Sports Massage for Persons with a Disability

Written by Christine Salvary

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Abstract

The aim of this study was to investigate the efficacy of sports massage therapy (SMT) through the perceptions of users in a naturalistic setting and specifically to make a contribution to the literature of sport for persons with a disability by exploring its use by elite athletes with a disability in both competition and training.

This research investigated the perceptions of members of a team who competed in an IPC Athletics international competition, using questionnaires and semi-structured interviews, supported by competition treatment records.

A total of 19 athletes returned questionnaires, eight athletes representing all disability groups with physical disabilities were interviewed and treatment records were available for all 41 athletes who attended the competition.

Results showed that the majority of athletes surveyed believed that SMT was an important part of their training and had positive effects on their performance, primarily in terms of assisting with recovery, injury prevention, rest and relaxation. It was heavily used at the competition in training as well as pre- and post-event .Athletes stressed the importance of using a practitioner in whom they trusted and with whom they felt comfortable.

Previous studies have tended to concentrate on SMT as a short-term intervention to enhance a specific performance rather than investigating its cumulative effects in allowing the athlete to compete at a high level for a longer period of time.

Several areas worthy of further research are suggested, including a prospective longitudinal study on a national squad throughout training and competition cycles, research exploring new paradigms from mind/body medicine to provide explanations for the effects of sports massage therapy (SMT) and qualitative studies investigating the qualities inherent in the "excellent SMT practitioner".

Introduction

Having worked within elite sport for persons with a disability since 1994 the author's concern has been to bring sports massage therapy (SMT) to athletes with a disability and to educate them as to its potential benefits in enhancing their sporting performance. As the uptake of SMT has increased, especially at the international competitive level, so has the impetus to quantify and document its benefits.

The primary motivation for carrying out this study was the conviction that much of the existing research on the effects of SMT is unhelpful, as it is based on methodologically flawed studies that have little to do with SMT as it is currently practised (Field, 2000; Vickers, 1996). The secondary motivation was to make a contribution to the literature of sport for persons with a disability: the literature on massage for athletes with a disability is relatively sparse and tends to be anecdotal or descriptive (Clews, 1995; Salvary, 1995; Koopman, 1997; Leckie, 1998; Erdmanis, 1999; Milo, 2000; Schlossberg, 2002). There currently appear to be no research studies investigating the use of SMT by athletes with a disability. This study may therefore generate some valuable information that could be of use to both athletes and practitioners in the future.

Research Methodology

The aim of this research was to elicit the views of a number of elite track and field athletes with a physical disability regarding their experiences and perceptions of the effect of SMT on their own physical and psychological ability to perform. The information was obtained retrospectively using a survey approach, primarily through postal or e-mail questionnaires and semi-structured interviews, supported by data from competition treatment notes.

The objectives of this enquiry were to:

1. ascertain the use made of SMT up to, during and after competition and their perceptions of its effects on their performance. Information was collected through the use of a postal/e-mail questionnaire, designed according to standard questionnaire design methodology (Oppenheim, 1992) and sent to all athletes with a sensory disability (and their guides/escorts where applicable) who competed at a major International Paralympic Committee (IPC) Athletics World Championships for athletes with a disability in the summer of 2002.
2. explore athletes' experience and perceptions of SMT in greater depth through semi-structured interviews with eight athletes, representing each of the four physical disability groups and competing in a variety of track and field events.
3. ascertain the pattern of SMT provision throughout the duration of the competition through analysis of competition treatment records, and compare this data with that gained from the athlete questionnaires and interviews.

The subjects selected for this study were elite athletes with a physical disability who currently fall within the IPC competition criteria and who had been selected by UK Athletics (UKA) to represent Great Britain at a major IPC Athletics championships in the summer of 2002. The sample of athletes selected for interview was drawn from both track and field athletes from both power and endurance disciplines, in order to reflect the variety of athletic competition and performance. It was decided to include any guides/escorts involved in the competition as this would provide an "able-bodied" perspective that might be useful for purposes of comparison.

A purposive sampling strategy was used to select subjects for interview, allowing the exploration of a variety of perceptions and experiences from a range of athletes representing each of the four disability groups and competing in a variety of track and field events.

The sample size was originally dictated by the size of the team taken to this particular IPC competition but it was sufficient to yield some useful results as well as sufficient respondents from which to extract a sample for interviews. It could be seen as a small-scale study that might act as a pilot for a larger scale survey in the future.

The following athletes were selected for interview:
Athlete no. A01   Male, amputee, track athlete
Athlete no. A02   Male, visually impaired, track/road racer
Athlete no. A03   Male, spinal cord injury, wheelchair field athlete (discus)
Athlete no. A04   Male, cerebral palsy, track athlete
Athlete no. A05   Female, spinal cord injury, wheelchair track athlete
Athlete no. A06   Female, spinal cord injury, wheelchair track/road racer
Athlete no. A07   Female, cerebral palsy, field athlete (javelin)
Athlete no. A08   Male, guide runner

ETHICAL CONSIDERATIONS
Approval for this research was granted by the University of Westminster's School of Integrated Health Ethics Committee on the assurance that athletes would be contacted in accordance with the provisions of the Data Protection Act 1998. All athletes received a letter regarding the purpose and scope of the research, including issues of anonymity and confidentiality, seeking informed consent prior to participation and explaining that they could withdraw from the study at any time.

Results
The following summary highlights the most significant results obtained from the questionnaires, interviews and competition treatment data.

Results from Questionnaires
There were 41 athletes in the British team who competed in the event under study. A total of 19 questionnaires were received and analysed for this research (46% of the whole team). The responses were analysed using the SPSS for Windows Version 11 statistical package. Percentages have been rounded up to the nearest whole number.

Demographic Data
Of the 19 athletes who responded, 12 were male (63%) and seven were female (37%). Six athletes had a spinal cord injury (SCI), four were amputees (Amp), four had cerebral palsy (CP) and four had a visual impairment (VI). The other athlete was a guide runner. All of the female athletes had a congenital or hereditary disability but of the males, four had acquired their disability. One of these had a visual impairment, one had a spinal cord injury and two had upper extremity amputations through accidents.

The majority of athletes were track or road racers (74%) consisting of wheelchair racers (N=6), ambulant track athletes (N=6) or ambulant road racers (N=2). Of the field athletes, three were ambulant and one was a wheelchair user, while one athlete competed in both track and field events.

The greatest number of athletes were aged between 31-35 years (N=7) with only one athlete being older. Just two athletes were aged between 15-20 years, while five were between 21-25 and four were between 26-30 years old.

EXPERIENCE OF SPORTS MASSAGE THERAPY PRIOR TO THE COMPETITION
All except one athlete with a spinal cord injury had received SMT prior to the competition in summer 2002 and of those, 14 (74%) had received therapy in the previous six months. Most of these received SMT quite regularly, with 50% receiving it all year round. Of those athletes who received SMT once a month or more, 12 out of the 18 (67%) used it as an integral part of their training programme.

The most common reason by far for receiving SMT during the six months prior to the competition was to help the muscles recover after training or competition (12 out of 17 respondents or 71%). The second most popular reason was for rest and relaxation (four athletes i.e., 24%).

EXPERIENCE OF SPORTS MASSAGE THERAPY AT THE COMPETITION
All of the respondents received SMT at the competition. Athletes identified both general and competition-specific reasons for seeking SMT. Of the general reasons, the most popular were for relaxation (32%) and to help recover from the journey (21%).

Of the competition-specific reasons for receiving SMT, the most popular was to relieve tight muscles or aches and pains (47%). Almost equal numbers used it to relieve stress and anxiety before competition (26%). Massage was used by athletes pre-event (26%), inter-event (26%) and post-event (32%).

The majority of athletes felt that the SMT they received at the competition had a positive effect on their performance (N=14, 74%), while two athletes felt it had had no effect on their performance. No athletes stated that it had hindered their performance.

Athletes were asked how they recognised that it was the SMT that affected their performance. In response, 13 answers were received which were grouped into four categories, two of which were physical (pain was relieved and muscles were more relaxed) and two more psychological (mentally relaxed and increased confidence in condition).

EXPERIENCE OF SPORTS MASSAGE THERAPY SINCE THE COMPETITION
Since the competition 14 athletes (74%) reported that they are receiving regular SMT ie, once a month or more, two (11%) are having it occasionally and only three have not had any SMT at all. All of those who have not received any sports massage, and one of those who is an occasional user, comment that the main reason for this is a lack of finance and/or time.

It is interesting that 12 athletes (63%) say that they would have regular SMT even if they had to pay for it themselves while six (32%) state that they would only have it if they received funding for that purpose. Only one athlete would not have regular SMT. An overwhelming majority of athletes (N=17, 89%) believe that regular SMT is important to them as elite athletes.

The athletes were asked to list in descending order three of the reasons why they believe SMT is important. The reasons given fell into seven broad categories: all of the athletes' responses were placed into one of these categories and a crude scoring mechanism was used to rank them: the first named reason scored three points, the second, two, and the last named reason scored one point. This allowed the seven categories to be ranked in overall order of importance. (see Table 1)

Table 1
Reasons for receiving sports massage therapy in descending order of importance

Results from Competition treatment Documentation
The competition treatment documentation was analysed using the statistical package SPSS for Windows Version 11 to gain an overall picture of the use of SMT by the whole team. The records were full and complete: the sports massage practitioner and physiotherapists completed their records every night to ensure that entries were accurate and up-to-date.

Demographic Data
There were 41 athletes in total including five guide runners. 29 athletes (71%) were male and 12 (29%) female. The majority of athletes were in the age range 21 to 30 years (N=22, 54%) while 17 (41%) were 31 and over. Just two athletes were aged between 15 to 20 years old.

The majority of athletes were ambulant track or road athletes (N=22, 54%). There were six wheelchair racers (15%), three (7%) wheelchair field athletes (throws) and nine ambulant throwers (22%) with the remaining athlete competing in both track and field events (sprints and long jump).

Analysis of Treatment DataMembers of the British team tended to arrive in groups anything up to a week before the start of competition, although some might arrive only the day before (usually the marathon runners as this event is traditionally the last one of the championships). Some athletes had to arrive early to attend for classification (which is held several days before the start of competition), especially if this was their first international event. A number of athletes might therefore have around a week during which they would still be training.

All athletes except one track athlete with a visual impairment had some form of treatment at the competition. Four athletes (10%) had SMT only, seven (17%) had physiotherapy only, while the rest (71%) used both SMT and physiotherapy.

During the competition a total of 126 treatments were given by the sports massage therapist, with the majority (N=48, 38%) being given as part of training in the lead-up to competition. Pre-event treatments numbered 30 (24%) and post-event 24 (19%) while 16 (13%) of treatments were specifically to deal with injuries. It should be noted that in addition 14 pre-event and 12 post-event massages were carried out by the physiotherapists, particularly during busy periods when the sports massage therapist was already working on another athlete.

The 29 males on the team received a total of 91 treatments during competition (an average of 3.1 treatments each). The 12 females received 35 treatments (an average of 2.9 treatments each). Thus there is no significant difference in uptake of treatment between males and females. (see Table 2)

Table 2
Number of treatments received at competition by type of treatment, gender and type of disability

By far the heaviest users of SMT were the ambulant track athletes (N=13, 32% of the team) who received 67 treatments (53% of total treatments given). This probably reflects the fact that there is a stronger tradition of using SMT among track athletes compared to field event athletes (see Table 3).

Table 3
Number of treatments received by athletes, by event type and gender

COMPETITION PERFORMANCES

Competition performances were extremely creditable, leading to Great Britain finishing top of the medal table with 13 gold, 12 silver and 11 bronze medals, in an event that attracted competitors from all over the world. More than two thirds (67%) of the team (excluding guide runners whose performances do not count towards final totals) gave medal-winning or personal best performances.

Analysis of Interview Data
Each interview commenced with a general question asking about training progress, which served as an 'ice-breaker', before moving on to the questions outlined in the interview schedule, and ended with the athlete being offered the chance to add any other comments.