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For most of us, massage is the ultimate therapeutic treat that we indulge in once a month or so; to a professional athlete, massage therapy is an everyday and on-the-field essential.

Sports massage is a valuable component in most collegiate, professional, and Olympic training programs across the world. Athletes, trainers and doctors recognize its value in the training room, and out on the field, for conditioning, recovery and competitiveness.

Go behind the scenes – and oftentimes, right on the sideline – at any international sporting event and you’ll find massage therapists either working for an individual athlete, a team, or an organization. And, most sports medicine teams include massage therapists in their ranks.

Research conducted by scientists at McMaster University in Ontario, shows that massage reduces inflammation and promotes the growth of new mitochondria, meaning that sports massage reduces pain, and builds and repairs muscles.

According to AMTA, research shows that massage benefits for pro athletes (or you) include:

• Reduce muscle tension
• Help athletes monitor muscle tone
• Promote relaxation
• Increase range of motion
• Decrease muscle stiffness and soreness after exercise
• Enhance athletic performance
• Help prevent injuries when massage is received regularly

Every day is game day

“Pro athletes spend the majority of the day getting themselves in tiptop shape,” says Kala Flagg, a physical therapist and certified athletic trainer who has worked with NFL players and other elite athletes. An injured pro may go to physical therapy as much as three times a day, according to Flagg. “These athletes also may have a setup at home with hot tubs and cold tubs and icing machines. They have massage therapists and one-on-one yoga instructors. Their bodies are important. They aren’t afraid to invest in them,” she said. Some teams even fine players if they miss a treatment session, she said.

Mark Allen, six-time winner of the Hawaiian Ironman Triathlon, believes that massage was an indispensible part of his training: just as athletes need hard work to excel, they also need massage to quicken recovery between workouts, prevent injuries and reduce stress.

Ancient medicine that’s still working today

Sports massage isn’t new. In fact, the National Center for Biotechnology Information (NCBI) states that Chinese writings dating back thousands of years describe the use of massage therapy to treat injuries and prepare for sporting events.

Records indicate its methods date back to 2700, B.C., when ancient Greek Olympians were massaged with oils, herbs, and dirt with the goal of creating a better athlete, a better competitor, a better champion. Truth is, it remains a pretty accurate view of what sports massage can do to this day, and elite athletes recognize this fact.

The elite advantage

“While professional athletes are in terrific shape, which helps when they get injured, they also have advantages rarely available to the weekend warrior: an instant medical response and a physical therapy regimen that kicks in quickly, that operates practically around the clock and that continues even after the athlete is back in the game,” said Benjamin Shaffer, an orthopedic surgeon in Bethesda who is head team physician for the Washington Capitals and assistant team physician for the Washington Wizards.

The advantage starts as soon as a player goes down. Trainers and physicians rush in with immediate care and decide whether to bring the staff massage therapist into the locker room.

Time is of the essence when treating an injury, doctors and trainers say. In contrast to the pros’ quick-response teams, most of us are stuck scrounging for an appointment with an orthopedist or waiting to schedule an MRI after an athletic injury.

“Amateur athletes go home, wrap some ice on the injury, elevate, take some pain medicine, and call the doctor in a few days if things haven’t improved,” said Jason Craig, an associate professor of physical therapy at Marymount University in Arlington, who has worked with Irish Olympic athletes.  By the time an armchair athlete sees a doctor, not only may an ankle sprain still be very painful, but the delay — and what people do during that time — may also have made the injury worse.

“When our guys hurt themselves, moments after, we are treating them,” said Greg Smith, the head trainer for the Capitals.

“A cadre of professionals using electric stimulation, compression sleeves, anti-gravity treadmills and individually tailored exercises to speed the repair of the body. These techniques and devices can mean the difference between an early return or weeks on the bench,” Shaffer said.

Elite triathlete Marco Coelho agrees: “Massage helps me avoid injury. It reduces my muscle tension and stress.  Bodywork, especially massage, should be part of every athlete’s training.”

The go-to treatment of the elite

Coach, speaker and nationally ranked athlete, Brad Walker, says, “Massage is one of my all-time favorite injury rehabilitation techniques. I’d even go as far as saying; it’s the most effective form of injury rehabilitation therapy for speeding up the healing process and preventing re-injury. Without it, the injured athlete rarely recovers fully.”

According to the American College of Sports Medicine, delayed soreness can begin 12-24 hours after the muscle trauma happens and massage therapy can prevent or relieve this soreness.

NBA stars and legends such as Grant Hill, Steve Nash, and Kobe Bryant, have all used sports massage as a means to stay healthy on and off the court. World Series champs, the 2005 Chicago White Sox, relied heavily on the team’s massage therapist to experience peak performance. Most NFL teams also have a massage therapist on staff. And according to Forbes, James Harrison, the famed Pittsburgh Steelers linebacker, spends around half a million dollars per year on bodywork, which includes massage therapy.

Double-duty treatment

An athlete’s state of mind is almost as important as the state of their body.  Sports massage can also reduce stress and anxiety, which according to the Journal of Sports Medicine and Physical Fitness, can heavily impact performance. The psychological effect provided to an athlete by an experience such as massage may be of importance in a non-physiological manner.

The endorphins released during massage help to decrease anxiety, provide pain relief, improve mood and enhance the athlete’s sense of well-being.

Sports such as cycling, gymnastics or golf, which require maneuvering and focusing, can be affected by experiencing a sports massage prior to the event. The relaxed, lowered-tension states promote focus and agility – qualities of the elite athlete.

Our mission here at Deep Recovery, is to bring you the advantages enjoyed by elite athletes so you can relax, recover and avoid injury like a pro!

Thoracic Outlet Syndrome (TOS) is a complex and controversial condition in which the nerves and/or blood vessels in the thoracic outlet are compressed.  The thoracic outlet is the area between the base of the neck and the armpit, including the front of the shoulders and chest.

The term ‘thoracic outlet syndrome’ was originally coined in 1956, to indicate compression of the neurovascular structures in the interscalene triangle. Since then, the condition has emerged as one of the most controversial topics in musculoskeletal medicine and rehabilitation. This controversy extends to almost every aspect of the condition, including the definition, the incidence, the pathoanatomical contributions, diagnosis and treatment.

TOS affects mainly the upper limbs, with signs and symptoms manifesting in the shoulders, neck, arms, hands and sometimes fingers. In rare cases, the condition can lead to eye and vision problems.

Symptoms of TOS

Due to the many variations in cause and symptoms, TOS is a clinical controversy.

The National Center for Biotechnology Information reports that TOS is a frequently overlooked peripheral nerve compression that creates difficulties for the clinician regarding diagnosis and management.

The symptoms of TOS range from an aching pain in the neck, shoulder, arm, or hand, as well as pain, numbness, or tingling in the forearm and the fourth and fifth fingers of the hand. The pressure can limit blood flow to and from the arm, causing swelling, redness, and fatigue. Many sufferers of thoracic outlet syndrome have trouble performing overhead activities. Some experience swelling or discoloration of the arm as well as a depression in the shoulder.

Pain can be present on an intermittent or permanent basis. It can be sharp/stabbing, burning, or aching. Pain can also be in the side of the neck, the pectoral area below the clavicle, the armpit/axillary area, and the upper back (i.e., the trapezius and rhomboid area). Discoloration of the hands, one hand colder than the other hand, weakness of the hand and arm muscles, and tingling are commonly present.

Types of TOS

Currently, TOS is classified into three main categories, named according to the cause of the symptoms; however, these classifications are part of the condition’s controversial status because TOS can involve all three types of compression to various degrees.

The compression can occur in three anatomical structures: arteries, veins and nerves; it can be isolated, or, more commonly, two or three of the structures are compressed to greater or lesser degrees. In addition, the compressive forces can be of different magnitude in each affected structure. Therefore, symptoms can be variable.

• Neurogenic thoracic outlet syndrome: This condition is related to abnormalities of bony and soft tissue in the lower neck region (which may include the cervical rib area) that compress and irritate the nerves of the brachial plexus, the complex of nerves that supply motor (movement) and sensory (feeling) function to the arm and hand. Symptoms include weakness or numbness of the hand; decreased size of hand muscles, which usually occurs on one side of the body; and/or pain, tingling, prickling, numbness and weakness of the neck, chest, and arms.
• Venous thoracic outlet syndrome: This condition is caused by damage to the major veins in the lower neck and upper chest. The condition develops suddenly, often after unusual and tiring exercise of the arms. Symptoms include swelling of the hands, fingers and arms, as well as heaviness and weakness of the neck and arms. The veins in the anterior (front) chest wall veins also may appear dilated (swollen).
• Arterial Thoracic Outlet Syndrome: The least common, but most serious, type of TOS is caused by congenital (present at birth) bony abnormalities in the lower neck and upper chest. Symptoms include cold sensitivity in the hands and fingers; numbness, pain or sores of the fingers; and poor blood circulation to the arms, hands and fingers.

Causes of TOS

According to clinical evidence, the disorders caused by TOS are not well understood. When the shoulder muscles are too weak to properly stabilize the collarbone, the bone can slip down and forward into the thoracic outlet. The bone puts pressure on the nerves and blood vessels in this small passageway, creating the various symptoms.  Poor posture rapidly aggravates TOS.

The following may increase the risk of developing thoracic outlet syndrome:

• Participating in sports that involve repetitive arm or shoulder movement, such as baseball, swimming, golfing, volleyball and others
• Repetitive motion injuries from carrying heavy shoulder loads
• Trauma to the neck or back (whiplash injury)
• Poor posture
• Weightlifting
• Pregnancy
• Anatomical abnormality causing an extra first rib
• Tumors or large lymph nodes in the upper chest or underarm area
• Stress or depression
• Sleep disorders

Often, there is no direct cause found in patients suffering from TOS, which leads to one of the controversial points on the condition.

Chicken or egg?

Since TOS is often the underlying cause of conditions such as frozen shoulder, carpal tunnel syndrome or forward head posture, it is difficult to pinpoint true cause or to determine which came first, TOS or a related condition.

Another clinical puzzle is that the symptoms of TOS mimick other conditions that can produce similar symptoms, such as rotator cuff tear, cervical disc disorders, fibromyalgia, multiple sclerosis and complex regional pain syndrome.

Who is affected by TOS?

Thoracic outlet syndrome can occur in people of all ages and gender, though recent studies have shown that TOS is more common in women, particularly middle-aged women, and those with poor muscular development, poor posture, or both.  Clinical evidence suggests that TOS affects less than 2% of the population.

The condition is common among athletes who participate in sports that require repetitive motions of the arm and shoulder, such as baseball (especially pitchers), swimming, volleyball, and weightlifting. It’s not uncommon to see musicians and electricians with TOS, as they work long hours with their hands above their heads.

Several major league baseball players have been diagnosed with TOS.  In July this year, Mets starting pitcher Matt Harvey, announced that he is opting to have surgery for TOS after saying “his shoulder was dead, his arm was dead, that there was no energy there and that he couldn’t feel the ball” after his last start.

Musician Isaac Hanson suffered a potentially life-threatening pulmonary embolism as a consequence of thoracic outlet syndrome.

UFC fighter Matt Serra had a rib removed to alleviate TOS, as did singer Tamar Braxton.

Diagnosing TOS

NCBI reports that the disagreement regarding the definition of TOS makes the overall incidence of the condition difficult to track. Complicating matters, the recognized prevalence of the diagnosis varies between disciplines. For example, it is estimated that surgeons diagnose TOS 100 times more frequently than neurologists.

In some cases, a thorough evaluation by a neurologist may be recommended to rule out cervical spine disease or other neurological conditions that may be mimicking or causing TOS symptoms.

Additional tests performed to diagnose thoracic outlet syndrome include:

• Nerve conduction studies (to evaluate the function of the motor and sensory nerves)
• Vascular studies (of the arteries or veins)
• Chest X-ray, to rule out cervical rib abnormalities
• Cervical spine X-rays to rule out a cervical rib (extra rib) or cervical (neck) spine abnormalities
• CT scan and (MRI) of the chest
• CT scan or MRI of the spine to rule out cervical spine impingement (pressure), which can mimic neurogenic thoracic outlet syndrome
• Magnetic resonance imaging with angiography (MRA) to view blood vessels
• Arteriogram/venogram (X-ray that uses dye to look at blood flow)
• Blood tests

How to treat TOS

Early identification of TOS can help improve the success of treatment. Thoracic outlet syndrome treatments vary, depending on the type of TOS and symptoms. The goals of treatment are to reduce symptoms and pain.

Treatment of neurogenic thoracic outlet syndrome include:

• Physical therapy / bodywork: The most common initial treatment for neurogenic thoracic outlet syndrome is physical therapy. Physical therapy increases the range of motion of the neck and shoulders, strengthens muscles and promotes better posture. Most patients experience an improvement in symptoms after undergoing physical therapy including deep tissue massage, myofascial release and other bodywork. Of course it makes sense that restoring the posture, flexibility and good biomechanics we’re born with, might be helpful! Watch our how to videos for upper / lower back and chest / shoulders.
• Medications: For pain relief, over-the-counter pain medications, such as aspirin, acetaminophen, or ibuprofen may be recommended. A muscle relaxant or cortisone may be recommended for additional pain relief. Just remember that pharmaceuticals are processed by your liver and may cause unforeseen complications. Please try yoga, physical therapy and bodywork first!
• Surgery: In some cases, surgery may be considered if the symptoms continue if all other efforts fail.

Additionally, stretching, acupuncture, breathing exercises, ergonomic desk set-up, motion and posture practices and chiropractic adjustments, are common non-invasive approaches used in the treatment of TOS.

Ice can be used to decrease inflammation of sore or injured muscles. Heat can also aid in relieving sore muscles by improving blood circulation to them. While the whole arm generally feels painful in TOS, some relief can be seen when ice or heat is intermittently applied to the thoracic region (collar bone, armpit, or shoulder blades).

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Fascia has gone from being a nobody to being the body’s superhero. Fascia is the current biological phenomenon that is receiving long-overdue attention from body workers, athletes, medical professionals, alternative practitioners and now, finally, researchers.

The Fascia Research Society states, “Fascia is the most pervasive, but perhaps least understood network of the human body. No longer considered the ‘scraps’ of cadaver dissections, fascia has now attracted the attention of scientists and clinicians alike.”

Until recently, we understood the body to be composed of, literally, skin and bones, which supported internal systems such as muscles, organs and the fluids that make up over 60% of our body.  Something was missing, however, because what holds it all in place?  The skin?  No.  The skin is a part of the immune system and provides no structural support.  And, what keeps all that water and fluid in us from pooling down at our feet?

Among the many drawings of the human anatomy, 500 years ago, Leonardo DaVinci astutely depicted fascia in one of his pieces.  This remarkable depiction comes ages before its actual discovery by modern medicine.

Thomas W. Meyers, of Anatomy Trains, poses the point, “Individual muscles acting on bones across joints’ simply does not adequately explain human stability and movement.”

The answer lies in fascia.  In fact, fascia could be the answer to a lot of questions about structure, movement, stability, pain and healing.

Fascia is a web of connective tissue formed in bands that wraps around all the internal parts of the body from head to toe and fuses it all together.  It allows the muscles to move freely alongside other structures and reduces friction. It can be found immediately beneath the skin, around muscles, groups of muscles, bones, nerves, blood vessels, organs and cells. Fascia is everywhere.  Biologically, it’s what holds us together.  Like a snug pair of pantyhose (as if there is any other kind), fasciae are the bands that bind us.

Muscle tension or fascia tension?

Like bones, fascia bands are composed primarily of collagen which gives them a tough but pliable texture.  The fascial system maintains a balance of tension and elasticity which allows for smooth, unrestricted movement of each muscle group while holding everything in place. If the fascia is restricted then muscle contraction is restricted.

Restriction is where pain and injury can happen, but the restriction could come from either muscle or fascia, and possibly in another part of the body.  This is the part that has clinicians scratching their heads. Tight fascia is every bit as painful and restrictive as a tight muscle. This is the aim of myofascial release: to restore the natural elasticity to tight and hardened fascia.

In an NCBI publication, Dr. Thomas Findley illustrates the pervasiveness and complexity of fascia with this simple clinical demonstration:

Sit in your chair with your knees bent and dorsiflex your ankle (flex up and down). Now take that leg and with the knee straight, put it on the table in front of you and do the same thing. The foot moves less. Now bend your trunk forward. Even less motion. Next, drop your head. Now you can really feel tightness in your calf. This demonstrates just one simple fascial connection, the back-line, but the fascial connections throughout the body are far, far more intricate.

Since there is one singular piece of this stretchy, mesh-like substance interweaving through muscles and organs from head to toe like shrink-wrap, distress in one area can affect movement and create symptoms elsewhere.

This answers the question as to why our shoulder begins to hurt after a sore ankle has been bothering us, or any one of a number of scenarios where stress from one area causes tension in another part of the body. The body might be composed of different parts, but they are all connected through this mysterious organic glove-like web of fascia.

Wellness Advisory Services states, “As soon as there is dysfunction or pain in one area, the body adapts and compensates to keep the body upright and work without causing pain. As it does this the fascia will shorten or tighten in areas because the muscles cannot hold the extra tension alone. Posture changes to accommodate this.”

And, like a glove, fascia has enough substance to hold shape, but not enough to support weight.  This illustrates how movement and structure conditions, such as poor posture, affect fascia, causing pain and unstable movement.

If we stood a thick, leather driving glove and positioned it so that it was standing, at first, it would retain its shape.  Gradually, however, because it does not contain enough substance of its own, it would begin to slouch, bend, sink and eventually fold in on itself.

All the parts function individually, but never alone

Every organ and system in the body has a job that only it can perform; however, none of it happens without the work of the body as a whole functioning unit.  We can’t effectively treat a distressed organ, system or even a muscle without affecting the whole unit.  So, the answer is to treat the unit of the human body as whole.  The nature of fascia confirms this.

A perfect example of this happened recently in a local yoga class.  About ten minutes into the class, one of the students commented to the instructor, “I’m tight.”  The instructor instantly realized she had passed over an essential and routine warm-up exercise that specifically targets loosening the fascia.  It’s called “Wiggle it! Shake it! Wake it up!” Basically, it’s gently running in place with a bit of a shimmy going on.  This full-body vibration relaxes and softens tight fascia so that the muscles beneath are free to get stretched, flexed and toned during exercise.  “Better,” reported the student, after the warm-up exercise.

Now we can see why myofascial release of the psoas can relieve peroneal tendonitis pain (as it did for my daughter who puts a lot of strain on her ankles in volleyball).

Now we can see why someone with hand pain benefits greatly from releasing the traps, lats, armpits, shoulders and forearms.

Above all, understanding fascia helps us understand the extraordinary power of massage.

Because the fascia is three-dimensional – running not just around the muscles but also through it – stretching cannot penetrate your muscle to reach tight fascia the way massage balls or a therapists elbow can.

Fascia isn’t the latest answer to everything, but the questions it seems to be answering, as growing research sheds new light on old theories about structure and movement, are revolutionizing the way we treat the body clinically, athletically, individually and holistically.

Massage can reduce athletic injuries

Getting injured is every athlete’s worst fear. Injuries impair performance, delay training and conditioning schedules during recovery, are costly to treat, and, most of all, injuries hurt.

Dealing with pain and limited mobility after an injury is exhausting, frustrating, and worth the measures necessary to avoid an injury from happening.

Plus, over time, injuries take their toll on the body.  Most of the time, damaged tissue heals, but when muscles are continually taxed to their max through high-performance athletics, the odds increase that an injury, especially a recurring one, will result in a permanent condition.

Massage therapy has come a long way.  From spa treatment to relaxation therapy; to specialized therapies, such as sports massage and prenatal massage; and, currently, according to recent research, massage therapy is making headway in preventative medicine, such as preventing injuries in athletes.

As recently as May, 2016, Oxford University research suggests that massage therapy may be beneficial for improving individuals experiencing pain.  The findings state massage therapy should be offered to a patient for pain management. The study concluded that massage therapy is beneficial across various function outcomes including anxiety and HrQoL.

Health-related quality of life (HRQoL) is a multi-dimensional concept that includes domains related to physical, mental, emotional, and social functioning.

Researchers at McMaster University reported that massage following an intense workout actually causes muscles to enlarge and grow new mitochondria.  Mitochondria are the powerhouses of our cells and are responsible for converting nutrients into useful energy.

For an athlete, energy is everything.

The study found that deep-tissue massage increased the size and number of new mitochondria more than exercising without massage. Increasing mitochondria can improve endurance performance by increasing the rate that muscles utilize oxygen.

To the body, oxygen is everything.

The McMaster University study also found that massage therapy increases the range of motion in muscles and decreases recovery time between workouts or athletic events.

Massage for sports injuries not only concentrates on existing injuries, but can also help prevent injuries. Massage before conditioning training helps to prevent injuries and should be administered after a warm-up session. Massage can also help to prevent common injuries when administered after a training session, as it helps to return the muscles to their relaxed state.

The better we feel, the better we heal.  For muscles, too.

Massage is beneficial to more than muscles 

Muscles might be the richest benefactors of a massage, but, most people report a feeling of pure relaxation, reduced anxiety, enhanced attentiveness, and improved mood following a massage.

Athletes may find an edge in these psychological benefits, making massage a double-duty treatment; a mind and body therapy.  That’s a lot of bounce for your ounce!

Various bodies of research compiled by the National Center for Biotechnology Information indicate that massage therapy:

• Reduces heart rate.
• Lowers blood pressure.
• Reduces recovery time after an injury.
• Rehabs an injury.
• Lowers anxiety.
• Improves mood.
• Increases blood flow throughout the body, bringing vital oxygen and nutrients all over.
• Relieves muscle pain and tension.
• Improves connective tissue healing, which promotes muscle elasticity.
• Stabilizes cortisol levels (a stress hormone, similar to adrenaline).
• Improves muscle flexibility, which reduces and prevents injury.

And, as if all these benefits weren’t enough, research published in the International Journal of Neuroscience suggests that massage therapy improves the quality of sleep.

Do you want to drive a Maserati or a Ford Focus?

The Ford Focus is a fine vehicle, designed for economy and low maintenance.  It’s a clean, solid ride.

Then, there’s the Maserati. A masterfully engineered Italian machine, designed for high-performance, power and superior luxury.  While it’s a bit pricey for most of us, its sticker price is not the only factor to consider when it comes to owning a Maserati.

A Maserati is an exceptionally high-maintenance vehicle, known to be expensive to maintain and repair; much more so than other cars in its class.  Ask a Maserati owner why they spend so much time and money maintaining a car whose value and performance could be found elsewhere and their response will echo that of designer and car collector, Ralph Lauren, “You can enjoy both the beauty of the machine and the journey it takes you on.”

High-performance output requires high performance input, in both cars and bodies.  Athletes are the high-performance models of the human body.  In order to keep up with the substantial demands required of being optimally fit, athletes must stick to an impeccable diet regimen, maintain quality and consistent rest habits, and adhere to regular exercise, training and conditioning programs.

Athletes also need superior health and wellness strategies to sustain optimal performance by their bodies. By having regular massage, athletes can keep their muscles healthy, improve their flexibility, maintain relaxation, and have a better sleep cycle.

Research compiled by NCBI, states, “Athletes and coaches are constantly fine tuning their training strategies in order to develop a competitive edge. The use of therapeutic modalities, such as thermal agents, electrical stimulation, and massage are often performed for this purpose. “

For most athletes, professional or the weekend warrior brand, enjoying less muscle stiffness, preventing injury, improving relaxation and well-being are reasons enough to enjoy a regular massage program. For some, it’s also about giving the Maserati its due.