The Role of Sports Massage in the Prevention and Management of Training Injuries: An Interview With Dianna Linden, MT, CFT, Part 1

by Charles Staley

(Part 1 of 2)

Introduction: I first met Dianna Linden at a seminar I was teaching for the International Sports Sciences Association in Santa Barbara, California in 1996. Dianna stood out to me because she asked great questions— some of the best I’ve ever encountered during my 8 year experience as a presenter. I found it refreshing to encounter a student who actually challenged me, despite having no formal experience as an exercise professional.

Since that time, Dianna and I have formed a close professional relationship, working together with a variety of athletes, from World-class to regional level in several different sporting disciplines.

One of the most important things I’ve learned from Dianna, and something I hope to get across to my reading audience, is that massage therapists, much like any other class of professionals, vary greatly across ranks. I often joke that her fingertips have little brains of their own— she has an astounding ability to immediately locate damaged tissue, and then, using a wide range of techniques and therapeutic modalities, heal, or at the very least, improve the condition of that tissue.

In the first part of this interview, I asked Dianna to outline the role of sports massage in an athlete’s training program, how to find a skilled MT, and what course to follow upon the incidence of a training injury.

In part two, Dianna and I will discuss the most common injuries that she sees in her athlete-clients, how they might be prevented, and we’ll also detail the importance of the feedback that a skilled MT can provide to an athletes coach or conditioning specialist.

-- Charles Staley

Dianna Linden of Dianna Linden Sports Massage

CS: Dianna, thanks for taking the time to share your expertise with my readers— I know they’ll come away from this interview with a much more refined concept of how to stay healthy and productive throughout their lifting careers. I’d like to start with a brief description of your background. Can you tell us how long you’ve been a massage therapist, and a little about the various methods or styles that you use?

DL: Happy to, Charles, thanks for the opportunity to talk about my field and its role in recovery in sport. It's a topic for which I have a lot of enthusiasm and an interest in furthering collaborative exploration.

I discovered the creative process as a sculptor/potter in college. The clay was really more of a teacher for me, along with a couple of crazy artists hanging around at 3am in the arts building, which, at that time was open all night, than the tenured professor who had lost his enthusiasm for teaching long before I met him. The path to bodywork from clay was a bit convoluted, but both involve sculpting a very plastic medium. The body, with its added dimensions of consciousness and spirit, presents a very broad field of exploration for what's possible when you bring knowledge, a quiver of tools, intuition, a willingness to follow the moment and communication skills into the creative act. I love working with people.

In 1979, the field of massage was just opening up as a legitimate form of alternative care. The massage parlors in Santa Monica and Venice were still hand job joints paying regular "fines" to the police to stay in business, exploiting indentured women from Asia, who were stuck there indefinitely paying off their inflated travel and living expenses. So, to get some legitimate training, I started with acupressure. Two forms; Jin Shin Do and Shiatsu. The Japanese ethic and their ideas of tapping into and utilizing ki (energy) interested me from my introduction to them in ceramic arts, Zen and rudimentary attempts at Judo.

I then studied conventional Swedish massage, Rolfing, some forms of deep tissue work which were taught by a series of several therapists who worked primarily with athletes, utilizing massage as a support for high performance. These methods include deep transverse friction massage, especially for tendinitis, compression therapy for trigger points, several forms of actively releasing adhesions in tissues, pre- and post-event considerations, what not to do, mostly, as well as a sense of when in the cycle of training certain methods would and would not be used.

Somewhere in there I also apprenticed for over a year with a psychologist who was teaching Ericksonian techniques of utilizing altered states to enhance integration of the self to full functioning. I studied that because I realized that clients were in a state of deep relaxation by the time a session was half way through and thought that with a bit more psychological sophistication, I might be more adept at utilizing that deep relaxation to enhance recovery and rehab.

It seems that I learn best hands-on in apprentice situations in real life, so I have continued to search out talented folks from which to learn. My clients are really my first teachers and they continue to teach me in many ways. That's how I found ISSA and you. One of my clients, in search of some assistance strengthening for his sport, had consulted Fred Hatfield about a program, handed me Fitness: The Complete Guide, (ISSA's training manual), and said "What do you think of this?" After reading through it, I realized I had much to learn from this organization and called to find out more. Since Dr. Squat recommended that I speak with you and also suggested that my client see you for questions and follow up on the strengthening, I was happy to find out that you would be instructing the certification seminar I signed up for. I wanted to pick your brain as much as I could to see if we could collaborate before I brought him to you for a program. I wanted know how you would handle my curiosity and nit-picky questions as well as get some of my specific questions about training answered. You were not only not bugged by my incessant queries but gave me far more information than I had hoped to get in one weekend.

CS: Well thank you!

DL: In May I’ll participate in an 80 hour seminar with a therapist from Oregon (Rich Phaigh) who worked with Mary Decker, among others, and who now utilizes adaptations of Muscle Energy Technique with his athletes to help balance underlying spine and hip misalignments which might contribute to stubborn recurring problems some athletes experience. I'm excited about reviewing and adding more of these tools to my quiver of techniques. I figure the more methods I can skillfully employ, the wider range of situations with which I might be an effective practitioner. I hope I'm still learning till I die. That, and not knowing what the moment will bring, are what keeps the work exciting to me as a creative vehicle for mutual benefit.

CS: You know, a lot of readers may be thinking "Why would I hire a massage therapist?" thinking that massage is mostly for relaxation or stress reduction, when in fact, as you and I both know, skillfully applied massage has a range of recuperative benefits. Would you outline these for us?

DL: Of course. Massage can help relieve muscle tension and stiffness, reduce spasms, increase ROM, improve circulation of blood and movement of lymph, reduce blood pressure, strengthen the immune system, foster faster healing of strained muscles and sprained ligaments, reduce pain and swelling and the formation of excessive scar tissue.

Sports massage could be classified into three main categories: maintenance, event, and clinical.

• Maintenance, which includes modalities to enhance recovery from the stress of sport, helps athletes maintain optimal performance by keeping them injury free.
• Event massage, before, during and after competition supplements an athlete's warm-up, cool down and reduces the spasms and metabolic build-up that occurs with vigorous exercise. It enhances recovery, if well designed, improves an athlete's return to high level training and reduces the risk of injury.
• Clinical applications are effective in the management of acute and chronic injuries, done as far away from the competition as possible and offer the coach and athlete a feedback on the status of the muscles, tendons and ligaments. The massage therapist can give them information as important when tailoring training choices to the athlete's current status as a local weather report is to a sailor at sea. It's easier and far more pleasant to avoid the squalls if you know they're out there than it is to blindly suffer through them.

Although Canadian track coach Charlie Francis' career was ruined by Ben Johnson's steroid bust, in my opinion, drugs alone could in no way account for their amazing accomplishments in sport. Charlie has a lot to say about his use of massage as part of his regeneration protocols for athletes in his book, The Charlie Francis Training System. Let me provide you with a few quotes:

"Central Nervous System (CNS) overtraining is caused by high intensity work occurring too frequently in the training cycle in too high a volume in a single training session or by the attempt to introduce high intensity work too rapidly into the program when residual fatigue still exists (i.e. incomplete regeneration). It takes 2.5 times longer to recover/regenerate fully after maximum intensity white fibre dominant work than from moderate to low intensity red fiber dominant work."

"The difference between a performance at 95% effort and at 100% (i.e. at World Record level) effort is that a 95% effort might require a recovery period of only 48 hours while a 100% effort might require up to 10 days."

"We feel that we can get up to 40% more CNS-power training time related to the performance of high intensity training by incorporation properly executed massage and regeneration."

"Before competition you use a very light, slapping type of massage, You don't go deep into the muscles, with the result that the athlete feels fresh and awake. You wouldn't do deep rubs within, say, 48-72 hours of the competition unless it was a very insignificant meet, because with deep massage you lower the tone of the muscle too far. To use an inappropriate type of massage or to have an unskilled person doing the massage can undo much of the training effect you have accomplished during your final preparation for a key competition."

"You want to remove any lumping of the muscle, but you have to have this done long enough before the meet so that the athlete can recover from the treatment. In a calf muscle it is possible for an athlete to have a lump or spasm large that 35% of his or her muscle may be nonfunctional. The spasmed muscle is not able to contribute to movement and there is the potential for a muscle pull— above or below the spasmed area. You have to take out that lumping or the athlete loses a tremendous amount of power."

"You don't wait for injury to occur. The athletes are being probed and screened constantly by (the MT’s) hands, the chiropractor's hands or my own. Among us we are usually able to find potential injuries before they occur."

"An athlete who is receiving regeneration treatments regularly can increase his or her work by as much as 40%— and not so much in terms of volume but rather in terms of the quality of high intensity work."

"PNF (proprio-neural facilitation) type stretching in combination with massage can be a very effective recovery combination. Stretching for the purpose of resetting muscle tonus to desired levels can shorten your recovery time significantly, by up to 3 or 4 hours. Most of the time we do PNF stretching before and after competition and practice. It can shorten recovery time because if the muscle is contracted and tight, it doesn't allow as much circulation as when it's restored to full length."

CS: You’ve obviously studied Charlie’s work in detail! In my opinion he was incredibly brilliant, and in fact, he was perhaps the primary inspiration for my becoming involved in the conditioning sciences. Francis showed how training could be elevated from a rather pedestrian pursuit (which is how 90% of coaches practice it) to a truly sophisticated science and art. I think I recently heard that he is now an insurance salesman, which to me is just abhorrent.

Getting back to task, let me ask you a question that I myself find difficulty answering for my clients: "What do you look for in a massage therapist (MT)?" In other words, if I don’t have a frame of reference, how do I know that you’re skilled? Am I looking for a diploma, references, to feel good after I leave, what?

DL: It really depends a lot on what you are wanting from a particular massage experience. If you are just looking for relaxation and circulatory effect then you could find a local spa and get yourself a "feel good" rub which will support tissue recovery in a general way. Sauna, hot tub, cold plunge, Swedish type massage would all compliment each other in the flushing of wastes out of and bringing nutrients in to tissues as well as generally relieving spasms. If the practitioner is not specifically trained in sports massage in this case it will not so much matter because the spa context provides its own kind of experience.

If, however, you want to work more precisely, utilizing well applied techniques to support recovery as you train hard for an event or competition, then you need someone with more specific training and ability. The work done close to an event is much less deep than that which would be done early in the training season. The clinical aspects of various types of deep tissue work can augment training earlier in the season by resetting proper muscle length and tonus, identifying and rooting out adhesions, deep spasms, trigger points, slightly inflamed tendons, etc., hopefully, before they become problems big enough to interfere with workout rhythms or require rehab. This type feedback to a coach or athlete from a skilled massage therapist can be very helpful in determining if some muscles or tendons are a little worse for the wear, thus help them make well informed decisions.

CS: Boy, you said it. I know that our mutual collaboration has provided me with essential feedback regarding just how much damage a particular workout has created— in fact, I really want to talk about this in detail later in the interview.

Dianna, before we continue, I suspect some of our readers will not know what is meant by the terms "spasm," "adhesions," and "trigger points." Would you just briefly clarify these terms for us?

DL: Actually there's a lot that could be said distinguishing these three as well as tendinitis, tenosynovitis, bursitis, strain, and sprain, what they are and what to do when you have them, but for our purposes here, let's just talk about those three you asked about.

A spasm is an involuntary muscle contraction. If tonic (sustained), sharp and painful they are sometimes call cramps or "Charlie horses" if in the calf (I wonder where that one comes from?). Marathon runners can get them due to lack of hydration causing electrolyte imbalances. These need to be treated with immediate electrolyte and fluid replacement. If elderly people sleep with heavy blankets weighing down the foot into plantar flexion, then turn, suddenly dorsi-flexing it, the extreme shortening combined with lack of blood flow can cause a severe and painful "Charlie horse" when the calf is asked to lengthen. There must be some biochemical component to these, as well, because docs often prescribe quinine tablets if increased calcium doesn't help, and that seems to work really well.

In those cases massage is not going to relieve the underlying cause of the spasm. If, however, sections of muscles remain shortened due to fatigue or overuse after a workout, it can inhibit the blood flow and inhibit that muscle's capacity to function in the next training session since it is already shortened and therefore weaker by what ever percentage is no longer capable of full contraction under load. Heat, water jets, diathermy, electrical stim, ultra sound and certain massage techniques will all help relieve these. That's a major component in recovery considerations regarding training rhythms. Docs sometimes prescribe analgesics or muscle relaxants.

Adhesions are fibrous bands holding parts together that are normally separated. They naturally occur as part of wound healing, but if granulation scar tissue doesn't properly re-organize as it heals it can bind the connective tissue within the muscle or tendon virtually gluing it into place. Various styles of deep tissue massage are devised to attend to clearing these out of the tissues.

James Cyriax, an orthopedist, developed Deep Transverse Friction massage to work directly on the adhesions which form in tendons and ligaments. Rolfing strokes as well as Myofascial Release developed and taught by John Barnes, PT are two different ways to release adhesions which are in connective tissue within muscles and tendons.

Trigger points were most extensively mapped and worked with by Janet Travell, M.D. In her books, (co-authored with David Simon, M.D.): Myofascial Pain and Dysfunction, theTrigger Point Manual, Vols. 1 & 2, she outlines very extensive diagnostic procedures and protocols for treating them. I'll give you her definition: "A focus of hyperirritability in a tissue that, when compressed, is locally tender and, if sufficiently hypersensitive, gives rise to referred pain and tenderness, and sometimes to a referred autonomic phenomena and distortion of proprioception. Types include myofascial, cutaneous, fascial, ligamentous, and periosteal trigger points. A myofascial trigger point is a hyperirritable spot usually within a taut band of skeletal muscle or in the muscle's fascia."

TP’s can cause dysfunction in muscles in a number of ways:

1. They are ischemic (i.e., lack oxygen).
2. The taut bands surrounding them are contracted tissue not available to the training stimulus making it difficult to properly strengthen that muscle.
3. They cause pain when irritated and can produce secondary trigger points in their synergists or satellite trigger points within the original TP's zone of reference, thus they cause a generally noxious state of affairs, and inhibit the training effect synergistically.

There are several treatment modalities available to docs or PT’s, but massage therapists use specifically applied compression combined with stretching and heat to relieve them. If you mistakenly use deep friction upon them you will just irritate them further. Not a plan. They are often latent, that is, painful only upon palpation, lurking within the muscle, etc. undetected by the person, but with all the other clinical characteristics of active ones.

OK, getting back to the topic: Finding a therapist with the requisite skill for the type of collaborative work I discussed earlier is a more difficult proposition. In Canada, massage therapists must have a minimum of 1000 hours of training, much of that hands on, to legally be allowed to practice. So by its own licensing requirements, Canada establishes a standard for its therapists. In America there is no such licensing. Some states have a 500 hour requirement for their state licenses, but those 500 hours might not include any specific training for sports applications.

In California there is no state licensing. A person could take a 100 hour course, pass a local exam or simply pay for a business license, and, depending on the local ordinances, call themselves a "sports" massage therapist and be legally practicing. Licenses don’t necessarily provide enough information to insure that you have found a skilled massage practitioner.

CS: Are PT’s a reasonable option?

DL: There are some physical therapists who have good hands on training and skills, but from what I've seen, they don't generally get much massage technique in college. The ones whom I know who are good at sports massage have also studied sports massage on their own to augment their formal academic education.

One of the past presidents of the AMTA (American Massage Therapy Association) checked the curriculums of the colleges in his state to see what hands-on training was included in their PT programs and found that none totaled more than 30 hours of hands-on technical massage training. That was a few years back, hopefully things have improved since then. But, I'd still say that going to a physical therapist won't necessarily get you a good sports massage either.

The best way to find a good practitioner is by a personal recommendation from someone whose scrutiny you trust. If you have a friend who also trains and can offer you a referral for someone with whom they've had a good experience, this is the best way. Not always possible, and even if it is, a good rapport between a massage therapist and her client is a really important part of the work. If you find a skillful person, you personally must also trust and feel good about that person for your work together to be really beneficial. Keep looking until talent, skill, training and mutual rapport are all present before you settle in to an ongoing professional relationship.

I have a friend who is a Harvard-trained MD. In medical school. She coined her so-called "90% rule." Meaning, 90% of what you find out there in any field is sh*t. Your job is to search out the 10%.

A competent sports therapist should know pre- and post-event massage, some deep tissue applications like what would be taught in Rolfing (or Aston Patterning, Hellerwork) as applicable to enhancing performance as well as structural realignment, deep transverse friction massage especially for tendons and ligaments, trigger point compression, contract/relax stretching protocols, ice massage, or possibly NMT, Myofascial Release, or Active Release Technique (ART).

There are a few teachers of sports massage in America whose work I know well enough to assume that if someone trained with them at the advanced level the requisite skills should be there. Based on this, I’ve put together some resources to get someone started on a search:

Ben Benjamin teaches at the Muscular Therapy Institute in Cambridge, MA. Call 800-543-4740, or on the web at http://www.mtti.com/center . Ask for a referral for one of his advanced graduates with sports training.

Benny Vaughn developed the clinical massage training program at the Atlanta School of Massage. Call 888-276-6277, or visit his web site at http://www.atlantaschoolofmassage.com/ . If you leave them a note on the web site with your location, they could refer to one of the graduates of the clinical program in your area.

Rich Phaigh has worked with several track and field athletes including Mary Decker, Alberto Salazar and Joan Benoit. He has taught Sports massage for many years, and might have some graduate students whom he could recommend. Call 541-344-4768 or 541-683-5134, or visit his website at http://www.zeemans.com/. Or, e-mail him at: jaqua@rio.com

The National Certification Board for Therapeutic Massage and Bodywork referrals can be found at: http://www.ncbtmb.com/ncb-database/query.htm . All the therapists who've passed this test have at least 500 hours of education, but not necessarily sports related training, so specify that in your request.

There are 2 major professional organizations for massage therapists in America. The AMTA, requires 500 hour educational training or a written exam for entry as a professional, they require an additional exam for their sports therapist certification: You can locate the AMTA on the web at http://www.amtamassage.org/findtherapist/locator.htm

ABMP, (Associated Bodywork and Massage Professionals) has a referral site at: http://www.abmp.com/referral.htm . Their organization offers many levels of entry, so specify certified or professional sports therapist.

Another site run by a Florida massage therapist which requires AMTA membership and screens for educational training, can be found at: http://massagetherapynetwork.com/client1.html .

This site for the International Association of Healthcare Practitioners:

http://www.upledger.com/pract.htm . This site lists practitioners who have been trained in Neuromuscular Therapy as well as Upledger's cranio-sacral work, his affiliates' techniques and who have paid some money to be included in this list. NMT was developed by Paul St. John and contains some valuable deep tissue techniques.

Paul's site (http://www.stjohnnmtseminars.com/ ) doesn't have referral links on it so if his work interests you, look on IAHP's site for folks who have NMT 1, 2, 3, 4, or 5 in the classes column or call 888-NMT-HEAL (668-4325) and Eileen will give you a referral in your area for one of their graduates. Paul's work is not necessarily sport specific, but technically good work.

Charles Poliquin, other strength coaches and a number of high level athletes seem to really like Michael Leahy's Active Release Technique as a soft tissue application designed to enhance optimal performance. His training seminars are very expensive, so prepare to spend the big bucks for them. Call 719-473-7000, or fax 719-473-7479, or visit his website at http://www.charlespoliquin.net/ to get the name of a practitioner in your area.

I hope that's enough information to get someone going on the right track for good sports massage support.

CS: Yes, just excellent. OK, now the next thing I’d like to cover is, what to do upon the incidence of injury. A lot of athletes don't know if they should just rest and see how it goes, or to seek medical attention. To make matters more complicated, if they do decide to seek medical attention, do they see a MD first, a PT, MT, or what?

DL: Well, when in doubt, see a doc, especially if your bone is sticking out of your leg and staring right at you.

CS: This would probably be a revelation of sorts for my training partner!

DL: (Laughing) Seriously, if you have had an impact injury of any kind, see a sports doc or an orthopedist for an x ray and diagnosis, make sure those bones aren't fractured or pieces broken off, or some other complication lurking within.

Or if you ever hear a loud pop and somehow the arm (or whatever popped) seems a bit weaker, get to the doc immediately and don't let him or her tell you that it's not necessary to surgically repair the lump that was the biceps now rolled up like a Venetian blind. I've seen a couple of folks to whom this happened. One was advised that his arm would work without the biceps because the brachialis would do the job!

CS: I guess if you don’t ever plan to lift anything heavier than your own arm, plus maybe your wristwatch, he’d be right.

DL: Yes— well he came to me several days later and asked my opinion. I suggested that if he wanted to handle the wench on the big boats in the big winds again, he should get that tendon stapled back on the forearm, pronto. His Kaiser doc's idea that it would work ok without being fixed was definitely not based on an understanding of the stresses of sailing.

Another client was told that his pec didn't really need to be reattached. In the second case he followed that advice and after that when he tried to do yoga, specifically the "Chatarranga" posture (which is like a push up from the toes), he inflamed the nerves in his arm because his body can't be supported in that plane without the pec there. He'd already done that twice when I first saw him. Asked me what to do about it. We iced it and worked the spasms out of the inflamed arm and I advised him to stop doing the posture, since it was too late to get the pec reattached. It had bunched up like an old redwood burl, irrevocably glued as an unidentifiable wad on his chest. Yuk.

CS: What a shame, considering how easy it is to reattach the muscle if it’s addressed soon after injury!

DL: It just proves that you can get lame advice even from well educated high end professionals. This was an expensive Beverly Hills orthopedist who gave him that advice.

It seems that whatever happens, you must be the captain of your own healing journey. Whomever you use is in your employ and can be fired at any time.

CS: This is a very important point! As obvious as it is, a lot of people forget that they are in charge of their support team, not vice versa.

DL: Absolutely! And another thing— more than one opinion is often a good thing especially if the options are serious enough to involve surgery. It’s hard to know how to go about it when you don't always have the necessary information to make a well informed decision, but since you have the most invested in the outcome, it's worth doing your homework. Unless serious invasive action is immanent, I would personally choose the least invasive tactic first and give it a good chance before going under the knife. In the above cases, the opposite was true, surgical repair was the only choice and timing was definitely a factor.

Often in training, "stuff" happens which is far less dramatic and clear cut. The first thing to remember as an athlete, ice is your friend. You train, something hurts, sharp pain especially, get the ice on it ASAP. Often you can stop the secondary swelling and subsequent spreading of the trauma into the surrounding tissue. This keeps the injury minimal and the healing proceeds much more quickly. The first couple of days after a micro trauma or macro trauma use ice frequently. On for a minimum of 5 minutes up to 15 minutes, off for at least 1 to 1 1/2 hours between icings to allow the reflexive vaso-dilation which occurs after the cold is removed to bring nutrients and proteins into the tissues for repair. Ice it 5 times the first day, and the same on the second day.

Keep icing frequently as long as your swelling and pain is decreasing as a result. If your pain doesn't decrease using these acute care protocols... if there isn’t noticeable improvement within 3 days, see a doc for further diagnosis. Why? Just as one example, low back pain can be a sign of cancer as well as the result of a muscle strain from a training incident. Don’t take chances!

CS: I actually have 8 ice packs in my freezer which are numbered, so I know that I’m always using the coldest possible ice pack. Of course ice is part of the famous "RICE" acronym. Do you agree with and/or use the RICE formula?

DL: Eight? Really? How near the edge of your capacities do you train? I know you like to keep things moving, but how many body parts do you ice after a tough session?!!

CS: I mostly use it for my right knee, which has had so much surgery that it will soon be featured in an episode of "That’s Incredible!" If I think I’ve irritated it during training, I’ll ice it every hour for the rest of the day as a minimum. I’ll use one pack behind the knee, and another on the knee, and then wrap the whole thing with an ace bandage. So the numbering system is just to ensure I’m using the coldest possible packs in the rotation.

DL: That’s a great system actually (necessity is the mother of invention, as they say). But yes, RICE is the acronym for acute injury care. Rest, ice, compression, elevation.

We covered the ice part. Rest is obvious (I hope)— if it hurts don't use It while the injury is still acute.

Compression, if you can’t avoid using the injured bodypart, wrap it while you do to protect it and keep the swelling down. Elevate it above the heart whenever possible to help with venous return and keep the swelling down. With smaller soft tissue injuries this will get you back in action quite swiftly and often is enough to prevent micro trauma from becoming macro trauma and start the healing process or repair and regeneration instead.

Anti-inflammatories help if they aren't contra-indicated due to systemic sensitivities. Whatever you choose topically, RICE is the most important first stage intervention.

Sometimes, if you have a muscle which has simply gone into spasm in response to fatigue, overuse and accompanying trigger points, moist heat is a better choice. Hot and cold alternating showers or jacuzzi baths can help to restore fatigued muscles. Trigger points and the spasms they create respond better to heat and to anti-inflammatories. If, however, there's a chance that some micro trauma is there as well, ice is a better choice or you might follow the heat with a short icing on the area which feels injured.

Beyond that, who you see would depend upon what kind of injury you have. Physical therapy primarily uses electrical stim, ultra sound, cold and exercise routines designed for different stages of rehab, often including water workouts to keep an athlete training while rehabilitating from an injury. If you can't bear your weight on the sprained ankle or torn hamstring for example, this is where to go. It is important that you find a therapist whose orientation is rehab for a high level of performance and not someone whose practice is primarily personal injury accident cases where the emphasis is simply racking up as many fees in as little time as possible to help make a good legal case.

I know an athlete who herniated a disc during a deadlift. MRI diagnosis confirmed it. He had pain down the thigh, splinted spasmed low back muscles. He found a great PT team, worked with them 4 hours per day, 6 days per week, in a very intense comprehensive program which included some deep tissue massage and trigger point compression and was back to full sport specific training in 6 weeks. He won in his match 4 weeks later. I was really impressed with their choices and especially the results.

If your injury is less severe than those mentioned above, i.e: some of the stuff commonly happening in the gym; tennis elbow, biceps tendinitis, rotator cuff tendinitis, trauma forming adhesions in muscles or tendons due to overuse, or reinjury of sites with unnoticed micro-trauma until it becomes macro-trauma, good sports massage could help speed up the healing considerably.

Lymphatic massage techniques will improve the secondary hypoxic injury and enhance edemous fluid removal. Trigger point compression reduces pain from TPs and their taut bands, which occur after injury. Cross-fiber friction improves the formation of strong and flexible repair tissue, thus helping to restore pain free full ROM. Sometimes if you rest and ice the area but don't get it worked on as well, the site of the injury can linger in an adhered, spasmed, fibrous state for a while after the initial injury is healed. Then when you try to use it under load it tears again around the adhesions and can interfere with full performance in training for a long time. Here's where the clinical aspect of sports massage can really make a difference.

To quote Mary Decker (from Athletic Massage by Rich Phaigh & Paul Perry) "My training runs became painless, with fewer injuries than in the past. And with my shorter recovery time, I soon began training at a consistently high level, better than ever before. Since discovering massage I have set eight world records, won several national titles and been able to win two world championship titles. I am in the best shape of my life due to my lack of injury. I owe most of my high fitness level to Rich and his method of athletic massage. I know this is true because I don't get Rich's massage treatments when I travel for an extended period of time. Then, old injuries creep back and recovery time increases with each hard run. I recommend massage to athletes at any level of ability, from world class to the weekend competitor. It will not only improve your performance, it will speed your recovery time and cut down on the number of muscle injuries."

Charles Staley: Next month in Part 2 of my interview, we’ll discuss common injury patterns and strategies for managing them. We’ll also detail the collaborative system that Dianna and I use when working with athlete-clients.