I recently presented a continuing education class on Russian sports massage during the FSMTA Convention. After receiving so many inspiring and heartfelt testimonials from the practitioners who participated in the class, I decided to reflect one more time on the subject of sports massage science and the progress made in this field in the U.S. today.
In fact, is there a progress? Definitely “yes”, if we look at the increased numbers of sports massage practitioners in general and those working with professional sports teams, in particular. Thus, its popularity is up! It is refreshing to see massage practitioners filled with enthusiasm while setting up their stations at the numerous race events nationwide. However, the question remains: Is there adequate training in place, – to equip massage practitioners with both the knowledge and skills needed to help athletes, both professionals and amateurs, perform better in their sports? My argument is – it is not enough to show up at a sports event with a massage table to be considered a sports massage therapist!
Therefore, getting back to answering the question about the progress made, we might choose “maybe”, when it comes down to the quality of sports massage education here in the U.S. (Naturally, we could assume that some sports massage programs are better than others.)
In contrast, – based on my personal experience as a student of sports massage in the former Soviet Union over two decades ago, there is a unique system of sports massage that has been scientifically developed and clinically proven. That fact itself has made my job as an instructor of sports massage a very easy and rewarding one, because I present a proven system, the system that works every time it is applied! I only wish for that system to be both embraced and enjoyed by the sports massage schools and practitioners across the country, which would, in turn, lead to the creation of a highly recognized and respected community of sports massage experts united by that system!
So far, we still see articles, like the one published in the American Journal of Sport Medicine in September, 2004, (Jonhagen S., et a., 2004) stating that “Post-Event Sports Massage has no positive therapeutic impact on post-workout recovery in athletes”. For unknown reasons, The New York Times later re-printed that article, giving the impression to the public, medical, and sports community that sports massage is a waste of time and money. Imagine how many potential clients the sports massage practitioners lost overnight after the New York Times published its article.
Much more sadly, there was no official response to that nonsense from the massage community. Where were leading massage therapy organizations or associations, educators who travel around the country with sports massage seminars, etc.? My colleagues and I were surprised that no one dared to confront such nonsense. We reviewed the article and pointed out the inconsistencies and flaws in the design of the study protocol. However, our lonely voice wasn’t supported by anyone in the sports massage industry. We were deeply puzzled by this fact. Later, I understood why.
The following year I observed the panel of sports massage experts who discussed the issue of sports massage. What struck me the most was their presentations’ complete absence of scientific data. Each expert relied on his or her personal experience only. Even more disappointing was what several speakers recommended to the practitioners who could get to work with professional sports teams. Are you ready? Here it is: “If you get lucky enough to work with a professional sports team, remember -You are NOBODY! So, keep your mouth shut and keep your opinions and suggestions to yourself! As far as massage strokes, – stick with effleurage as a main technique.”
Wow! I can hardly wait! Where can I sign up to become a sports massage therapist, so that I could feel like nobody? What a future to look forward to! I was shocked even more when I had looked around that room, filled with over a hundred practitioners, and saw not a single blink at that statement! Clearly, something was really wrong with that picture.
For us, sports massage practitioners, to get the respect we deserve, we need to start by respecting ourselves. We should proudly offer our scientifically developed and historically proven services to any professional sports team, which should feel like a lucky winner by retaining our services!
As an athlete and later sports massage practitioner and teacher, I had a completely different experience. I was educated and still practice sports massage in an environment where my words (as well as those of my colleagues) have great practical value for the coach, athlete, or team’s physician. My work, as well as the work of my colleagues and students, is respected so much because it is empowered by the scientific system of Russian Sports Massage.
Russian Sports Massage is the most advanced system of sports massage in the world. It was considered an integrative part of sports training and competition in the former Soviet Union. Massage therapists were highly respected, sharing the spotlight with athletes and coaches. When an athlete brings home a gold Olympic medal, he or she will get a medal of honor and recognition from the Soviet Government. However, his or her massage therapist would get official recognition from the Government as well as a part of the team who helped the athlete to win the Olympic competition.
Essentially, massage therapy was used as a ‘secret weapon’ during the Cold War, when winning at the top international competitions had become a political statement about the supremacy of the socialist system over the West. Based on historical facts, it is empowering to learn that sports massage therapy played a great role in giving the Eastern Bloc Olympic Teams the edge they needed to dominate the Games.
The science of sports massage is a very extended topic, and I am not able to cover all aspects of it in this article. Since the above-mentioned article refused to accept the validity of post-event sports massage, I chose it as the topic for this article and, hopefully, the first stepping stone on your journey through the world of Sports Massage! So, let’s get straight to business.
The concept of post-event sports massage and its practical application to speed up athletes’ recovery has been considered and researched by many Western European and American scientists working in the field of Sports Medicine. However, many of those scientists concluded that massage does not have any significant impact on the process of recovery after vigorous exercise (Drews, et al., 1990; Carfarelli, et al., 1990; Rodenberg, et al., 1994; Tiidus, et al., 1995; Gupta, et al., 1996, Jonhagen S., et a., 2004).
To understand how they came to that conclusion, let’s pretend you bought a lottery ticket. Would you say that the lottery does not work if you do not have a winning ticket, or would you go for another ticket, hoping for more luck next time? That is exactly what happened with those authors—they had simply drawn their conclusion based on one “unlucky lottery ticket” that was incorrectly applied to post-event sports massage protocol.
Russian scientists who developed the concept of Russian Sports Massage had spent many years of looking for the right combination, leading to a “lucky winner protocol” (Sarkisov-Sirasini, 1957; Krilov et al., 1985 Burovik et al., 1989 etc.). Let us thank the Cold War for that!
Interestingly enough, even when that winning combination was presented in the form of the special protocol of post-event sports massage, scientists were still trying to win that lottery while improvising and changing the formula offered by Russian scientists. No wonder they had different outcomes! Hello! Just follow the protocol!!!
Here is the optimal protocol for the post-event recovery massage, with four equally important components. Failure to follow even one of them would totally alter the session’s outcome.
All Eastern-European authors agree that massage should be started 2-2.5 hours after vigorous exercise (not earlier or later).
The massage session should last 30-40 minutes to 1 hour. During this time, the massage therapist works on the athlete’s whole body, paying special attention to the muscle groups that were overloaded during the vigorous exercise.
It is best to use a combination of effleurage, kneading, permanent vibration, gentle compression, stretching, and long-range shaking. However, 40-50% of the treatment has to be spent on kneading. With the proper execution of this technique, a therapist will be able to alternately stimulate and relax the massaged muscles. Thus, kneading is the best tool for restoring muscular strength.
The applied pressure has to be significant but without activating the pain-analyzing system. The threshold of pain varies from one part of the body to another or even within the borders of the same massaged segment. Thus, the pressure has to be continually adjusted. The practitioner should use the wide contact areas of the hand and avoid the pinpoint application of massage strokes (e.g., using the tip of the thumb).
All Western articles, which reported the failure of massage therapy to speed up the recovery process (including article I mentioned), were united by one striking similarity. Despite a truly scientific approach to evaluating treatment outcomes, these studies neglected to follow the correct protocol of post-even massage I mentioned above. The Table below (Turchaninov, 2000) summarizes the protocols used in these studies, and I would like the readers to compare them with the protocol I presented above.
| AUTHOR | TIME OF THE TREATMENT | DURATION |
|---|---|---|
| Cafarell, et al., 1990 | immediately after exercise | 4 min |
| Drews, 1990 | immediately after exercise | 30 min |
| Wenos, et al., 1990 | 48 hours after exercise | N/A |
| Rodenberg, et al., 1994 | 15 minutes after exercise | 15 min |
| Tiidus, 1995 | 48 hours after exercise | 10 min |
| Gupta, 1996 | 48 hours after exercise | 10 min |
| Jonhagen S., et a., 2004 | immediately after exercise | 8 min |
It seems that sports massage faced a great controversy. On one side, these studies were conducted by respected authors in well-known scientific institutions, and they denied the impact of massage on recovery after muscle soreness. On the other hand, Russian scientists claimed, and Soviet athletes proved that the protocol mentioned above works. There was no reconciliation in sight.
However, the scientific validity of post-event sports massage, so long advocated by Russian scientists, was proven beyond reasonable doubt by a group of authors from North Carolina and Virginia (Smith, L.L. et al., 1994).
The Russian authors developed their protocol using the clinical observation mostly. They did not offer any scientific explanation as to why and how it works. The American scientists went much further when they confirmed the clinical validity of the post-event sports massage protocol and explained its mechanisms.
The first correct step the American scientists took was to precisely recreate the Russian protocol in every small detail, basing their experimental study on publications from Russian scientific journals.
They evaluated the effect of massage on muscle soreness, by examining the athlete performance, detecting the level of creatine kinase (an enzyme indicator of muscle damage) and examining the neutrophil (an inflammatory white blood cell) count.
The American scientists found an interesting chain of events in the overexercised muscle tissue. Vigorous exercises induce micro damage to the myofibrils, which leads to the development of local aseptic (non-infectious) inflammation and interstitial edema in the overexercised muscles. The body reacts to this inflammation by sending neutrophils to the affected area.
Neutrophils enter the muscle tissue from the neighboring capillaries and start their cleaning job (i.e., phagocytosis) to remove the waste products produced by this inflammation. The increased concentration of neutrophils also attracts other phagocytic cells, such as macrophages. In the process of phagocytosis, catabolic enzymes are released from neutrophils, and they also damage already injured muscle fibers.
Dr. Smith and his colleagues detected a temporary reduction of neutrophil count in the blood with simultaneous increase in the concentration of creatine kinase in the athletes after vigorous exercise. The simultaneous increase in the concentration of creatine kinase was a direct outcome of damage to the myofibrils by the enzymes released from the neutrophils. The study also showed that this process happens exactly within a 2-hour time limit after the end of excessive exercise.
This is what Smith and his associates had to say in the conclusion of their article:
“During acute inflammation, blood flow slows as vessels dilate in an area of injury. When this occurs, the white blood cells, including neutrophils, are displaced from the central axial zone of blood flow to the peripheral plasmatic zone and subsequently marginate along the vessel walls. Since sports massage appears to increase blood flow through the vascular bed, the increased flow rate in the area of microtrauma could prevent the typical outward displacement of neutrophils. In addition, the mechanical action of sports massage could shear marginated cells from vessel walls and thus hinder emigration of cells from the circulation into tissues spaces.”
” …Control group exhibiting a more rapid and steeper increase CK (i.e. creatine kinase) values than the massage group” and
“…Sports massage rendered two hours after termination of unaccustomed eccentric exercise reduces the intensity of delayed onset muscle soreness and reduces serum creatine kinase levels.”
To fully understand and appreciate the importance of this study I will use the interactive diagram developed by Dr. R. Turchaninov which re-creates all these events in the chronological order. To replay the diagram please click at the beginning of the sliding bar (blue line) located just below the diagram.
The diagram shows the microphotograph of the human capillary with the blood flow in the center. The blood flow in the microphotograph is seen as various types of blood cells moving along the center of the capillary (i.e., axial zone). Let us imagine for a second that this capillar is located in the skeletal muscle, which was exposed to vigorous exercises two hours ago. In such cases, the white areas on both sides of the capillary walls will indicate the muscle tissue.
At the beginning of the interactive diagram, the red arrow indicates the direction of the blood flow, and the neutrophil cells are emphasized. A study showed that approximately two hours after the end of the vigorous exercises, the neutrophils start to marginate closer to the capillary walls while they continue to flow with other blood cells along the capillary. This process is indicated in the diagram as margination.
After the neutrophils marginate close to the capillary walls, they migrate through the walls into the tissue of skeletal muscles, which is indicated in the diagram as a migration. When neutrophils migrate into the tissue, they release enzymes, which additionally damage already affected myofibrils, which greatly contributes to muscle soreness on the next day after vigorous exercise. Thus, as Russian and American scientists proved, the massage strokes applied two hours after the excessive exercise prevent the margination of neutrophils inside the capillary bead, and it decreases the excessive migration of neutrophils into the soft tissue, which causes unwanted damage to myofibrils.
There is one more issue I would like to mention here. Dr. Smith and his colleagues finally discovered the exact cause of the delayed soreness after vigorous exercise. Intensive physiology studies started in the middle 1980s (Schwane et al., 1983) showed that the increase in lactic acid has nothing to do with muscle soreness after excessive exercise. In fact, lactic acid is one of the critical factors that supports proper muscle contractions, and without its increase, the muscles would not be able to maintain the necessary contraction rate. As it was correctly stated by B.J. Sharkey and S.E. Gaskill (2006):
“This fallacy has been around for years, even though it lacks any basis in fact. The lactic acid isn’t the direct cause of the sourness.”
Even though lactic acid’s myth was put to rest by modern science, the question remained: what causes delayed muscle soreness? As Dr. Smith and his colleagues discovered, the migration of the neutrophils into the skeletal muscles is the real cause of the pain, and it is now obvious that only sports massage conducted according to the Russian sports massage protocol is able to eliminate this factor and help the athlete or sports enthusiast to recovery quicker and more efficiently.
Of course, the decrease of muscle soreness is not the only goal of Post-Event Sports Massage. Other objectives of Post-Event Sports Massage are:
To reduce the tension in muscles and connective tissue structures
To reduce peripheral vascular resistance
To accelerate drainage of venous blood as well as lymphatic fluid
and, ultimately, To balance the activities of the sympathetic and parasympathetic divisions of the autonomic nervous system
I hope you, my dear readers, found great value in this article’s theoretical and practical aspects of sports massage. It is my sincere belief that only by uniting our efforts in sharing the knowledge of the science of sports massage will we become a prevalent force in the arena of sports training and rehabilitation!
To contact O. Bouimer and acquire information about Sports Massage Seminars or DVDs please visit: www.owellnessglobal.com
Burovik A.N., Samsonova I.A., Manuilov I.A. Evaluation oh the Effect of Individual Variants of Sports Massage on Muscles’s Blood Flow. Soviet Sports Rev, 24:197-200, 1989.
Cafarelli E., Sim J., Carolan B., Liebesman J. Massage and Short Term Recovery From Muscle Fatigue. Int J Sports Med, 11:474-478, 1990.
Drews T., Kreider R.B., Drinkard B., Cortes C.W., Lester C., Somma C.T., Shall L.M., Woodhouse M. Effects of Postevent Massage on Repeated Ultra-Endurance Cycling. Int J Sports Med, 11:407, 1990.
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Rodenberg J.B., Steenbeek D., Schiereck P., Bar P.R. Warm-up, Stretching and Massage Diminish Harmful Effects of Eccentric Exercises. Inter J Sports Med, 15:414-419, 1994.
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Schwane JA, Johnson SR, Vandenakker CB, Armstrong RB. Delayed-Onset Muscular Soreness and Plasma CPK and LDH activities after downhill running. Med Sci Sports Exerc, 15(1):51-6, 1983.
Sharkey B.J., Gaskill S.E. Sport Physiology For Coaches. Human Kinetics.Windsor, Champaign, Ill. 2006.
Schwane JA, Johnson SR, Vandenakker CB, Armstrong RB. Delayed-Onset Muscular Soreness and Plasma CPK and LDH activities after downhill running. Med Sci Sports Exerc, 15(1):51-6, 1983.
Smith L.L., Keating M.N., Holbert D., Spratt D.S., McCammon M.R., Smith S.S., Israel R.G. The Effect of Athletic Massage on Delayed Onset Muscle Soreness. Creatine Kinase and Neutrophil Count. J. Orthop Sports Phys Ther, 19(2):93-99, 1994.
Tiidus P.M., Shoemaker J.K. Effleurage Massage, Muscle Blood Flow and Long Term Postexercise Strength Recovery. Inter J Sports Med, 16:475-483, 1995.
Turchaninov R. Therapeutic Massage. A Scientific Approach. ‘Aesculapius Books’, Phoenix, 2000.
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Oleg Bouimer, LMT, graduated from State Institute of Physical Education in Ukraine in 1985. Currently he has an extensive private practice in Los Angeles. Among his clients are celebrities, famous politicians and sports stars. The NBA, NHL and NFL widely recognize Oleg and the system of Russian Sports Massage. He teaches nationwide and has founded a Medical and Sports Massage Club in Los Angeles. Oleg is author of many articles in American and European professional journals. He can be reached by e-mail: olegnancy@msn.com
Category: Sport Massage