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• Recovery Strategies Part 2
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• Lower Leg Injuries, by Dr. Jenn Turner
• Moveo: Collaborative Health Care

RECOVERY STRATEGIES- (Part II of II)

MASSAGE AND STRETCHING

Dr. Jenn Turner

 

The focus of this series is to examine various methods of recovery strategies after training or racing. The first part of this article discussed the benefits of using acupuncture and ice baths as recovery methods. Part two examines two more common ways triathletes try to speed up muscle healing: massage and stretching.

What is it? How is it done?

Massage is a soft tissue technique that is a frequently sought after choice of recovery for triathletes both during the training season and is also offered post-race at many events.  Massage and other soft tissue techniques such as Active Release Technique, Rolfing, and Graston Technique use comparable principles to guide the treatments have similar desired outcomes.  The concept of healing and therapeutic touch was studied in depth in the 1970’s and the concept of healing touch in sports was developed further in the 80’s.  Massage is defined as therapeutic manipulation of the soft tissues of the body with a goal of achieving normalization of those tissues. There are many different strategies and types of massage that a therapist can apply to achieve these goals; effleurage, compression, trigger point, deep tissue and friction.  The basic principle of massage is that it produces local increases in blood flow via several different mechanisms. This increase of blood flow theoretically helps to accelerate the rate at which lactate is removed, which would help with muscle recovery.

 

Stretching is one of the “hot topics” of debate in literature currently. Stretching is commonly believed by athletes and coaches to prevent injury and increase flexibility in athletes.  While stretching after activity seems to have long term effects on injury prevention, stretching before activity appears to have very little benefit and can even increase the risk of injury in some cases.   There are different types of stretching that can be effective in increasing flexibility. 

 

Types of Stretching

Static stretching	The most common type of stretching where the muscle is held in a lengthened position for a time period- 60 to 120 seconds as in a yoga class.
Ballistic stretching	An older method of stretching that Involves bouncing repeatedly in and out of a stretch beyond the body’s regular safe range of motion. This type of stretching can easily cause damage,  as the muscle contracts in response to activating the stretch reflex.
Contract-relax stretching (formerly called PNF stretching)	Uses an isometric muscle contraction followed by a static stretch and can be very effective in increasing flexibility
Dynamic Stretching	The newest form of stretching to take research by storm.  It Incorporates movements that mimic a specific sport or exercise in an exaggerated yet controlled manner. Dynamic stretching is slowly becoming recognized as the most effective way to increase flexibility and strength at the same time preparing the body’s neuromuscular system for sport.

What are the benefits?

Massage claims to have benefits to various systems in the body. The primary benefits are that of reducing edema, or swelling, and to increase local blood flow. Benefits can also include decreasing muscle soreness and stiffness, moderation of pain, relaxation of the muscles and eliminating scar tissue build up.  Other benefits include psychological or “feel good” benefits.  Massage and other soft tissue modalities are thought to release different hormones such as endorphins and other sensory stimulatory effects which promote this “feel good” response.   

 

The benefits of stretching are based on the timing and type of stretch.  Adding in a dynamic stretching segment into the warm up can help train the neuromuscular system, thus reducing the risk of injury during sport.  Stretching statically helps to improve flexibility which allows the joints to improve their range of motion. The joint can then accommodate the desired angles without stress on the tissues around them. Flexibility is therefore helpful for injury prevention.  Following an injury, a muscle tear or strain will heal with scar tissue. This scar tissue tends to be shorter and have more resistance to stretch than normal healthy muscle tissue.  Stretching is used at an appropriate time in the healing process to assist in lengthening this contracted scar tissue.   Flexibility, because it increases range of motion, may improve motor performance and skill execution. Skill execution and reduced risk of injury will be greatly enhanced if the body has the flexibility necessary for that particular sport.

There is also the argument that stretching may reduce post exercise muscle soreness, or DOMS, by reducing muscle spasm associated with exercise.

 

What are the contraindications?

Massage is not recommended to anyone who has an acute infection, internal bruising or bleeding or new open wounds.  Also massage can be fatal in one who has a deep vein thrombosis or a DVT, which is a blood clot usually in the calf.  One must be very careful receiving massage if they have fragile skin, an inflammatory muscle disease, calcified soft tissue, incomplete scar formation or during pregnancy. 

 

Stretching is discouraged in athletes who have acute inflammatory arthritis as there is a danger of exacerbating pain and inflammation. Athletes who have incurred a recent traumatic injury should avoid aggressive stretching in the initial stages especially if they have a hemotoma or a fracture.  Any stretch should be aborted immediately if there is any sharp pain in the joint or a hard blocking feel to the stretch.

What does the research say?

Massage research is very difficult to execute as there are so many uncontrollable variables and any research composed is difficult to replicate.  The parameters such as the activity of the athlete, the type of massage, the duration of massage, all contribute to differing results using massage as a recovery tool.  Therefore much of the research published regarding massage has few transferable results.  One research paper in the British Journal of Sports Medicine, found that massage following high intensity exercise bouts did not increase power or change blood lactate concentration but a lower fatigue index was observed, indicating that these athletes felt less fatigued following massage, perhaps enhancing recovery. 

 

Some studies do support that range of motion and flexibility can be increased by stretching each day. Researchers point out that some people require a longer duration or more repetitions. In one study, stretching produced only small and statistically non-significant reductions in muscle soreness. Data from two studies on army recruits in military training show that muscle stretching before exercising does not produce useful reductions in injury. 

 

Athletes looking to

 

.Dr. Jenn Turner is a chiropractor who focuses on sports injuries and travels with pro cyclists to competitions around the world to concentrate on recovery. Jenn herself is a triathlete who just competed at Ironman Arizona (10:56) and owns Moveo Sport and Rehabilitation Centre, a multi-disciplinary clinic in North Vancouver, British Columbia