inflammation, swelling, and discoloration. Any athlete displaying symptoms of a dislocated shoulder should be referred to a physician immediately. Dislocated shoulders are contraindicated for massage and will not be addressed here. Rotator cuff injuries typically refer to the partial or full tearing of one or more of the four rotator cuff muscles – infraspinatus, supraspinatus, subscapularis, and teres minor – and are usually the result of repetitive overhead motions such as those performed by swimmers, baseball pitchers, and tennis players. (According to the N ational Institute of Health , rotator cuff injuries are the dominant injury among baseball pitchers in particular and baseball players in general.) If an athlete has not been diagnosed by a physician but massage therapists suspect this specific injury, they should identify which rotator cuff muscles are injured. To do this, therapists should ask the athlete to move the arm through the movements specific to each muscle and determine when pain or stiffness occurs. For the infraspinatus and teres minor, pain or stiffness will occur or become worse when externally rotating the arm. For supraspinatus, therapists should have the athlete raise the arm laterally. A subscapularis injury reveals itself when the athlete rotates the arm inward. The opposite motion produces pain in an injured infraspinatus. Treating rotator cuff injuries may involve the use of cross fiber friction, directional massage, hot stones, myofascial release, and trigger point therapy. When applying these techniques, massage therapists should keep in mind two things: First, hot stones are difficult to use on the subscapularis because of its position deep to the axillary fold (under arm). Long, thin stones are best for applying heat to this muscle when an athlete is in the supine position. Second, massage therapists can save time trying to find a trigger point in any given muscle by knowing its pain referral pattern. Infraspinatus refers pain to the middle and anterior deltoid and to a lesser degree, the outside of the arm as far as the wrist. Supraspinatus refers pain to the middle and posterior deltoid as well as the posterior elbow. Subscapularis refers pain to the posterior deltoid and occasionally the posterior wrist. Teres minor refers pain to the posterior deltoid and to a lesser degree, the triceps close to the deltoid. Massage therapists may also incorporate stretches, as long as they do not produce pain. However, massage therapists should stretch all rotator cuff muscles even if only one is injured, as the non-injured muscles may become overworked by compensating for a single injured muscle. Note that massaging the rotator cuff muscles will provide relief; however, ending the massage with the rotator cuff muscles is not enough. This is because rotator cuff injuries tend to induce tension in the surrounding muscles such as the upper trapezius, rhomboids, latissimus dorsi, deltoids, and pec major as the body attempts to stabilize the shoulder region. Therapists may use the same techniques to treat these muscles as the rotator cuff muscles. Tennis elbow Tennis elbow is the generic term for the inflammation and pain that occurs at the lateral epicondyle of the humerus and weakness at the wrist due to the repetitive use of the forearm’s extensor muscles. (This injury is not to be confused with Golfer’s elbow, a similar but less common overuse injury that causes swelling at the medial and lateral epicondyle of the humerus due to a repetitive use of the forearm’s flexor muscles.) The symptoms of this injury are due to small tears of the extensor muscles’ common tendon through which synovial fluid, the fluid that lubricates joints is lost, making any movement at the elbow painful. Sometimes the degree of the tendon damage requires surgery to repair. When surgery is not required, massage therapists can treat tennis elbow using counter torque twisting, cross fiber friction, directional massage, petrissage, and trigger point therapy. Before using any of these techniques, however, the lateral epicondyle should be iced for a few minutes to reduce inflammation and pain. Once the injury has been iced and the athlete is in the supine position, therapists can attempt counter torque twisting by beginning at the wrist and working up the
Adhesive capsulitis is the clinical term for frozen shoulder, an injury characterized by extreme tension of the rotator cuff muscles and inflammation at the glenohumeral joint (shoulder joint) which may cause scar tissue to form. The scar tissue causes less room for the humerus to move freely at the shoulder joint, resulting in pain and a dramatic decrease in ROM. There is no known specific cause of this injury, although it becomes more common with age, particularly after the age of 40. As far as athletes are concerned, adhesive capsulitis normally occurs after a fall onto the affected shoulder instead of resulting from an overuse of muscles. In these ways, adhesive capsulitis differs from the tears that characterize the rotator cuff injuries mentioned earlier. Surgery is often prescribed to repair this injury, which leads to a one- to three- year recovery period. Athletes should consider massage to treat adhesive capsulitis before consenting to surgery. Due to the extra tension of the rotator cuff muscles associated with this injury, the primary techniques for treatment include directional massage, hot stones, myofascial release, stretches, and trigger point therapy. (Therapists should not use cross fiber friction to treat this injury, because it may create more inflammation in the shoulder region. For this injury, massage therapists should treat the tightened muscle bellies that are a byproduct of adhesive capsulitis and not the tears near muscle origins and insertions normally associated with other rotator cuff injuries.) Therapists should begin with myofascial release and directional massage on each of the rotator cuff muscles, checking in with the athlete about the pain level. After applying lubricant, massage therapists will use hot stones or begin searching for trigger points, recalling the pain patter of trigger points in the rotator cuff muscles reviewed earlier. With adhesive capsulitis, trigger points almost always exist present, so massage therapists may wish to use this technique first or entirely on its own. Finally, because there are no tears associated with adhesive capsulitis, any of the three stretches (passive, AC, and CRAC stretches) should be safe to perform. However, massage therapists should stop if athletes state they are in pain through any of the movements (whereas simply feeling uncomfortable is to be expected). Additional treatment and prevention For rotator cuff tears, athletes should take NSAIDs and apply ice for pain management. Kinesio tape or a full shoulder brace can help support the shoulder muscles through simple actions. For adhesive capsulitis, athletes in severe pain should seek a corticosteroid injection from their physician, which will reduce the inflammation at the glenohumeral joint. Once an athlete has recovered from either of these injuries, therapists should recommend that the athlete takes more time than usual to stretch the rotator cuff muscles to include a simple forward and backward circumduction of the affected arm. Rotator cuff tears occur in baseball players (particularly pitchers), swimmers, tennis players, and on occasion, golfers. Adhesive capsulitis occurs more often in contact sports or sports in which players come in contact with the ground, such as football. forearm towards the elbow. Then, therapists should cross the elbow so that they are counter torque twisting the forearm with one hand and the bicep with the other. Massage therapists should finish by conducting counter torque twisting on the bicep. Next, they should try cross fiber friction perpendicular to the extensor tendon above and below the lateral epicondyle. (Therapists should remember to ice before and afterwards when performing cross fiber friction for tendonitis injuries.) Directional massage is a good follow-up to cross fiber friction. Therapists can begin the technique by placing the athlete’s arm in its reverse anatomical position (palm face down) and holding the hand down while sinking into and engaging the extensor muscles at the wrist. Then, therapists should move one inch towards the elbow, reduce their pressure and take out any slack in the skin, then repeat the procedure until they reach the elbow. Petrissage is a good technique to help loosen tense muscles surrounding the elbow and should be performed liberally on the upper forearm and bicep.
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Book Code: MTX1323
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