How intense does massage really need to be?

When it comes to massage therapy, many people wonder how intense the pressure needs to be to achieve the best results. There is a common misconception that the deeper and harder the pressure, the more effective the massage. However, the relationship between pressure and therapeutic outcome is more nuanced. Let’s explore the difference between deep pressure and deep tissue massage, why excessive pressure can be counterproductive, and how to find the optimal level of pressure for your needs.

Too Much Pressure?

One key aspect of effective massage therapy is understanding that getting muscles to release isn't about forcing them into submission. When a massage therapist applies pressure, sensory receptors in the skin and muscles send signals to the brain. These signals can help the brain to recognize tension, slowly convincing it to relax the muscles.

While other physiological effects also contribute to reduced tension in the body, putting the brain into a parasympathetic state is key to maximizing the benefits of massage. This means that excessive pressure is actually counterproductive, causing the body to go into a protective mode and tightening up the muscles even more in response to pain or perceived threat. Even worse, too much pressure can cause bruising, inflammation, or further injury.

Finding the Optimal Pressure

The goal of massage therapy is to promote relaxation and facilitate muscle release, not to cause pain. While a certain level of discomfort might be expected, particularly when working on tight or knotted areas, the sensation should be more of a "hurts so good" feeling rather than outright pain.

The optimal pressure during a massage varies from person to person and even from one area of the body to another. What feels good for one person might be too intense or too light for another. The "hurts so good" sensation is often an indicator that the right amount of pressure is being applied. This feeling suggests that the pressure is sufficient to address the muscle tension without causing excessive pain.

Take Control of Your Experience

To get the most out of your massage therapy session, there are several things you can do to help facilitate muscle release:

1. Stay in Communication

Always communicate with your massage therapist about the pressure being applied. No massage therapist, no matter how experienced, can know exactly what you are feeling. Your feedback is essential to ensure the pressure is just right.

2. Avoid Tensing Up

Try to keep your own muscles from tensing during the massage. Tension in the muscles can counteract the effects of the massage and make it harder for the therapist to work effectively.

3. Breathe Deeply

Make sure not to hold your breath. Deep, steady breathing can help to relax your muscles and enhance the therapeutic effects of the massage. When an especially tender or tight area is being worked on, focus on taking deep breaths to help the muscles release.

4. Relax Your Mind

Mental relaxation is just as important as physical relaxation. Try to let go of any stress or anxiety you may be holding onto. A calm mind can help facilitate muscle relaxation.

Effective muscle release involves communicating with the brain through slow and deliberate touch. The right amount of pressure to accomplish this is different from person to person and won’t even be consistent throughout your entire massage. Let go of any preconceived notions about how light or deep a massage needs to be. By finding a balance that promotes relaxation and healing without causing unnecessary pain, and by communicating with your massage therapist, you’ll be surprised at how much more benefit you can get out of each massage!

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To learn more, check out these articles:

Journal of Bodywork and Movement Therapies

Deep tissue massage: What are we talking about?

National Library of Medicine

Brain Activity Underlying Muscle Relaxation

The mechanisms of massage and effects on performance, muscle recovery and injury prevention

The Value of Sports Massage for Athletes of Every Level

Sports massage is a specialized therapy designed to cater to athletes and active individuals. It offers a range of benefits from enhancing performance to improving overall well-being. Here are five reasons why you should consider incorporating sports massage into your routine:

1. Increased Flexibility and Freedom of Movement

Flexibility is key to optimal performance in many sports. Techniques used in sports massage work to stretch and lengthen the muscles, break down adhesions, and improve elasticity. In addition to an increasing flexibility, these techniques also free up restrictions within normal range of motion. These benefits can help your muscles and joints function optimally, giving you a competitive edge.

2. Accelerated Recovery and Reduced Muscle Soreness

One of the primary benefits of sports massage is its ability to speed up the recovery process. After intense physical activity, muscles often experience micro-tears, leading to soreness and stiffness. Sports massage promotes the flow of oxygen and nutrients to the affected areas, facilitating faster repair and reducing delayed onset muscle soreness (DOMS). By helping your muscles recover more quickly, sports massage allows you to return to your training regimen sooner and with less discomfort. This accelerated recovery is essential for athletes who need to maintain a rigorous training schedule without prolonged downtime.

3. Relief from Chronic Pain

The very nature of sport is to perform the same actions over and over and, as such, many athletes suffer from chronic pain due to repetitive use injuries. Focusing on the root causes of pain and addressing muscle tightness, trigger points, and adhesions, sports massage helps to reduce chronic pain from these injuries. This reduction in pain combined with an increase in circulation from the massage itself encourages healing, leading to increased performance.

4. Injury Prevention

Preventing injuries is crucial for anyone engaged in regular physical activity. Sports massage helps to maintain optimal muscle function by addressing muscle imbalances and tightness. These issues can lead to strain or overuse injuries if left unaddressed. Sports massage also enhances proprioception, or body awareness, which can improve coordination and balance. Regular sports massage sessions ensure that your muscles remain flexible and responsive, reducing the risk of strains, sprains, and other common sports injuries.

5. Improved Mental Focus and Relaxation

Physical performance is closely linked to mental well-being. The relaxing and stress-relieving effects of sports massage can help to calm your mind, improve your focus, and boost your overall mood. This mental clarity and relaxation can help you concentrate, translating into better performance and a more enjoyable training experience. Improved mental focus means you can strategize and perform with greater efficiency, making sports massage a valuable tool for both physical and mental improvement.

Incorporating sports massage into your routine offers a wide range of benefits that can elevate your athletic performance, promote recovery from and prevention of injuries, and bolster your mental well-being. The techniques used in sports massage are designed to target the specific needs of athletes and active individuals, ensuring maximum benefit from each session.

Whether you’re a seasoned athlete or someone who enjoys regular physical activity, sports massage is a valuable addition to your wellness routine. Experience the transformative effects of sports massage by scheduling a session with our experienced massage therapist.

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As Physical TherapPT’s in-house massage therapist, Jamison helps to expertly deliver comprehensive care to our patients and athletes. His area of expertise includes: range of motion assessment, postural analysis, trigger point treatment, and manual therapy for injury prevention.

Jamison is currently accepting new clients.

To learn more, check out these articles:

American Massage Therapy Association. (2011) Position Statement on Massage Therapy for Those Who Exercise. Retrieved from https://www.amtamassage.org/about/position-statements/massage-therapy-for-those-who-exercise/

Kargarfard, M., Lam, E. T. C., Shariat, A., Shaw, I., Shaw, B. S., & Tamrin, S. B. M. (2015). Efficacy of massage on muscle soreness, perceived recovery, physiological restoration and physical performance in male bodybuilders. Journal of Sports Sciences, 34(10), 959–965. https://doi.org/10.1080/02640414.2015.1081264

Lee, J., Crosman, B.S. Chateauvert, S.R., Hateauvert, J.W. (1984). The Effects of Massage to the Hamstring Muscle Group on Range of Motion. Journal of Orthopaedic & Sports Physical Therapy, 6(3) 163-208. https://www.jospt.org/doi/epdf/10.2519/jospt.1984.6.3.168

Aeini, Maryam. (2022). Effect of Massage on Fatigue and Mood in Female Rowers. Humanistic Approach to Sport and Exercise Studies (HASES). 2. 10.52547/hases.2.2.7.

Reactive vs Proactive Athletic Wellness

Depending on where you are in the country, preseason is underway for fall sports. No matter what level, most teams require some form of pre-participation exam. These annual appointments are designed “to screen for injuries or medical conditions that may place an athlete at risk for safe participation."¹ Regrettably, there is not a standardized exam in the US, resulting in a wide range of effectiveness. The National Athletic Trainers' Association Position Statement includes the following guidelines for designing an exam:

• Medical and Family Health History

• General Health Screening

• Cardiovascular Screening

• Neurological Screening

• Orthopedic Screening

• General Medical Screening

• Review of Medication Use

• Nutrition Assessment

• Heat- and Hydration-Related Illness Risk Factors

Considering all the areas assessed, it is important a medical physician (MDs or DOs) supervise these exams. Missing from that list however, is a Functional Movement Assessment. Both ATCs and PTs can be instrumental in helping you establish an athletic baseline.²

By evaluating basic movement patterns, any strength imbalances or compensatory strategies can quickly be identified. Check out our instagram post on the functional assessment I used with the Warriors Dance Team for the 2021-2022 preseason screens!

Your provider can review any significant findings with you, helping you understand how they may be impacting your performance. But if the findings from your assessment don’t correspond with pain, should you still address them?

Short answer: It depends. 

As clinicians, it is important to take the whole athlete and their goals into account. Understanding the demands of the sport and the anticipated load throughout the season is one piece of the puzzle. A rising high school freshman basketball player with lower extremity strength imbalance may have been fine playing at the middle school level 3-4 times per week. However, once introduced to the demands of a varsity squad- weight lifting, practices 5 times a week, and a heavier competition schedule- may no longer thrive. It is reasonable to anticipate that they will begin to experience lower extremity joint pain at some point during the season. By providing them a short home exercise protocol that addresses the imbalance, they may be able to avoid the scenario altogether.

A semi-professional golfer will expectedly present with a strength imbalance dominant to non-dominant side rotation due to the demands of their sport. Assuming their regular strength and conditioning includes bilateral rotational power and deceleration work, minimal changes may need to be made.

Ultimately, we believe that sports medicine should be proactive not reactive. While it is impossible to avoid injury in sports entirely, athletes can train more effectively based on their individual strengths and demands.

To learn more, check out these articles:

1. Wingfield K, Matheson GO, Meeuwisse WH. Preparticipation Evaluation: An Evidence-Based Review. Clin J Sport Med 2004; 14(3):109-122.

2. Conley KM, Bolin DJ, Carek PJ, Konin JG, Neal TL, Violette D. National Athletic Trainers’ Association Position Statement: Preparticipation Physical Examinations and Disqualifying Conditions. Journal of Athletic Training 2014;49(1):102–120.

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Upper Extremity Sport Durability

For the majority of our upper extremity athletes, the toughest opponent they face is their screen. Here in the Capital of Tech, the hour or two you spend on the field may be the only break from technology. With the challenges of the last year, we’re all spending more time online and on a screen than ever before. While intuitively we all recognize that increased screentime can lead to decreased performance, this post will help break down the impact on upper extremity athletes.

Daily Posture

Start by assessing your resting posture. Look at the position of the head, neck, shoulder and arms relative to the torso. All too often when working on a laptop or handheld device we find ourselves seated with shoulders slumped, looking down, arms and hands together at chest center. Sound familiar?

This will impact your resting breathing posture, as well as your anterior chest and neck muscle tone. The closed position of the throat and rib cage requires the body to work harder and recruit different muscles to inhale and exhale, potentially overusing some muscles in the neck. Adducting the arms, or bringing them together in front of the chest, shortens the muscles of the chest causing them to tighten. The muscles in the back are put in an over-lengthened position, causing them to atrophy due to lack of use. This combination of tight and weak muscles makes it more challenging to find and maintain your athletic posture when you need it.

Finding Balance + Repetitive Behaviors

Using the body described above as our example, the strength imbalance and shoulder position will impact throwing mechanics. To rebalance the system, more emphasis needs to be placed on pulling exercises. This allows the muscles in the upper back to contract while lengthening the muscles in the chest. To compliment this work, incorporate focused dynamic chest stretching and thoracic spine mobility to re-enforce these new postures.

Looking to the back of the body, scapular control is equally essential for throwing mechanics. The scapula has limited ligamentous attachments- it’s the reason the shoulder has such a large range of motion. The catch? The scapula relies more heavily on muscular control than other joints. If you plan on throwing longer and faster, you need to have the eccentric strength to slow all that extra power down. Building a stable foundation (and maintaining it) requires regular rotator cuff strengthening- try incorporating these exercises into your pre-practice warmup or post-strength cool down.

Daily + Weekly Load

Every single athlete, no matter the level, needs recovery days. These low intensity days are the body’s chance to “recharge and download” new movement patterns and muscle fibers. Consistent optimal load to rest ratios will ultimately result in increased durability. To start tracking your load, try this simple low tech strategy:

Upon completing a workout or competition, rate the session using the scale. Multiple that number by the duration of the session in minutes. Track these numbers daily. On a weekly or monthly cycle, aim to create a soft waves rather than dramatic spikes and gaps in activity. Use this chart to plan for important competitions and heavy training days.

M.Gibala Ph.D.

Recovery is not synonymous with rest. Several of our highly competitive athletes have balked at the idea of a rest day, envisioning being confined to the couch for the day. Instead, think about recovery in the following areas:

• Getting adequate sleep following training (7 hours or more!)

• Optimizing soft tissues between sessions (massage, foam roll, stretching, etc)

• Rebalancing consumed macro + micro nutrients (Protein AND electrolytes)

• Diversifying your skills by trying new sports or activities (VR for reaction time, or swimming for reciprocal rotation)

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Daily Foam Rolling

Myofascial release is a hands-on technique using sustained pressure to the connective tissue restrictions to relieve pain and restore motion. But does it work? Dr. Betsy Webb certainly thinks so, stating “this is one of the most common modifications I suggest to patients. Maintaining soft tissue and joint mobility is so important in preserving joint health and building strength.”

According to a systematic review conducted by Beardsley and Škarabot, myofascial release can help to increase flexibility and reduce soreness. Regular maintenance helps with joint and soft tissue extensibility and mobility, will improve tissue length and pliability and its ability to accept force and load. This allows the body to do more work with less strain overall. Methods like foam rolling, gua sha and massage can improve arterial and vascular endothelial function, or the flow of blood and lymph through the tissues. Self-myofascial release allows for consistent and cost-effective management. Athletes of all levels most commonly use a foam roller or ball of varying density.

Despite being versed on the benefits, Betsy has trouble incorporating soft tissue work. “I love working on strength and cardio work,” she laughs, “but often under prioritize mobility in my own physical fitness. I know how valuable mobility work is, yet I struggle to incorporate it into my routine.” As part of our Athlete Within Challenge, Betsy agreed to spend 10 minutes foam rolling everyday for two weeks. Here’s how it went:

As with any new habit, the most challenging part about for Betsy was adherence. “I started out really strong for the first week but then the weekend hit and falling out of my daily routine made it more challenging to stay diligent,” she says. Sound familiar?

In order to stay consistent, Betsy found three different techniques to be most helpful: routine, external accountability, and increased accessibility. “I found using an alarm worked really well. I set an alarm for 9:15 every night to remind me.” (As an added benefit, myofascial release can also help to improve parasympathetic nervous system activity, allowing us to mentally and physically calm down so our bodies can regenerate. Soft tissue work in the evening can set you up for a great night’s sleep!)

Betsy shared her goals with her fiancé, finding that having “someone to hold me accountable, who knew to remind me if I hadn’t done it for the day” helped to keep her on track. The last thing she found to be helpful? Relocating her foam roller. “I ended up putting it next to the tv,” says Webb, “so that when I would sit down to watch tv at night I would see the roller and be reminded to use it.”

So is it worth the time? After the two weeks were up Betsy’s body was thanking her. “Foam rolling is something I know I should do more of, especially for my thoracic spine, but never was able to get into a routine." Like so many of our patients, Betsy saw tremendous benefit from going back to the basics: “After the first week I felt good but not too much different, but a full two weeks really started to make a difference in how I felt from a mobility standpoint.” The true payoff for myofascial release work is in the consistency. Studies have yet to show if any of these improvements in flexibility and tissue quality have longterm effects once treatment is stopped. “I fully intend to maintain this behavior. As I saw with the two weeks, the longer I remained consistent the better I felt,” states Webb.

Our vote? Yes to myofascial release!

Looking for Dr. Betsy Webb? As of July 1st, she will be practicing in the Chicago Area!

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