the level of activity that is required of the athlete’s sport. After recovery, the athlete should focus on exercises that strengthen the inner thigh.
This injury is common among athletes who participate in sports that require a great deal of inner thigh strength such as football, ice hockey, soccer, and volleyball. Among ice hockey players, groin strains affect one out of every 10 players. refer pain to the gluteal muscles, the greater trochanter of the femur, and the region just above the anterior iliac crest. If trigger point work is too painful for an athlete, hot stones are highly effective for relieving pain and reducing tension. Massage therapists should be sure to work the stones into the QL and not simply left on the spine, as this will only help the erector spinae muscles. Stretches are highly effective for mild to moderate back strains, too. Massage therapists should use AC and CRAC stretches by resisting the athlete’s movements with their hands on the iliac crest when they hike their hip (hiking the unaffected side for AC stretches, alternating hiking each side for CRAC stretches). Massage therapists can treat the erector spinae muscles with all the same techniques, although they may have to cover more territory, since the erectors as a group run the length of the spine from the thoracolumbar fascia to the vertebrae of T1 and T2. While therapists may be able to massage a particular strained erector muscle, it is not unusual for a strained erector in the lower back to cause tension in the middle to upper erectors as the muscles working as a group attempt to stabilize the trunk. If there are time constraints during a massage (the athlete wants a full body massage with attention to the lower back, for example), using hot stones over the length of the strained erectors is the fastest way to treat them. Massage therapists can provide a stretch for the erectors in much the same manner as they would the QL, but they can also include an easy passive stretch for the muscle group by using traction on the feet and head (slowly pulling the feet or head away from the body, lengthening the spine). And, although not listed among the techniques in Section I, a gentle compression and vibration with the palm of the hand on the athlete’s sacrum may help release tension of the QL and lower back erectors. One important aspect of lower back pain and strains that is often overlooked is the potential for the psoas major to be involved. Due to the proximity in which the psoas major lies in relation to the QL, trigger points in the psoas muscle can mislead athletes into thinking they have hurt their lower back, when in fact, they have injured their main trunk flexor. To assess the psoas without feeling them, its trigger points will refer pain to the region of the QL itself. Massage therapists should also ask athletes if they experience lower back pain when they flex their trunk as opposed to extending their trunk. If they feel more pain when flexing their trunk, the psoas is involved. Accessing the psoas to work trigger points requires therapists’ fingertips to gently penetrate the rectus abdominal muscle approximately one inch below the navel and one inch lateral to the body’s midline. Accessing the psoas is easier if therapists bring an athlete’s leg into a 45-degree angle and push it slightly towards the midline, which will bring slack to the rectus abdominal muscle. Once therapists feel the psoas just medial to the spine between T12 and L5, they can move their fingers up or down the muscle to search for trigger points. Massage therapists should be sure to check in with an athlete, as psoas work is uncomfortable for many clients. Additional treatment and prevention When athletes have chronic pain, they should try to move into and stay in a position of least pain. Appropriate positions may be lying on their back with their legs elevated, lying on their stomach (sometimes with a pillow
Lower back pain Injuries to the lower back do not discriminate. While lower back injuries come in many forms – strains, spondylolysis, spondylolisthesis, and herniated discs – this course will focus on strains, the muscular dysfunction massage can most effectively treat. Muscle strains of the quadratus lumborum (QL) and erector spinae group (spinalis, longissimus, and iliocostalis) are exceedingly common: The Journal of Sports Medicine estimates that lower back strains account for as much as 20 percent of injuries among football players alone. If not treated soon enough, lower back strains can lead to a myriad of problems such as altering a runner’s gait which may lead to runner’s knee or shin splints (see below). Note : Therapists may work with cases of mild to moderate lower back strain, but if an athlete presents with severe pain, it is contraindicated for massage and the athlete should be referred to a physician. With the exception of counter torque twisting and petrissage, any of the remaining techniques – cross fiber friction, deep tissue, directional massage, hot stones, myofascial release, stretches, and trigger point therapy – can be used to ease the pain of lower back strains and restore function. Naturally, where therapists apply each technique will depend upon which muscle is injured, but massaging the surrounding muscles (the erector spinae group if the QL is injured and vice versa) can only help and certainly should be done after treating the strained muscle. To treat the QL, therapists should begin with cross fiber friction at its origin at the posterior superior iliac crest and work towards the spine. They should then treat the QL insertion along the lumbar vertebrae and at the inferior border of the athlete’s lowest rib. Next, therapists should try myofascial release as lower back pain sometimes results from superficial restrictions between skin and muscle tissue and not a strain at all. If the athlete experiences no relief after attempting myofascial release, therapists should engage the QL with directional massage. After one passage of directional massage, therapists should move slowly into the QL with a forearm or elbow, as the QL is fairly broad and will take a while to work if using directional massage alone. Deep tissue is also a good technique for this injury because therapists can approach the QL from several angles: With athletes in the prone position, massage therapists can approach the QL from the side, pushing their forearm into the soft tissue between the iliac crest and the last rib, even using the elbow to give the iliac crest cross fiber friction. Or massage therapists can lean over the client and lay their forearm or elbow into the thoracolumbar fascia near the spine and work their way between the iliac crest and the last rib towards the outside of the body. (Therapists should be mindful of their body mechanics here to ensure they don’t slip and fall on the athlete’s injured back!) Therapists can also have the athlete lay in a side-lying position with the affected side up and a pillow between the uninjured side and the table; this position gives massage therapists full access to the QL and makes deep tissue and trigger point work much easier. Trigger points in the QL are common and are usually found just below the QL’s insertion at the last rib. (Massage therapists should be careful to stay on the QL and not stray into the area of the kidneys, which are only partially protected by the lower ribs.) Trigger points in the QL will
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