Tendonitis This injury refers to the inflammation of a tendon , the connective tissue that attaches muscle to bone. It is characterized by chronic pain, inflammation (occasionally), and muscular weakness. Therapists may massage on a tendon that has been inflamed provided they have first reduced the inflammation with ice or a cold pack.
inflammation and reduce pain. ‘Compression’ means wrapping an injury site to reduce swelling and for stabilizing injured joints. ‘Elevation’ means preventing the pooling of blood at the injury site by raising the injured area slightly above the head. R.I.C.E. is the immediate although general response to almost all sports injuries. Note: An injured athlete should not be given non-steroidal anti-inflammatory drugs (NSAIDs) immediately following an injury, as NSAIDs thin the blood and may inhibit the blood clotting that is often a necessary part of the healing process. Achilles tendinitis The Achilles tendon is a tendon of the posterior leg and the biggest tendon in the body. This muscle originates where the soleus and gastrocnemius muscles combine, and it inserts at the inferior aspect of the posterior calcaneus (heel bone). As part of the soleus and gastrocnemius muscles, the Achilles tendon is responsible for plantar flexion. Because the Achilles tendon is integral to basic walking, running, and jumping movements, the additional strain of high performance sports make this part of the body highly susceptible to injury. On average, there are over 200,000 cases of Achilles tendon injuries a year, 89 percent of which affect men. The most common Achilles tendon injury occurs through overuse, resulting in inflammation and pain from micro-tears in the tendon. If left untreated, this condition may become chronic and leave a client unable to run, or, unable to run or walk without pain. Achilles tendonitis is characterized by pain from the back of the foot to above the heel, pain upon plantar flexion of the foot or pointing the toes, general stiffness or tenderness of the tendon, and/or inflammation anywhere along the tendon. Treatment for this injury begins with checking for inflammation first. If inflammation is present but not to the degree of contraindication (that is, minor), ice should be applied to the affected area for at least 10-20 minutes to reduce as much swelling as possible before applying a massage technique. Whether or not ice has been applied to the tendon before massage begins, massage therapists should prepare or ‘warm- up’ the Achilles tendon before massaging it as tendons are less flexible and have poorer circulation than muscles. Preparation for this injury should begin with the client in the prone position with the foot hanging off the massage table. (Massaging a client’s Achilles tendon in the supine position is less effective.) The client’s leg muscles should be relaxed while the massage therapist takes the foot of the affected leg through its unrestricted range-of-motion at the ankle. The massage therapist should keep an open line of communication with the athlete; during this time, the athlete should feel nothing more than the slightest pain as the massage therapist plantar flexes, inverts, everts, and especially dorsi flexes the foot (as dorsiflexion may stretch the tendon too far). Next, the therapist may apply lubricant with light effleurage from the heel to the posterior knee in preparation of petrissage, which will increase blood flow to the area, preparing it for deeper work. The massage therapist should petrissage the posterior leg from the tendon at the heel, using fingertips to gently grasp Ankle sprain The ankle is considered sprained when its ligaments are forced to stretch beyond their normal ROM and tear, causing pain, a loss of stability, and a loss of strength of the lower leg muscles. Inflammation often accompanies a sprain, as well. In most cases, the joint referred to as the ankle syndesmosis – where ligaments joins the lateral, distal ends of the tibia and fibula – is the site of most sports-related ankle sprains. An ankle syndesmosis sprain is more commonly referred to as a high ankle sprain . It results from the foot over-rotating inward, leaving the sole of the foot facing inward. Less commonly, the sole of the foot will roll outward, damaging the ligaments on the medial side of the ankle, but the force required to damage the medial ligaments is much greater than the force required to damage lateral ankle ligaments since the medial ankle ligament are shorter and stronger. Therefore, it
SECTION III: SPECIFIC CONDITIONS ASSOCIATED WITH SPORTS INJURIES
and squeeze the tendon upward, then petrissage up the leg towards the knee, grasping more muscle mass as the massage therapist goes along. Again, the athlete should not be in any pain or discomfort at this point beyond that caused by the injury. Once three to four passes from the heel to knee are complete, the massage therapist may apply one or more complementary techniques. Several complementary massage techniques have been shown to be effective for Achilles tendonitis; they are transverse mobilization, circular friction, and stripping. With transverse mobilization, the massage therapist’s hands are perpendicular to the tendon so that the fingers of each can grasp the tendon, with no more than one inch between hands. Beginning near the heel, move one side of the tendon away from you while the other hand moves the tendon toward you, alternating several times. Done lightly without too much pushing or pulling in either direction should loosen any stiffness associated with the injury. With circular friction, the massage therapist should place fingertips on each side of the affected tendon starting near the heel and making light circular movements towards the tendon’s origin. Once near the tendon’s origin, the therapist should move back to the beginning and repeat for three to five minutes. Stripping the Achilles tendon begins similarly to circular friction, but with the thumbs on each side of the tendon and moving them in unison up towards the tendon’s origin and back again. Similar to the preparation phase, an athlete should not be in much more pain or discomfort beyond that caused by the injury during the application of these techniques. Upon the completion of these techniques, the therapist may want to ice the tendon once again, as any friction technique may cause inflammation. Additional treatment and prevention Rest, ice, compression, and elevation (RICE), pain-relieving anti-inflammatory medicines (NSAIDs), and Kinesio taping can help ease the pain and inflammation associated with Achilles tendonitis. Athletes should not resume their sport until the injury is completely healed (usually 4-6 weeks) or the condition may worsen or become chronic. Therapists should recommend to their athletes that they rehabilitate with calf raises (a plantar flexion exercise) to strengthen their soleus and gastroc muscles. Therapists should also recommend to athlete that they always stretch their Achilles tendon before training. This injury is most common among runners, accounting for approximately 50 percent of annually reported cases in the U.S., followed by basketball players, tennis players, and gymnasts. is much more likely massage therapists will deal with a high ankle sprain when working with athletes. An ankle sprain is categorized by degree: A first degree sprain involves only a minor ligament tearing that results in minor pain and loss of stability, allowing an athlete to continue walking. Usually, there is no inflammation with a first degree ankle sprain. A second degree sprain involves noticeable pain at the ankle even when not bearing weight, and a loss of stability often accompanied by inflammation. The athlete may still be able to walk on a second degree sprain, but not without pain and not without further damaging the ligaments. A third degree sprain is a complete tearing of the ligaments that results in a high degree of pain even when the ankle is not bearing weight, inflammation,
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Book Code: MTX1323
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