Tuesday, March 27, 2018

Benefits of massage for triathletes

As many of you know, I am a registered massage therapist at Swansea Massage Clinic at Jane/Bloor and WattsUp Cycling at Kipling/Gardiner. I am also an endurance coach to many triathletes, runners, swimmers and cyclists and an elite triathlete. I received my BScHon from McGill University in Biochemistry, my MSc from U of T in Medical Biophysics and my massage diploma from Sutherland-Chan. I have been coaching for 15 years and a massage therapist for the past 2 years. This blog post is based on a talk I gave at the Running Room and will demonstrate how massage can help triathletes.

Massage, by definition, is the assessment and treatment of soft tissue and joints in order to maintain, rehab or augment physical function or relieve pain. This means that massage therapists can perform various forms of assessment such as assessment of posture, gait, muscle strength, nerve function, and even more. In addition, therapists can perform many techniques such as general Swedish massage, deep tissue massage, myofascial release, low grade joint mobilizations, muscle energy techniques and some massage therapists are even further specialized and can perform modalities such as acupuncture, myofascial stretching, cupping and Active Release Techniques (ART). Even if you don’t know what these techniques are, you can bet that any manipulation that can improve the function of soft tissue and joints can be of use to triathletes, given the strain of swimming, cycling and running on the body. Also, massage therapists usually spend an hour or more with each patient, which allows for a more holistic approach to therapy. This means that rather than focus on just one area of the body at a time, like some time constrained health practitioners have to (some Chiropractors only have 20 minutes with their patients - however, my Chiropractor Bill Wells spends as long as he needs to relieve pain!). Massage therapists have time to assess related areas as well and sometimes the whole body.

So, when would you go see a massage therapist? Most triathletes who I see either come to me for maintenance of function, injury prevention and/or to benefit their performance (if they have an upcoming race). Other times, triathletes come to me with various injuries and pain.

Massage for maintenance:

Massage for maintenance of function and better performance is very important. A massage therapist can assess an individual and identify muscles that are weak or joints that have decreased mobility. They can use various techniques to improve circulation, break up adhesions, increase range of motion and decrease muscle tension. Massage has even been shown to reduce overall anxiety, lower stress and improve sleep, all of which can all help prevent injury and improve the performance of triathletes. Not only that, but massage therapists are qualified to provide a strengthening and stretching program that can complement a triathletes’s training plan.

How often should a triathlete go for massage?

When I was competitive, I would go for a massage once every 1-2 weeks or about once for every 30 hours I spent training. For most recreational athletes/triathletes, this translates to about one massage every 2-4 weeks. This is what I recommend to the athletes I coach. However, other factors play into this. If you are older or have a history of injury then more frequent massage is beneficial. If you don’t stretch or do your own program of stretching and strengthening, then this means you would also benefit from more frequent massages. If you see a chiropractor or physiotherapist, then less frequent massage is necessary. It also depends on budget. If you have a health care plan, (and this is a good time to mention that most benefit plans cover massage therapy) it’s best to plan more frequent massages when the volume/intensity of your training is high and less frequent massages when you are training less.

What is the ideal timing for a massage?

The best timing for a massage is the day or two days after a hard workout, on an OFF day or after light exercise. The day following a massage should be either an off or easy run day. I would recommend getting a pre-race massage 2-4 days beforehand. This shouldn’t be a very deep tissue massage, but a bit lighter pressure with the focus on circulation. Do not get your first ever massage right before a race.

What to tell your massage therapist?

I see a lot of patients who tell me mid-way during the massage that they are training for a triathlon. Before the massage starts, you should most certainly let your therapist know what you are training for, your total training volume at the time, how often you are doing speed work, hills or intervals, if you trained that day or have a training session the next day. If you are OK with allowing a few minutes of the massage time for assessment, tell your therapist this if they don't ask you. This will allow the therapist to check your posture for any imbalances, check the strength of your hips, check your balance, check your flexibility, check common joints that typically get stuck: ankles, SI joint, tib-fib joint, upper back. That will allow for a treatment that is focused on ensuring proper function of the muscles you are using for your training.

Massage for injury:

There are many times when I see athletes who have various ailments. If this is the case, the massage therapist will spend about 10-15 minutes prior to the treatment assessing for the cause of the pain/injury. Even if it is knee pain, a proper assessment also includes checking the hips and the ankles and their associated muscles. Once the massage therapist has identified the areas of weak or tight muscles, or decreased or increased mobility at certain joints or a spot of swelling then that therapist will plan for the massage treatment. The massage treatment will last about 30-40 minutes with time at the end of the appointment for a re-assessment and for the therapist to prescribe a self-care program with stretching and strengthening exercises to help the injury heal.

There are many triathlon related injuries that I see. Acute injuries, such as those from a trauma, such as a rolled ankle or a ligament tear, can be treated by a massage therapist. In the early stages of the injury, the massage therapist can massage related structures (but not any swollen area) and areas that might overcompensate for the injured area. For example, someone with a rolled ankle will typically have tightness in the outside of their lower leg and usually tight muscles on the opposite leg from an altered gait/walking style. Some of the joints may also be restricted. After that structure has started healing, the therapist can help prevent scar tissue from forming and re-injury. For chronic injuries, which are common in triathletes, massage can also be effective. For example, tendonitis is often caused by muscle weakness, decreased mobility at a joint and increasing the volume by too much too soon, without adequate rest. Fro example, poor or uncontrolled mobility at the hips, glute weakness and hamstring tightness/weakness can be a cause of upper hamstring tendonitis. A weak rotator cuff can lead to shoulder tendonitis. Massage therapists can help this injury by massaging the tight muscles, performing techniques at the site of the tendonitis to help heal the tissue and by prescribing exercises to help to strengthen appropriate muscles. Another example, are shin splits, which can be relieved by the massage therapist massaging the front of the shin and improving mobility of the ankle. IT band syndrome (ITBS) is another common triathlete/running injury. Massage therapists can improve the mobility of the fascia surrounding the IT band, perform cupping techniques, decrease tension in the muscles surrounding the area and prescribe glute strengthening exercises to the athlete to improve stability of their hips. These are just a few examples of injuries and how massage therapists can help with them.

Good self-care for the triathlete: