upper arm.) With the injury well into the mending phase and any inflammation or swelling subsided, massage therapists will want to implement cross fiber friction first, as this will reduce scar tissue as well as prevent new scar tissue from forming. Regardless of where the fracture of the clavicle occurred, therapists will want to start cross fiber friction on the clavicle at the AC joint and work along the clavicle towards the neck. As always, massage therapists should work within the athlete’s tolerance for pain, remembering that the pain threshold will decrease as therapists approach the site of the break. If the site of the injury is too sensitive to pain, therapists should work as closely as they can to it. They may also use ice to numb the area near the injury. However, if the athlete has already indicated that working the injury site is too painful, therapists avoid direct pressure on that area; it may cause further damage otherwise. Having worked the clavicle itself, therapists may want to perform cross fiber friction along the upper one third of the sternum to Cervical (neck) injuries Given the number of neck muscles involved in supporting and moving the head, sprains and strains involving the neck and cervical spine are common in contact sports. In fact, neck injuries involving the cervical spine account for more than half of all career-threatening injuries. As athletes become bigger and stronger, there is ample opportunity for neck muscles to become overloaded or overpowered by outside forces. Usually, these outside forces are other players who, in colliding with another athlete, can cause an overextension or over-flexion of the head in any number of directions. On occasion, athletes can injure themselves by causing compression on their own vertebral column, such as in the case of high platform divers when their head comes in contact with the water. There are five muscles/muscle groups that are typically involved in neck sprains and strains in athletes. They are the sternocleidomastoid (SCM), scalenes group, upper trapezius, levator scapulae, and the suboccipital muscles. This course reviews the techniques for each muscle separately. The SCM, which rotates the head to the opposite side and assists flexion and lateral flexion of the neck, originates at the lateral portion of the sternum and the medial third portion of the clavicle and inserts at the mastoid process behind the earlobe. Sprains or strains of the SCM usually occur at the insertion, causing tension throughout the muscle’s length. Massage therapists should treat the insertion with cross-fiber friction, and the rest of the muscle with directional massage, myofascial release, stretches, and trigger point therapy. Note that doing direction massage and myofascial release will be done from insertion towards origin with this muscle and that because of this muscle’s proximity to the trachea (windpipe), it can be uncomfortable for the athlete. Trigger point therapy (if trigger points are indicated by pain behind or in the ear, or by pain just above the eyebrow) can be done by pinching the SCM between the thumb and fingers and drawing the SCM away from the trachea which may be a slightly more comfortable approach to an SCM injury. Passive stretches are most suitable for stretching the SCM; therapists should avoid AC and CRAC stretches, as these techniques are often reported as being uncomfortable for SCM injuries. Next, the scalenes group (anterior, medial, and posterior scalene muscles) collectively originate from the transverse processes of C2 to C7 and insert onto the first and second ribs. An injury to one or more of the scalene muscles may be indicated by pain when flexing the neck to the same side as the scalenes, or by pain upon inhalation, as the scalenes assist breathing by elevating the first two ribs. Treating the scalenes can be done with deep tissue, directional massage, hot stones, myofascial release, stretching, and trigger point therapy. Therapists can apply deep tissue massage to the scalenes with a thumb or the first two fingers, working from insertion to origin. As with the SCM, deep tissue, directional massage, myofacial release, and trigger point therapy (if trigger points are indicated by pain
loosen any restrictions there that may have occurred from the body trying to stabilize the injury. Because muscles surrounding an injury tend to become tense, massage therapists may also want to massage the pectoralis major and the neck muscles such as the sternocleidomastoid (SCM), scalenes, and upper trapezius with some simple effleurage or petrissage on the affected side. They may also want to search for trigger points along the SCM and scalenes at this time. Loosening these muscles will help restore mobility of the clavicle if not reduce the pain. Additional treatment and prevention Includes NSAIDs and ice for pain management and to help reduce inflammation and swelling. This injury is most common among football players, bicyclists, and skiers. to the upper arm or thumb and index finger) for the scalenes should be done from the head towards the body, although it is not expected that the insertion at the ribs will always be reached, particularly if an athlete has well-developed upper trapezius or pectoralis muscles. Particularly tense scalenes are a prime candidate for the application of long, flat hot stones to reduce tension. Any stretching technique is also suitable for the scalenes, although CRAC stretches are particularly beneficial since CRAC stretches utilize opposing scalene groups to relieve their own tension. The upper trapezius muscles originate at the occipital protuberance and medial superior nuchal line and insert at the spine of the scapula, the acromion, and the lateral one-third of the clavicle. In relation to other neck muscles, the upper trapezius muscles are strong, and it is uncommon for them to be sprained or strained. When a strain does occur near the trapezius muscle’s origin, the injury is actually to the suboccipital muscles, which are much weaker. However, the upper trapezius can become extremely tense due to their long and broad nature. Tension in the upper trapezius is best treated with petrissage, hot stones, and trigger point therapy, with petrissage and hot stones targeting the belly of the muscle. Conversely, trigger point therapy (if trigger points are indicated by pain in the posterior neck or temples), will usually be found near the insertion at the acromion and lateral third of the clavicle. Levator scapulae, below the upper trapezius, originates from the transverse processes of C1 to C4 and inserts at the superior angle of the scapula. Among other actions, the levator scapulae unilaterally flexes the head and rotates the head to the same side. This muscle can be treated with directional massage, myofascial release, trigger point therapy, and some stretches. Once again, directional massage and myofascial release will be done from the head towards the body. Trigger point therapy may be more beneficial, though, as trigger points are exceedingly common near or at the muscle’s insertion. Stretches for the levator scapulae should involve mostly passive stretches, as AC and CRAC stretches involve the contraction of too many muscles to be practical, time management wise. Finally, the suboccipital muscles are eight muscles (four on each side) that lie just inferior to the skull’s occipital bone, deep to the upper trapezius. These muscles serve to rotate, extend, and laterally flex the head. By themselves, this muscle group is relatively weak, making it prone to sprains and strains. When these muscles are injured, the resulting pain is almost always accompanied by inflammation and is tender to the touch. (As always, avoid hot stones if inflammation is present.) The application of ice before massaging the suboccipitals will do much to ease the athlete’s discomfort when performing the necessary cross fiber friction along the inferior portion of the occipital bone and moving towards the mastoid process. Trigger points can routinely be found by applying finger pressure in this area (as if trying to reach under the occipital bone), which will
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Book Code: MLA1224
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