strength if they cannot hold them in position). When the client relaxes, therapists should be able to draw or push the muscle into a longer passive stretch. Therapists should repeat this cycle one to two times, and then perform the technique on the antagonistic muscle or muscle group. The Trigger point therapy Sometimes referred to as a form of Neuromuscular Therapy (NMT), this technique was developed in the 1940s by Janet Travel when she discovered that the palpation of some irritable muscles bundles (commonly referred to as knots) resulted not only in local pain, but pain distant from the site of palpation as well. Biopsies of these irritable muscle bundles, clinically referred to as trigger points , were electrically active tight spindles of muscle in the general muscle tissue. The tightness and electrical activity found in trigger points helps them to become self-perpetuating; the tightness stimulates an electrical impulse to the muscle spindles and the electrical impulses cause the spindles to contract, causing tightness. Although it is not known what initiates a trigger point, left untreated they may cause chronic pain across broad areas of the body.
resulting stretch on the target muscle usually has a greater effect and lasts longer than other methods of stretching. PNF stretches cannot always be performed, though, depending on which muscles an athlete has injured.
that the pain is about seven to eight on a scale of ten. (The client may also feel pain at a location away from the trigger point at this time if the trigger point is active. Trigger points that do not refer pain away from their general area are considered latent.) Massage therapists should continue to maintain pressure until the twitching stops – indicating that the perpetuating electrical signal has been interrupted – and the pain has subsided to at least a two to three on a scale of ten. As it relates to sports injuries, trigger points are quite
Trigger point therapy attempts to relieve these sources of pain through a very particular application of pressure: The technique requires holding pinpoint pressure upon the irritable muscle bundle until the trigger point begins to twitch. Once the muscle begins to twitch, massage therapists should apply more pressure until the client says common in and around the area of the rotator cuff muscles, although trigger points may occur in any injured muscle. Trigger point therapy should not be used if the athlete is too sensitive to the trigger points being palpated, regardless of how beneficial the technique may be. And, as is the case with deep tissue massage, therapists should avoid trigger point therapy when an athlete has a blood disorder or is taking medication that causes hemophilia (prevents blood from clotting), or, causes thrombophilia (increased blood coagulation) since the latter condition may lead to the development of a thrombosis (blood clot). SECTION II: GENERAL TERMINOLOGY ASSOCIATED WITH SPORTS INJURIES
and thus help repair the break, so long as the client does not experience pain while the area is massaged. Burns Many athletes experience friction burns (minor first-degree burns) by coming into contact with either playing surfaces such as a wood floor or grass court, or other athletes. Massaging a burn is often painful and may lead to further injury, thus, massage is locally contraindicated. The gentle application of soothing topicals whose ingredients include aloe vera, beta carotene, chamomile, hydrocortisone, or Vitamin E, however, is permissible with the athlete’s consent. Bursitis Bursae are small fluid filled sacs that cushion the space between muscles, tendons, and bones near joints. On occasion, usually through frequent, repetitive motions, bursae become painful and inflamed; a condition known as bursitis . Bursitis commonly occurs near the glenohumeral joint (shoulder joint), at the elbow, at the trochanter (the hip at the head of the femur) and less commonly at the knee and posterior ankle near calcaneus (heel bone). Contusions Athletes that play contact sports often suffer contusions, an injury in which a physical impact damages muscle fibers and connective tissue. The damage may be severe enough to cause blood pooling, which is characterized by a noticeable discoloration and inflammation of the skin. R.I.C.E. (see below) is the immediate response for contusions. Deep tissue massage for contusions should be avoided for 48 hours after the injury occurs or until the injury site is no longer painful to touch and any swelling has subsided. Hernias Due to the forces athletes in contact sports are subjected to, hernias – the protrusion of an organ through its containing wall or cavity – are not uncommon for athletes. Hernias may be extremely painful and they should never be corrected by attempts to push an organ back into place. Only a physician should attempt to correct a hernia. Hernia rehabilitation should be conducted only under the guidance of a physician
This section reviews some of the general conditions massage therapists are likely to encounter or see on an athlete’s intake form. First, the general condition is listed alphabetically followed by its description and symptoms. Then, any auxiliary information is discussed as well as whether any contraindications to massage exist. Acute phase In relation to medical terminology, the acute phase of an injury refers to the time immediately following an injury up to 72 hours afterwards. The symptoms of an acute injury include sharp pain, inflammation or swelling, loss of or decreased ROM, muscle weakness, tenderness at the injury site, and/or a visible deformity. These symptoms are contrasted against an injury’s chronic phase, which typically includes dull aches while resting or performing physical activity, minor inflammation or swelling, a decrease in muscle strength, and/or a decrease in ROM. Many of the injuries discussed later in this course will be contraindicated for massage therapy during the acute phase. Until massage therapy can be used to rehabilitate an injury, rest, ice, compression, and elevation (known as R.I.C.E ., see below) is the default treatment for the acute stage of injuries. Broken bones In sports, a broken bone is usually caused by either colliding with another player or falling onto a hard surface. If the break is not a compound fracture (bone protruding from the skin), a broken bone may be difficult to diagnose and is therefore left to medical doctors. Broken bones may be characterized by intense pain, blood pooling under the skin, bruising, limited ROM or inability to move a limb, a misaligned limb or joint, numbness, and/or tingling. The site of a broken bone should not be massaged until a client has had clearance from their physician for massage therapy. This is because the recovery and setting time for broken bone injuries vary with the athlete’s age, existing health, and what bone or bones were broken. Massaging the area around a broken bone may help stimulate blood flow to the injury
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