Sport massage therapy
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Benefits of sports massage
- When injured tissue is
- massaged it heals with less scaring.
- The repair of tissue that
- is massaged is 5-7 times faster than tissue that is not massaged.
- The pain can be reduced
- with massage.
- Function of the injured
- area can be regained faster with massage
- Massage can help maintain
- the full range of movement of the injured area.
- Massage can help the
- client to remain more psychologically positive.
- Sports massage does not
- just have to be saved for the treatment of injuries that have already
- occurred ,it is much more powerful used as a preventative tool to keep the
- body healthy
- An injury that is treated
- with sports massage techniques will have a lesser risk of reoccurrence
- than one left to heal itself.
- The athletes fitness
- capabilities will be increased due to massage can with recovery time, improve
- flexibility, etc. Increase ROM.
- Post event massage helps
- clear out waste and toxins e.g. lactic acids from the muscles, reducing
- stiffness and enabling a faster recovery than post –event rest.
- Scar tissue
- Fibrous adhesion
- Forms after a tear in the tissues
- Formed as a result of excess tension in the tissue-may not
- be any tearing
- New tissue forms with larger amount of collagen
- Formed from existing muscle tissue that knots and tangles
- lts in areas of extreme tension and lack of
- Results in general increase in tension in tissue
Sports massage movements and techniques
- Standard effleurage is done with the flat of a relaxed hand.
- It is a relaxing stroke always done at the beginning and end of the massage. It
- can also be used to connect different strokes to maintain rhythm. It warm the
- skin, prepares the area for deeper work, spreads the massage medium and helps
- to eliminate toxins.
- Sports massage effleurage is very similar to effleurage used
- in others forms of massage. However, in addition to traditional effleurage,
- which is performed using the palms, it may involve the use of the lower arm to
- apply deeper pressure strokes over larger areas.
- Petrissage is a compression stroke, such as kneading, which
- squashes the muscle tissue against itself and the underlying bone. This helps
- to break down tension in large muscles and is not used directly over bony areas
- due to the risk of bruising. It help to improve the elasticity of the muscles,
- decreases muscle tension and aids relaxation and circulation.
- Compression as the
- name suggest, result in the muscle being compressed against the deeper tissues
- and bone. This results in an improvement in circulation and removal of lactic
- acid and other wastes from the muscle tissue. The therapist begins by pressing
- at the insertion of the muscle and moves along to its origin.
- A very deep technique, heavily stimulating on the blood
- supply. Good for adhesions and scar tissue in the muscles and loosens and realigns
- tangled muscle fibers. Beneficial at muscle attachments and around joints. The
- digits or elbows can be used, and care must be taken not to crush the tissues
- against the underlying bone as this can cause bruising and damage to the tissues.
- The pressure must stay within the pain threshold and the movement should not be
- performed for too long at the time, it is better to move off the area and
- return to it later.
- There are three different types of frictions that will be
- studied in detail.
- Circular frictions used
- around joints.
- frictions used on tense muscles
- Cross fiber frictions used
- on used on tense muscles or ligaments that are weak
- All frictions help to
- increase heat in the area, increase circulation and lymphatic drainage to
- the region, stimulates the nerves and loosens areas of tension and scar
- Percussion strokes include hacking, cupping, beating,
- pounding and the smaller fingertip
- Movements of Tapotement.
- These are invigorating strokes which will stimulate a muscle and are
- used primarily over weakened atrophied muscles. In a relaxation massage they
- can be used before the final effleurage to help wake up the client. They all
- result in increased circulation, warming of the skin and the muscles, increased
- muscle tone and invigoration of the nerves
- The aim of vibrations are to shake the muscle fibers to help
- with relaxation and to loosen tension .Used on the quadriceps and calves
Neuromuscular technique – NMT
- A technique where the digit is held in the one place over a
- sore point and the pressure increased to the clients pain threshold limit. This
- provokes a reflex in the nervous system, which helps the muscles to relax and
- reduces spasm and pain.
- This can be used alone or in conjunction with NMT to relieve
- tightness and pain in the muscle or tendon injuries. It involves moving the
- muscles into a more relaxed position while performing a neuromuscular technique
- to aid in relaxation.
Connective Tissue Manipulation-CTM
- A form of stretching that involves movements which help to
- loosen adhesions, fluid and fibrous accumulations, outside of thigh-lower back
- are typical area, between the muscle fascia and the subcutaneous layer.
Soft Tissue Release-STR
- Technique that
- improves flexibility in a localized areas of muscle or tendon. It involves a
- combination of pressure and movement which causes the muscles to lengthen and
Muscle Energy Technique-MET
- Very effective movement in increasing overall flexibility
- and decreasing muscle tension. It involves using restricted or resistive
- movements to stretch muscles. This inhibits the muscle spindles and Golgi
- tendon organs to allow an improvement in flexibility.
Neuro-muscular Technique (NMT)
- Warm the area with either – Effleurage and
- petrissage. Massage and heat treatment.
- Using either the thumbs, elbow or fists, locate
- the most tender spots in the muscle.
- When on the tender spots gradually increase the
- pressure into the area.
- Tell your client to use a scale of 0-5 for the
- pain,5 meaning the pain is too much to bear,4 is maximum tolerate,0- being no
- pain only pressure can be felt. The treatment should work within the pain
- tolerance of the client at all times.
- As this is an uncomfortable form of treatment
- explain to the client that they need to help you by doing three things
-To relax the area completely
- - To focus all their attention
- on the area
- To take deep breaths.
- 6. Tell the
- client to tell you when the pain in easing using the scale above. 6. Seconds is
- a good average time to apply pressure, with an absolute maximum of 9 seconds. If
- the pain does not ease after 90 seconds and the client is relaxed and breathing,
- there could be an underlying complication or the injury may be more serious
- than originally thought.
- 7. One area can be returned to up to three
- times in a session, any more than that may aggravate the area.
- 8. After the NMT you will need to perform a
- stretching movement on the muscle to further restore a health tone. This can be
- done by manually stretching the muscle or by performing a massage stroke that
- has a stretching effect i.e. stripping/deep effleurage.
- 9. Always finish with effleurage towards the
- nearest lymph node.
Physiological benefits of NMT.
- This techniques should inhibit the neural
- message from the muscle to the brain, which should bring about pain relief
- and relaxation.
- Def.- It provokes a reflex in the nervous system
- that aids in muscle relaxation.-
- Reduces the protective muscle spasm that has
- developed in the muscle as a result of the injury.
- Temporarily compress the blood vessels supplying
- the injured tissue, so that when the pressure is released, the blood
- floods the area causing an extreme change that induces relaxation in the
- Stimulates the nervous system to suppress the
- body’s normal reflex reaction of contracting injured muscles.
- Stimulates the release of endorphins, the body’s
- natural pain killers.
- Applying too much pressure,
- applying the pressure too fast or coming off the area too quickly, can result
- in the muscle tone increasing further to the point of spasm.
- A very deep technique, heavily stimulating on the blood
- supply. Good for adhesions and scar tissue in the muscles and loosens and realigns
- tangled muscle fibres. Beneficial at muscle attachments and around joints
- The digit or elbows can be used. Frictions should never be
- used on acute problems and should not crush the muscle into the bones, as this
- can bruise the tissues. The pressure must stay within the pain threshold, and
- the movement should not be performed for too long at one time, better to move
- off the area and return to it later. Always follow with stretching movements.
- Used mainly around the joints to loosen shrunken and stiff
- fibrous capsules. Good after an injury in which the joints has been immobilised
- for a period of time. In this case the fibrous capsule will have formed fibrous
- adhesions that will limit the movement of joint leaving it open to injury. Also
- good where stiffness muscle has limited joint range of movement
- Friction that is applied working with the direction of the
- muscle fibres.
- This stroke will break down fibrous adhesions and scar tissue while also
- lengthening the muscle.
- Good on muscles that have become too shot, example, upper trapezius due to
- overuse or any muscle after an injury.
Transverse friction or Cross fibre friction
- Friction that is applied working against the direction of
- the muscle or ligament fibres.
- This stroke will also break down fibrous adhesions and scar tissue while also shortening and strengthening the muscle/ligament.
- Good on muscles that are too long and too weak: example middle trapezius.
- This stroke is also extensively used on ligaments
- that have been injured as these structures always heal too long and suffer from
- less strength that before.
- Damage to the body’s tissue triggers a response called
- inflammation. This can be caused by pressure, friction, repeated load and
- external trauma. Tissue injuries damage tissue cells and blood vessels causing
- fluids to leak into the spaces between the cells, which causes inflammation.
Symptoms of inflammation
- Loss of function, depending
- on the site and extent of damage
- When muscles, tendons or
- ligaments are damaged, blood vessels in the area are torn. As a result bleeding
- occurs and spreads rapidly into adjacent tissues. This bleeding causes swelling
- which in turn results in increased pressure on surrounding tissues, which
- become tense and tender.
- In the early stages this is the
- body’s attempt to stop the bleeding, as increased pressure in the surrounding
- tissues increases the pressure on the damaged blood vessels, which does slow down
- the blood loss. However, over time the increased pressure causes pain in
- sensitive tissue by pressing on nerves. This pressure also restricts blood flow
- to the area, which impairs the healing process and causes a build-up of waste
- products. Therefore, repair of the damaged tissue begins in the active phase of
- inflammation by limiting blood loss but cannot be completed until all harmful
- substances have been removed from the site of the injury.
- If this cycle of events can be interrupted,
- healing is enhanced. So in cases of soft tissue injury, it is important to
- inhibit and control bleeding as soon as possible. Treatment should be started
- immediately. If carried out correctly it can greatly reduce recovery time for
- an injury.
- If inflammation is left
- unchecked, congealed blood will remain in the area will be converted to scar
- tissue and for this reason early intensive treatment is recommended. For tissue
- to heal it is important that the body produces new tissue to repair the area. The
- new bundles of fibres made mainly from collagen re-unite the broken fibres but
- not with the same uniform pattern as the rest of the tissue. Instead the fibres
- have a very haphazard fashion and tend to be less flexible and more rigid that
- rest of the structure. For the injury to heal as well as possible the initial
- inflammation process needs limiting with the P.R.I.C.E. principle, the new scar
- tissue fibres need gentle but repeated stretching into place, something massage
- is very good for.
Average tissue healing rates
- Muscle is more prone to injury
- but heals faster than other types of tissue, usually between 2-3 weeks.
- Tendons and ligaments are less
- prone to injury but are much slower to heal than muscle usually about 8 weeks,
- with ligaments sometimes taking longer.
The P.R.I.C.E. Principle
- The price principle is applied to injuries in the acute
- phase of an injury, i.e. usually the first 48-72 hours when inflammation and
- bleeding is occurring. It is necessary to promote healthy healing of the
- P Protection. Protect the area from further
- R Rest. Rest the injured
- area from exercise and other day activities that could
- aggravate it. Active movements that do not cause pain are beneficial.
- I Ice. To restrict
- blood flow and limit pain
- C Compression. Restrict blood flow, limit
- E Elevation. To enhance lymphatic
- drainage and removal of waste products,
- by aiding in venous blood flow.
- This elevation also slows the arterial blood flow to the area and
- therefore can help in restricting the amount
- of bleeding.
Acute phase 1-3 days (24-72h)
- Post-Acute phase -3-4 days massage,
- Remodelling phase – Full ROM, Pain free.
- Straight, training.
Assessing the soft Tissues
How do I find where the problems are and what to treat?
- the first massage Treatment, the therapist will need to palpate (feel) the
- clients muscles to look for problems areas, lumpiness, tightness and adhesions.
- Any pain felt in an indicator of injury or damage to muscle. Tightness or lumpiness
- indicates tension or that the muscle has not healed properly after a previous injury.
- Palpation generally reveals problem areas in superficial muscles; deep muscles
- may be inaccessible.
What is palpation?
- Palpation is the method used to assess muscles and/or the
- degree of swelling or damage. Very simply it is the process of using the hands
- to touch the different muscles and parts of the body in order to determinate
- their condition. To process is two-way- as the therapist touches the different
- areas of the body the client needs to explain whether there is any pain or
- discomfort in the areas of the body the client needs to explain whether there
- is any pain or discomfort in the various muscles, so that the therapist can
- assess the muscle in terms of both how it feels to the touch and how the client
- feels when it is touched. When working on deeper muscles where the damage may
- be hard to palpate, the non-working hand should be used for support because
- sometimes a reflex action in a muscle other than the one being palpated can
- suggest a problem. Tension in superficial muscle may also be caused by a
- problem in deeper layer of muscle.
- Palpation should be carried out slowly, to ensure that the
- assessment is thorough. The pressure should be light at the start then
- gradually increased to prevent any muscle tension developing or causing
- unnecessary discomfort to the client. This is especially important in areas
- that are obviously inflamed or that the client has reported as a problem.
- Through the palpation, the therapist should pay attention to all client
- feedback, both verbal and physical.
- Experience, gives massage therapist the ability to distinguish
- between the various kinds of soft tissue according to how they feel. When
- relaxed and in good condition muscle should feel soft, smooth and pliable,
- without lumps, tightness or knots. It should be easy to move and should not
- hurt. Tendons, being fibrous extension of the muscles fascia, feel firmer and
- stringier, but should not be rigid or stiff. Where there is specialized
- thickening of fascia, such as the Iliotibial band and the thoracolumbar fascia
- (lumbar spine) tissue will also feel firmer and less resilient.
- If they are not rehabilitated sufficiently after trauma, the
- condition of the body’s natural splinting system minimizes further damage. Fibrous
- tissue is vital to bind the area initially, but in the event of chronic tension,
- healing is impaired by curtailed circulation. The fibrous tissue does not
- process the characteristics of the tissue it has replaced so it remains, binding
- and gluing the area. The tension consisting of shortened less efficient fibers,
- also remains. Efficient muscular skeletal functioning cannot be resumed and
- over –use injury develops as postural adaptation occurs.
- General variations will occur with age, sex, fitness,
- occupation and previous injury. However, poor texture can be identified and
- categorized under the following headings:
Tension and Hyper tonicity
- The tissue are generally
- shortened and tense. They feel resistant and lack pliability and will be
- difficult to move and not very flexible.
- Following injury and inflammation, tissue-making cell called
- fibroblast rush to the area and start mending the damage with collagen fibers. In
- some instances, especially if to the injury remained tense after the injury or
- healing was not completed properly, the new tissue does not receive enough
- oxygen and nutrients and becomes sticky and inflexible and the muscles fibers
- stick together. In some instances, especially if the injury remained tense
- after the injury or healing was not completed properly, the new tissue does not
- receive enough oxygen and nutrients and becomes sticky and inflexible and the
- muscles fibers stick together. In some instances fibers develops between the
- different muscle fascia’s sticking them together. As a result the muscles will
- not be as efficient, other local muscles, bones and joints will adjust and overwork
- to compensate for the weakness of the damaged area and the problem, instead of
- being treated becomes part of the body’s structure. And the formation of
- fibrous tissue, adhesion of fascia can occur, these re usually longitudinal
- bands of tension. They feel woody and stringy and may “flick” if being palpated
- across their fibers.
- Adhesion can also be palpated in tense, shortened, overused
- muscles. These feel like knots and lumps, which will gradually break from one
- big lump, into several smaller lumps until eventually a gritty feeling is felt.
- Inflammation and damage to tissue can result in the
- formation of a collagenous scar. Scar tissue is localized and lacks mobility,
- flexibility and strength. It can feel like marbles and is usually hard and solid.
- The older the scar tissue the more rigid it will be.
- Oedema and swelling are caused by an excess of tissue fluid
- following injury, due to capillary damage. The area can feel spongy and squishy.
- The lymph fluid is the body’s protection for a damaged area, allowing it to
- concentrate on sorting out the problem. Swelling can be detected by pressing
- with a finger on an area that appears swollen, if the finger leaves a white
- mark in the area oedema is present. Also the affected area will feel watery and
- full of fluid. Extremely swollen areas will be firmer, even solid, and
- relatively immobile and painful due to the excess fluid pressure on the sensory
- Try and work out if pain is caused by any of the above. If not,
- and the client is unaware of the problem and has no reason for the pain, refer
- them to GP before continuing treatment.
- These occur close to the skin’s surface and feel lumpy to
- for redness, heat and pain and swelling. Do not treat with massage if these are
Common Causes of sport injuries
- The causes of sports injuries can be divided into two
Extrinsic/ Environmental injury
- External forces cause
- injury to the body e.g. fall kick, blow from a heavy object, poor training
- surfaces, cold training conditions.
- Internal forces cause
- injury to the body e.g. Muscle pull. This type of injury may be through the
- personal pushing themselves too hard or incorrect training.
Extrinsic/ Environmental injury
- and environmental injuries result from outside elements, some of which are
- under the control of the athlete, some are not.
- These injuries are caused by an
- external force. Another player falls and their knee impact your quadriceps
- causing injury due to squashing of your quadriceps muscle against the
- underlying femur. Or a player tackles you incorrectly and pulls your foot out
- from under you. This can result in
- injury your hamstrings is being over stretched.
Type of sport
- Certain sports, due to their
- physical nature will result in more injuries. Rugby for example, can cause
- serious extrinsic injuries, due to the amount of tackling involved that can
- result in the body weight of one player impacting onto another player.
- Incorrect training techniques
- will always guarantee an injury. Failing to perform a warm-up and cool-down
- will result in poor flexibility and cause a muscle tear. No lifting a weight
- through its full range of motion, will result in different amounts of strength
- in a muscle and this will cause injury.
- Environmental factors can result
- in injury. When athletes train in cold weather, they must allow extra time in
- the warm –up to ensure that the body has reached a suitable temperature that
- increases blood flow to the muscles. Athletes who perform the same warm-up
- regardless of whether condition, risk injury due to cold inflexible muscles.
- Cold weather also results in hard
- compacted ground for athletes who train on outdoor surfaces. This limits the
- shock absorption capabilities of the surface and cause injury, especially to
- the lower leg.
- Similarly, training in hot humid
- climates can cause injury due to heat stroke/ heat exhaustion and dehydration.
- Environment factors can also
- cover “Ugly Parent Syndrome”! Parental interference and pressure are one of the
- main reason why children drop out of sport. Too much pressure to perform and
- excel at a sport, either from a parent or from an overzealous coach, will
- result in injury to the athlete, not to mention mental stress and zero enjoyment
- in their sport.
- Training with old or faulty
- equipment can result in serious injury. Should a cable snap on a weights
- machine or a barbell snap during a heavy lift, this can result in potentially
- life threatening injuries to the athlete. Training with incorrect clothing
- especially worn out footwear, will result in injury to the lower leg and foot,
- due to lack of shock absorption and lack of support to the foot.
- Intrinsic injuries are the more common of two injuries.
- These are injuries which occur with no outside influences.
- The most common of all sports injuries is the overuse
- injury. It can develop slowly over a period of time ranging from days to weeks,
- months or even years. In many cases the sports person may not be aware of the
- problem until it reaches a critical level and injury occurs.
- Overuse injuries are generally caused by overload or
- repeated microscopic injuries to the muscular system. Some examples of causes
- of overuse injuries are muscle imbalance, training errors, faulty techniques
- (often seen in beginners), training on incorrect surface etc.
- Working strong muscle in a different way can cause injury.
- For example, a cyclist who normally trains by cycling 10 miles a day, decides
- to run 10 miles. This cyclist could easily cause an injury due to the different
- strains and pressures being placed on the muscles, as a result of performing a
- different form of exercise on a different training surface.
- This is a commonly neglected area, which can result in injury.
- The particular tissue involved in activity must be prepared for the stress that
- they are about to experience. If cold and tight muscles are suddenly expected
- to expend hard effort, they will be vulnerable to damage .Whereas, if a warm
- –up is done, then the blood circulation to the muscles is increased. This will
- result in the muscle becoming warmer and they will have a larger degree of flexibility,
- allowing them to take the strains placed on them by exercise without tearing.
- A sufficient cool-down is also essential as it helps to
- facilitate the removal of accumulated lactic acid, which if it remains in the
- muscles will cause tension, pain and stiffness, which in turn increase the risk
- of injury.
- Stretching is also an important part of cool-down, as it
- helps to realign muscle fibers, aids in the removal of lactic acid and
- therefore helps to prevent stiffness.
- Inflexible muscles Flexible
Fatigue or over training
- Repeated performance of a particular exercise can overly
- fatigue the muscles, which will leave them open to injury. This can easily
- happen, especially in competition, when the athletes push themselves to the
- limit, which is often seen at the end of match or training session. This can
- result in a muscle being asked to do more than it is able to, resulting in
- Similarly, problems can arise if training session are too
- frequent, with insufficient time for the tissues to recover fully between each one.
- Age effects the strength and resilience of the tissues.
- Muscular strength begins to decline at the relatively early age of 30-40 years.
- The elasticity in tendons and ligaments decreases from the age of 30 and the
- strength of bone decreases after the age of 50.
- Inactivity accelerates the natural degeneration of muscles,
- tendons, ligaments and bone, while activity delays it.
- Age can also play a role in injury, where mental maturity,
- or the lack of it, can cause injuries. This can be seen in teenage athletes who
- train excessively or incorrectly in a bid to bulk up/lose weight as fast as possible.
- They will use short cuts, commercial gadgets, dangerous supplements, and often
- poor training techniques to achieve their goal as quickly as possible.
- example, infections, cold, flu, high temperatures etc.
- These conditions increase the risk of complications such as inflammations of
- the cardiac muscle. The risk of the infection being spread throughout the body
- is increased, while the body’s ability to fight the disease is decreased as
- energy needed to combat the infection is being spent on exercise
- Never treat unless the injury has been diagnosed and
- treatment has been recommended by a medical practitioner.
- Cardiovascular conditions (thrombosis,
- phlebitis, hypertension, hypotension, heart conditions)
- Any conditions already being treated by GP or
- another health professional, e.g. Physiotherapist, Osteopath, Chiropractor,
- Nervous/Psychotic conditions
- Any dysfunction of the nervous system (e.g. Muscular
- sclerosis, Parkinson disease, Motor neuro disease)
- Trapped pinched nerve(e.g. Sciatica)
- When taking prescribed medication
that restrict treatment
- Contagious or infectious diseases
- Under the influence of recreational drugs or
- Undiagnosed lumps or bumps
- Scar tissue(2 years for major operation and 6
- months for a small scar)
- Abdomen(first few days of menstruation depending
- on how the client feels)
- Recent fractures(minimum 3 months)
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