hot stones are difficult to use on the subscapularis because of its position deep to the axillary fold (under arm). Long, thin stones are best for applying heat to this muscle when an athlete is in the supine position. Second, massage therapists can save time trying to find a trigger point in any given muscle by knowing its pain referral pattern. Infraspinatus refers pain to the middle and anterior deltoid and to a lesser degree, the outside of the arm as far as the wrist. Supraspinatus refers pain to the middle and posterior deltoid as well as the posterior elbow. Subscapularis refers pain to the posterior deltoid and occasionally the posterior wrist. Teres minor refers pain to the posterior deltoid and to a lesser degree, the triceps close to the deltoid. Massage therapists may also incorporate stretches, as long as they do not produce pain. However, massage therapists should stretch all rotator cuff muscles even if only one is injured, as the non-injured muscles may become overworked by compensating for a single injured muscle. Note that massaging the rotator cuff muscles will provide relief; however, ending the massage with the rotator cuff muscles is not enough. This is because rotator cuff injuries tend to induce tension in the surrounding muscles such as the upper trapezius, rhomboids, latissimus dorsi, deltoids, and pec major as the body attempts to stabilize the shoulder region. Therapists may use the same techniques to treat these muscles as the rotator cuff muscles. Adhesive capsulitis is the clinical term for frozen shoulder, an injury characterized by extreme tension of the rotator cuff muscles and inflammation at the glenohumeral joint (shoulder joint) which may cause scar tissue to form. The scar tissue causes less room for the humerus to move freely at the shoulder joint, resulting in pain and a dramatic decrease in ROM. There is no known specific cause of this injury, although it becomes more common with age, particularly after the age of 40. As far as athletes are concerned, adhesive capsulitis normally occurs after a fall onto the affected shoulder instead of resulting from an overuse of muscles. In these ways, adhesive capsulitis differs from the tears that characterize the rotator cuff injuries mentioned earlier. Surgery is often prescribed to repair this injury, which leads to a one- to three-year recovery period. Athletes should consider massage to treat adhesive capsulitis before consenting to surgery. Due to the extra tension of the rotator cuff muscles associated with this injury, the primary techniques for treatment include directional massage, hot stones, myofascial release, stretches, and trigger point therapy. (Therapists should not use cross fiber friction to treat this injury, because it may create more inflammation in the shoulder region. For this injury, massage therapists should treat the tightened muscle bellies that are a byproduct of adhesive capsulitis and not the tears near muscle origins and insertions normally associated with other rotator cuff injuries.) Therapists should begin with myofascial release and directional massage on each of the rotator cuff muscles, checking in with the athlete about the pain level. After applying lubricant, massage therapists will use hot stones or begin searching for trigger points, recalling the pain patter of trigger points in the rotator cuff muscles reviewed earlier. With adhesive capsulitis, trigger points almost always exist present, so massage therapists may wish to use this technique first or entirely on its own. Finally, because there are no tears associated with adhesive capsulitis, any of the three stretches (passive, AC, and CRAC stretches) should be safe to perform. However, massage therapists should stop if athletes state they are in pain through any of the movements (whereas simply feeling uncomfortable is to be expected).
forearm or elbow before slowly gliding their stroke down towards the tendon at the ankle. Hot stones are a good way to soften up the tibialis anterior muscle before deep tissue work. Following up deep tissue work with hot stones is an equally good idea, as the stones may lessen any soreness associated with the deep work. Massage therapists may also search for trigger points anywhere in the muscle during the application of any other technique, however, they are most likely to find one – if present – in the upper half of the muscle close to lateral border of the tibia. Next massage therapists will end treatment for shin splints with a passive or AC stretch, both of which will involve plantar flexion of the foot. Therapists should use a CRAC stretch until the injury is well on its way to recovery. Additional treatment and prevention Besides the common protocol for all sports injuries, runners in particular may wish to either change the type of surface they run on, change the manner in which they run, and/or change their running shoes. An ankle brace or Kinesio tape may help re-stabilize the ankle. This injury occurs more often with runners by a wide margin, followed by tennis players, basketball players, and soccer player. Shoulder injuries Because it is the most flexible joint in the body, there is a wide variety of injuries that can occur at the shoulder. As far as sports injuries are concerned, though, rotator cuff injuries and adhesive capsulitis (also known as frozen shoulder ) are the two most common shoulder injuries and account for upwards of 20 percent of all sports injuries. Both conditions are generally characterized by continuous pain even at rest, a decrease in shoulder mobility, a decrease in shoulder strength, crackling or popping sounds at the shoulder when moving the arm, and an inability to sleep on the affected shoulder’s side. Dislocated shoulders are the third most common shoulder injury; they involve the previously mentioned symptoms but also include inflammation, swelling, and discoloration. Any athlete displaying symptoms of a dislocated shoulder should be referred to a physician immediately. Dislocated shoulders are contraindicated for massage and will not be addressed here. Rotator cuff injuries typically refer to the partial or full tearing of one or more of the four rotator cuff muscles – infraspinatus, supraspinatus, subscapularis, and teres minor – and are usually the result of repetitive overhead motions such as those performed by swimmers, baseball pitchers, and tennis players. (According to the N ational Institute of Health , rotator cuff injuries are the dominant injury among baseball pitchers in particular and baseball players in general.) If an athlete has not been diagnosed by a physician but massage therapists suspect this specific injury, they should identify which rotator cuff muscles are injured. To do this, therapists should ask the athlete to move the arm through the movements specific to each muscle and determine when pain or stiffness occurs. For the infraspinatus and teres minor, pain or stiffness will occur or become worse when externally rotating the arm. For supraspinatus, therapists should have the athlete raise the arm laterally. A subscapularis injury reveals itself when the athlete rotates the arm inward. The opposite motion produces pain in an injured infraspinatus. Treating rotator cuff injuries may involve the use of cross fiber friction, directional massage, hot stones, myofascial release, and trigger point therapy. When applying these techniques, massage therapists should keep in mind two things: First,
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