water-resistant and will stay applied for three to five days making it a popular alternative to sports wrapping. Muscle tear Similar to contusions, this phrase means exactly what it suggests, a tear or tears of the muscle fibers due to overexertion, being overstretched, or physical impact. Muscle tears may be minor, damaging only small blood vessels, or major, separating a muscle and its tendon from its origin or insertion. (Major muscle tears require surgery to repair.) Muscle tears are characterized by pain even when the muscle is resting, and bruising, redness, swelling, and weakness of the affected muscle. R.I.C.E. (see below) is the immediate response for muscle tears. Therapists should avoid deep tissue massage for muscle tears for 48 hours after the injury occurs or until the injury site is no longer painful to touch and any swelling has subsided. Myositis ossificans This condition is particular to young athletes who have not yet completed puberty. In some instances, young athletes who suffer contusions or muscle tears may have their bodies repair damaged muscle tissue with bone tissue instead. Myositis ossificans may be indicated by a hard lump in a muscle. This condition can be very painful and severely limits a muscle’s strength and ability to stretch. Preliminary studies indicate that the application of massage therapy will worsen this condition. Therefore, massage is contraindicated without the approval of a physician. Sprain When ligaments (the fibrous tissue that connects bone to bone) are forced to stretch beyond their normal ROM – for example, hyperextension of the knee – the resulting tear is known as a sprain . Sprains may be characterized by pain, inflammation, and the inability of a joint to bear weight, align correctly, or move a limb below the site of the sprain. Strain Generally less severe than sprains, there are two types of strains. First, when the musculotendinous junction (the area where a muscle starts becoming tendon) is forced into a stretch beyond its normal ROM and suddenly or forcibly contracted, the resulting tear is known as an acute strain . Mild strains that build up over time from constant overuse or repetitive stress at a joint – for example, a tennis player continuously volleying with force – result in chronic strains . In general, strains may be characterized by pain, inflammation, muscle spasms, a reduction in strength, and a reduced ROM near the strain. Achilles tendinitis The Achilles tendon is a tendon of the posterior leg and the biggest tendon in the body. This muscle originates where the soleus and gastrocnemius muscles combine, and it inserts at the inferior aspect of the posterior calcaneus (heel bone). As part of the soleus and gastrocnemius muscles, the Achilles tendon is responsible for plantar flexion. Because the Achilles tendon is integral to basic walking, running, and jumping movements, the additional strain of high performance sports make this part of the body highly susceptible to injury. On average, there are over 200,000 cases of Achilles tendon injuries a year, 89 percent of which affect men. The most common Achilles tendon injury occurs through overuse, resulting in inflammation and pain from micro-tears in the tendon. If left untreated, this condition may become chronic and leave a client unable to run, or, unable to run or walk without pain. Achilles tendonitis is characterized by pain from the back of the foot to above the heel, pain upon plantar flexion of the foot or pointing the toes, general stiffness or tenderness of the tendon, and/or inflammation anywhere along the tendon. Treatment for this injury begins with checking for inflammation first. If inflammation is present but not to the degree of contraindication (that is, minor), ice should be applied to the affected area for
An athlete working with a physician may have their sprain or strain categorized according to the severity of the injury. A mild, Grade I sprain or strain describes a minor over-stretching or tearing of a ligament or muscle. A moderate, Grade II sprain or strain describes a partially torn but still intact ligament or muscle and some degraded joint stability. A severe, Grade III sprain or strain indicates that there is a fully torn ligament or muscle and therefore, no joint stability. Massage therapists may work with the first two grades of sprains and strains once the acute phase of the injury has passed. They will not treat the third grade of sprains and strains, though, as only surgery can repair this level of injury. Of course, once surgery has been completed and an athlete’s rehabilitation phase begun, therapists may help an athlete recover by loosening the muscles, reducing the scar tissue, and increasing the blood flow around the injury. Fighting inflammation may also be aided by making changes to the athlete’s diet; foods and spices such as berries, garlic, oily fish, olive oil, dark leafy vegetables, nuts, peppers, and turmeric have all been shown to reduce inflammation in the body. R.I.C.E. This is an acronym for rest, ice, compression, and elevation. R.I.C.E. is the default treatment for the first 72 hours of an acute injury. ‘Rest’ means taking the time to recuperate, allowing time for healing thereby reducing the potential for aggravating the injury. ‘Ice’ means applying ice or a cooling pack to the injury site for at least 10 minutes but no more than 20 minutes to fight inflammation and reduce pain. ‘Compression’ means wrapping an injury site to reduce swelling and for stabilizing injured joints. ‘Elevation’ means preventing the pooling of blood at the injury site by raising the injured area slightly above the head. R.I.C.E. is the immediate although general response to almost all sports injuries. Note: An injured athlete should not be given non-steroidal anti-inflammatory drugs (NSAIDs) immediately following an injury, as NSAIDs thin the blood and may inhibit the blood clotting that is often a necessary part of the healing process. Tendonitis This injury refers to the inflammation of a tendon , the connective tissue that attaches muscle to bone. It is characterized by chronic pain, inflammation (occasionally), and muscular weakness. Therapists may massage on a tendon that has been inflamed provided they have first reduced the inflammation with ice or a cold pack.
SECTION III: SPECIFIC CONDITIONS ASSOCIATED WITH SPORTS INJURIES
at least 10-20 minutes to reduce as much swelling as possible before applying a massage technique. Whether or not ice has been applied to the tendon before massage begins, massage therapists should prepare or ‘warm- up’ the Achilles tendon before massaging it as tendons are less flexible and have poorer circulation than muscles. Preparation for this injury should begin with the client in the prone position with the foot hanging off the massage table. (Massaging a client’s Achilles tendon in the supine position is less effective.) The client’s leg muscles should be relaxed while the massage therapist takes the foot of the affected leg through its unrestricted range-of-motion at the ankle. The massage therapist should keep an open line of communication with the athlete; during this time, the athlete should feel nothing more than the slightest pain as the massage therapist plantar flexes, inverts, everts, and especially dorsi flexes the foot (as dorsiflexion may stretch the tendon too far). Next, the therapist may apply lubricant with light effleurage from the heel to the posterior knee in preparation of petrissage, which will increase blood flow to the area, preparing it for deeper work. The massage therapist should petrissage the posterior leg from the tendon at the heel, using fingertips to gently grasp
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Book Code: MLA1224
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