Travelling In Sport As A Massage Therapist

 

When I decided to go back to school to be a Massage Therapist, the one thing that made me decide on this new profession was the chance to work with athletes and sports teams.

The whole idea of working with teams always had a certain lure to me, getting to be part of that team environment always seemed more appealing than strictly working in a clinic.

While in college I was lucky enough to start working with our local Junior A hockey club and continued working with them for seven years, even being the head trainer and medical director for one season. During that season, I did some travel with the team to other parts of the province and got the feel of what it’s like to be on the road with a team, dealing with transport, setting up dressing rooms, loading and reloading the bus with equipment and all the other issues that happen on the road.

Because of putting in the time volunteering with that team, some other great opportunities have come my way. I got to spend a year working with our Rugby 7’s men’s national team, and in 2016 I got my first opportunity to work with our national women’s development program in hockey.

Since working with the women’s development program, I’ve had two opportunities to travel internationally with them. I thought I knew the work and effort it takes to work with a team from my past experience, but working and travelling internationally takes on a whole other level of work and work ethic to be successful.

I know many of our readers are interested in this type of work, so I’ll try to outline what an average couple of days looks like work-wise, so you’ll know what you’re getting into if this is your chosen area of interest.

Daily Schedule

While I’m sure it’s different for every sport and probably every venue, it takes a ton of work to get things set up at hotels, dressing rooms, and whatever venue you are using to help the athletes throughout a tournament.

You aren’t doing strictly massage therapy when you’re on the road, you’re helping out wherever is needed, plus covering some aspects you may not have thought of (keep in mind this is just three days of a three-week trip).

Pretournament Game

5:00 amLight snack

5:30 amAthlete exercise routine  

6:00 amTeam meetings/presentations

6:30 amTeam practice/dryland

7:00 amRegular breakfast

7:30 amMorning session with S&C coach

7:45 – 9:10amPractice session for some athletes  

10:00am – 12:00pmPhysio & Massage Therapy treatments

1:30 pmPregame Meal

3:10 pmAthletes and coaches meeting

3:45 pmDryland warmup

4:30 pmOn ice warmup for both teams

5:00 pmGame time

5:10 pmAthlete cool down  

8:20 pmDinner

9:00 pmStaff meeting

Travel Day

5:00 amLight snack

5:30 amAthlete exercise routine

5:45 amTeam meetings/presentations

6:30 amBreakfast

6:50 amAthletes and coaches meeting

7:15 amDryland warmup

8:00am – 9:15amTeam practice

9:30 amAthlete cooldown 

9:30 am – 10:15 amHelp equipment manager pack up the dressing room and load all equipment on the bus

10:30 amLunch

12:15 pmLoad all team luggage on the bus

12:30 pmLeave for airport

1:45 pmCheck all baggage and equipment in through airport security

5:05 pmFlight leaves

6:30 amLand for connecting flight

10:10amConnecting flight departs

3:25 pmLand in destination, collect luggage, load bus

6:00 pmCheck into hotel

6:30 pmDinner

7:00 pmAll support staff (medical, logistics, equipment manager etc) set up athletes dressing room, medical room, and all associated equipment.

9:10 pm Staff meeting (time depending on dressing room setup completion)

Pre-competition

8:15 amBreakfast

8:45 amAthlete and coaches meeting

9:30 amDryland warmup

10:00 am – 11:45 amPractice

12:00 pmAthlete cool down

12:40 pmLunch

1:15 pmTeam meetings/presentations

2:00 pm – 4:00 pmPhysio and Massage Therapy treatments

4:30 pmLight meal

5:30 pmDryland warmup

6:00 pm – 7:15pmPractice

7:25 pmAthlete cool down

8:30 pmDinner

9:00 pm – 10:00 pmTreatment window for Physio and Massage

10:10 pmStaff meeting

Gameday

7:15 amBreakfast

7:45 am – Athlete and coaches meeting

8:15 amDryland warmup

9:00 am – 9:45 amPregame Skate

9:55 amAthlete cool down

11:00 amLight lunch

12:00 pm – 2:00 pmPhysio and Massage Therapy treatments

3:30 pmPregame Meal

4:50 pmAthlete and coaches meeting

5:45 pmDryland warmup

6:30 pmOn ice warmup for both teams

7:00 pmGame time

9:10 pmAthlete cool down

10:30 pmDinner

11:00pmStaff meeting

So when you look through this schedule, everywhere it talks about dryland warmup, athlete cool down, and practices, at least one member of the medical team is expected to be in attendance. Typically one member attends while the other therapist tends to some other tasks like filling game water bottles, getting ice, making up ice bags, or helping the equipment manager if needed (essentially doing the background work that isn’t typically thought about). Sometimes the practices and warmups etc. overlap each other depending on how the schedule is set, so you could be covering one practice and another medical staff member is covering the other one.  

During game times I would go up and help the video coach by shooting video during the game, while the physiotherapist is on the bench. Essentially everyone has a job description, so each members time is utilized and productive. 

If you’ve followed this blog for very long, you’ve seen articles stressing the need for us as a profession to be certified in First Aid training. In sports, it’s even more important to be trained as a First Responder. In cases like this, anytime there is an emergency with one of the athletes, the Massage Therapist is part of the emergency action plan and is expected to take part in the injury or emergency, whether it’s on the ice, or off. 

I can’t stress enough how important it is to get this training if working in sports is your interest!

The Team Within The Team

All of the staff are literally another team, within a sports team, it’s not just about the athletes working together.

As I mentioned before, you could be tasked with some menial work (filling water bottles etc.) while another member of the medical staff is working directly with the athletes at a warm up or cool down.

You can’t have an ego about this! 

Even if you work with a team at home and you’re the head trainer, that may not be your role when you travel with a national team. They will have a specific job description for you, and it’s important you adhere to it. There are some really long days where you could be setting up a dressing room, or loading equipment for travel (and not actually do any massage), while the coaches are doing their prep work, logistics are organizing travel, and other members are filling the role for whatever their responsibility is.

But just like the athletes who may be playing a smaller role on the team than they play at home, everyone comes together as a team to accomplish a goal. EVERYONE is filing a different role than they are used to. There will be days you get frustrated, you’ll be tired, and maybe even annoyed with other staff members. But part of being on a team is the ability to put that aside, come together, and work for the benefit of the athlete, it’s about them, not you. 

However, if you are willing to work, put your ego aside and do this kind of work, the benefits are phenomenal. The friendships you’ll make, the pride of not only helping the athletes performance but also representing your country (or whatever organization you’re working with) is incomparable. Plus, you may even end up with a cool picture and a medal at the end of it all.

 

Articles Of The Week December 31, 2017

We have to be careful when loading certain injuries like a fracture or complete tendon tears. However, with muscle and tendon injuries the evidence is showing that loading early is beneficial, and a little bit of pain isn’t a reason to back off. 

“Starting Rehab Early Can Speed Recovery From Muscle Injuries: Study” – The Globe And Mail

 

This is a great article (however I think I connect with it because I used to be that guy!). Manual therapy is great, but we don’t need to crush tissues or use heavy weighted force to ‘release’ tissue. We need a more logical way to work, and this article helps us understand that. 


“Should We Crush Tissue?” – Mitch Hauschildt

 

This one is actually a video from David Butler on assessment of the upper and lower limb. It’s great information and can be implemented in your clinical setting right away.

“NOI Neurodynamics” – David Butler

 

We are all business people, so it’s just as important to learn about business as it is therapy. This article shows how recognizing a pattern and reacting to it differently can change a bad habit and create new positive ones.

“How Your Patterns Can Kill Your Business – The Solution Is Not So Simple” – Alley Jean

 

I’m sure we’ve all helped a patient in our practice who has dealt with a concussion. Whether from a car accident, a fall, or from playing sports, concussions can be difficult to deal with. For this reason, some parents are pulling their kids from sports because they’re afraid of them getting a concussion. But what about all of the other things sports do for kids? Here are 5 reasons why they should still be in sports:

“5 Reasons Kids Should Play Sports” – Complete Concussion Management

 

Change is hard, change within an entire industry is even harder! However, this post goes on to discuss why manual therapy needs to change, and why the change is important.

“Embrace Change” – Eric Purves

 

Articles Of The Week December 24, 2017

We all know how important movement is, but what about the quality of movement? Well, there are a few things to look at in this regard, and Greg Lehman has some arguments around pain, movement and quality of movement. 

“Why I Put Strength On Dysfunction” – Greg Lehman

How good are you at listening to your patients? There are times where a patients recovery could be held up because they are blaming the scenario that put them in pain. But if a person feels they have been heard, they may have less of a reason to hang on to that blame. 

“The Blame Game” – Alison Sim

As humans, we have many different behaviours. Did you know we also have pain behaviours? These behaviours can influence your patients response to pain, so there may be a way for us to help them if we understand this better.

“One Way Of Using A Biopshychosocial Framework In Pain Management – II” – Bronnie Thompson

I’m sure we’ve all heard (and some of us have preached) about not letting your knee go past your toes with certain exercises, in an effort to have great form. But what about when the intent of any given exercise changes? Here’s a great article looking at the mechanics of a split squat and how its intent and thus form can change. 

“The Split Squat And The Knee Over Toe Conundrum” – Michael Gouldon

This one is important, not just for our loved ones, but also for our patients. There may be cues you pick up on with your patients, where their loved ones may not. Its important for all of us to be able to recognize warning signs of dementia, so this article should help. 

“5 Early Signs Of Dementia (And Why Everyone Should Know Them)” – Jamie Wiles

Treatment Tips: An Easy Way To Achieve Posterior Pelvic Tilt

 

As I teach, there are certain concepts/techniques which are self-explanatory, while others have nuances which make them harder to convey, both in the classroom as well as once the therapist is back in their clinic. In the past, I’ve sent out Treatment Tips, but the printed word and still photos only go so far. Recently I had another photo shoot to provide updated content for the new Upper Body and Lower Body Foundations in Myofascial Release Seminars as well as the renamed Myofascial Release for Neck, Voice, and Swallowing Disorders Seminar and we shot a dozen or so short sequence videos. Here is the first one and excuse the first-time-editor-mistakes.

Though not a mandatory aspect of lower back/abdominal/pelvis manual therapy/myofascial release, increasing posterior pelvic rotation and applying light lumbosacral traction often changes the dynamics while treating.

My preference, and what I teach, is manual sacral traction applied in supine with the opposite hand on the lower abdominal region.

I beg and plead with therapists to try this method, but I know that placing a hand under their sacral area by placing the arm between the legs is too much of a boundary issue. I get it. So over the past few years, I devised a “cheater’s” method of accomplishing sacral traction/posterior pelvic tilting without the need to place a hand under the sacrum. Watch the video to see what I mean:

 

Pretty easy, right? If you add a piece of Dycem under the sacrum beforehand, you have an even better-felt sense for the patient. You can find more treatment tips over at Foundations in Myofascial Release Seminars.

Articles Of The Week December 17, 2017

If I’ve heard this once in life, I’ve heard it a thousand times, (Work Smarter, Not Harder!) however, this is the first time I’ve heard it from a fellow therapist. And what’s cool, is that it’s from one of my heroes in this profession. She’s one of the few who will tell it like it is (and honestly, when I first started following her, she pissed me off but I realized she’s pretty amazing), which is rare for us. So take her words to heart!

“How Massage Therapists Can Work Smarter, Instead Of Harder” – Alice Sanvito

I’m sure we all have patients who are dealing with fibromyalgia. For me, I sometimes wonder what advice to give as far as home care. This article comes straight from someone with the condition and gives some sound advice for this holiday season that you could share with your patients.

“Banish The Word Should For The Holidays” – Christine Lynch

Rajam Roose gives some quality advice on client retention and building relationships in this post. I promise if you even do one of the things she recommends you will see a return on your investment, because if we’ve said it once, we’ve said it 1,000 times, building relationships is crucial in this business.

“Retain Your Massage Clients” – Rajam Roose

This one is a conversation piece. A conversation with Lorimer Moseley so you can understand the difference between pain science education, and understanding pain science. And let’s be honest, anything with Lorimer in it is worth reading.

“Lorimer Moseley WOW Chat: Pain Science Education Vs. Understanding Pain. What’s The Difference?” – Shelly Prosko

This is a great post on pain and why it persists. Everything Rachel writes in this post, you could easily use as an explanation to your patients. Please give it a read and use the info she has shared, and talk to your patients about what meaningful touch is!

“Why Does Pain Persist?” – Rachael Scott

 

The Science Behind Why Assessing And Blaming Posture For Pain Is B.S.

If I had a £ for everybody that mentioned posture on social media or when they had a pain problem…… well lets just say I would be a pretty rich guy.

POSTURE has literally become engrained in peoples thoughts when talking about back, shoulder or neck pain even though we have a shit ton of studies that compare the postures of pain-free people with those with back, shoulder or neck pain and find no real differences, this information gets regularly IGNORED.

NEVER let science get in the way of a good story, especially if it’s on the interwebs!

In fact, I have written about posture a few times before:

The definitive guide to posture and pain 3 minutes flat

Do you really need your joints to be centred?

But just to kick off with a bit of science, this paper HERE from 2016 found NO significant difference in lumbar lordosis (spinal curve) between people with back pain and those without.

This is super important. HOW can we blame something that we see in people WITHOUT pain as a cause of pain for those that do?

I will just let that sink in…

What Are You Measuring?

In this blog, we are going to explore a few questions related to how we assess posture and if they are actually scientifically VALID, because if you don’t have a good measure, to begin with then it is pretty tough to blame something for the problem.

The first piece of ACTUAL EVIDENCE, something often missing in the posture debate, looks at the measurement of STANDING LUMBAR LORDOSIS (the curve in the back often blamed for back pain) and this assessment is something that is performed in treatment rooms and gyms the world over.

The idea is that an increase (and sometimes decrease) in lumbar curve increases back pain and is often coupled with the idea that the tilt of the pelvis has an influence on the size of the lumbar curve, even though lumbar curves do not seem to be much of a factor in lower back pain anyway (see the SCIENCE above : )

Way back in 1990 this was explored by Heino et al HERE and they found that the angle of someones pelvic tilt and their lumbar curve do not simply correlate! So looking at the position of the pelvis tells us very little about what is occurring at the lumbar spine, which is much harder to measure. A very similar study HERE from before this in 1987 also threw up the same result but this BS is still being taught today.

Anyway, back to the standing measurement paper HERE. The authors explored the variability in standing posture of 400 people, 332 without pain and 83 with low back pain, and they found that each time we stand we do it in a slightly different way.

The authors in their words state standing is highly individual and poorly reproducible”.

So why does this matter?

Well simply put, which posture are you ACTUALLY measuring with your postural assessment. One may show an increase in lordosis, another less so.

I have some questions related to how we interpret postural assessments in light of this information.

  • Which of these postures is related to the problem?
  • How many times do you measure and do you average?
  • What are you comparing against to determine if the curve is too much or not enough?

The authors highlight a good point that the lack of consistency in standing posture may actually lead to the “wrong diagnosis and possibly unnecessary treatment”.

If you focus on something that is not an issue you do not focus on something else that might be or be blinded to the fact that it is not working or only works transiently (potentially why so much back pain is persistent).

What people actually use in their everyday lives might also be different to what is measured in the clinic or gym. A clinic or gym measure could be described as a ‘snapshot’ and this study HERE compared this ‘snapshot’ to what was actually used on a daily basis by the study participants.

The authors found that on average whilst standing, as most postural assessments are, there was a 33.3° lumbar lordosis but the average used over a 24hr period was only 8°, a huge difference!

So the ‘snapshot’ postural assessment would not really inform us very well about how much lordosis was REALLY being used and we could overestimate the extent of the imaginary problem.

We also have to remember these were radiological measurements and this is the clinical ‘gold standard’. Often a lordosis is measured in a much more rudimentary fashion by looking at the relationship of landmarks at the pelvis indicating a pelvic tilt and therefore change in the lumbar curve, which we have already discussed as not being well related to lumbar curve! This in itself is a problem as demonstrated by Preece in 2008 HERE as pelvic morphology is also VARIABLE leading to incorrect measures.

These results suggest that variations in pelvic morphology may significantly influence measures of pelvic tilt and innominate rotational asymmetry”

 Here is the distribution of side to side difference of the ASIS-PSIS relationship (used to assess pelvic tilt), we can see it is skewed to the right side meaning it is more anteriorly tilted at a BONY level.

Jmmt0016 0113 F04

So it might be that we are really bad at measuring something that doesn’t matter that much. OUCH

Are You Biased?

Another important question for those that assess posture is…are you MORE inclined to see an ‘abnormality’ in posture when you know pain is present?

This paper HERE would suggest so. Here the authors looked at scapular dyskinesis or abnormal posture and movement of the shoulder blade, which is often proposed as a CAUSE of shoulder pain.

They compared 67 people with shoulder pain and 68 without and firstly found that there was no difference in shoulder posture or motion between those with pain and those without.

Fascinatingly though when the assessors were aware that they were assessing someone IN PAIN, they reported a greater prevalence of a postural or movement problem. This shows a bias towards finding an ‘abnormality’ to blame when there is pain, even though there was NO MORE ‘abnormality’ in those with pain than without.

The authors also suggest that scapular dyskinesis actually represents normal variability between humans! Perhaps if they assessed it multiple times it would throw up different measures each time?! It is important to remember we have no scientifically defined ‘good posture’ to base deviations from in the first place.

How Do Healthy People Sit?

Another question is how do people without back pain actually behave? They must have great daily posture, right? Well actually NO.

This paper HERE shows that asymptomatic folk, 50 of them, when seating actually SLUMP. In 10-min sitting, spinal angles flexed 24 deg at lumbar and 12 deg at thoracolumbar regions relative to a standing posture. But this slumping does not seem to cause them problems.

So changes in our spinal curves seem to be fairly unrelated to pain as we can see below.

 

PowerPoint Presentation

 

So If Posture Does Not Really Correlate With Pain, What Does It Correlate With?

Well, this paper HERE shows that cervical spine alignment changes actually correlate with age. This study split the participants into 4 groups determined by age. They found that the measures of the angles of the neck all correlated with the increasing age range of the 4 groups.

The key point to remember here is that all the participants, 120 of them, had no pain. In fact, the exclusion criteria here was pretty rigorous and the authors actually excluded 64 people, so 1/3 of the original sample, for having current or previous pain.

So simply put, as we get older our posture becomes ‘worse’ or perhaps better put our posture increases….BUT and a this a big BUT, this does not seem to cause MORE pain.

To sum up it does not seem as simple as ‘bad’ posture = pain whatever you read or are told in a bar, gym or clinic room.

Key Take Homes

  • People IN pain DON’T have different postures to those that don’t have pain
  • Posture displays variability just like movement
  • This means your assessment may not tell you what you think it does
  • Your assessment could be biased to finding a postural ‘problem’
  • Postures used throughout the day are probably different to those being assessed
  • As we get older our posture change and this happens to people NOT in pain too