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'Recover quicker, train harder, and increase flexibility': Massage therapy for elite paracyclists, a mixed-methods study


Abstract and Figures

Objectives Massage therapy (MT) enhances recovery by reducing pain and fatigue in able-bodied endurance athletes. In athletes with disabilities, no studies have examined similar MT outcomes, yet participation in sport has increased by >1000 athletes from 1996 to 2016 Olympic games. We examined the effect of MT on pain, sleep, stress, function and performance goals on the bike, as well as quality of life off the bike, in elite paracycling athletes. Methods This is a quasi-experimental, convergent, parallel, mixed-methods design study of one team, with nine paracycling participants, in years 2015 and 2016. One-hour MT sessions were scheduled one time per week for 4 weeks, and then every other week for the duration of the time the athlete was on the team and/or in the study. Closed and open-ended survey questions investigating athlete goals, stress, sleep, pain and muscle tightness were gathered pre and post each MT session, and every 6 months for health-related quality of life. Quantitative analysis timepoints include baseline, 4–6 months of intervention and final visit. Additional qualitative data were derived from therapists’ treatment notes, exit surveys, and follow-up emails from the athletes and therapists. Results Significant improvement was found for sleep and muscle tightness; quantitative results were reinforced by athlete comments indicating MT assisted in their recovery while in training. There were no improvements in dimensions measuring quality of life; qualitative comments from athletes suggest reasons for lack of improvement. Conclusion This real-world study provides new information to support MT for recovery in elite paracyclists.
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KennedyAB, etal. BMJ Open Sport Exerc Med 2018;4:e000319. doi:10.1136/bmjsem-2017-000319 1
Open Access Original article
‘Recover quicker, train harder, and
increase exibility’: massage therapy
for elite paracyclists, a mixed-
methods study
Ann Blair Kennedy,1 Nirav Patil,2 Jennifer L. Trilk1
To cite: KennedyAB, PatilN,
TrilkJL.. ‘Recover quicker,
train harder, and increase
exibility’: massage therapy
for elite paracyclists, a mixed-
methods study. BMJ Open
Sport & Exercise Medicine
2018;4:e000319. doi:10.1136/
Accepted 22 December 2017
1Department of Biomedical
Sciences, University of South
Carolina School of Medicine
Greenville, Greenville, South
Carolina, USA
2Department of Quality
Management, Greenville Health
System, Greenville, South
Carolina, USA
Correspondence to
DrAnn BlairKennedy,
University of South Carolina
School of Medicine Greenville;
kenneda5@ greenvillemed. sc.
Objectives Massage therapy (MT) enhances recovery
by reducing pain and fatigue in able-bodied endurance
athletes. In athletes with disabilities, no studies have
examined similar MT outcomes, yet participation in sport
has increased by >1000 athletes from 1996 to 2016
Olympic games. We examined the effect of MT on pain,
sleep, stress, function and performance goals on the bike,
as well as quality of life off the bike, in elite paracycling
Methods This is a quasi-experimental, convergent,
parallel, mixed-methods design study of one team, with
nine paracycling participants, in years 2015 and 2016.
One-hour MT sessions were scheduled one time per week
for 4 weeks, and then every other week for the duration of
the time the athlete was on the team and/or in the study.
Closed and open-ended survey questions investigating
athlete goals, stress, sleep, pain and muscle tightness
were gathered pre and post each MT session, and every
6 months for health-related quality of life. Quantitative
analysis timepoints include baseline, 4–6 months of
intervention and nal visit. Additional qualitative data were
derived from therapists’ treatment notes, exit surveys, and
follow-up emails from the athletes and therapists.
Results Signicant improvement was found for sleep
and muscle tightness; quantitative results were reinforced
by athlete comments indicating MT assisted in their
recovery while in training. There were no improvements in
dimensions measuring quality of life; qualitative comments
from athletes suggest reasons for lack of improvement.
Conclusion This real-world study provides new
information to support MT for recovery in elite paracyclists.
In the past 20 years, the number of disabled
athletes competing at elite levels has increased,
as is witnessed in the number of participants
at the 1996 Summer Paralympics in Atlanta
(n=3255) compared with the number of
participants in 2016 in Rio (n=4328).1 The
Paralympics is not the only venue for disabled
athletes, as positive health and social benefits
have been noted for those who participate
in both professional and recreational adap-
tive sports.2–5 Yet studies demonstrate that
para-athletes also have higher incidence and
prevalence of injures compared with able-
bodied athletes.6–9
The increasing number of disabled
athletes, as well as increased risk of injuries,
gives credence for investigation into ways
to support disabled athletes during their
training and sport competition. Massage
therapy (MT) has been shown to improve
recovery by reducing pain and fatigue in
endurance able-bodied athletes.10 11 Addition-
ally, a recent analysis of treatments pursued
by athletes at the Pan American games indi-
cates that MT was the most sought treatment,
and more than half of MTs were performed
by massage therapists.12 Reports suggest MT
availability for para-athletes6 13 14; however,
to our knowledge, outcomes of MT treat-
ment have not been tracked for athletes with
disabilities. While no identifiable evidence
exists to support MT for disabled athletes,
there is evidence for MT benefiting those with
health conditions seen in para-athletes, such
as spinal cord injury,15–17 cerebral palsy18 19
and amputation.20 21
Best and Crawford,22 as well as Poppend-
ieck et al,23 suggest the need to investigate
multiple bouts of massage during an athletic
season for athletes to advance the science of
massage and sport recovery.22–26 The purpose
of this paper is to examine the effect of MT
on pain, sleep, stress, function and perfor-
mance goals on the bike, as well as the quality
Key messages
Massage therapy aids able-bodied athlete recovery.
Until now, no studies have investigated the effects of
massage therapy in a para-athlete population.
Massage therapy, however, showed no improvement
in health-related quality of life for a small sample of
elite paracyclists.
Our study showed that massage therapy assisted
in para-athletes’ recovery, particularly in the area of
reducing muscle tightness and in improving sleep. on January 28, 2018 - Published by from
2KennedyAB, etal. BMJ Open Sport Exerc Med 2018;4:e000319. doi:10.1136/bmjsem-2017-000319
Open Access
of life off the bike, in elite paracycling athletes in training
from January 2015 until the Rio Olympics in 2016.
All members of Greenville Health System Team Roger C
Peace (Greenville, South Carolina, USA), an elite para-
cycling team, were invited to join the study in 2015 and
2016. In 2015, a total of 9 of the team’s 11 athletes began
the programme; two athletes left the team in 2015 and two
athletes dropped from the study prior to completing the
intervention. At the beginning of 2016, four new athletes
joined the team and began the study protocol. While a
total of 13 athletes completed the study visits; the data
from only of nine athletes were used for this analysis after
reviewing study visit timeline due to lack of consistent
survey completion by the athletes and massage therapists.
All participants signed a written informed consent.
Study design and intervention description
A quasi-experimental, convergent, parallel, mixed-
methods design was used.27 Both qualitative and
quantitative data were gathered in one phase of the
research, analysed separately and then merged to find
where the results converged. Merging the quantitative/
qualitative data strengthened the overall outcome by
providing more comprehensive results.27
In 2014, a standardised MT programme was designed
with the intention to help a decentralised team of elite
paracyclists to improve recovery, rest, performance and
quality of life both on and off the bike. The decentralised
nature of the paracycling team allowed for athletes to
be on the same team and also to live across the country.
Development of the programme is described elsewhere28
and included input from relevant stakeholders including
athletes, coaches and massage therapists. In brief,
the intervention allows for five different protocols (1,
general relaxation; 2, muscle relaxation; 3, combination
of general and muscle relaxation; 4, injury rehabilitation;
and 5, integrated injury rehabilitation and general and/
or muscular relaxation) to be integrated into clinical MT
treatment based on an intake assessment survey, which
also specified the athlete’s specific goals for the session.28
This type of flexible and adaptive protocol allows for indi-
vidualised treatment of athletes based on their treatment
goals and allows for the programme implementers (ie,
massage therapists) to work within their strengths and
skillsets.29–31 Massage therapists used to implement the
programme were identified either by the athlete, through
a search through a locator service, or through local and
national contacts. For massage therapists to be qualified
as implementers, they had to practise sports MT, be willing
to be trained in and follow study protocols, and be willing
to work with their assigned athlete. A total of 17 massage
therapists were recruited and trained as implementers via
online live webinar; more therapists were recruited than
athletes, as some athletes worked with multiple massage
therapists. Of the 17 massage therapists, 11 (64.71%)
were female and all therapists had an average of 14 years
(SD 8.59) in practice. Ten of the 17 therapists (58.8%)
held a bachelor’s degree or higher; 58.8% had more
than 600 hours of initial MT education. All massage ther-
apists were paid their standard fees for their services and
provided MT treatment in either their offices or in the
athlete’s home.
On entering the study and signing informed consent,
athletes were asked to schedule a 1-hour MT sessions
one time per week for 4 weeks (eg, loading phase) and
then every other week for the duration of the time (eg,
maintenance phase) they were on the team and/or in
the study. This schedule was chosen to try to minimise
time burden on the athletes, as well as mirror ‘real-world’
clinical implementation. The maximum amount of MT
sessions an athlete could obtain if they remained on the
team and in the study over the 18-month period was 39
MT sessions.
Outcome measures
Quantitative data were gathered from the RAND Medical
Outcomes Survey MOS Short Form Health Survey
36 (SF-36),32 33 or SF-36V34 (for non-ambulatory athletes),
and on an MT session intake and exit questionnaires to
measure stress, sleep, muscle tightness, spasticity and
pain on a 10-point scale, with higher numbers indicating
greater impairment.28 Qualitative data were obtained
from open-ended questions on the massage intake and
exit questionnaires, from the massage therapists’ treat-
ment notes, from the programme exit questionnaire,
as well as programme feedback emails provided by the
Data collection
On entering the programme, the athletes completed
a health history form as well as either the SF-36 V.2 or
SF-36V. The athletes subsequently filled out the SF-36
(or SF-36V) after the 14th MT session (approximately
6 months into the programme) and at the end of the
programme. The MT session intake surveys were emailed
to each athlete on the morning of their scheduled MT
session; once the survey was completed, an email noti-
fication was sent to their massage therapist. Massage
therapists also received an email link to their treatment
notes on the morning of the scheduled session with
their athlete. The morning after the MT session, athletes
received the session exit survey to follow up on progress
after treatment. All surveys were managed through the
REDCap system, a secure and Health Insurance Porta-
bility and Accountability Act (HIPAA)-compliant system
for survey and database development.35
Data analysis
Quantitative analysis (SAS Enterprise Guide Software,
V.7.1) included comparing the nine dimensions of SF-36
questionnaire and the 10-point scales for pain, sleep,
function, spasticity and stress before, during and after
the intervention. Repeated-measures analysis of variance on January 28, 2018 - Published by from
KennedyAB, etal. BMJ Open Sport Exerc Med 2018;4:e000319. doi:10.1136/bmjsem-2017-000319
Open Access
(ANOVA) was used to analyse the differences in compar-
ison variables at three timepoints: baseline, at 4–6 months
and at final visit. Further, multiple pairwise comparison
was performed using Tukey’s test whenever a significant
difference was revealed by repeated-measures ANOVA.
The difference between intake and exit outcome vari-
ables was analysed at each timepoint separately using
paired t-test. P values less than 0.1 are considered signifi-
cant for this feasibility study.
Qualitative analysis (NVivo V.11 qualitative data anal-
ysis software; QSR International, Doncaster, Victoria,
Australia) began with data immersion by reading and
rereading the text provided by the athletes and thera-
pists. Next, word count queries were performed for each
qualitative survey question, athlete feedback emails and
the therapists’ notes to begin to understand potential
patterns in the data.36 Then initial codes were created
from the textual data through an iterative thematic anal-
ysis process of reading the data and highlighting text
and assigning a code identifier.37 Once all the data were
coded, emergent themes were identified by gathering
similar codes together.37 The coding scheme evolved to
have four major themes: goals for MT sessions, perceived
benefits of MT sessions, beliefs and expectations about
MT, and the interaction and importance of the thera-
peutic relationship with their massage therapist. These
themes are mentioned here, in the Methods, as they then
guided the integration of the quantitative and qualita-
tive data. The quantitative results tables were integrated
with athlete and therapist comments from the represen-
tative themes. These qualitative quotations were used to
explore and expand the understanding and of the quan-
titative findings.38 39
Seven male and two female athletes of the Roger C Peace
paracycling team (analysis n=9) with an average age of
39.14 (SD 9.23) years and an average time since injury/
impairment of 19.09 years (SD 12.02) provided sufficient
data for analysis. Figure 1 indicates the states where the
athletes lived; it should be noted that one athlete split his
time living in two separate states (Ohio and Florida) and
received the intervention in both locations.
The athletes presented with varying impairments that
limited activity: three with spinal cord injuries, two with
amputations, one with stroke, one with traumatic brain
injury, one with a lower limb crush injury leading to
neuromuscular impairment, and one with cerebral palsy.
In the sport of paracycling, an athlete’s level of impair-
ment is evaluated and graded to allow athletes of similar
abilities to compete against each other. Of the grades
(1–5), a lower grade represents a greater physical impair-
ment and limitation for activity; an athlete with a grade of
2 has a greater impairment and a higher level of disability
than an athlete with a grade of 5.40 Additionally, there
are four types of sport class categories in which athletes
can compete: handcycle, tricycle, tandem and upright
bicycle.40 The categories in which the athletes compete
include three handcyclists (two H3, one H4), one tricycle
(T1), and five cyclists (three C5, one C4, one C2).
Athlete perceptions of quality of life
Athletes’ quality of life was quantitatively assessed with
the SF-36 and confirmed with qualitative data (figure 2).
The dimensions within the SF-36 are created by aver-
aging items together, each scale totalling up to 100, with
higher scores indicating higher quality of life. Athletes’
comments (figure 2) point to other indicators for lack
of improvement, including the level of disability of the
athletes, less than desired frequency of MT, amount of
intense training and continued health issues for many of
the athletes.
Athlete goals point to benets and outcomes
The athletes indicated that reducing muscular tension
was their most often sought goal for treatment, while
pain reduction was mentioned less often on the session
intake form (figure 3). However, within the therapist’s
notes, pain reduction was mentioned as an athlete’s
session goal (figure 3).
In figures 4 and 5, it should be noted that pain is not
included in the outcome variable comparison, as the
athletes did not sufficiently answer both intake and exit
questions for this variable. Figure 4 looks at each variable
longitudinally by pre-MT or post-MT. Figure 5 exam-
ines the variables pre-MT and post-MT to each other
and longitudinally. The athletes report several benefits
of treatment, with the most often reported benefit of
assisting in recovery from training and racing including
relief from symptoms and helping with sleep. These
benefits from recovery led to improved training and
racing performance.
Programme implementation
Programme implementation data and programme exit
survey data indicated that the recommended protocol of
one massage per week for 4 weeks and then every other
week for the length of the study appeared to be difficult
to follow. Athlete travel, life events, transportation issues
Figure 1 State residence of athletes. on January 28, 2018 - Published by from
4KennedyAB, etal. BMJ Open Sport Exerc Med 2018;4:e000319. doi:10.1136/bmjsem-2017-000319
Open Access
and busy athlete schedules were indicated as barriers to
maintaining the protocol. Additionally, while surveys were
delivered electronically to both athletes and therapists,
and therapists were expected to check the completion of
the surveys prior to initiation of therapy session, survey
completion for all sessions (intake, exit and therapist’s
notes) was not consistently completed by all athletes or
massage therapists.
In this quasi-experimental, mixed-methods design study,
elite paracycling athletes reported an improvement in
muscular tension and sleep after MT treatment. This
study found three noteworthy results: (1) Athletes’
expectations and programme implementation may
have impacted the expected improvement in athletes’
quality of life. (2) Verbal intakes may be important when
compared with written intake forms to help elucidate
goals and improve treatment. (3) The athletes’ percep-
tions of the benefits of MT, mainly assisting in recovery,
support the quantitative improvement in reduced muscle
tightness and sleep.
MT improves the quality of life in many popula-
tions.41–45 Yet MT did not significantly improve quality of
Figure 2 Athletes’ perceptions of quality of life. Integration of quantitative and qualitative data. Results of SF-36 and quotes
from athletes from quality of life and massage expectations themes.ANOVA, analysis of variance.
Figure 3 Word frequencies displayed in a word cloud exploring the athlete’s goals for sessions from the athlete reported goal
on the intake form and from the athlete report (verbal) to therapist as indicated by the therapist in their notes. on January 28, 2018 - Published by from
KennedyAB, etal. BMJ Open Sport Exerc Med 2018;4:e000319. doi:10.1136/bmjsem-2017-000319
Open Access
life as measured by the SF-36 instruments for the paracy-
clists. This could be because some of the expectations of
treatment did not lead to the desired outcomes (as noted
by the athletes’ comments from the qualitative data) or
it could result from the inconsistent programme imple-
The scarcity of reporting pain reduction as a goal
of treatment in written form by the athletes versus the
Figure 4 Athletes’ goals point to perceived benets and outcomes. Integration of quantitative and qualitative data. Outcome
variables comparison from intake (pre-MT) and exit forms (post-MT) and quotes from athletes and from therapist notes.
ANOVA, analysis of variance; MT, massage therapy.
Figure 5 Athletes’ perceived benets and outcomes. Integration of quantitative and qualitative data. Comparison at each
timepoint from intake exit (pre-MT and post-MT) forms and quotes from athletes and from therapist notes. MT, massage
therapy. on January 28, 2018 - Published by from
6KennedyAB, etal. BMJ Open Sport Exerc Med 2018;4:e000319. doi:10.1136/bmjsem-2017-000319
Open Access
greater indication of pain reduction as a goal as indicated
in the therapists’ notes may indicate the importance of
communication between the therapist and the patient.
Communication within an MT practice has not yet
been investigated, but it has been mentioned as a crit-
ical component of care within the MT setting.46 47 Other
healthcare literature indicates improved outcomes for
patients with good healthcare provider communica-
tion48–51 and findings could be similar for MT treatment.
Additionally, while MT did not significantly improve
pain or stress, another hypothesis could be an actual
focus of the athletes to shift more from relieving pain
to improving function, as is indicated by their most indi-
cated goals of reducing muscle tightness/tension. This
shift, from pain management to functional improvement,
is mentioned as a new suggestion in the management
of subacute and chronic pain in elite athletes by the
International Olympic Committee (IOC); the IOC also
suggests that treatment should take a multidisciplinary
approach.52 In the IOC report, the committee does take
special note of Paralympic athletes indicating they may
have more pain than able-bodied athletes and therefore
may have higher usage of pain medications, yet there is
not mention of the multidisciplinary approach for these
athletes.52 This lack of mention of additional approaches
could be due to the current lack of evidence for MT
benefiting Paralympic athletes.
Our study extends previous studies in various non-ath-
lete and athlete populations (including those with breast
cancer, pregnant women, older individuals, patients with
fibromyalgia, osteoarthritis, athletes and healthy individ-
uals) indicating MT can aid in improving sleep44 53 54 and
muscle tightness.45 55–57 Ours is the first study to investigate
these outcomes in a para-athlete population. Integrating
the qualitative results indicates that athletes felt that MT
helped with recovery and training. The athletes clearly
indicated in the qualitative data that they felt MT helped
them to train harder, rest better and possibly perform
better. These results mirror previous studies showing MT
assisting in recovery from exercise in able-bodied individ-
uals.11 58–60
Limitations and future directions
Results should be viewed with caution as the limitations
include a small sample size with no comparison group.
Furthermore, the measures used to evaluate change in
the population are largely subjective, and the athletes and
therapists did not consistently supply data via forms or
consistently follow the recommended protocol. However,
this study was implemented in real-world settings, and
lack of consistent survey completion still led to positive
Additionally, this is the first known study to follow
decentralised athletes for this length of time, as most
massage studies are short in duration (one to six sessions
generally). This study shows continued improvements in
muscle tightness and sleep over time. Further research
is needed to explore the impact of MT on pain in this
population, as well as investigate the effect of MT on
para-athletes in other adaptive sports.
Previous work reported MT as a common technique for
athletes to use to reduce recovery time,11 25 26 although
to date no literature has explored the effects of MT in
a para-athlete population. This real-world implemented
study provides new information to support MT for
recovery in elite paracyclists.
Acknowledgements The authors would like to thank and acknowledge the
massage therapists who implemented the study throughout the country. Their work
and willingness to engage in the training and research process made this project
possible. We would also like to thank the athletes of Team Roger C Peace, the team
manager Jerry Page and the Director Sportif Jim Cunningham for their tireless
efforts to train harder, recover quicker and nd the best ways to support each other
in the sport of paracycling as well as in life.
Contributors ABK designed the intervention, analysed the qualitative data and
prepared the manuscript. NP analysed the quantitative data and helped to prepare
the manuscript. JLT helped to design the intervention and helped to prepare the
Funding This project was funded by the generous sponsorship of Team Roger C
Peace by the American Massage Therapy Association.
Competing interests None declared.
Patient consent Obtained.
Ethics approval This study was approved by the Institutional Review Board at
the Greenville Health System Ofce of Research Compliance and Administration
Provenance and peer review Not commissioned; externally peer reviewed.
Open Access This is an Open Access article distributed in accordance with the
Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which
permits others to distribute, remix, adapt, build upon this work non-commercially,
and license their derivative works on different terms, provided the original work is
properly cited and the use is non-commercial. See: http:// creativecommons. org/
licenses/ by- nc/ 4. 0/
© Article author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2018. All rights reserved. No commercial use is permitted unless otherwise
expressly granted.
1. International Paralympic Committee. Paralympic results & historical
records. Int. Paralympic Comm. 2017 https://www. paralympic. org/
results/ historical (accessed 28 Aug 2017).
2. Lastuka A, Cottingham M. The effect of adaptive sports on
employment among people with disabilities. Disabil Rehabil
3. Blauwet C, Willick SE. The Paralympic Movement: using sports to
promote health, disability rights, and social integration for athletes
with disabilities. Pm R 2012;4:851–6.
4. Jaarsma EA, Dijkstra PU, Geertzen JH, et al. Barriers to and
facilitators of sports participation for people with physical
disabilities: a systematic review. Scand J Med Sci Sports
5. Yazicioglu K, Yavuz F, Goktepe AS, et al. Inuence of adapted
sports on quality of life and life satisfaction in sport participants and
non-sport participants with physical disabilities. Disabil Health J
6. Gawronski W, Sobiecka J, Malesza J. Fit and healthy Paralympians-
-medical care guidelines for disabled athletes: a study of the injuries
and illnesses incurred by the Polish Paralympic team in Beijing 2008
and London 2012. Br J Sports Med 2013;47:844–9.
7. Fagher K, Lexell J. Sports-related injuries in athletes with disabilities.
Scand J Med Sci Sports 2014;24:e320–e331.
8. Willick SE, Webborn N, Emery C, et al. The epidemiology of
injuries at the London 2012 Paralympic Games. Br J Sports Med
2013;47:426–32. on January 28, 2018 - Published by from
KennedyAB, etal. BMJ Open Sport Exerc Med 2018;4:e000319. doi:10.1136/bmjsem-2017-000319
Open Access
9. Webborn N, Emery C. Descriptive epidemiology of paralympic sports
injuries. Pm R 2014;6:S18–S22.
10. Nunes GS, Bender PU, de Menezes FS, et al. Massage therapy
decreases pain and perceived fatigue after long-distance Ironman
triathlon: a randomised trial. J Physiother 2016;62:83–7.
11. Best TM, Hunter R, Wilcox A, et al. Effectiveness of sports massage
for recovery of skeletal muscle from strenuous exercise. Clin J Sport
Med 2008;18:446–60.
12. Siedlik JA, Bergeron C, Cooper M, et al. Advanced treatment
monitoring for olympic-level athletes using unsupervised modeling
techniques. J Athl Train 2016;51:74–81.
13. Mendonça LD, Macedo CSG, Antonelo MC, et al. Preparation and
organization of Brazilian physical therapy for the Rio 2016 Olympic
and Paralympic Games. Phys Ther Sport 2017;25:62–4.
14. Gawroński W, Sobiecka J. Medical care before and during the winter
paralympic games in Turin 2006, Vancouver 2010 and Sochi 2014.
J Hum Kinet 2015;48.
15. Ayaş S, Leblebici B, Sözay S, et al. The effect of abdominal massage
on bowel function in patients with spinal cord injury. Am J Phys Med
Rehabil 2006;85:951–5.
16. Cardenas DD, Felix ER. Pain after spinal cord injury: a review of
classication, treatment approaches, and treatment assessment. Pm
R 2009;1:1077–90.
17. Lovas J, Tran Y, Middleton J, et al. Managing pain and fatigue
in people with spinal cord injury: a randomized controlled trial
feasibility study examining the efcacy of massage therapy. Spinal
Cord 2017;55.
18. Orhan C, Kaya Kara O, Kaya S, et al. The effects of connective
tissue manipulation and Kinesio Taping on chronic constipation in
children with cerebral palsy: a randomized controlled trial. Disabil
Rehabil 2018;40.
19. Whisler SL, Lang DM, Armstrong M, et al. Effects of myofascial
release and other advanced myofascial therapies on children with
cerebral palsy: six case reports. Explore 2012;8:199–205.
20. Shue S, Kania-Richmond A, Mulvihill T, et al. Treating individuals
with amputations in therapeutic massage and bodywork practice: a
qualitative study. Complement Ther Med 2017;32:98–104.
21. Brown CA, Lido C. Reexology treatment for patients with lower
limb amputations and phantom limb pain–an exploratory pilot study.
Complement Ther Clin Pract 2008;14:124–31.
22. Best TM, Crawford SK. Massage and postexercise recovery: the
science is emerging. Br J Sports Med 2017;51.
23. Poppendieck W, Wegmann M, Ferrauti A, et al. Massage and
performance recovery: a meta-analytical review. Sports Med
24. Zainuddin Z, Newton M, Sacco P, et al. Effects of massage on
delayed-onset muscle soreness, swelling, and recovery of muscle
function. J Athl Train 2005;40:174–80.
25. Brummitt J. The role of massage in sports performance and
rehabilitation: current evidence and future direction. N Am J Sports
Phys Ther 2008;3:7–21.
26. Moraska A. Sports massage. A comprehensive review. J Sports Med
Phys Fitness 2005;45:370–80.
27. Creswell JW, Plano Clark VL. Designing and conducting mixed
methods research. 2nd edn. Los Angeles: SAGE Publications, 2011.
28. Kennedy AB, Trilk JL. A standardized, evidence-based massage
therapy program for decentralized elite paracyclists: creating the
model. Int J Ther Massage Bodywork 2015;8:3–9.
29. Haynes A, Brennan S, Redman S, et al. Figuring out delity: a
worked example of the methods used to identify, critique and revise
the essential elements of a contextualised intervention in health
policy agencies. Implement Sci 2016;11:23.
30. Saunders RP. Implementation monitoring and process evaluation.
Thousand Oaks, CA: SAGE, 2015.
31. Saunders RP, Evans AE, Kenison K, et al. Conceptualizing,
implementing, and monitoring a structural health promotion
intervention in an organizational setting. Health Promot Pract
32. Ware JE, Sherbourne CD. The MOS 36-item short-form health
survey (SF-36). I. Conceptual framework and item selection. Med
Care 1992;30:473–83.
33. In: Stewart AL, Ware JE, eds. Measuring functioning and well-being:
the medical outcomes study approach. Durham: Duke University
Press, 1992.
34. Luther SL, Kromrey J, Powell-Cope G, et al. A pilot study to modify
the SF-36V physical functioning scale for use with veterans with
spinal cord injury. Arch Phys Med Rehabil 2006;87:1059–66.
35. Harris PA, Taylor R, Thielke R, et al. Research electronic data capture
(REDCap)—a metadata-driven methodology and workow process
for providing translational research informatics support. J Biomed
Inform 2009;42:377–81.
36. Leech NL, Onwuegbuzie AJ. An array of qualitative data analysis
tools: a call for data analysis triangulation. Sch Psychol Q
37. Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic
analysis: implications for conducting a qualitative descriptive study.
Nurs Health Sci 2013;15:398–405.
38. Legocki LJ, Meurer WJ, Frederiksen S, et al. Clinical trialist
perspectives on the ethics of adaptive clinical trials: a mixed-
methods analysis. BMC Med Ethics 2015;16:27.
39. Fetters MD, Curry LA, Creswell JW. Achieving integration in mixed
methods designs-principles and practices. Health Serv Res
40. Aalgaard T. Get familiar with UCI paracycling classication terms:
Canadian Cycling Magazines, 2015. https:// cyclingmagazine. ca/
sections/ news/ as- the- uci- paracycling- world- championships- roll-
out- in- switzerland- get- familiar- with- classication- terms/. (accessed
6 Nov 2017).
41. Crawford C, Boyd C, Paat CF, et al. The impact of massage therapy
on function in pain populations-a systematic review and meta-
analysis of randomized controlled trials: part i, patients experiencing
pain in the general population. Pain Med 2016 [Epub ahead of print
10 May 2016].
42. Hillier SL, Louw Q, Morris L, et al. Massage therapy for people with
HIV/AIDS. Cochrane Database Syst Rev 2010:CD007502.
43. Pan YQ, Yang KH, Wang YL, et al. Massage interventions and
treatment-related side effects of breast cancer: a systematic review
and meta-analysis. Int J Clin Oncol 2014;19:829–41.
44. Sturgeon M, Wetta-Hall R, Hart T, et al. Effects of therapeutic
massage on the quality of life among patients with breast cancer
during treatment. J Altern Complement Med 2009;15:373–80.
45. Yuan SL, Matsutani LA, Marques AP. Effectiveness of different styles
of massage therapy in bromyalgia: a systematic review and meta-
analysis. Man Ther 2015;20.
46. Kennedy AB, Cambron JA, Sharpe PA, et al. Clarifying denitions
for the massage therapy profession: the results of the best
practices symposium†. Int J Ther Massage Bodyw Res Educ Pract
47. Kennedy AB, Munk N. Experienced practitioners' beliefs
utilized to create a successful massage therapist conceptual
model: a qualitative investigation. Int J Ther Massage Bodywork
48. Di Blasi Z, Harkness E, Ernst E, et al. Inuence of context effects on
health outcomes: a systematic review. Lancet 2001;357:757–62.
49. Maizes V, Rakel D, Niemiec C. Integrative medicine and patient-
centered care. Explore 2009;5:277–89.
50. McAllister M, Matarasso B, Dixon B, et al. Conversation starters: re-
examining and reconstructing rst encounters within the therapeutic
relationship. J Psychiatr Ment Health Nurs 2004;11:575–82.
51. Tongue JR, Epps HR, Forese LL. Communication skills for patient-
centered care: research-based, easily learned techniques for
medical interviews that benet orthopaedic surgeons and their
patients. J Bone Jt Surg 2005;87-A:652–8.
52. Hainline B, Derman W, Vernec A, et al. International Olympic
Committee consensus statement on pain management in elite
athletes. Br J Sports Med 2017;51:1245–58.
53. Hollenbach D, Broker R, Herlehy S, et al. Non-pharmacological
interventions for sleep quality and insomnia during pregnancy: A
systematic review. J Can Chiropr Assoc 2013;57:260–70.
54. McFeeters S, Pront L, Cuthbertson L, et al. Massage, a
complementary therapy effectively promoting the health and well-
being of older people in residential care settings: a review of the
literature. Int J Older People Nurs 2016;11:266–83.
55. Atkins DV, Eichler DA. The effects of self-massage on osteoarthritis
of the knee: a randomized, controlled trial. Int J Ther Massage
Bodywork 2013;6:4–14.
56. Eriksson Crommert M, Lacourpaille L, Heales LJ, et al. Massage
induces an immediate, albeit short-term, reduction in muscle
stiffness. Scand J Med Sci Sports 2015;25.
57. Weerapong P, Hume PA, Kolt GS. The mechanisms of massage
and effects on performance, muscle recovery and injury prevention.
Sports Med 2005;35:235–56.
58. Ogai R, Yamane M, Matsumoto T, et al. Effects of petrissage
massage on fatigue and exercise performance following intensive
cycle pedalling. Br J Sports Med 2008;42:534–8.
59. Crane JD, Ogborn DI, Cupido C, et al. Massage therapy attenuates
inammatory signaling after exercise-induced muscle damage. Sci
Transl Med 2012;4:119ra13.
60. Kargarfard M, Lam ET, Shariat A, et al. Efcacy of massage on
muscle soreness, perceived recovery, physiological restoration
and physical performance in male bodybuilders. J Sports Sci
2016;34:959–65. on January 28, 2018 - Published by from
paracyclists, a mixed-methods study
flexibility': massage therapy for elite
'Recover quicker, train harder, and increase
Ann Blair Kennedy, Nirav Patil and Jennifer L. Trilk
doi: 10.1136/bmjsem-2017-000319
2018 4: BMJ Open Sport Exerc Med
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... The basis for restoration methodology development was the approach proposed by Kennedy et al. [17,18] for Paralympic athletes. The massage procedure was gentle, short-term, relaxing, sensu the recommendations of Epsi-Lopez et al. (2020) [19]. ...
... The search for an optimal combination of contemporary rehabilitation means for Paralympic athletes and their effective inclusion in the training process is an urgent task for many sports authorities [15,18]. Particular importance is given to the possibilities of conducting timely recovery of disabled athletes, using modern and effective technologies and means, in a natural training environment [15]. ...
... Our results on the effect of restorative massage, integrated into a training session, on blood circulation in athletes with IMSS are aimed at changing the predominantly peripheral component of hemodynamics and improving the tissue tone, and they match the findings of other authors [15,[18][19][20]. ...
Objective — to evaluate an impact of a restorative massage course, integrated into a training session, on the regional blood circulation in Paralympic athletes. Materials and Methods — Athletes with impaired musculoskeletal system (IMSS), shooters and powerlifters (n=23), were subjected to a course of restorative massage in a special preparatory microcycle of the competitive period. In the main group, massage sessions were included in the training session, whereas in the control group, they were conducted at the end of the training session. The evaluation of peripheral circulation in the upper limbs was performed via vascular blood flow test; and the effectiveness of arterial and venous blood flow, vascular tone and elasticity were assessed. Results — The obtained results for the first time allowed describing the effect of restorative massage on the peripheral circulation of Paralympic athletes. After a course of restorative massage was integrated into a training session, changes in peripheral hemodynamics were noted. We revealed an improvement in arterial blood flow due to an increase in the time of rapid blood filling, a decrease in the tone of medium and small vessels, and a reduction in peripheral vascular resistance (PVR). Arterial and venous blood flow at the level of postcapillaries improved in all segments. The blood flow was effectively redistributed between the distal and proximal segments of the upper limbs. Conclusion — The use of massage sessions in the middle of a training session has a positive effect on the state of peripheral circulation in the proximal upper limbs and the tone of large vessels, whereas the use of massage at the end of a workout has a predominant effect on the tone of small vessels and the state of blood circulation in distal segments of the limbs.
... In line with these findings, Li et al. (31) reported associations between high levels of anxiety and a higher prevalence of injury. In addition, Kennedy et al. (32) examined massage effect on psychological variables such as sleep, stress and quality obtained from our results. This generated a sample size of a total of 30 participants plus an estimated 20% loss in follow-up, yielding a total of 36 participants (18 per group). ...
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Background: Despite the general belief of the benefits and the widespread use of massage in sport field, there are limited empirical data on possible effectiveness of massage on psychological and physical functional variables. Purpose: The main objective of the present study was to compare the effectiveness of classical and light touch massage on psychological and physical functional variables in athletes. Setting: Athletic club of Valencia. Participants: 20 amateur athletes were recruited from two athletic clubs. Research design: A single-blind, randomized, pilot-placebo trial. Intervention: The subjects were randomly allocated to two different groups: a) Massage group (MG) (n=10); b) Control group (CG) (n=10). The intervention period lasted one month (one session per week). Main outcome measures: Assessment of the participants was performed at baseline and 24 hours following the completion of the intervention. Outcome measures included hip flexion, knee extension, and mood state. Results: The results suggest that MG obtained better results on physical variables (p < .05). However, for both groups, trends suggest significant improvements in the overall mood state of the participants (p < .05). Conclusion: Our results suggest that classic massage could be an effective intervention to improve functional physical variables in athletes. However, trends suggest that a light touch intervention could provoke improvements in physiological measures.
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This study aimed to investigate the effects of repeated massage adjusted for swimmers’ training on the perceptive, functional, and performance outcomes of a sprint. We also investigated the effects of a single short massage on swimmers’ self-reported perceptions after resistance training. This cross-over randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis included 19 male and female competitive swimmers between 12 and 20 years old. Participants were subjected to three 12-min interventions over a week between resistance and swim training and monitored regarding training load and perceptions. After the intervention week we assessed: perceptive (well-being, heaviness, tiredness, discomfort, and pain), performance (sprint time, FINA points, and stroke characteristics), and functional outcomes (flexibility, squat jump, bench press, proprioception), in addition to athlete beliefs and preferences. A massage was defined as consisting of sliding movements on the arms, back, and anterior thigh, with metronomic rhythm control (1:1), and was divided into two protocols: superficial massage (SM) (light touch) and deep massage (DM) (light, moderate, intense effleurage) while the control (CON) rested. After repeated massage (SM and SM), participants had less chances to report tiredness, and they also maintained perceptions of well-being while CON got worse throughout the week. However, we found evidence of worsening of the perceptions of heaviness and pain at the main stages of the swim training for the massage groups. SM and DM had no effects over sprint and functional performance. Our results suggest that the swimmers were able to train harder with no harm to recovery.
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Introduction and purpose: Massage and dry cupping are two pre-competition modalities that are used to help improve athletes’ performance. The purpose of this study was to examine the effects of pre-exercise massage and dry cupping on selected skill-related fitness components, and psycho-cognitive functioning in athletes. Materials and Methods: Twelve male athletes ([mean±SD] age: 22.25±1.8 years, weight: 84.2±14.8 kg, height: 1.8±0.1 m) volunteered to participate in this study. In a Quasi-experimental randomized counterbalanced crossover design, they performed three test sessions at the same time of day, one week apart: after dry cupping, after massage, and after no intervention. Ten minutes after each intervention, explosive power, speed, agility, and cognitive performance were measured and the subjects completed the Profile of Mood States questionnaire. Data were analyzed using RM-ANOVA and the statistical significance level was set at p≤0.05. Results: The data indicated that power significantly increased after dry cupping compared to massage and no intervention(p≤0.05), however the speed and agility were not significant anymore(p˃0.05). Both dry cupping and massage caused a significant increase in the Tower of London test scores(p≤0.05). Finally, there were no significant differences among three interventions in the positive and negative mood states(p˃0.05). Discussion and Conclusion: Findings of the present study suggest that pre-exercise massage and dry cupping may improve physical and mental performances of athletes, but it does not affect their mood.
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Athlete health and sport performance research for athletes with disabilities has increased substantially over the years as the level of competition and intensity in Paralympic sport has grown. However, relative to able-bodied sport, there remains some key areas of parasport research which are distinctly lacking. Athlete recovery, as a counterbalance to training stress and an important factor in preventing adverse health consequences such as illness and injury, is one of these understudied areas for elite para-athletes. Thus, the purpose of this descriptive qualitative study was to understand factors impacting recovery among Paralympic athletes, based on practitioner perspectives, with the aim of providing insightful guidance for applied practice. Semi-structured interviews were conducted with 15 North American sport practitioners who worked with elite para-athletes. Through thematic analysis, five main themes about optimizing athlete recovery in various populations of para-athletes were developed: a) prioritize the simple concepts, b) get to know the whole athlete, c) experience matters, d) musculoskeletal factors, and e) non-training load. Collectively, these results highlight how humanistic approaches to care, augmented by individual athlete expertise, extensive education, and a consideration of fundamental lifestyle factors is exceedingly important for para-athlete recovery. This study further describes that the approach to recovery among para-athletes, a diverse population, is uniquely complex from that of able-bodied sport and warrants scholarly attention.
Objectives This study aims to examine acute and late effects of five consecutive sessions of Swedish massage on hamstring flexibility and agility of players.Methods: a random sample of 34 female players having bilateral tight hamstrings [passive straight leg raise ≤70° and active knee extension test ≥ 30°] was randomly allocated to two equal groups. Study design involved 7 minutes massage given on each posterior thigh for 5 continuous days; followed by 5 days of no massage. Experimental group received classical Swedish massage whereas control group received only superficial stroking. Outcome measures were Passive straight leg raise [PSLR], Active knee extension test [AKET], Passive knee extension test [PKET], Back saver sit and reach test [BSSR] for flexibility and 5-0-5 change of direction test for agility measured pre and post intervention on each days of massage and also on 10th day. Two way ANOVA with post hoc t test was the tool of statistical analysis with significance level 0.05.Results: significant [p≤0.05] post intervention increase in all parameters of flexibility was observed each day in experimental group within PSLR (8%-12% ↑), AKET (10%24% ↓) and PKET (12%-30% ↓) and highly significant (p≤0.001) increase on 5th and 10th day in BSSR (4%-21% ↑) for both legs. Pre and post intervention values for control group were not significantly different. No significant changes were observed in agility performance of both groups.Conclusion: Swedish massage of posterior thigh acutely increases flexibility of hamstrings in sports person which persisted for 5 days even after cessation of massage.
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In the present review, we identify which instruments and parameters are used for sleep quality monitoring in individual sport athletes and which definitions were used for sleep quality parameters in this literature field. Systematic searches for articles reporting the qualitative markers related to sleep in team sport athletes were conducted in PubMed, Scopus and Web of Science online databases. The systematic review followed the Preferred Reporting Items for Systematic Reviews. The initial search returned 3316 articles. After the removal of duplicate articles, eligibility assessment, 75 studies were included in this systematic review. Our main findings were that the most widely used measurement instruments were Actigraphy (25%), Rating Likert Scales (16%) and Sleep Diary (13%). On sleep quality parameters (Sleep duration = 14%; Wake after sleep onset = 14%; Sleep Quality = 12%; Sleep Effciency = 11% and Sleep Latency = 9%), the main point is that there are different definitions for the same parameters in many cases reported in the literature. We conclude that the most widely used instruments for monitoring sleep quality were Actigraphy, Likert scales and Sleep diary. Moreover, the definitions of sleep parameters are inconsistent in the literature, hindering the understanding of the sleep-sport performance relationship.
This narrative review summarizes research on three forms of touch that have enhanced development and well-being. These include social touch, CT touch, and massage therapy. The lightest form of touch called CT touch (stimulation of unmyelinated afferents) is important for parent-infant and romantic relationships and for pain syndromes. Social touch including hugging and handholding is also important for those relationships. And the deepest form of touch, i.e. moderate pressure massage therapy, has been important for reducing stress. Most of the CT touch research has focused on identifying optimal velocities of touch and using fMRI scans to identify parts of the brain that are activated by light touch. The social touch literature has been primarily oriented toward the role of touch during early mother-infant interactions and later romantic relationships. The deepest form of touch has been researched for its therapeutic applications including massage therapy for pain syndromes. Each form has several methodological limitations that are reviewed here. Although the literatures on these forms of touch have many differences, they also have similarities, and they share their importance for enhancing development and well-being.
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Background The massage therapy profession in the United States has grown exponentially, with 35% of the profession’s practitioners in practice for three years or less. Investigating personal and social factors with regard to the massage therapy profession could help to identify constructs needed to be successful in the field. Purpose This data-gathering exercise explores massage therapists’ perceptions on what makes a successful massage therapist that will provide guidance for future research. Success is defined as supporting oneself and practice solely through massage therapy and related, revenue-generating field activity. Participants and Setting Ten successful massage therapy practitioners from around the United States who have a minimum of five years of experience. Research Design Semistructured qualitative interviews were used in an analytic induction framework; index cards with preidentified concepts printed on them were utilized to enhance conversation. An iterative process of interview coding and analysis was used to determine themes and subthemes. Results Based on the participants input, the categories in which therapists needed to be successful were organized into four main themes: effectively establish therapeutic relationships, develop massage therapy business acumen, seek valuable learning environments and opportunities, and cultivate strong social ties and networks. The four themes operate within specific contexts (e.g., regulation and licensing requirements in the therapists’ state), which may also influence the success of the massage therapist. Conclusions The model needs to be tested to explore which constructs explain variability in success and attrition rate. Limitations and future research implications are discussed.
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Background Massage therapists are at times unclear about the definition of massage therapy, which creates challenges for the profession. It is important to investigate the current definitions and to consider the field as a whole in order to move toward clarity on what constitutes the constructs within the profession. Purpose To determine how a sample of experts understand and describe the field of massage therapy as a step toward clarifying definitions for massage and massage therapy, and framing the process of massage therapy practice. Setting A two-day symposium held in 2010 with the purpose of gathering knowledge to inform and aid in the creation of massage therapy best practice guidelines for stress and low back pain. Participants Thirty-two experts in the field of massage therapy from the United States, Europe, and Canada. Design Qualitative analysis of secondary cross-sectional data using a grounded theory approach. Results Three over-arching themes were identified: 1) What is massage?; 2) The multidimensional nature of massage therapy; and 3) The influencing factors on massage therapy practice. Discussion The data offered clarifying definitions for massage and massage therapy, as well as a framework for the context for massage therapy practice. These clarifications can serve as initial steps toward the ultimate goal of creating new theory for the field of massage therapy, which can then be applied in practice, education, research, and policy. Conclusions Foundational research into how experts in the profession understand and describe the field of massage therapy is limited. Understanding the potential differences between the terms massage and massage therapy could contribute to a transformation in the profession in the areas of education, practice, research, policy and/or regulation. Additionally, framing the context for massage therapy practice invites future discussions to further clarify practice issues.
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Purpose: Pain is multi-dimensional and may be better addressed through a holistic, biopsychosocial approach. Massage therapy is commonly practiced among patients seeking pain management; however, its efficacy is unclear. This systematic review and meta-analysis is the first to rigorously assess the quality of massage therapy research and evidence for its efficacy in treating pain, function-related and health-related quality of life outcomes across all pain populations. Methods: Key databases were searched from inception through February 2014. Eligible randomized controlled trials were assessed for methodological quality using SIGN 50 Checklist. Meta-analysis was applied at the outcome level. A diverse steering committee interpreted the results to develop recommendations. Results: Sixty high quality and seven low quality studies were included in the review. Results demonstrate massage therapy effectively treats pain compared to sham [standardized mean difference (SMD) = -.44], no treatment (SMD = -1.14), and active (SMD = -0.26) comparators. Compared to active comparators, massage therapy was also beneficial for treating anxiety (SMD = -0.57) and health-related quality of life (SMD = 0.14). Conclusion: Based on the evidence, massage therapy, compared to no treatment, should be strongly recommended as a pain management option. Massage therapy is weakly recommended for reducing pain, compared to other sham or active comparators, and improving mood and health-related quality of life, compared to other active comparators. Massage therapy safety, research challenges, how to address identified research gaps, and necessary next steps for implementing massage therapy as a viable pain management option are discussed.
Pain is a common problem among elite athletes and is frequently associated with sport injury. Both pain and injury interfere with the performance of elite athletes. There are currently no evidence-based or consensus-based guidelines for the management of pain in elite athletes. Typically, pain management consists of the provision of analgesics, rest and physical therapy. More appropriately, a treatment strategy should address all contributors to pain including underlying pathophysiology, biomechanical abnormalities and psychosocial issues, and should employ therapies providing optimal benefit and minimal harm. To advance the development of a more standardised, evidence-informed approach to pain management in elite athletes, an IOC Consensus Group critically evaluated the current state of the science and practice of pain management in sport and prepared recommendations for a more unified approach to this important topic.
Introduction: Best practices for massage therapy and bodywork (TMB) treatment of individuals with amputations are not well established. Although anecdotal observations are available, they have limited applicability for informing effective massage therapy and bodywork approaches for individuals with amputations. This study is part of a multifaceted research program seeking to establish a foundation for education and investigation of TMB for amputation related conditions/symptomology. The purpose of this study was to understand how TMB practitioners approach and treat individuals with amputations and their perceptions of outcomes. The TMB practitioner perspective is important in informing the development of a TMB practice framework for people with amputation. Methods: The methodology of this study was informed by the phenomenological approach to qualitative inquiry. Semi-structured telephone interviews were conducted between June and September 2015, recorded and transcribed. Analysis consisted of descriptive coding and themes emerged through an iterative process. Codes and themes were discussed and verified with the research team. Participants were invited to review developed themes to indicate the extent to which results accurately encompassed their experiences as TMB practitioners. Results: Twenty-five community practicing, professional TMB practitioners from 16 states consented to participate and all completed one interview. Analysis identified four themes which indicated TMB practitioners: value touch and consider it a core aspect of treatment for individuals with amputations; operate under a core belief that individuals with amputations greatly benefit from TMB; and consider relief that stems from TMB to be multidimensional, including physical, mental, and emotional aspects; and, certain components of treatment approach are unique to amputation clients. Conclusions: Findings support that individuals with amputation benefit from TMB, at least from the perspective of TMB practitioners. Findings of this exploratory research identify important questions regarding approaches to treatment and potential TMB effectiveness hypotheses for amputation populations. Next steps will consider TMB approach and effects from the perspective of those with amputation(s).
Study design: A randomized controlled trial (RCT). Objectives: To determine the efficacy of massage therapy (MT) as a treatment that could be implemented to reduce pain and fatigue in people with chronic spinal cord injury (SCI). Setting: Laboratory setting in Sydney, Australia. Methods: Participants included 40 people with SCI living in the community who were randomly assigned into one of two RCT arms: MT (Swedish massage to upper body) or an active concurrent control (guided imagery (GI) relaxation). All participants received 30 min once a week of either massage or GI over 5 consecutive weeks. In addition to sociodemographic and injury factors, assessments and reliable measures including the short-form McGill Pain Questionnaire and Chalder's Fatigue Scale were validated. Results: Chronic pain and fatigue were significantly reduced in the massage group when assessed at the end of 5 weeks (P<0.05), with large effect sizes. Interestingly, GI was as effective as MT in reducing pain and fatigue. Pain scores were reduced significantly over time in both MT and GI groups (P=0.049 and P=0.032, respectively). Total fatigue scores were also reduced in both MT and GI groups (P=0004 and P=0.037, respectively.)Conclusions:Massage and GI are both active treatments that provide potential clinical benefits for adults with SCI. Future research should clarify the role of massage and GI in managing pain and fatigue in SCI and assess outcomes into the longer-term.Spinal Cord advance online publication, 29 November 2016; doi:10.1038/sc.2016.156.