Runner’s knee Injuries to the knee account for more than 50 percent of documented sports injury cases for runners. Of these cases, approximately one out of every four is in the form of torn ligaments or damaged cartilage that will require surgery to repair. The remaining three out of four cases are usually categorized according to one of two types of dysfunction at the knee; patella femoral pain syndrome (PFPS) or iliotibial band syndrome (ITBS). Either case may occur when the knee joint is repetitively stressed from constant movement. As its name implies, PFPS is particular to the front of the knee. The pain of PFPS is usually caused by damage to or irritation of the muscles or tendons around the knee. The damage to or irritation of the muscles or tendons around the knee is commonly due to simple overuse, improper stretching, or an imbalance between muscles. Conversely, ITBS primarily affects the side of the knee. The pain associated with ITBS may be restricted to the outside of the knee or run the length of the iliotibial band from the outside of the knee all the way up to the hip. ITBS can be further characterized by inflammation or swelling on the outside of the knee as well as at the greater trochanter of the femur. Unlike PFPS, ITBS is usually due to poor training or performance habits or musculoskeletal imbalances. Massage therapists should also note that in rare cases, pain at the knee can be referred pain originating from injuries to or hypertension in the hips, lower back, or gluteal muscles; these areas should be checked to rule them out if the immediate cause of knee pain is not obvious. Knowing or figuring out what the precise cause is of either type of knee injury allows massage therapists to determine how to treat PFPS or ITBS. Where overuse or muscle imbalances cause runner’s knee, almost any of the sports injury techniques listed in Section I (with the exception of cross fiber friction) may help to treat the quadriceps and hamstrings, or the fibularis longus Shin splints Another common running injury, noted biologist and running author Daniel Leiberman estimates 35 percent of all running injuries are shin splints (clinically referred to as Medial Tibial Stress Syndrome, or MTSS). Shin splints is a generic term for the pain, inflammation, and swelling that occurs in and around the tibialis anterior muscle of the lower leg. Pain may also occur along the lateral border of the tibia. Shin splints are further characterized by weakness at the ankle and during dorsiflexion. There are several causes of shin splints, although among athletes the cause is usually due to tendonitis at the upper two-thirds of the lateral tibia from either prolonged bouts of running on hard surfaces or playing sports that require quick stopping and starting motions, such as tennis and basketball. When the cause among athletes is not tendonitis at the upper two-thirds of the lateral tibia, shin splints are often due to the presence of trigger points which may refer pain anywhere along the length of the tibialis anterior and as far as the first phalange (big toe). To treat shin splints, massage therapists can employ cross fiber friction, deep tissue, directional massage, hot stones, myofascial release, stretches and trigger point therapy. Before using deep tissue, hot stones, or trigger point therapy, therapists may wish to attempt the techniques that do not require a lubricant. Cross fiber friction can be applied at the tibialis anterior’s origin and along the lateral border of the tibia. (Cross fiber friction at the lateral border of the tibia will help free the tibialis anterior from any restrictions where the muscle meets the bone.) Therapists should first attempt directional massage and myofascial release from where the inferior tibialis anterior tendon begins to cross from the instep and medial side of the ankle to the lateral side of the ankle and working towards the insertion at the upper two- thirds of the lateral tibia. To perform deep tissue work, therapists should stand next to the massage table facing the foot of the Shoulder injuries Because it is the most flexible joint in the body, there is a wide variety of injuries that can occur at the shoulder. As far as sports injuries are concerned, though, rotator cuff injuries and adhesive capsulitis (also known as frozen shoulder ) are the two most common shoulder injuries and account for upwards of 20 percent of all sports injuries. Both conditions are generally
and brevis if hypertension of these muscles are causing the performance imbalances that lead to ITBS. (This is rarely the case but does occur, so massage therapists will want to check the fibularis muscles to rule them out as a contributor to ITBS.) Cross fiber friction may be useful at the origin and attachment sites of the iliotibial band and around the knee so long as inflammation is not present in those areas. Myofascial release is most helpful for relieving the hypertension associated with ITBS so long as therapists remember to use the technique from the origin or insertion all the way to its other end. Any of the stretches may be incorporated as well, though massage therapists will want to avoid moving clients into any position that is painful or places too much stress on the injury. For this latter reason, massage therapists may want to avoid the PNF stretches for runner’s knee. Additional treatment and prevention For an athlete’s self-care, the general prevention of runner’s knee calls for a proper warm-up period that includes stretching. Proper equipment can also greatly reduce the potential for injuries. For runners, choosing and replacing shoes as well as replacing insoles regularly is a must. Runners should also vary their running surfaces which enables the muscles around the knee to strengthen as they adapt to different environments. For bicyclists, proper body alignment on their bicycle and varying their riding position on occasion should be considered. More generally, an athlete that is able to cross train can rest the muscles that act upon the knee thereby preventing an overuse injury. And, of course, during a competition, a pre- and/or post-sports massage may be very useful for preventing injuries later. Although runner’s knee affects runners most of all, this sports injury also commonly affects bicyclists and athletes that play basketball, football, soccer, and volleyball. affected leg. With the hand nearest the foot, massage therapists will rotate the foot of the affected leg towards the other foot so that the tibialis anterior is facing upward. With the opposite arm, therapists gently lean into the muscle at the insertion with a forearm or elbow, being sure to check in with the athlete about pressure and pain levels. Massage therapists should use care; this area of the body is not as sensitive to pressure and pain as other areas, so it is easy to further injure an athlete. Therapists should always allow time for the muscle tissue to soften under their forearm or elbow before slowly gliding their stroke down towards the tendon at the ankle. Hot stones are a good way to soften up the tibialis anterior muscle before deep tissue work. Following up deep tissue work with hot stones is an equally good idea, as the stones may lessen any soreness associated with the deep work. Massage therapists may also search for trigger points anywhere in the muscle during the application of any other technique, however, they are most likely to find one – if present – in the upper half of the muscle close to lateral border of the tibia. Next massage therapists will end treatment for shin splints with a passive or AC stretch, both of which will involve plantar flexion of the foot. Therapists should use a CRAC stretch until the injury is well on its way to recovery. Additional treatment and prevention Besides the common protocol for all sports injuries, runners in particular may wish to either change the type of surface they run on, change the manner in which they run, and/or change their running shoes. An ankle brace or Kinesio tape may help re- stabilize the ankle. This injury occurs more often with runners by a wide margin, followed by tennis players, basketball players, and soccer player.
characterized by continuous pain even at rest, a decrease in shoulder mobility, a decrease in shoulder strength, crackling or popping sounds at the shoulder when moving the arm, and an inability to sleep on the affected shoulder’s side. Dislocated shoulders are the third most common shoulder injury; they involve the previously mentioned symptoms but also include
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