begins to twitch, massage therapists should apply more pressure until the client says 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 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). 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 or physical therapist. Hernias are usually corrected with surgery, or in the case of a sports hernia (in which a muscle, commonly the adductor magnus, ruptures at the pubis/pubic tubercle), under the guidance of a physical therapist. Inflammation The often painful redness and puffiness of skin and joints can have a variety of causes, as inflammation is one of the body’s first lines of defense against pathogens and disease. When it comes to athletes, though, inflammation usually results from blunt force trauma, or a muscle, tendon, or ligament tear. In this case, inflammation is the body’s attempt to remove damaged tissue. This attempt to remove damaged tissue is more specifically referred to as acute inflammation , where the body’s response to a physical blow sees plasma and white blood cells pool in the injury site. On occasion, this type of inflammation lasts longer than it should and leads to chronic inflammation in which healthy tissue is destroyed alongside damaged tissue, prolonging or halting the rehabilitation process. In general, inflammation can be treated with icing the site of inflammation for up to 20 minutes at a time and/or compressing the site of inflammation with a sports wrap to reduce blood flow in the area. Kinesio tape
SECTION II: GENERAL TERMINOLOGY ASSOCIATED WITH SPORTS INJURIES
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 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).
More generally known as elastic therapeutic tap e, Kinesio Tape became very popular among athletes after its exposure during the 2008 Summer Olympics when it was worn by beach volleyball player Kerri Walsh. Although only recently popular, Kinesio Tape was invented over two decades ago as a replacement for sports wraps. Kinesio Tape not only physically
supports muscles during activity, it also lifts the skin away from muscle tissue so that blood and other bodily fluids can move more freely thereby speeding recovery. When applied properly, Kinesio Tape can allegedly improve ROM, improve strength, and reduce pain and inflammation. The tape is sweat-proof and
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