Trisoma® - Sports Massage & Rehab Bodywork
The human body is a neurobiochemical unit, not just a mechanical unit. All components must be prepared, recovered and rehabilitated properly to continue optimal function, whether pulling a canoe or pushing a pencil.
is a general term for a very broad area of bodywork, which focuses on physiologic processes which promote neuromuscular and soft tissue function, recovery and healing, and pain relief.
Types of Sports Massage encompass:
is not just for the athlete who frequently performs near failure, but also for the typical office worker who also performs near failure for certain muscles, simply because the body is not designed to sit holding a pencil for hours at a time.
In ancient Greece, gladiators and Olympic athletes were massaged before their events.
Modern day athletes receive massage regularly, and the growing number of young and old athletes, as well as typically slumped-over office workers, are learning that sports massage is a valuable tool for
improving performance, recovery and rehabilitation on a cellular level.
The human body has a fascinating intelligence when it come to healing, and when the body is allowed to listen to itself, healing can resume.
Whether one is a top athlete or an office worker, injuries may not be immediately evident.
or just standing, sitting or holding a pencil for several hours without proper rest, may cause microscopic breakdown of various soft tissue. Over time symptoms will appear, usually after significant damage has been done. Sports massage, along with proper training periodization, physical therapy, sleep, diet and
is one method of treatment to minimize reduction of active time or work hours.
Targets of sports massage
tendinosis (which is a tendinopathy much more common than tendinitis,)
fascial restrictions, and other myofascial pathology, including scarring in muscle, fascia, tendons, ligaments and cartilage. Treatment may include assessment, stretching, client feedback, and various techniques of manipulating tissue- some relaxing, yet some others less than comfortable.
Most sessions are clothed, may last 2 minutes or over an hour, and may encompass full-body and/ or emphasis on a particular problem area.
goals are to increase blood circulation, tissue and joint flexibility and mental clarity to prepare for performance and reduce injury.
Methods include effleurage,
tension and tapotement. This does not replace the
athlete's warm-up but complements it.
Factors such as temperature, nervousness, fatigue, hyperactivity and past experience with massage are considered before giving treatment.
Static stretching and
trigger point therapy
or other deep tissue work is normally contraindicated for pre-event treatment as it may interfere with the client's coordination and strength.
goals are to aid repair and restoration of tissues, reduce soreness and to return parasympathetic dominance.
The modality choices are wide, including
Barefoot Deep Tissue,
Trigger Point therapy,
resistance stretching, and chosen for the specific client's situation.
Paul's arsenal includes
Proprioceptive Neuromuscular Facilitation,
and other therapies, such as
Barefoot Deep Tissue,
which may or may not be painless nor initially relaxing, but can help enhance top athletic performance in one or several treatments.
Treatment can be adjusted to the comfort-versus-effect preference of the client.
Although top athletes use bodywork for maximizing performance while minimizing injury,
recreational athletes and other people are becoming aware of the salubrious benefits of sports massage.
Long-term pain patterns
are most often the result of scar tissue or other pathologic conditions that form in muscles, tendons, ligaments, bursas, nerves and joints after an injury, or hundreds of discrete injuries. The pain typically results in activated trigger points, and decreased function.
Rehabilitation techniques, such as transverse friction or cross-fiber frictioning, involve applying deep pressure to tissues repeatedly to break down adhesions and scar tissue, partially reducing an injury back to its acute stage in order to trigger the body's natural healing response.
Human skin, muscles and connective tissue have at least 8 types of receptors, and the human body has a fascinating intelligence when it comes to healing. When the body is reminded and allowed to listen to itself, healing and parasympathetic response can resume.
Massage is therapeutic for connective tissue healing where physical therapy or medications alone have failed, and it is preventative therapy for acute tendon injuries.
Connective tissues around joints and cartilage
have poor blood circulation, so conventional medicine maintained that any injury to connective tissue was irreparable except by surgery.
However studies since the 1980's are showing that, after disruption of normally homeostatic structures, the body's healing response is activated to mobilize materials that are used to reconstruct damaged tissues.
The phases of tendon healing were described in 1968 as inflammation, proliferation, and organization.
Some medical doctors seem to employ incomplete knowledge of research on tendinopathies,
and may perform inadequate physical assessment and surgical technique, possibly contributing to misdiagnoses and decreased success rates for healing.
Most conditions diagnosed as "tendinitis" or tenosynovitis are actually tendinosis,
attributed to microscopic tearing with formation of immature reparative tissue (angiofibroblastic hyperplasia) and lacking acute inflammatory cells.
Tendinosis is characterized by the presence of active fibroblasts and vascular granulation (scarring and weakening) and loss of collagen.
The term angiofibroblastic hyperplasia (tendinosis) refers to the degenerative changes that occur when a tendon has failed to heal properly after an injury or after repetitive microtrauma resulting from overuse caused by even slight tension, such as holding a pencil, mouse or steering wheel for hours.
Tendinitis is characterized by the presence of an increased number of lymphocytes or neutrophils (inflammation), and is rare.
Histopathological studies in the 1970's revealed that even tennis elbow is not an inflammatory condition.
So why do many doctors continue to precribe anti-inflammatories or pull out the cortisone syringe so often? Ask your doctor.
Also, incomplete surgical procedures have prevented proper observation of the true causes, and reduced the success in treatment.
Tendinosis results from chronic overuse injuries,
which are the result of long-term tension (even holding a pencil) or multiple microtraumatic events that cause disruption of the healing response, and degeneration of the internal structure of the tendon, cells and matrix
and also from medications such as some antibiotics (Cipro, etc.)
or rare disorders.
The goal of nonsurgical treatment is a revascularization and collagen repair of this pathologic tissue.
Dr. James Cyriax (1904-1985), British Internist and Orthopaedic Surgeon, also called
the "Einstein" of orthopaedic medicine, developed a technique for
deep transverse friction,
also termed cross fiber friction, which effectively reduces existing fibrosis,
crystalline roughness that forms between tendons and their sheaths and encourages tendon fibroblasts to form increased collagen and cross-linkages in response to internal microtears,
and more proper alignment of strong, pliable tissue at the site of healing injuries in
Cross-fiber has been used for
tennis elbow (lateral epicondylitis, or more properly termed a tendinosis that specifically involves the origin of the extensor carpi radialis brevis muscle),
golfer's elbow (medial epicondylitis),
jumper's knee) and other painful tendinopathies. It can also prevent or soften
help restore mobility, remove toxins from muscle tissue, and relieve tension and possibly trigger points.
Transverse or Cross-Fiber Friction therapy
and prolotherapy (dextrose injection), along with a properly planned physical therapy program of exercise and rest, are being supported by more research for active rehabilitation of tendons and ligaments.
Many sources describe that tendons have an intrinsic capacity to remodel as a continuous healing process because tension across fibroblasts causes these cells to divide and to align perpendicular to the line of stretch, leading to development of a preferential direction of collagen in the fibers.[10,11,12,13]
Regrowth of collagen and cartilage by such therapies is also being verified by clinical studies.
Massage prevents acute tendon injuries.
may involve side-to-side dehiscence of the fascicles, or actual longitudinal disruption of the fibers, and should be evaluated by an orthopedic doctor for possible surgical repair.
However it is well supported that tearing is an acute worsening of an accumulated series of microscopic injuries within the tendon, and there is evidence that approximately two-thirds of acute ruptures of the Achilles tendon are associated with histological evidence of chronic degenerative pathological changes within the tendon (hypoxic degenerative tendinopathy, mucoid degeneration, tendolipomatosis, and calcifying tendinopathy, either alone or in combination.)
Thus sports massage would be a preventative therapy for ruptured tendons.
and other deep work has been known to reduce pain and stiffness from osteoarthritis. For rheumatoid arthritis, which is a chronic inflammatory condition characterized by lymphocyte and neutrophil reactions, lymphatic drainage is useful. Inflamed joints should be massaged only under medical supervision.
Stretching and strengthening muscles
to heal tendinopathies is typically prescribed, but one difficulty with such treatment is the fact that muscles repair and strengthen in weeks, but tendons, ligaments and periosteum may take months to regain structure, leading to chronic damage.
Many avulsions occur at the musculotendinous junction, and physical therapy should be individually specific.
Electromyographic studies have repeatedly demonstrated how altered muscle activation sequences (firing order) adversely affect coordination and speed, and that the inhibition of dynamic extrinsic muscles may be so great, that strengthening them may further intensify the inhibition.
is being researched as the next panacea medical treatment in connective tissue disorders and repair.
My proceleusmatic instructor and mentor,
worked in the 1984 Los Angeles Olympics, and founded the first full-time
Sports Massage school in the USA, has trained thousands of bodyworkers around the world and continues to teach at
The Santa Barbara Body Therapy Institute.
As a wise man stated,
"I do not diagnose, prescribe nor treat; I just rub it and if it feels better, groovy!"
Buy the book Fix Pain by John Harris and Fred Kenyon on Am@%*n for over $100, or here for a discounted price with free shipping!
Buy the New DVD Barefoot Deep Tissue by John Harris for a discounted price and free shipping!
1. Calvert, Robert Noah, :
The History of Massage, An Illustrated Survey from around the World.
Inner Traditions International, (2002)
(Return to Reference 1 in text)
sometimes called chronic tendinitis, chronic tendinopathy or chronic tendon injury, is damage to a tendon at a cellular level. It is thought to be caused by microtears in the connective tissue in and around the tendon.
Tendinosis is typically diagnosed as tendinitis/ tendonitis due to the limited understanding of tendinopathies by the medical community.
The suffix 'itis' means inflammation leading to anti-inflammatories being prescribed, despite clinical trials proving little or no benefit from such medication treatment. The strongest evidence for treatment of tendinosis is for nitric oxide patches, cross-fiber friction massage and for forms of resistance training exercises that 'load' the affected tendon. (2008)
(Return to Reference 2 in text)
BARRY S. KRAUSHAAR, M.D., EMERSON, NEW JERSEY and ROBERT P. NIRSCHL, M.D., M.S., ARLINGTON, VIRGINIA. :
Current Concepts Review - Tendinosis of the Elbow (Tennis Elbow). Clinical Features and Findings of Histological, Immunohistochemical, and Electron Microscopy Studies.
The Journal of Bone and Joint Surgery 81:259-278 (1999)
Investigation performed at Nirschl Orthopedic Sportsmedicine Clinic, Arlington; Arlington Hospital, Arlington; and Georgetown University Medical Center, Washington, D.C.
(Return to Reference 3 in text)
Nirschl, R. P.:
Elbow tendinosis/tennis elbow.
Clin. Sports Med., 11: 851-870, 1992.[Medline]
(Return to Reference 4 in text)
Leadbetter, W. B.:
Cell-matrix response in tendon injury.
Clin. Sports Med., 11: 533-578, 1992.[Medline] Department of Orthopaedic Surgery, Georgetown University, Washington, DC.
(Return to Reference 5 in text)
Gamble, J. G.:
The musculoskeletal system: physiologic basics. In Athletic Training and Sports Medicine,
edited by L. Y. Hunter-Griffin. Ed. 2, p. 105. New York, Raven Press, 1988.
(Return to Reference 6 in text)
The fibroblast and wound repair.
Biological reviews of the Cambridge Philosophical Society. 43: 51-96, 1968 Feb.[Medline]
(Return to Reference 7 in text)
Józsa, L. G., and Kannus, P. [editors]:
Overuse injuries of tendons.
In Human Tendons: Anatomy, Physiology, and Pathology, pp. 164-253. Champaign, Illinois, Human Kinetics, 1997.
(Return to Reference 8 in text)
Kannus, P., and and Józsa, L.:
The fibroblast and wound repair.
Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. J. Bone and Joint Surg., 73-A: 1507-1525, Dec. 1991.
(Return to Reference 9 in text)
Nirschl, R. P.:
Patterns of failed tendon healing in tendon injury. In Sports-Induced Inflammation: Clinical and Basic Science Concepts,
pp. 609-618. Edited by W. B. Leadbetter, J. A. Buckwalter, and S. L. Gordon. Park Ridge, Illinois, American Academy of Orthopaedic Surgeons, 1990.
(Return to Reference 10 in text)
Eyre, D. R.; Paz, M. A.; and and Gallop, P. M.:
Cross-linking in collagen and elastin.
Annual Review of Biochemistry., 53: 717-748, 1984.
(Return to Reference 11 in text)
Forrester, J. C.; Zederfeldt, B. H.; Hayes, T. L.; and and Hunt, T. K.:
Wolff's law in relation to the healing skin wound.
The Journal of Trauma., 1970 Sep;10(9):770-779.
(Return to Reference 12 in text)
Gelberman, R.; Goldberg, V.; An, K.-N.; and Banes, A.:
In Injury and Repair of the Musculoskeletal Soft Tissues: Workshop, Savannah, Georgia, June 1987, pp. 1-40. Edited by S. L-Y. Woo and J. A. Buckwalter. Park Ridge, Illinois, American Academy of Orthopaedic Surgeons, 1988.
(Return to Reference 13 in text)
Riley J. Williams, III, MD; Erik Attia; Thomas L. Wickiewicz, MD; Jo A. Hannafin, MD, PhD:
The Effect of Ciprofloxacin On Tendon, Paratenon, and Capsular Fibroblast Metabolism
Laboratory for Soft Tissue Research, Sports Medicine & Shoulder Service, Hospital for Special Surgery, affiliated with New York Hospital, Cornell University Medical Center, New York, New York. Riley J. Williams III, MD, 535 E. 70th Street New York, NY 10021.
The American Journal of Sports Medicine 28:364-369 (2000), © 2000 American Orthopaedic Society for Sports Medicine, Presented at the 24th annual meeting of the AOSSM, Vancouver, British Columbia, Canada, July 1998. Winner of the 1998 O'Donoghue Sports Injury Research Award.
(Return to Reference 14 in text)
Florence Peterson Kendall, Elizabeth Kendall McCreary
Muscles: Testing and Function
Lippincott Williams & Wilkins
(Return to Reference 15 in text)
RP Nirschl and FA Pettrone
Tennis elbow. The surgical treatment of lateral epicondylitis
1979, The Journal of Bone and Joint Surgery, Vol 61, Issue 6 832-839.
(Return to Reference 16 in text)
Defining and Treating Tennis Elbow
Contemporary Surgery 10: 13-17 Feb. 1977.
(Return to Reference 17 in text)
Kanai'a Canoe Men's Race Team ©2008 Paul Svacina.
Courtesy of www.massagenerd.com.
3. Kanai'a Canoe Women's Race Team ©2002 Paul Svacina.
4. Disco Inferno Ultimate Frisbee ©2006 Paul Svacina.
5. UCSB Intramural Soccer ©2008 Paul Svacina.
6. Friend playing tennis ©2003 Paul Svacina
Erika of SonneBlauma Danscz Theatre,
courtesy of and ©2008 Am Wu photography.
Dancer muscles courtesy of www.massagenerd.com.
9. Courtesy of
Football player muscles courtesy of www.massagenerd.com.
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