Massage is the scientific manipulation of soft tissue for restorative purposes. Clinically, physical therapists, licensed massage therapists, and legitimate chiropractors commonly use massage as a passive treatment modality. In short, the mechanism is this: repetitive pressure to the skin induces neural fiber transmission from peripheral nerve receptors, through the spine, to centers in the brain. The brain—the master control center—then sends signals back to the area. These signals trigger the following responses:
- Relaxation of muscle(s) in spasm
- Local dilation of blood vessels
- Increased blood and lymphatic flow
- Decrease in swelling, due to fluid mobilization
- Removal of necrotic (dead) tissue, and reabsorption of residual cells present as a result of the inflammatory process
While these products of soft tissue mobilization are important for providing the optimal environment for healing, perhaps the most important effect of massage is this:
- Stretch and breakdown of adhesions, with a resultant increase in tissue mobility
Before going any farther, a little muscle anatomy: every skeletal muscle is enveloped in a supportive, Saran Wrap-like structure called fascia. We can access the first level of fascia through massage and foam rolling—to the muscle, this first level acts like control-top pantyhose. It provides support, compression, and a surface to glide upon, and has a very high tensile strength to tolerate multidirectional forces.
Now, picture a typical 60-year-old woman. Think about the quality of her movement as she walks up a flight of stairs. Now, imagine a young child—three or four years of age—frolicking about as little kids do. He or she will not have much physical development, and undoubtedly less than the 60-year-old adult. Yet, the fluidity and ease of movement for the child will be geometrically greater. Why? In the older adult, the superficial fascia likely has so many restrictions that tissue extensibility and mobility are greatly reduced. These fascial restrictions may take months or years to develop into pathology, and occur in two ways:
- Non-acute: from injury or unbalanced biomechanics
- Acute: scar tissue matrix develops in tissue as a result of trauma
Non-acute fascial restrictions occur over long periods of time, as low-load forces lead to changes in neuromuscular response and coordination. For instance, sitting at a desk for eight hours a day (sound familiar?), five days a week is a totally unnatural stimulus, and causes neural tightening in the hip flexors. Over time, these altered neural patterns will bias the hip flexors in squat pattern movements, and will cause tightening of the musculature and eventual scar tissue formation. The chair situation will also place a tensile (stretch) force on the hamstrings, causing them to neurologically lengthen (the body will have a harder time recruiting them) and become weak. The resultant combination of overactive hip flexors and under-active hamstrings leads to a dangerous, vicious, pathological cycle. No good. Other non-acute forces include poor posture (upper back/shoulder, neck, pelvis, hip, knee, and ankle issues), and poor mechanics when exercising.
Acute restrictions occur as a result of hard training or bodily injury. Extreme soreness after a challenging workout indicates that you have created micro-tears to muscle and fascia tissue at the cellular level—this is a good thing, because the tissue will rebuild itself stronger than it was pre-stimulus. However, if your muscle tissue does not align itself properly during the rebuilding process, a scar tissue matrix will form within the fascia—an adhesion. This adhesion will restrict nerve, blood and lymphatic vessels, and will consequently decrease local tissue metabolism—effectively slowing down the recovery process for future workouts! Often, the adhesion will develop into a trigger point, a hyperirritable muscle in spasm. Trigger points initiate common patterns of referred pain, and often feel like a “dull ache” in the muscle or surrounding muscles.
Both acute and non-acute fascial restrictions can be treated effectively with a combination of modalities, including massage. Deep tissue massage, in any form (e.g., foam rolling, trigger point therapy, sports massage), will mechanically break up the muscular adhesions, and allow for proper patterns of fluid exchange within the muscle. To release trigger points, deep pressure is especially effective. Once the adhesions have been removed from the muscle, greater tissue extensibility can be created through stretching (to be covered in part three of this series). The take-home message is this: use your foam roller (or tennis ball, golf ball, etc.) where it hurts, because these areas of pain are likely to be adhesions or trigger points. By releasing the areas of tension within the muscle belly, you will improve muscle extensibility and recovery, and facilitate proper biomechanics.
Rest today, and maybe get a massage.
–Melody and John