Re­pair and re­store

While many find a mas­sage plea­sur­able, the tim­ing is very im­por­tant – and also whether you are car­ry­ing an in­jury

The Irish Times - Tuesday - Health - - Health Massage - Ge­orge Win­ter

Those whose re­solve to get fit re­mains undimmed this far into 2017 should al­ready be reap­ing the phys­i­cal and men­tal re­wards of reg­u­lar ac­tiv­ity. But those aim­ing to boost their ath­letic per­for­mance should re­mem­ber that heav­ier train­ing in­creases the risk of in­jury. A 2012 re­port in the Bri­tish Jour­nal of

Sports Medicine stated that about 45 per cent of sports-re­lated in­juries de­rive from mus­cle strains and mus­cle trauma. Yet al­though skele­tal mus­cle can re­pair it­self, heal­ing can be slow and in­juries may re­cur. So how can we help avert skele­tal mus­cle in­juries and ac­cel­er­ate re­cov­ery from them?

Fac­tors such as train­ing load, stretching and diet are im­por­tant, but anec­do­tal ev­i­dence shows the value of mas­sage ther­apy, which in­cludes relief of mus­cle ten­sion and stiff­ness, faster heal­ing of mus­cle strains and lig­a­ment sprains, re­duced mus­cle pain and en­hanced flex­i­bil­ity.

Mer­rell brand am­bas­sador Dr An­drew Mur­ray has com­peted as an ul­tra-run­ner at in­ter­na­tional level, and is a sports and ex­er­cise medicine con­sul­tant to the Euro­pean Tour Golf, the SportScot­land In­sti­tute of Sport, and Univer­sity of Ed­in­burgh.

He told The Ir­ish Times: “In pure per­for­mance terms, the things that make the big­gest dif­fer­ence for run­ning are to train ad­e­quately, and train smart; eat healthily – if it’s ad­ver­tised on TV it’s prob­a­bly bad for you; and sleep at least seven to eight hours per night.

“But be­yond that,” he added, “many things may make a smaller dif­fer­ence. At a per­for­mance level, it’s com­mon to see ath­letes re­ceiv­ing a mas­sage – some of them call it a ‘flush’ – af­ter a hard ses­sion, or to work out those aches and pains.

“Some peo­ple say it helps re­move lac­tic acid, or re­lease knots from mus­cles, etc and it can be valu­able to aid re­lax­ation, with many find­ing it a pleas­ant ex­pe­ri­ence.”

Mur­ray also high­lights the small gaps be­tween suc­cess and fail­ure, not­ing that in the Olympics the dif­fer­ence be­tween gold and fourth is less than 1 per cent, in which case sports mas­sage may help bridge such gaps.

Ra­heny Sham­rock AC’s Mick Clo­hisey, who rep­re­sented Ire­land in the marathon at last year’s Rio Olympics, uses mas­sage in his train­ing regime. “I have a reg­u­lar physio,” he told The Ir­ish Times, “and I find it ben­e­fi­cial to have some­body who gets to know my own body.” Dur­ing heavy train­ing pe­ri­ods Clo­hisey has a sports mas­sage ev­ery other week, say­ing it is mainly for “main­te­nance and in­jury pre­ven­tion”.

Mus­cle dam­age

So what hap­pens fol­low­ing mus­cle dam­age? There are four phases of skele­tal mus­cle re­pair: de­gen­er­a­tion, in­flam­ma­tion, re­gen­er­a­tion and fi­bro­sis – an ex­cess ac­cu­mu­la­tion of con­nec­tive tis­sue, which af­fects mus­cle flex­i­bil­ity.

Mus­cle re­gen­er­a­tion in­volves an influx of repar­a­tive cells that are mainly mus­cle-de­rived stem cells (MDSC). MDSCs en­hance the re­pair of skele­tal mus­cle, and they also se­crete a chem­i­cal called vas­cu­lar en­dothe­lial growth fac­tor (VEGF), pro­mot­ing blood ves­sel for­ma­tion whole re­duc­ing fi­bro­sis. Lab­o­ra­tory stud­ies show that me­chan­i­cal stim­u­la­tion of MDSCs in­creases their pro­duc­tion of VEGF, which brings us to me­chan­i­cal stim­u­la­tion by mas­sage.

Clo­hisey – Ire­land’s cross-coun­try cham­pion in 2014 and 2015, and last year’s win­ner of the Ra­heny five-mile road race – is clear: “I def­i­nitely think mas­sage helps im­prove re­cov­ery and in­creases blood flow, which helps re­pair mus­cles af­ter hard stress. How­ever, I do feel that a too deep mas­sage can be counter-pro­duc­tive at times and can leave your mus­cles sore for a few days.

“I gen­er­ally try to get a mas­sage on an easy train­ing day and also a few days out from a race as op­posed to right be­fore. If you un­der­take mas­sage reg­u­larly, the less in­tense it has to be, and your body be­comes ac­cus­tomed to it. I would also en­cour­age drink­ing plenty of wa­ter post-ses­sion as you tend to be­come quite de­hy­drated.”

Foam rollers

For those con­strained by cash or time, a pop­u­lar and rel­a­tively re­cent in­no­va­tion is the use of foam rollers – ba­si­cally, cylin­ders of firm foam.

This en­tails an in­di­vid­ual us­ing their own body mass on a roller to ex­ert pres­sure on af­fected soft tis­sues such as, for ex­am­ple, quadri­ceps, ham­strings, calf and gluteal mus­cles.

In a re­view of the topic, pub­lished in the jour­nal Cur­rent Sports Medicine Re­ports (2015: 14; 200-208), nine stud­ies were ex­am­ined, with the authors con­clud­ing that the use of foam rollers as a mas­sage tool “ap­pears to have a pos­i­tive ef­fect on range of mo­tion and sore­ness/fa­tigue fol­low­ing ex­er­cise, but fur­ther study is needed to de­fine op­ti­mal pa­ram­e­ters (tim­ing and du­ra­tion of use) to aid per­for­mance and re­cov­ery”.

In their gen­eral dis­cus­sion of mas­sage, while the authors cited “many gaps in the lit­er­a­ture and in­con­clu­sive ev­i­dence on the ben­e­fits of mas­sage”, they ac­knowl­edged that “Sports medicine per­son­nel be­lieve that mas­sage pro­vides many ben­e­fits to the body through biome­chan­i­cal, phys­i­o­log­i­cal, neu­ro­log­i­cal and psy­cho­log­i­cal mech­a­nisms.” For run­ners con­sid­er­ing in­tro­duc­ing sports mas­sage into their train­ing sched­ules, Clo­hisey of­fers this ad­vice: “I would rec­om­mend not get­ting one too close to com­pe­ti­tion and also to rest af­ter­wards or even take a light jog a few hours af­ter, if pos­si­ble, to ‘shake out’ the legs. In ad­di­tion,” he says, “if you’re al­ready in­jured, be care­ful not to ag­gra­vate an in­jury with mas­sage. That’s were a knowl­edge­able, trust­wor­thy physio is im­por­tant.”

Im­mune sys­tem

In re­cent years re­search has fo­cused on whether mas­sage fol­low­ing in­tense phys­i­cal ex­er­cise may also ben­e­fit the im­mune sys­tem. For ex­am­ple, stud­ies have shown that mas­sage en­hances the parasym­pa­thetic – or the so-called “rest and digest” – ner­vous sys­tem; in­creases both saliva se­cre­tion and the pro­duc­tion of al­pha-amy­lase, an en­zyme in­volved in neu­tral­is­ing bac­te­ria in the mouth; and “pushes” neu­trophils – a type of white blood cell – away from sites of in­flam­ma­tion and back into the blood­stream.

These stud­ies are cited by Dr Manuel Ar­royo-Mo­rales – of Spain’s Univer­sity of Granada – and col­leagues, whose re­port in the jour­nal Phys­i­cal Ther­apy in Sport (2015, 16: 187-192) de­scribes their in­ves­ti­ga­tion, en­ti­tled “Im­muno­log­i­cal ef­fects of mas-

sage af­ter ex­er­cise: a sys­tem­atic re­view”.

They eval­u­ated five ran­domised con­trolled stud­ies and found ev­i­dence that fol­low­ing in­tense phys­i­cal ex­er­cise, mas­sage pro­duced “a sig­nif­i­cant and per­sis­tent” in­crease in the num­ber of neu­trophils cir­cu­lat­ing in the blood­stream and in­creased the pro­duc­tion of an an­ti­body called im­munoglob­u­lin type A (IgA), pre­vi­ously de­pleted as a re­sult of in­tense ex­er­cise, with fe­males show­ing greater con­cen­tra­tions of IgA than males.

The Span­ish re­searchers sug­gest that the ef­fect of mas­sage on the im­mune sys­tem “may be in­flu­enced by var­i­ous fac­tors, in­clud­ing the at­ti­tude of the in­di­vid­ual to­wards these pro­ce­dures . . . or the use of spe­cialised forms of mas­sage such as my­ofas­cial re­lease”.

They fur­ther spec­u­late “that mas­sage may have a more rel­e­vant ef­fect on the im­mune re­sponse af­ter ex­er­cise with a higher car­dio­vas­cu­lar de­mand [such as run­ning]”.

The re­view also in­di­cated that mas­sage can in­flu­ence im­mune re­sponses at a lo­cal mus­cle level.

For ex­am­ple, it cites a 2012 re­port whose authors stud­ied biop­sies taken from the mas­saged (on one leg) and non-mas­saged (the other leg) ar­eas of the quadri­ceps mus­cle of the same in­di­vid­ual.

The biop­sies showed that the mas­saged mus­cle showed lower amounts of two chem­i­cal indicators of in­flam­ma­tion, called TNF-al­pha and IL-6. As TNF-al­pha can dam­age mus­cle fi­bres, any re­duc­tion in mark­ers of in­flam­ma­tion through mas­sage should be help­ful.

At present, while the ev­i­dence base sup­port­ing the ben­e­fits of sports mas­sage is not as wide as one might as­sume, we might rea­son­ably ex­pect fur­ther clin­i­cal stud­ies to ex­pand it in time to come.

Ra­heny Sham­rock AC’s Mick Clo­hisey, who rep­re­sented Ire­land in the marathon at last year’s Rio Olympics, uses mas­sage in his train­ing regime.

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