and squeeze the tendon upward, then petrissage up the leg towards the knee, grasping more muscle mass as the massage therapist goes along. Again, the athlete should not be in any pain or discomfort at this point beyond that caused by the injury. Once three to four passes from the heel to knee are complete, the massage therapist may apply one or more complementary techniques. Several complementary massage techniques have been shown to be effective for Achilles tendonitis; they are transverse mobilization, circular friction, and stripping. With transverse mobilization, the massage therapist’s hands are perpendicular to the tendon so that the fingers of each can grasp the tendon, with no more than one inch between hands. Beginning near the heel, move one side of the tendon away from you while the other hand moves the tendon toward you, alternating several times. Done lightly without too much pushing or pulling in either direction should loosen any stiffness associated with the injury. With circular friction, the massage therapist should place fingertips on each side of the affected tendon starting near the heel and making light circular movements towards the tendon’s origin. Once near the tendon’s origin, the therapist should move back to the beginning and repeat for three to five minutes. Ankle sprain The ankle is considered sprained when its ligaments are forced to stretch beyond their normal ROM and tear, causing pain, a loss of stability, and a loss of strength of the lower leg muscles. Inflammation often accompanies a sprain, as well. In most cases, the joint referred to as the ankle syndesmosis – where ligaments joins the lateral, distal ends of the tibia and fibula – is the site of most sports-related ankle sprains. An ankle syndesmosis sprain is more commonly referred to as a high ankle sprain . It results from the foot over-rotating inward, leaving the sole of the foot facing inward. Less commonly, the sole of the foot will roll outward, damaging the ligaments on the medial side of the ankle, but the force required to damage the medial ligaments is much greater than the force required to damage lateral ankle ligaments since the medial ankle ligament are shorter and stronger. Therefore, it is much more likely massage therapists will deal with a high ankle sprain when working with athletes. An ankle sprain is categorized by degree: A first degree sprain involves only a minor ligament tearing that results in minor pain and loss of stability, allowing an athlete to continue walking. Usually, there is no inflammation with a first degree ankle sprain. A second degree sprain involves noticeable pain at the ankle even when not bearing weight, and a loss of stability often accompanied by inflammation. The athlete may still be able to walk on a second degree sprain, but not without pain and not without further damaging the ligaments. A third degree sprain is a complete tearing of the ligaments that results in a high degree of pain even when the ankle is not bearing weight, inflammation, possible blood pooling, and in most cases, a visible deformity that leaves the athlete completely unable to walk. Third degree sprains can only be fixed by surgery, although massage may speed recovery post-surgery. For first and second degree ankle sprains, cross fiber friction will be the primary technique used to treat this injury, since it helps break down scar tissue as well as helps it from reforming while helping to realign existing connective tissue. To apply cross fiber friction at the ankle, massage therapists should first make sure Broken clavicle This common fracture occurs when an athlete falls onto the shoulder or an outstretched hand and more force than can be withstood is transmitted to the collar bone. The resulting injury is sometimes accompanied by an audible popping or snapping sound, is immediately painful, and felt somewhere between the neck and the acromioclavicular joint (the AC joint) where the clavicle meets the scapula’s acromion. On occasion, the clavicle will appear deformed or out of place. The pain of this injury typically becomes worse when the athlete tries to move
Stripping the Achilles tendon begins similarly to circular friction, but with the thumbs on each side of the tendon and moving them in unison up towards the tendon’s origin and back again. Similar to the preparation phase, an athlete should not be in much more pain or discomfort beyond that caused by the injury during the application of these techniques. Upon the completion of these techniques, the therapist may want to ice the tendon once again, as any friction technique may cause inflammation. Additional treatment and prevention Rest, ice, compression, and elevation (RICE), pain-relieving anti-inflammatory medicines (NSAIDs), and Kinesio taping can help ease the pain and inflammation associated with Achilles tendonitis. Athletes should not resume their sport until the injury is completely healed (usually 4-6 weeks) or the condition may worsen or become chronic. Therapists should recommend to their athletes that they rehabilitate with calf raises (a plantar flexion exercise) to strengthen their soleus and gastroc muscles. Therapists should also recommend to athlete that they always stretch their Achilles tendon before training. This injury is most common among runners, accounting for approximately 50 percent of annually reported cases in the U.S., followed by basketball players, tennis players, and gymnasts. that the client is in a comfortable position, which may be either sitting or lying face up, or even lying prone with the feet hanging off the end of the massage table, if that is the most comfortable position for them. Next therapists should check for inflammation or swelling; they will want to apply ice to the injury site first if there is even a small amount of inflammation or swelling present. Once therapists are sure that the acute stage of the injury has passed and there is no inflammation or swelling, they can apply cross fiber friction near the site of the injury and work slowly towards it, along the length of the injured ligament. Therapists should use as much pressure with the friction that does not cause athletes to feel too much pain. Too much pain leads to muscle guarding which will lead to pressure on the ankle ligaments causing more pain. Therapists should continue the cross fiber friction for up to 10 minutes, then check for inflammation or swelling; if present, apply ice and discontinue massaging the ankle. Then, therapists should not reapply cross fiber friction until at least 24 hours have passed. Additional treatment and prevention Rest, ice, compression, and elevation (RICE), NSAIDs, and Kinesio taping can help ease the pain and inflammation associated with ankle sprains. Massage therapists may recommend to athletes that they wear an ankle support if they are not doing so already. Athletes should not resume their sport until the injury is completely healed (depending upon the degree of the sprain, anywhere for a few days to months) or the condition will worsen. Once recovered, athletes may want to incorporate a balancing device known as a wobble board into their training program, which will help them regain their strength and increase their stability at the ankle. According to the American College of Sports Medicine, ankle sprains account for more than half of all sports injuries. This injury is most common among runners, followed by football players, basketball players, soccer players, and tennis players. the upper arm through virtually any plane of movement. As with most broken bones, inflammation or blood pooling may accompany the injury. Any type of massage done for the clavicle that goes beyond light pressure that is meant to assist or stimulate blood flow to the area of the injury should not be done until the bone is well into its mending phase, usually at least a month after the injury for adults. (Recovery times vary depending on the severity of the break and how much the athlete continues to use the
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