense that they may elude to misdiagnosis. For example, "chronic jaw pain, toothaches, earaches, sinusitis, ringing in the ears (tinnitus), and dizziness may be symptoms of trigger points in the muscles around the jaw, face, head and neck." Neuromuscular therapy also addresses circulation, nerve compression, postural issues, and biomechanical problems that can be affected by specific injuries.
There are many hands-on approaches to myofascial bodywork, many that come from the long lineage of Dr. Ida Rolf's structural integration and its osteopathic influences. Her life's work was devoted to this investigation which led to the system of soft tissue manipulation and movement education that we now call Rolfing®, and has influenced Myofascial approaches for many years. As quoted from the Myofascial Release® Treatment Center website, "Myofascial Release is a safe and very effective hands-on technique that involves applying gentle sustained pressure into the Myofascial connective tissue restrictions to eliminate pain and restore motion. This essential “time element” has to do with the viscous flow and the piezoelectric phenomenon: a low load (gentle pressure) applied slowly will allow a viscoelastic medium (fascia) to elongate."
Long, firm stretching strokes are employed without the use of oils to release fascial restrictions in the soft tissue caused by trauma and injury, poor posture, or inflammation. Fascia is defined as "a band or sheet of connective tissue that attaches, stabilizes, encloses, and separates muscles and other internal organs." The three layers of fascia are termed superficial, visceral, or deep. Superficial fascia is on the lowermost layer of the skin in nearly all the regions of the body, such as on the face, nape of the neck, and overlying the breastbone. The superficial fascia primarily determines the shape of the body. Visceral fascia is mostly associated with the internal organs and the name of that fascia varies according to the anatomical location or structure. For example, the visceral fascia covering the heart is called the pericardium, and in the brain, they are known as meninges.
Deep fascia is mostly associated with the muscles, bones, nerves and blood vessels. It is a layer of deep connective tissue which surrounds individual muscle fibers, individual muscles, and groups of muscles. A helpful analogy to understand fascial restriction would be if you got a single snag or pull on a knit sweater, and the sweater bunches up and becomes disorganized. Deep fascia in the body works like this, and has an effect on the surrounding muscles, nerves, and soft tissue. This layer is richly supplied with sensory receptors and can benefit from myofascial release during a massage. Examples would be plantar fascia and thoracolumbar fascia.
Many of my favorite and most effective myofascial techniques for specific injury work have been developed by Til Luchau, former Rolfer and lead instructor and the Director of Advanced-Trainings.com. These techniques have been employed by many manual therapy practitioners, including structural integration therapists, physical therapists, massage therapists, osteopaths, chiropractors, acupuncturists, and more.
Til describes the two primary goals as (1): “Increase options for movement and mobility, ranging from subtle micro movement pulsations to gross range of movement”; and (2): “Refine the proprioceptive sense, meaning wanting the client to feel and perceive their bodies in new ways as a result of the work.” Myofascial work can have a deep effect on our bodies, musculature, and postural habits, while relieving pain and improving the patients' level of functioning and recovery.
Deep Tissue Massage
Although Deep Tissue Massage has a reputation for being an aggressive and painful approach, it can be a very helpful modality to treat injuries. Professionally, I do not advertise "Deep Tissue" on my website because of such false connotations. Generally, clients who are looking for massages that "hurt so good" are seeking an aggressive form of treatment which may or may not cause enduring soreness for days following a session. No pain, no gain is certainly a myth in my opinion when it comes to massage. For example, extremely light work such as lymphatic drainage and craniosacral therapy, can have a huge and positive impact on clients. This is not to say that other techniques are not “deep tissue” or affecting the deeper layers of soft tissue to achieve effective results. In fact, its quite common for my workers’ comp patients with injuries to be sore for 1-3 days following the first session, however, the length of soreness subsides with subsequent and consistent work. By medical definition, however, deep tissue is not so scary and can be a beneficial modality.
As defined by the Medical Dictionary, Deep Tissue Massage is characterized by "a group of massage techniques designed to access multiple layers of muscle and fascia to improve alignment, reduce levels of resting tension, and create more efficient postural and movement patterns." It is a type of massage in which the "fingers, thumbs and elbows are used to release chronic muscle tension, using slow, deep strokes and friction; the therapist may work perpendicularly to the length of the fibers of the superficial muscles, with the intent of massaging muscle that lies underneath."
Deep tissue massage addresses fascial restrictions, relieves muscular and joint pain, and improves posture. It is known to decrease chronic back pain, decrease arthritic symptoms, aid muscle rehabilitation in athletes, alleviate fibromyalgia symptoms, and break down scar tissue.
Swedish Massage is probably one of the most well-known massage techniques and very popular in spa settings. It is generally given as a relaxation massage, incorporating long, broad strokes. To increase circulation and improve flexibility while easing tension, Swedish Massage incorporates the following five basic strokes, all flowing towards the heart.
Davies, Clair and Amber. The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief. Oakland: New Harbinger Publications, Inc., 2004. Print.
“What is Myofascial Release?” Myofascial Release®: Treatment Centers & Seminars.
Retrieved from www.myofascialrelease.com/about/definition.aspx
Luchau, Til. Advanced Myofascial Techniques: Shoulder, Pelvis , Leg, and Foot. Scotland: Handspring Publishing Limited, 2015. Print.
"Deep Tissue Massage". (n.d.) Segen's Medical Dictionary. (2011). Retrieved March 16 2018 from https://medical-dictionary.thefreedictionary.com/deep+tissue+massage
"Deep Tissue Massage". (n.d.) Medical Dictionary for the Health Professions and Nursing. (2012). Retrieved March 16 2018 from https://medical-dictionary.thefreedictionary.com/deep+tissue+massage
Swedish Massage. Retrieved from http://strictlytherapeutic.com/swedish.html
Photo by Harlie Raethel on Unsplash
Coviello, Jason. “Ranpreet Kaur, Massage Therapist.” 2015. Digital Photographs, http://www.jcartistry.com.