Issue link: https://www.massageandbodyworkdigital.com/i/72195
at all, it may indicate a problem for interpreting the study's results. SPORTS MASSAGE So what's going on with the research literature in sports massage? At a time when more and more athletes and trainers are using—and reporting benefits from—sports massage, why do so many studies report "no effect" of massage on recovery, like the Jönhagen article mentioned above? What does that mean for sports massage? Weerapong's ("The Mechanisms of Massage and Effects on Performance, Muscle Recovery, and Injury Prevention") team looked at the evidence for massage in several areas of interest to athletes, including physiological and psychological indicators, performance improvement, injury prevention, and recovery. They found conflicting trends—many of the claims made for massage were not borne out by the results of studies, yet those studies also tended to have methodological problems.5 they found that many of the claims made for neurological effects of sports massage, such as increasing neuromuscular excitability, have not been studied, so there is no evidence one way or the other for such claims. They did find evidence for other effects, including mechanical effects on muscles and psychological effects promoting recovery, and they call for more specific research, clarifying what massage techniques and outcome measures are examined, and avoiding the methodological flaws of previous studies. They call for research on the following specific questions: • Can massage increase muscle blood flow, muscle temperature, neuromuscular excitability, or muscle flexibility? • Can massage increase performance, such as sprinting, jumping, or endurance athletic events? • What type of massage can produce benefits? How long should massage be applied? When should athletes receive massage? • Are the effects of massage universal or are they specific to each massage therapist? • Is the cost and time for massage appropriate when a warm-up or cool- down may be as, or more, effective? The fourth research question raised by Weerapong's team is particularly intriguing, as it ties into research Moraska carried out on the effect therapist education had on outcomes after a race. He found that therapists with 950 hours of education achieved greater reduction in soreness than did therapists with fewer hours of education.6 This suggests that there Additionally, may indeed be therapist-specific effects at some level that are escaping the studies, a consideration which gets back to the methodological trade-off mentioned above about the difference between studying the effects of a standard protocol versus studying what therapists really do (as difficult to replicate as that is). Not only does this open the door to future research to explore what those therapist-specific effects may be, it also raises intriguing methodological questions about how to carry out those explorations. What trade-offs may be involved to preserve those effects while studying them, without having to sacrifice scientific rigor? It is a variation of the trade-off mentioned previously, about balancing the need for replicability in later studies with fidelity to the actual process of massage. It will remain an ongoing dialogue for some time to come. The current state of the sports massage research literature is confusing and difficult to navigate. One of the reasons for this difficulty is the lack of methodological clarity, both within individual studies, and among them for comparison to each other. This situation highlights the vital importance of solid methodology in research and the problems that can result when that methodology is not as strong as it could be. In order to gain a firmer shared understanding of what sports massage can offer, a crucial step is to reinforce a stronger methodology by clarifying what athletic outcomes are being looked for, what massage techniques are being examined, what therapist-specific factors need to be examined, and what study design factors—including sufficient sample size—are needed to ensure that the results are as valid as possible. practitioner and biomedical informatician in Seattle, Washington. She has practiced massage at the former Refugee Clinic at Harborview Medical Center and in private practice. In addition to teaching research methods in massage since 1996, she is the author of an upcoming book on research literacy in massage. Contact her at researching. massage@gmail.com with questions and comments. Ravensara S. Travillian is a massage NOTES 1. A. Moraska, "Sports Massage. A Comprehensive Review," Journal of Sports Medicine and Physical Fitness 45, no. 3 (September 2005): 370–80. 2. L. Brosseau et al., "Deep Transverse Friction Massage for Treating Tendinitis," Cochrane Database of Systematic Reviews 4 (2002): CD003528. 3. S. Jönhagen et al., "Sports Massage After Eccentric Exercise," American Journal of Sports Medicine 32, no. 6 (September 2004): 1499–503. 4. J. Hattan, L. King, and P. Griffiths, "The Impact of Foot Massage and Guided Relaxation Following Cardiac Surgery: A Randomized Controlled Trial," Journal of Advanced Nursing 37, no. 2 (January 2002): 199–207. 5. P. Weerapong, P.A. Hume, and G.S. Kolt, "The Mechanisms of Massage and Effects on Performance, Muscle Recovery and Injury Prevention," Sports Medicine 35, no. 3 (2005): 235–56. 6. A. Moraska. "Therapist Education Impacts the Massage Effect on Postrace Muscle Recovery," Medicine & Science in Sports & Exercise 39, no. 1 (January 2007): 34–7. massagetherapy.com—for you and your clients 141