Jan 29, 2015Recovered and Ready
One of the secrets to Florida State’s successful 2012 football season was the implementation of massage therapy for all players. A local partnership kept costs low.
By Jake Pfeil
Jake Pfeil, MS, LAT, ATC, is the Associate Director of Sports Medicine and Head Football Athletic Trainer at Florida State University, where he is also an Approved Clinical Instructor in the Athletic Training Education Program. He can be reached at: [email protected].
Florida State University football had its best season in a dozen years this past fall, winning 12 games, a conference championship, and a BCS bowl game. A lot of big pieces needed to come together for a season like this one, including great coaching, hardworking players, and a dedicated support staff. But a number of smaller pieces needed to come together as well, including an optimal recovery program for the players.
Recovery has been a new focus for the team over the past couple of years. And not just recovery for injured players or another specific group–recovery for the majority of our contributing roster. One way that we have focused on this goal is through the implementation of a massage therapy program.
The benefits of massage therapy as an aid in the recovery process are well known throughout the athletic training profession, but providing massage therapy to a large number of athletes is not always practical, affordable, or feasible. With 100-plus players on a typical football roster, space can be an issue, athletic department budgets are certainly not limitless, and with athletes’ busy days, scheduling can be a headache.
However, over the past two seasons, we have been able to develop a successful massage therapy program in partnership with the CORE Institute, which is located right here in Tallahassee. I believe that the results speak for themselves. Along with the team’s overall success this past fall, we experienced a drastic reduction in lower extremity soft tissue injuries. I think this can be attributed to several changes in our overall training and recovery models, but the introduction of massage therapy for the majority of our team has definitely been a significant factor.
STARTING POINT
We have historically employed a few local, licensed massage therapists to work with various athletes who suffered specific injuries such as hamstring or back strains. While this was helpful in assisting these athletes in their recovery, it also presented a number of challenges.
For example, sometimes fellow injured teammates were jealous when they found out their friends were getting massages as part of their treatment plans. All we heard was, “He got a massage?! Why can’t I get a massage?!” We would then have to explain the need for the treatment and why they may not necessarily need it that day, or for that degree or phase of their injury.
We also had some issues with the cost and availability of the therapists we worked with. And while utilizing massage therapy was beneficial to some of our athletes, the way we were using the modality did not fall in line with accomplishing the new program goal of a more effective recovery for the majority of our contributing roster.
To better meet our needs, we set out to create a new massage therapy program. Our current plan was put together in the summer of 2011 by myself and Erik Korem, MS, CSCS, SCCC, our former Director of Football Operations and Sports Science. (Erik recently took on the role of High Performance Coach at the University of Kentucky.) When we began discussing the idea, we were faced with two main questions: How do we find enough licensed massage therapists, and how do we pay them?
With regard to cost, it was obvious that massage therapy services on a team-wide scale were not going to be covered by our sports medicine budget alone. Fortunately for us, Head Football Coach Jimbo Fisher was in full support of implementing this type of treatment program and was willing to use funds from the football budget.
We then reached out to the CORE Institute. The Institute’s founder and president, George Kousaleos, BA, LMT, had previously shown interest in setting up an internship program for new massage therapy graduates who wanted to gain more experience working with our higher-level athletes, so we knew he’d be open to the idea. The Institute needed sore bodies, which we certainly had, and we needed more massage therapists. The match was made.
With just three weeks until the start of the 2011 preseason, Erik and I began meeting with George to discuss how to develop a program that we could afford and would fit our schedule. George had experience putting together a team like this for various events, but we knew that finding enough massage therapists to cover our needs of at least one session a week might be difficult on such short notice.
We decided to use 12 therapists who would massage for two hours. This would allow for at least 48 athletes to be seen in half-hour blocks, which would cover our two-deep roster. We started the program at one session per week to gauge the interest of the players and track the benefits because we certainly didn’t want to put in all of the effort required to develop this type of program only to have the athletes resist the treatment.
George was able to recruit local, licensed massage therapists who had recently graduated from the CORE Institute or were current employees. This group volunteered their time on Sunday afternoons, each bringing their own portable massage tables. We set them up in a large multipurpose room in our athletic center that allowed for plenty of space.
Out of the sports medicine budget, we bought enough linens for all of the therapists to change sheets for each athlete that they treated. We also provided water and hand sanitizer for everyone.
We were able to compensate the volunteer therapists with tickets to our home games and some Florida State apparel. The CORE Institute was paid a very reasonable flat rate that covered the supplies used by the therapists and the time George and his assistants had spent contacting and recruiting them.
During the week of practice leading up to the first game, we explained the new massage protocol and announced to our players that they could sign up for a Sunday session. This was well received, and the athletes all seemed eager and appreciative of the service being offered. We instructed the players to be open with the therapists and give them feedback during the session. We also asked the athletes, as well as the therapists, to address only the needs of basic recovery and not the treatment of a specific new injury that had not yet been evaluated by a member of the sports medicine staff.
The therapists had all been trained in a specific type of myofascial therapy called CORE Sports and Performance Bodywork that they had learned at the Institute. The therapy is a slower and deeper style of myofascial release that focuses on the broader layers of extrinsic tissues in the legs, back, neck, and shoulders. Therapists from the CORE Institute demonstrated its benefits years ago when treating athletes from the British Olympic teams that trained in Tallahassee for the 1996 Atlanta Games.
The initial phase of introducing massage therapy to our program on a large scale was very successful. The players were responsive to the treatment and they were quick to tell us of the advantages they were experiencing after the first few weeks. As a sports performance team, we had already been sold on the benefits of the therapy, but it was encouraging to hear positive feedback from our players, too. We ended the 2011 season with full intentions to continue working with the CORE Institute.
EXPANDING THE PROGRAM
Though we did not utilize the massage therapy team during our 2012 spring practice sessions (with limited, spread out practices, recovery days were already built in), we planned to resume the program during our summer training in the months leading up to preseason camp in August.
This time, George provided us with current students from the CORE Institute who were available to intern as part of their ongoing education. These students, while not as experienced as the team we used in 2011, were eager to work with athletic bodies and were extremely capable of providing what we needed. There was also an experienced instructor who came to campus with the students to direct them.
Because they did the massage therapy work as part of their education requirement, we didn’t have to compensate the therapists this time around. We again paid a flat rate to the CORE Institute to cover supplies and the instructor’s time. With 15 to 20 students, we were able to schedule two sessions per week for our athletes instead of just one–Tuesday and Thursday late afternoons.
Two sessions per week was extremely popular with our athletes. Even more positive was the fact that we saw a reduction in soft tissue injuries during summer training. I’m confident that the massage therapy was responsible for at least some of the drop in injuries.
KEEPING IT GOING
At the conclusion of our summer training program in August, the team entered preseason camp. This is the most critical time of year to emphasize recovery. Players are training hard in long sessions for multiple days in a row, and without proper recovery, the risk of injury is higher.
We again worked with the CORE Institute to schedule recovery massage sessions twice a week around our highest-load days. This time, we brought back the more experienced licensed massage therapists that we had used during the 2011 season. We were able to pay them each for their time, using funding from the football program. This was easy to justify given the injury results from our summer training program.
The therapists said that they noticed a change in the returning players’ approach to the therapy. They seemed more aware of what it did for them, and they knew their specific recovery needs and what to ask for during treatment.
When we exited training camp for the start of the regular season, we initially returned to one therapy session per week on the day after games as we had employed in 2011. But about a quarter of the way through the season, we decided to bring the team in twice a week, adding post-practice sessions on Thursdays. We did so after noticing that while the practice week workload is designed to increase toward mid-week and then taper down to the end, the athletes needed a boost in the recovery process to prepare for the game–not just recover from it. We practice hard, and depending on the game, some players experience more fatigue from the reps they perform during Tuesday and Wednesday practices than they do from Saturday’s contest.
The introduction of the Thursday sessions was tremendous. While still using the CORE myofascial therapy model, the sessions were designed to be a bit lighter so the players could recover from the practice week. The Sunday sessions remained focused on recovery from the game and incorporated more deep tissue work.
By building our relationship with the CORE Institute, we were able to offset the common issues of excessive costs and feasibility of having enough therapists for our athletes. Because of the successful results we have experienced so far, we look forward to continuing the program and exploring the possibility of incorporating it into the recovery needs of other Seminole teams as well.
Sidebar: THE SCIENCE
Does massage really do anything in regards to repairing muscle tissue? By providing this type of treatment to our athletes, are we merely making the athletes feel good, or are we actually assisting their recovery? Two studies from last year support the latter.
In one study, researchers from The Ohio State University and the University of Pittsburgh questioned, among other things, how fibrosis development affected the process of muscle recovery after injury and how to potentially reduce this development. The researchers identified the importance of vascular endothelial growth factor (VEGF) in increasing angiogenesis after injury. (Angiogenisis has been found to have an inversely-related effect on the levels of fibrosis in injured animal muscle tissue.) The study identified several techniques to potentially increase VEGF and promote angiogenesis, with massage therapy being the least invasive.
Another study from researchers at McMaster University in Ontario found massage therapy to be the fifth most commonly used form of alternative medicine in the United States (18 million individuals annually) and questioned why it was so popular beyond its subjective results. The study involved actual biopsy of leg muscles in 11 young male subjects after strenuous exercise on a stationary bicycle. Prior to obtaining the muscle samples, random subjects received massage therapy to one of their legs. The muscle samples revealed that while common beliefs of reduced lactic acid and changes in glycogen as a result of massage therapy were unfounded, when massage therapy was employed, there was an increase in the formation of mitochondria, which is believed to promote accelerated healing of the tissue.
