As a health professional with more than two decades of experience in performance sports, I witness the positive impact of massage and manual therapy on athletes and patients all the time. Nonetheless, I firmly believe that employing the appropriate technique, at the right moment, and for the suitable individual is crucial. The debate concerning hands-on or hands-off therapy in sports is still ongoing. Nevertheless, the most rational and fair approach is a balanced one that lies in the middle. Many of my colleagues working in performance sports practice this balanced approach.
Not Passive Therapy
There is a common misconception that massage and manual therapy are passive treatments. However, the most skilled practitioners understand that assessing the patient's movement quality and range of motion both before and after the therapy is crucial. In fact, effective massage and manual therapy not only promote better movement in the short term but also establish a foundation for better movement in the long term.
Additionally, skilled practitioners frequently incorporate active movement from the athlete or patient during the sessions. This approach not only helps promote an active and collaborative therapeutic experience but also enhances the effectiveness of the treatment by involving the patient in their own treatment process.
Short Term Outcomes are Needed
The debate around massage and manual therapy often centres on pain modulation, particularly for chronic pain. However, hands-on therapies have been shown to effectively improve short-term pain relief without the side effects or risks associated with pharmacological and electrophysical treatments.
For instance, massage or manual therapy could be beneficial for a tennis player with a stiff and painful neck who needs to compete the following day. This type of treatment could improve pain, increase functional/required range of motion, and boost confidence, ultimately leading to an optimal outcome and performance with minimal risk.
Individualised Evidence Based Approach
My approach to massage and manual therapy is based on “evidence” and takes into account what works best for each patient or athlete. For instance, if an athlete has hip degeneration and is undergoing – and compliant with a prescribed rehabilitation and exercises, but I can consistently increase their hip extension by ten degrees and reduce their pain by two points before a competition, that should be considered evidence-based care for that individual. Although this technique may not work for everyone, if it proves effective for that person, it's a positive and beneficial outcome. To ensure maximum benefit in minimal time, objective outcome measures should be utilised to test before and after therapy, and the approach should be streamlined accordingly.
Massage & manual therapy: do what works
Massage and Manual Therapy isn’t a Silver Bullet
It is important to acknowledge that massage and manual therapy techniques have limitations. Several techniques and methods are founded on outdated theories and teachings from "gurus" of the past. It's essential to note that joints cannot be "out of place" unless there is evidence of subluxation or dislocation visible on an x-ray. Similarly, muscles cannot be "untwisted," and tendons cannot be healed solely through soft tissue frictions. Therefore, massage and manual therapy should be viewed as temporary pain relief or as a temporary enhancement in range and movement quality. While hands on therapies may rarely cure an ailment, they can establish a foundation for natural healing to take its course.
In my practice, I firmly believe in combining a hands-on approach with a well-structured and progressive strength and conditioning/rehabilitation program to optimise athletic performance and patient outcome. My aim is to provide athletes and patients with as much assistance as possible initially, but ultimately work towards increasing their independence, with the understanding that I am always available to adapt and modify the plan as needed. Most people appreciate support and guidance when striving to achieve their physical goals.
Self massage: a great way to move towards independence