SPORTS MASSAGE

Disclaimer: The recommendations and suggestions  are

not meant as a prescription but are intended for information purposes only. The

we recommend seeking professional

medical advice by a physician before attempting any course of therapy.

Click on the links to find out more about the type of injury you may have:

Injuries on the Legs and Lower Body

Achilles Tendinitis

Achilles Tendon Rupture (Total)

Achilles Tendon Rupture (Partial)

Ankle Sprain

Anterior Impingement of the Ankle (Footballerís Ankle)

Calf Muscle Tightness

Foot Stress Fracture

Groin Strain

Compartment Syndrome

Hamstring Contusion, Tendinitis, Tendon Rupture, Tightness

Iliotibial Band Syndrome (Runnerís Knee)

Lower Leg Stress Fracture

Medial Collateral Ligament (MCI) Injury

Patellar Tendinopathy (Jumperís Knee)

Peroneal Tendon Dislocation

Piriformis Syndrome

Plantar Fasciitis

Peroneus Brevis Tendinitis

Quadriceps Strain

Shin Splints

Injuries on the Arms and Upper Body

Carpal Tunnel Syndrome

Lateral Epicondylitis (Tennis Elbow)

Medial Epicondylitis (Golferís Elbow)

Rotator Cuff Injury

Triceps Tendinitis

The benefits of sports massage:

Reduce muscle tension

Improve flexibility

Increase circulation

Assist in the warm-up and warm-down routine

Relieve swelling

Lessen the chance of injury or recurrence of injury

Restore mobility

Enhance performance

Maintain peak muscle and joint condition

Reduce the stress of competition

Speed up recovery time after injury or strenuous exercise

Soothe overworked muscles

Relax muscle spasms

Reduce the long-term effects of injuries

Lessen excessive muscle tone post-exercise

Increase muscle range of motion

Deactivate symptomatic trigger points

Identify soft tissue problems which could progress to injury

Reduce scar formation in soft tissue lesions

Reduce lactic-acid build-up in the tissues

Decrease adhesions between tendon fibers

PHASES OF SPORTS MASSAGE

PRE-EVENT: Twenty to thirty minutes before an athletic event, it is important to

warm up and increase blood circulation to the muscles and calm nervous tension

in order to achieve peak athletic performance. By warming and stretching the

muscles, you increase their flexibility, thereby reducing the risk of injury. To

prevent relaxation which can adversely affect performance, keep the tempo brisk

and energetic. Contraindications to pre-event massage include deep muscle

massage and massage techniques designed to breakup adhesions.

POST-EVENT: Post-event massage should begin as soon as possible following the event

and not last for more than 15 minutes. Before proceeding, evaluate the athlete for

obvious injuries and refer for medical treatment by a physician if necessary. The goal of

post-event massage is to increase oxygen-rich blood flow to the muscles and tissues,

reduce cramping and stiffness, and decrease recovery time. During the event, intense

physical activity can produce a build-up of lactic acid in the muscles. Lactic acid build-up

in the muscles can lead to muscle fatigue and deep muscle soreness following an

event. Massage post-event can aid in the removal of lactic acid as well as other waste

products from the muscles. General soft tissue techniques are used to promote

relaxation of spasmed muscles.

TRAINING: Training massage is used regularly to help athletes recover quicker from

workouts. It serves to increase flexibility and range of motion as well as relax and tone

the muscles. The goal of training massage is to help prevent future injuries and

decrease the healing time of any current injuries.

Training massage is often initiated using deep effleurage and quick strokes to aid in

increasing blood circulation and to warm up the muscles. Transverse friction should be

directed at tissues beneath the skin. This technique can help identify areas needing

special attention. Any areas needing special attention can be addressed with deeper

local work which can help breakup adhesions and align muscle fibers.

REHABILITATION: Rehabilitation massage focuses on gentle soft tissue techniques

aimed at relaxing muscle spasms. Passive and active techniques can be utilized to

improve range of motion, thereby thwarting the possibility of future injury.

SPORTS-RELATED INJURIES AND MEDICAL PROBLEMS

ACHILLES TENDINITIS:

The Achilles tendon (also known as tendo achillis and tendo

calcaneus) is a fibrous cord-like structure at the back of the heel that

connects the gastrocnemius/soleus muscle group to the calcaneus.

Approximately 6Ē long, the Achilles tendon is the thickest and

strongest tendon in the human body. Achilles tendinitis occurs when

there is an underlying degeneration of collagen tissues as a result of

overuse causing the Achilles tendon and surrounding tissues to

become inflamed.

Common Causes and Risk Factors

1. Overuse or misuse.

2. Excessive pronation (rolling the foot inward) or repetitive

motion.

3. Poor biomechanics of the foot and ankle.

4. A recent change in footwear providing inadequate support.

5. A recent increase in activity level.

6. Fatigued calf muscles.

7. Inadequate stretching of the muscles of the lower leg.

8. Running on overly hard or uneven pavement.

9. Misalignment of the ankle joints.

10. Tight calf muscles.

11. Sports at increased risk for developing Achilles tendinitis

include hill, distance and speed running, tennis, squash, volleyball

and basketball.

 

Signs and Symptoms

1. A diffuse aching or burning pain from the calf to the heel.

2. Difficulty flexing or extending the foot.

3. Pain aggravated by climbing stairs or uphill running.

4. Pain lessened by wearing high-heeled shoes.

5. Pain when participating in sport.

6. Pain when taking the first steps upon awakening from sleep or

prolonged rest.

7. Pain on pinching the Achilles tendon.

Prevention

1. Avoid a sudden increase in activity or training levels.

2. Perform regular stretching exercises to the lower leg and

gradually add ankle rotations to the stretch.

3. Wear footwear that will prevent pronation of the ankle.

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations

2. Apply ice the first three to four days following injury for 20

minutes every 4 hours.

3. Rest.

4. Elevate the affected lower leg to keep swelling down.

5. Use heel lifts to reduce Achilles tendon strain by shortening the

tendon and allowing it to rest.

6. Apply gentle stretching to the gastrocnemius/soleus muscle

group to stimulate connective tissue repair. Gradually add

rotation of the ankle to the stretches as tolerated.

7. Reduce activity level.

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy.

2. Sports massage techniques to the lower leg and calf muscles

will help reduce swelling, improve circulation and flexibility, and

prevent build-up of adhesions.

 

3. Apply transverse friction technique to the Achilles tendon for 2

to 5 minutes. The technique involves applying oscillating

pressure using the thumbs, fingertips, or knuckles directly over

the affected area transverse to the direction of the connective

tissue fibers. Lubricant should not be used as there should be

no movement between the therapistís hands and the underlying

skin.

4. Apply pressure in a circular direction using your first two fingers

on each side of the Achilles tendon. Pressure should be gentle

enough not to cause the athlete pain. Slight discomfort during

the procedure is normal. Apply circular motions for

approximately 2 to 5 minutes.

5. Ice may be applied post-massage for 10 minutes.

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ACHILLES TENDON RUPTURE (TOTAL):

Overview

The Achilles tendon (also known as tendo achillis and tendo

calcaneus) is a fibrous cord-like structure at the back of the heel that

connects the gastrocnemius/soleus muscle group to the calcaneus.

Approximately 6Ē long, the Achilles tendon is the thickest and

strongest tendon in the human body. Total rupture of the Achilles

tendon can be acutely painful. It can be the result of sudden trauma

or chronic repetitive microtears in the tendon resulting in

degeneration and subsequent rupture.

Common Causes and Risk Factors

1. Occurs most commonly in athletes in their 30ís and 40ís

following an acute traumatic event.

 

2. Pushing off hard on the toes.

3. Jumping.

4. Sports at increased risk for developing total Achilles tendon

rupture include tennis, racquetball, and sprinting.

5. Incorrectly performed stretching techniques.

6. Inflammatory arthropathies.

7. Local steroid injections.

Signs and Symptoms

1. A sudden onset of severe pain in the Achilles region.

2. A snapping or cracking sound or may be heard as the Achilles

tendon ruptures.

3. A sudden inability to walk on the affected foot.

4. An inability to stand on tip toe.

5. Increasing swelling.

6. A palpable gap in the Achilles tendon.

Prevention

1. Regular physical training can help maintain tendon strength.

2. Avoid a sudden increase in activity or training levels.

3. Perform regular stretching exercises correctly.

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations.

2. Surgical repair may be necessary.

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy. Obtain physicianís approval before

performing massage on patients with total Achilles tendon

rupture.

2. Approximately eight weeks after surgery, longitudinal and

transverse gliding techniques may be used to speed healing,

reduce stiffness and improve range of motion.

 

3. Transverse friction technique may be applied to the Achilles

tendon for 2 to 5 minutes. The technique involves applying

oscillating pressure using the thumbs, fingertips, or knuckles

directly over the affected area transverse to the direction of the

connective tissue fibers. Lubricant should not be used as there

should be no movement between the therapistís hands and the

underlying skin.

4. Apply pressure in a circular direction using your first two fingers

on each side of the Achilles tendon. Pressure should be gentle

enough not to cause the athlete pain. Slight discomfort during

the procedure is normal. Apply circular motions for

approximately 2 to 5 minutes.

5. Ice may be applied post-massage for 10 minutes.

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ACHILLES TENDON RUPTURE (PARTIAL):

Overview

The Achilles tendon (also known as tendo achillis and tendo

calcaneus) is a fibrous cord-like structure at the back of the heel that

connects the gastrocnemius/soleus muscle group to the calcaneus.

Approximately 6Ē long, the Achilles tendon is the thickest and

strongest tendon in the human body. Partial rupture of the Achilles

tendon occurs when the tendon tears but not completely. The athlete

may be unaware of the tear at the time of injury. It can be the result

of sudden trauma or chronic repetitive microtears in the tendon

resulting in degeneration and subsequent rupture.

Common Causes and Risk Factors

1. Occurs most commonly in athletes in their 30ís and 40ís

following an acute traumatic event.

 

2. Pushing off hard on the toes.

3. Jumping.

4. Sports at increased risk for developing partial Achilles tendon

rupture include tennis, racquetball, basketball, volleyball, and

sprinting.

5. Incorrectly performed stretching techniques.

6. Inflammatory arthropathies.

7. Local steroid injections.

Signs and Symptoms

1. A sudden onset of sharp pain in the Achilles region.

Sometimes pain will not be felt immediately but will come on

later.

2. Stiffness in the Achilles tendon upon waking in the morning.

3. A small swelling in the Achilles tendon.

Prevention

1. Regular physical training can help maintain tendon strength.

2. Avoid a sudden increase in activity or training levels.

3. Perform regular stretching exercises correctly.

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations.

2. Follow R.I.C.E. guidelines (Rest, Ice, Compression, Elevation)

for the first three to four days following partial rupture of the

Achilles tendon.

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy. Obtain physicianís approval before

performing massage on patients with partial Achilles tendon

rupture.

 

2. Approximately eight weeks after surgery, longitudinal and

transverse gliding techniques may be used to speed healing,

reduce stiffness and improve range of motion.

3. Transverse friction technique may be applied to the Achilles

tendon for 2 to 5 minutes. The technique involves applying

oscillating pressure using the thumbs, fingertips, or knuckles

directly over the affected area transverse to the direction of the

connective tissue fibers. Lubricant should not be used as there

should be no movement between the therapistís hands and the

underlying skin.

4. Apply pressure in a circular direction using your first two fingers

on each side of the Achilles tendon. Pressure should be gentle

enough not to cause the athlete pain. Slight discomfort during

the procedure is normal. Apply circular motions for

approximately 2 to 5 minutes.

5. Ice may be applied post-massage for 10 minutes.

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ANKLE SPRAIN:

Overview

An ankle sprain is an injury as a result of a stretch or tear of one or

more ligaments in the ankle. Ligaments are cord-like structures that

connects bone to bone. Depending on the amount of ligament

damage, sprains are graded I, II, or III with III being the most severe.

Common Causes and Risk Factors

1. Twisting of the ankle.

2. A sharp change in direction of movement.

3. Lack of conditioning of the structures supporting the ankle joint.

4. Inadequate stretching during warm-up.

5. A previous history of ankle injury or sprain.

 

6. Running on an uneven surface.

7. Inadequate footwear.

8. Sports at increased risk for developing an ankle sprain include,

running, jumping, volleyball and basketball.

Signs and Symptoms

1. Pain.

2. Swelling.

3. Joint stiffness.

4. Joint instability.

5. Discoloration of the skin at the ankle.

Prevention

1. Run or jog on even surfaces.

2. Perform regular stretching exercises.

3. Wear good quality, well-fitting footwear.

4. Avoid sudden changes in movement or direction while engaged

in sports-related activities.

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations.

2. Follow R.I.C.E. guidelines (Rest, Ice, Compression, Elevation)

for the first three to four days following ankle sprain.

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy.

2. Massage may be helpful in athletes with repeated ankle sprains

by helping to break-down scar tissue.

3. Following the acute phase, transverse friction technique may be

applied to the ligament in the stretched position for 5 to 10

minutes. If the athlete tightens up with pain, you are using too

much pressure. Lubricant should not be used as there should

be no movement between the therapistís hands and the

underlying skin.

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ANTERIOR IMPINGEMENT OF THE ANKLE (FOOTBALLERíS

ANKLE):

Overview

Footballerís ankle can cause a bony growth or spur to develop at the

front of the ankle where the joint capsule attaches. This can cause

inflammation in the joint capsule. Impingement occurs when the joint

capsule is tight. The condition is usually a result of the ankle being

overstretched.

Common Causes and Risk Factors

1. Overstretching of the ankle.

2. Having had repetitive strains or contact injuries.

3. Common in soccer players and those involved in kicking sports.

4. Having had poor rehabilitation following an ankle injury.

Signs and Symptoms

1. Pain at the front of the ankle.

2. Reduced dorsiflexion of the ankle.

3. Tenderness over the anterior talofibular ligament.

Prevention

1. Complete rehabilitation for any ankle injuries.

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations.

2. Surgical repair may be necessary.

3. Physical therapy may be necessary.

 

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy. Seek the advice of a physician before

performing massage on patients with footballerís ankle.

2. Following the acute phase or surgery, transverse friction

technique may be applied to the ligament in the stretched

position for 5 to 10 minutes. If the athlete tightens up with pain,

you are using too much pressure. Lubricant should not be used

as there should be no movement between the therapistís hands

and the underlying skin.

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CALF MUSCLE TIGHTNESS:

Overview

Tight calf muscles (gastrocnemius and soleus) is a common problem

in athletes. Microtears in the muscles cause them to spasm or

contract making it difficult for blood to circulate in them. This causes

the muscles to tighten.

Common Causes and Risk Factors

1. Common in runners.

2. Poor stretching techniques.

3. Excessive exercising.

Signs and Symptoms

1. Limitation of ankle joint movement.

2. Pain in the calf.

 

Prevention

1. Practice good stretching techniques.

2. Avoid a sudden increase in activity or training levels.

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations.

2. A stretching program.

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy. A potentially fatal condition called deep vein

thrombosis, which can cause pain in the calf, should be ruled

out by a physician before massage is performed.

2. Tight calf muscles tend to respond to deep massage

techniques.

3. Start with effleurage for 5 to 10 minutes to warm up the

muscles and prepare them for deeper work. Stroke upwards

from the heel to the knee. Stroking towards the heart will

prevent damage to the veins. Use slow stroking movements.

4. Proceed to petrissage to help loosen the muscle fibers.

Alternate with effleurage. Continue alternating techniques for

30 minutes.

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CARPAL TUNNEL SYNDROME:

Overview

Carpal tunnel syndrome, the most common of the repetitive motion

disorders, is a medical condition produced by compression and

entrapment of the median nerve in the wrist.

 

The median nerve is a pencil-sized cord containing thousands of

nerve fibers. The flexor tendons which control finger movement and

the median nerve are contained within a tunnel-like structure called

the carpal tunnel. Each tendon is surrounded by a protective

covering called the synovial sheath. Certain medical conditions or

highly repetitive use of the hands may cause this sheath to swell. As

pressure within the carpal tunnel increases, the median nerve may

press up against the transverse carpal ligament producing carpal

tunnel syndrome.

This syndrome has been the focus of much debate over recent years

due to suggestions that occupations requiring continuous repetitive

motions of the hands may be at higher risk. Although there are many

reasons for developing this swelling of the tendon, it can result from

repetitive and forceful movements of the wrist during work and leisure

activities.

Common Causes and Risk Factors

There are many causes of carpal tunnel syndrome. Any condition

that reduces the size of the carpal tunnel can cause this syndrome.

The following non-occupational factors can predispose one to

developing carpal tunnel syndrome. These conditions and situations

may increase pressure in the carpal tunnel resulting in compression

of the median nerve.

1. Fluid accumulation in the tunnel.

2. Bony or ligamentous changes in the tunnel.

3. Inflammation of the tendon sheaths in the tunnel.

4. Tumors.

5. Diabetes mellitus.

6. Hypothyroidism.

7. Rheumatoid arthritis.

8. Acromegaly.

9. Obesity.

10. Lupus.

11. Multiple sclerosis.

12. Alcoholism.

13. Gout.

14. Amyloidosis.

15. Sarcoidosis.

16. Wrist cysts.

17. Wrist fractures or dislocations.

18. Pregnancy.

19. Use of oral contraceptives.

20. Hormonal changes or menopause.

21. Regularly sleeping with the wrist held in an acutely bent

position.

22. Regularly engaging in repetitive and forceful movements of

the wrist during leisure activities.

23. Multiple myeloma.

24. Leukemia.

Some of the sports or hobbies that require chronic repetitive hand

motions putting one at risk for developing carpal tunnel syndrome

include:

1. Knitting.

2. Golf.

3. Fishing.

4. Bowling.

5. Needlepoint.

6. Tennis.

7. Rowing.

8. Archery.

9. Racquetball.

10. Playing musical instruments.

11. Skiing.

12. Ping-pong.

13. Hockey.

14. Baseball.

15. Gymnastics.

Carpal tunnel syndrome is a common work-related injury. When

related to repetitive maneuvers, carpal tunnel syndrome is also

known as a repetitive stress injury. In the workplace, carpal tunnel

syndrome can be brought on by rapid, repetitive use of the hand and

fingers for many hours at a time, on a daily basis.

Occupations that require repeated flexion/extension of the wrist,

strong gripping, awkward hand positions, mechanical stress on the

palm, or use of vibrating tools are particularly at risk for developing

carpal tunnel syndrome. Research by the National Institute for

Occupational Safety and Health (NIOSH) indicates that job tasks

involving highly repetitive manual acts, or necessitating wrist bending

or other stressful wrist postures, are connected with incidents of

carpal tunnel syndrome or related problems. The more risk factors

involved, the greater the chance of developing the condition.

Moreover, it is apparent that this hazard is not confined to a single

industry or job but occurs in many occupations, especially those in

the manufacturing sector. Jobs involving cutting, small parts

assembly, finishing, sewing, and cleaning seem predominantly

associated with this syndrome. The factor common in these jobs is

the repetitive use of small hand tools.

Carpal tunnel syndrome can also be due to trauma from repetitive

work such as that of supermarket checkers, assembly line workers,

meat packers, typists, accountants, and writers. As such, there is a

higher risk of developing carpal tunnel syndrome in the following

occupations:

1. Massage therapist.

2. Data entry clerks or those who work at a computer terminal.

3. Assembly-line workers.

4. Dentists and dental hygienists.

5. Letter sorters.

6. Hairdressers.

7. Cashiers or supermarket checkers.

8. Garment workers.

9. Drillers.

10. Welders.

11. Press operators.

12. Carpenters.

13. Mechanics.

14. Medical transcriptionists.

15. Meat cutters.

16. Musicians.

17. Farmers.

18. Gardeners.

19. Painters.

20. Locksmiths.

21. Janitors or maids.

22. Typists.

23. Food servers.

24. Textile workers.

25. Accountants.

26. Writers.

27. Sign language interpreters.

28. Construction workers.

Signs and Symptoms

1. Numbness, tingling, or pain in the thumb, index, or ring fingers.

2. Symptoms in the hand or wrist that disrupt sleep.

3. Symptoms initially worse at night and early in the morning.

4. Aching pain extending into the forearm or possibly even up the

shoulder.

5. Redness or swelling of the forearm and hand.

6. Weakened hand and finger grip.

7. Trouble grasping or dropping objects more frequently.

8. Pain or burning in the wrist or fingers.

9. Increased or decreased sense of touch.

10. ďClumsinessĒ or poor coordination of the hands and fingers.

11. Difficulty making a fist.

12. Difficulty fastening buttons or unscrewing bottle tops.

13. Limited range of motion of the wrist.

14. Shrinking in size of the thumb on the affected side.

Prevention

There are many steps you can take to help prevent carpal tunnel

syndrome. Knowing the risk factors will help you identify which

activities are posing a risk. If you think you are at risk, you can often

prevent carpal tunnel syndrome through proper hand positioning and

hand exercises.

Some important tips to help prevent carpal tunnel syndrome are:

1. If possible, rotate job tasks on a regular basis to prevent

overuse of the same muscles.

2. Reduce the number of motions involved in completing a

repetitive task.

3. Reduce the amount of pressure you exert when completing a

task.

4. Perform exercises to strengthen your hand and wrist.

5. Choose to utilize tools that reduce or eliminate the need for

wrist bending.

6. Avoid the use of vibrating tools or insulate tools to reduce the

vibration.

7. Take frequent breaks from using your hands throughout the

workday.

8. Use tools that keep your wrist relaxed and in a neutral position.

9. Reduce time spent on hobbies requiring repetitive hand

movements such as knitting and needlepoint.

10. To rest your wrists during breaks, use a support pad for your

computer keyboard.

11. Avoid the use of too much salt if you have a tendency to

retain fluid.

12. Stop any activity that produces pain or numbness in the

fingers, hand, or wrist.

13. Consider switching to an ergonomically-designed workstation

that reduces awkward wrist positions.

14. Consider implementing a plan of job rotation among workers.

15. Consider redesigning tools used to complete repetitive tasks.

16. Educate workers regarding carpal tunnel syndrome

prevention.

17. Position your computer monitor directly in front of you and at

eye level.

18. Use a keyboard with a soft-touch and do not pound the keys

when typing.

19. Position your keyboard at elbow height or lower and use a

keyboard drawer if necessary.

20. Avoid working in a cold environment as cold temperatures

have been found to increase the risk of developing carpal

tunnel syndrome.

21. When typing, keep your wrists in a straight position and move

only your fingers.

22. Use appropriate force and relax your grip when performing

tasks.

23. Cross-train and rotate workers across jobs.

24. Avoid excessive alcohol use.

25. If obese, take measures to reduce your weight.

26. If much of your time is spent writing by hand, use a thick pen

with a soft grip.

27. If using a computer daily for extended periods of time, use a

trackball instead of a mouse.

28. Use an ergonomically-designed chair with a height-adjustable

seat and backrest, armrests, and wheels.

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations.

2. Rest.

3. Wrist brace or splint.

4. Yoga.

5. Anti-inflammatory medication.

6. Diuretic medication (water pills).

7. Limited corticosteroid injections.

8. Carpal tunnel release surgery.

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy.

2. Following the acute phase and reduction of swelling, deep

friction massage may be performed in an effort to improve

circulation and break down adhesions. Massage in the

direction of the tendon along the flexor retinaculum. This may

help reduce pressure on the median nerve. Avoid direct

pressure on the median nerve.

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COMPARTMENT SYNDROME:

Overview

Compartment syndrome is believed to occur when impact or injury

causes a build up of pressure within a closed anatomic space. This

can occur in different areas throughout the body but is more common

in the leg, particularly in runners. This syndrome can occur either

acutely or chronically.

Common Causes and Risk Factors

1. Increased intracompartemental osmotic pressure due to

muscle swelling may be a possible etiology.

2. Repetitive impact or injury.

3. Long bone fractures.

Signs and Symptoms

1. Pain with ambulation usually relieved by rest (in the leg).

2. Swelling and tenderness.

3. Paresthesias.

4. Sensory deficits.

5. Weakness.

Prevention

1. Avoid repetitive impact or injury.

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations.

2. Rest.

3. Apply ice to the area if acute.

4. Apply heat to the area if chronic.

5. Surgery in the form of fasciotomy may be indicated.

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy.

2. Do not perform massage in the acute phase of injury which may

last anywhere from 48 hours post injury to one week post injury.

Physician should advise when it is safe to begin massage

therapy.

3. Apply effleurage by stroking upwards in the direction of the

heart. Gradually increase pressure.

4. Proceed to petrissage to help loosen the muscle fibers.

Alternate with effleurage.

1. Apply deep friction in a circulation motion to any tight spots to

loosen any knots.

2. Apply trigger point therapy to any trigger point areas.

5. Finish off with petrissage and effleurage.

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FOOT STRESS FRACTURE:

Overview

Foot stress fractures occur from the repetitive stress of the foot

striking the ground. When foot muscles become fatigued, they are

unable to absorb shock and begin to transfer the stress to the bones,

thereby creating a tiny fracture.

Common Causes and Risk Factors

1. Overworn or poorly fitting footwear.

2. Athletes that participate in high-impact sports.

3. Female factors such as osteoporosis, eating disorders, or

abnormal menstrual cycles.

4. A sudden shift from a sedentary lifestyle to intense physical

activity.

5. Changing surfaces on which physical activity is performed.

6. Improper form or exercise technique.

7. Sports at increased risk for developing foot stress fractures

include basketball, ballet, running, gymnastics, and tennis.

Signs and Symptoms

1. Pain in the foot.

2. Localized soreness and swelling over a bone in the foot.

Prevention

1. Allow sufficient rest between training sessions.

2. Slowly increase training intensity.

3. Maintain an adequate amount of calcium in the diet.

4. Wear quality running shoes in good condition.

5. Take a break from training if you experience any foot pain.

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations.

2. Take a break from the activity that caused the stress fracture

for six to eight weeks to allow for healing.

3. When returning to activity, slowly build up training intensity.

4. Crutches may be advised by your physician.

5. Stretch the muscles of the lower leg just before returning to

activity.

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy. Seek the advice of a physician before

performing massage on patients with suspected foot fractures.

2. Apply gentle transverse friction massage in an up and down

motion to the bottom of the foot. If the athlete tightens up with

pain, you are using too much pressure. Lubricant should not be

used as there should be no movement between the therapistís

hands and the underlying skin.

3. Apply deep friction in a circulation motion to any tight spots on

the foot. Avoid applying pressure directly over the stress

fracture.

4. Utilize trigger point therapy to any trigger points found on the

foot.

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GROIN STRAIN:

Overview

A groin strain is a pull injury to the adductor muscles. The adductor

muscles help bring the legs together. A groin strain can range from a

slight stretching to a more serious rupture of the muscles that attach

the pelvis to the femur.

Common Causes and Risk Factors

1. Running.

2. A sharp change in direction of movement.

3. Kicking.

4. Jumping.

5. Sudden changes in movement or direction while engaged in

sports-related activities.

6. Pressure applied to the groin muscles.

7. Lack of physical conditioning.

8. Inadequate warm-up.

9. Sports at increased risk for developing foot groin strain include

football, hockey, running, basketball, tennis, and racquetball.

Signs and Symptoms

1. Localized point tenderness in the groin.

2. Pain with active and resistive motion.

3. Pain with adduction of the hip.

4. A palpable gap in the adductor muscles.

5. Swelling.

Prevention

1. Perform an adequate warm-up routine.

2. Perform regular stretching exercises.

3. Perform strengthening exercises such as machine adductions.

4. Avoid sudden changes in movement or direction while engaged

in sports-related activities.

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations.

2. Follow R.I.C.E. guidelines (Rest, Ice, Compression, Elevation)

immediately and for the first three to four days following the

onset of a groin strain.

3. Rest.

4. The use of crutches may be recommended by a physician.

5. Surgery may be necessary for a complete tear of the adductor

muscles.

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy.

2. Do not perform massage in the acute phase of injury which may

last anywhere from 48 hours post injury to one week post injury.

Physician should advise when it is safe to begin massage

therapy.

3. Following the acute phase, apply effleurage by stroking

upwards in the direction of the heart. Gradually increase

pressure.

4. Proceed to petrissage to help loosen the muscle fibers.

Alternate with effleurage. Continue alternating techniques for

30 minutes.

5. Apply deep friction in a circulation motion to any tight spots to

loosen any knots.

6. Apply trigger point therapy to any trigger point areas.

7. Finish off with petrissage and effleurage.

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HAMSTRING CONTUSION:

Overview

A hamstring contusion is a result of the hamstring muscle being

crushed against the bone which results in tearing of the muscle. The

hamstring muscle group consists of the semitendinosis,

semimembrinosis, and biceps femoris. Hamstring contusion is

common in contact sports such as football and wrestling.

The injury can vary in severity from grade I to III with grade III being

the most severe.

Common Causes and Risk Factors

1. Direct trauma to the hamstring area.

2. Sports at increased risk for developing hamstring contusion

include football and wresting.

Signs and Symptoms

1. Pain in the hamstrings.

2. There may or may not be swelling or bruising.

3. Limited range of movement.

4. Inability to walk properly if severe.

Prevention

1. Avoid direct trauma to the hamstring area.

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations. Seek medical attention

immediately if there is severe pain in the hamstring area.

2. Follow R.I.C.E. guidelines (Rest, Ice, Compression, Elevation)

for the first three to four days following the onset of a hamstring

contusion.

3. Therapeutic ultrasound.

4. Electrical stimulation.

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy.

2. Do not perform massage in the acute phase of injury which may

last anywhere from 48 hours post injury to one week post injury.

Physician should advise when it is safe to begin massage

therapy.

3. Following the acute phase, apply effleurage by stroking

upwards in the direction of the heart. Gradually increase

pressure.

4. Proceed to petrissage to help loosen the muscle fibers.

Alternate with effleurage. Continue alternating techniques for

30 minutes.

5. Apply deep friction in a circulation motion to any tight spots to

loosen any knots.

 

6. Apply trigger point therapy to any trigger point areas.

7. Finish off with petrissage and effleurage.

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HAMSTRING STRAIN:

Overview

A hamstring strain is a result of a tear in one or more of the hamstring

muscles (semitendinosis, semimembrinosis, and biceps femoris).

The injury can range in severity from microtears in the muscles to a

complete rupture of the muscles.

Common Causes and Risk Factors

1. An imbalance between the quadriceps and hamstring muscles.

2. Poor conditioning of the hamstring muscles.

3. Fatigued hamstring muscles.

4. Overload.

5. Accelerating too fast.

Signs and Symptoms

1. Pain in the back of the leg.

2. Muscle spasms.

3. There may or may not be swelling or bruising.

4. The inability to walk properly if severe.

5. May not be able to fully extend the knee.

Prevention

1. Perform hamstring stretching and strengthening exercises.

2. Keep a balance in strength between the hamstring muscles

and quadriceps.

 

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations. Seek medical attention

immediately if there is severe pain in the hamstring area.

2. Follow R.I.C.E. guidelines (Rest, Ice, Compression, Elevation)

for the first three to four days following the onset of a hamstring

strain.

3. Stretching and strengthening exercises.

4. The use of crutches may be recommended by a physician.

5. Therapeutic ultrasound.

6. Electrical stimulation.

7. Surgery may be necessary for a complete rupture of the

muscle.

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy.

2. Do not perform massage in the acute phase of injury which may

last anywhere from 48 hours post injury to one week post injury.

Physician should advise when it is safe to begin massage

therapy.

3. Following the acute phase, apply effleurage by stroking

upwards in the direction of the heart. Gradually increase

pressure.

4. Proceed to petrissage to help loosen the muscle fibers.

Alternate with effleurage. Continue alternating techniques for

30 minutes.

5. Apply deep friction in a circulation motion to any tight spots to

loosen any knots.

6. Apply trigger point therapy to any trigger point areas.

7. Finish off with petrissage and effleurage.

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ILIOTIBIAL BAND SYNDROME (RUNNERíS KNEE):

Overview

Iliotibial band syndrome is a common cause of knee pain in runners.

The iliotibial band, also known as iliotibial tract, is a fibrous band of

tissue on the lateral surface of the thigh. Knee pain and inflammation

are caused by the iliotibial band and lateral femoral epicondyle

rubbing together usually as a result of overtraining.

Common Causes and Risk Factors

1. Overtraining.

2. Sports at increased risk for developing iliotibial band syndrome

include running and sprinting.

3. Fatigued tensor fasciae latae muscle and iliotibial band.

4. Inadequate footwear.

5. An imbalance between the quadriceps and hamstring muscles.

6. Running on uneven or hard surfaces.

Signs and Symptoms

1. Lateral knee pain.

2. Pain worsened when running uphill or on uneven surfaces.

3. A popping sound in the knee while running may be heard.

Prevention

1. Perform an adequate warm-up routine.

2. Perform regular stretching exercises.

3. Run or jog on even surfaces.

4. Wear good quality, well-fitting footwear.

5. Avoid sudden changes in training intensity.

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations.

2. Follow R.I.C.E. guidelines (Rest, Ice, Compression, Elevation)

for the first three to four days following the onset of iliotibial

band syndrome.

3. Stretching and strengthening exercises.

4. Limited corticosteroid injections.

5. Physical therapy.

6. Exercise modification.

7. Anti-inflammatory medication.

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy.

2. Do not perform massage in the acute phase of injury which may

last anywhere from 48 hours post injury to one week post injury.

Physician should advise when it is safe to begin massage

therapy.

3. Following the acute phase, apply effleurage by stroking

upwards in the direction of the heart. Gradually increase

pressure.

4. Proceed to petrissage to help loosen the muscle fibers.

Alternate with effleurage. Continue alternating techniques for

30 minutes.

5. Apply deep friction in a circulation motion to any tight spots to

loosen any knots.

6. Apply trigger point therapy to any trigger point areas.

7. Finish off with petrissage and effleurage.

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LATERAL EPICONDYLITIS (TENNIS ELBOW):

Overview

Lateral epicondylitis is a common overload injury associated with

inflammatory changes around the wrist extensors of the forearm.

Overuse can cause the tendons that attach to the lateral epicondyle

to become inflamed. Lateral epicondylitis can also be a result of agerelated

degeneration of the muscles and tendons around the elbow.

Common Causes and Risk Factors

1. Overuse.

2. Age-related degeneration of the muscles and tendons around

the elbow.

3. Inadequate rest between training sessions or play.

4. Using a racquet or golf club that is too heavy.

5. Incorrect swing technique.

6. Incorrect grip on the racquet or golf club.

7. Overly tight racquet strings.

8. Sports at increased risk for developing lateral epicondylitis

include tennis, squash, and golf.

Signs and Symptoms

1. Pain in the elbow, upper forearm, or wrist worsened by activity.

2. Pain with resisted wrist extension.

3. Wrist weakness.

4. Pain to palpation around the lateral epicondyle.

Prevention

1. Perform an adequate warm-up routine.

2. Perform adequate stretching and strengthening exercises.

3. Perform correct swing technique.

4. Avoid sudden increases in training intensity or play.

5. Choose a racquet or golf club with a comfortable grip and

weight.

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations.

2. Follow R.I.C.E. guidelines (Rest, Ice, Compression, Elevation)

for the first 48 to 72 hours following the onset of lateral

epicondylitis.

3. Apply heat to the area.

4. A brace or support may be applied.

5. Anti-inflammatory medication.

6. Modify swing technique and correct biomechanics.

7. Stretching and strengthening exercises for the elbow.

8. Limited corticosteroid injections may be considered.

9. In rare cases, surgery may be indicated.

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy.

2. Do not perform massage in the acute phase of injury which may

last anywhere from 48 hours post injury to one week post injury.

Physician should advise when it is safe to begin massage

therapy.

3. Following the acute phase, apply gentle transverse friction

massage across the tendon with the wrist in a flexed position to

help prevent adhesion formation and help rupture existing

adhesions. Avoid massaging directly over the tendon

attachment. If the athlete tightens up with pain, you are using

too much pressure. Lubricant should not be used as there

should be no movement between the therapistís hands and the

underlying skin.

4. Apply deep friction in a circulation motion to any tight spots on

the forearm. Avoid applying pressure directly over the tendon

attachment.

5. Utilize trigger point therapy to any trigger points found on the

forearm. Follow with gentle stretching.

6. Apply effleurage by stroking upwards in the direction of the

heart. Gradually increase pressure.

7. Proceed to petrissage to help loosen the muscle fibers.

Alternate with effleurage. Continue alternating techniques for

30 minutes.

8. Ice may be applied post therapy.

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LOWER LEG STRESS FRACTURE:

Overview

The bones of the lower leg include the tibia and fibula. The tibia is

the bone responsible for load bearing. The fibula is the bone

responsible mainly for muscle attachment. It is more common for a

stress fracture to occur on the tibia. Stress fractures are tiny cracks

in the bone usually as a result of overload.

Common Causes and Risk Factors

1. Overload.

2. Muscle fatigue.

3. An abrupt change in running surface.

4. Repetitive impacts with the pavement.

Signs and Symptoms

1. Pain in the lower leg after running long distances.

2. Localized swelling or tenderness on the leg.

Prevention

1. Do not run when the muscles are fatigued.

2. Avoid changes in running surfaces.

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations.

2. Rest.

3. Switch to a different sport of less impact while the fracture

heals.

4. Exercise the muscles of the lower leg while healing.

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy.

2. Apply effleurage by stroking upwards in the direction of the

heart. Gradually increase pressure.

3. Apply gentle transverse friction massage starting at the lower

third of the shin and work upwards towards the heart. Do not

apply pressure over the bone itself. If the athlete tightens up

with pain, you are using too much pressure. Lubricant should

not be used as there should be no movement between the

therapistís hands and the underlying skin.

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MEDIAL COLLATERAL LIGAMENT INJURY:

Overview

Medial collateral ligament injuries usually occur as a result of trauma

to the medial collateral ligament of the knee during contact sports.

The ligament can be stretched, partially torn, or completely torn.

Depending on the amount of ligament damage, they are graded I, II,

or III with III being the most severe. The medial collateral ligament is

the most commonly injured knee ligament.

Common Causes and Risk Factors

1. Trauma to the knee during sports.

2. Overuse.

3. Rapid deceleration.

Signs and Symptoms

1. Localized knee tenderness and possible swelling.

2. Possible ecchymosis (black and blue)

3. Pain on stressing the knee.

4. Possible instability.

Prevention

1. Avoid sudden changes in movement or direction while

engaged in sports-related activities.

2. Avoid trauma to the knee area.

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations.

2. Follow R.I.C.E. guidelines (Rest, Ice, Compression, Elevation)

for the first three to four days following the onset of medial

collateral ligament injury.

3. Use crutches to remain non-weightbearing until the pain

subsides.

4. A knee support may be advised.

5. Stretching and strengthening exercises.

6. Anti-inflammatory medication.

7. In rare cases, surgery may be advised.

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy.

2. Do not perform massage in the acute phase of injury which may

last around five days to one week post injury. Physician should

advise when it is safe to begin massage therapy.

3. Following the acute phase or surgery, transverse friction

technique may be applied to the ligament in the stretched

position for 5 to 10 minutes. If the athlete tightens up with pain,

you are using too much pressure. Lubricant should not be used

as there should be no movement between the therapistís hands

and the underlying skin.

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MEDIAL EPICONDYLITIS (GOLFERíS ELBOW):

Overview

Golferís elbow is one of the three most common conditions affecting

the elbows of athletes. Overuse can create microtears in the tendons

and muscles of the elbow causing pain, decreased range of motion,

and inflammation. These microtears can lead to scar tissue formation

and calcium deposits.

Common Causes and Risk Factors

1. Repetitive stress to the muscles of the forearm.

2. Injury to the elbow.

3. Inadequate rest between training sessions.

4. Poor form when swinging a golf club.

5. Poor conditioning.

6. Sports at increased risk for developing foot golferís elbow

include golf, tennis, racquetball, squash, weightlifting, and

baseball.

Signs and Symptoms

1. Decreased range of motion in the elbow.

2. Pain in the inside of the forearm.

3. Wrist weakness.

4. Tingling and numbness in the forearm.

Prevention

1. Perform stretches to warm-up the muscles of the forearms prior

to activity.

2. Perform strengthening exercises to maintain condition of the

forearms.

3. Switch to lighter weight golf clubs or racquet.

4. Gradually increase physical activity.

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations.

2. Follow R.I.C.E. guidelines (Rest, Ice, Compression, Elevation)

for the first three to four days following the onset of golferís

elbow.

3. Apply heat following the acute phase.

4. Anti-inflammatory medication.

5. Physical therapy or rehabilitation may be prescribed.

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy.

2. Avoid massage in the acute phase of injury.

3. Apply transverse friction to the tendon in a stretched position to

help reduce pain and promote tissue repair. Transverse friction

is believed to prevent adhesion formation and help rupture

existing adhesions. The technique involves applying oscillating

pressure using the thumbs, fingertips, or knuckles directly over

the affected area transverse to the direction of the connective

tissue fibers. Lubricant should not be used as there should be

no movement between the therapistís hands and the underlying

skin. Many practitioners recommend transverse friction to

reduce pain and increase strength and mobility. Start gently

and gradually increase pressure. If the athlete tightens up with

pain, you are using too much pressure.

4. Apply effleurage by stroking upwards in the direction of the

shoulder. Gradually increase pressure.

5. Circular friction may be utilized to smooth out any knots.

55

6. Utilize trigger point therapy to any trigger points.

7. Use effleurage as a bridge between massage techniques.

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PATELLAR TENDINOPATHY (JUMPERíS KNEE):

Overview

The patellar tendon connects the patellar to the tibia. When this

tendon is stressed, it can result in inflammation or rupture.

Depending on the amount of tendon damage, patellar tendinopathy is

graded I, II, III or IV with IV being the most severe.

Common Causes and Risk Factors

1. Repetitive overloading.

2. Altered biomechanics of the patellofemoral joint may increase

the risk of patellar tendinopathy.

3. Weak gluteal muscles, abdominal muscles, quadriceps, and

calf muscles.

4. Tight iliotibial band.

5. Sports at increased risk for developing patellar tendinitis

include, running, jumping, weightlifting, volleyball, football,

rugby and basketball.

Signs and Symptoms

1. Anterior knee pain worsened with jumping.

2. Tenderness to palpation over the lower patellar region.

3. Pain when contracting the quadriceps muscles.

Prevention

1. Perform hamstring stretching and strengthening exercises.

2. Keep a balance in strength between the hamstring muscles and

quadriceps.

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations.

2. Apply ice to the area.

3. Activity modification.

4. Correction of biomechanical abnormalities.

5. Strength training.

6. Anti-inflammatory medication.

7. In rare cases, surgery may be advised.

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy.

2. Following the acute phase or surgery, transverse friction

technique may be applied across the patellar tendon for 5 to 10

minutes. If the athlete tightens up with pain, you are using too

much pressure. Lubricant should not be used as there should

be no movement between the therapistís hands and the

underlying skin.

3. Apply effleurage to the quadriceps by stroking upwards in the

direction of the heart. Gradually increase pressure.

4. Proceed to petrissage to help loosen the muscle fibers in the

quadriceps. Alternate with effleurage.

5. Apply deep friction in a circulation motion to any tight spots in

the quadriceps to loosen any knots.

6. If the quadriceps are tight, apply digital ischemic pressure by

sustaining pressure over a trigger point until you feel the trigger

point subsiding or when the trigger point is no longer tender to

compression. This process can be performed for up to 60

seconds. Follow with lengthening of the muscle by gentle

stretching.

7. Finish off with petrissage, effleurage, and apply ice.

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PERONEAL TENDON DISLOCATION:

Overview

The peroneal tendons originate on the outside of the calves. While

standing, these muscles allow the foot to roll outwards. These

tendons can be stretched, torn, or dislocated.

Common Causes and Risk Factors

1. Ankle sprains can increase risk of peroneal dislocation.

2. Ankle instability.

3. Sports at increased risk for developing peroneal dislocation

include snow-skiing, gymnastics, soccer, football, rugby and

basketball.

Signs and Symptoms

1. Pain or localized tenderness behind the lateral malleolus.

2. Possible swelling or ecchymosis.

Prevention

1. Strengthen the muscles around the ankles.

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations.

2. Follow R.I.C.E. guidelines (Rest, Ice, Compression, Elevation)

for the first three to four days following the onset of peroneal

dislocation.

3. Crutches may be advised to remain non-weightbearing.

4. A compression bandage or cast may be applied.

5. Anti-inflammatory medication.

6. In rare cases, surgery may be advised.

 

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy.

2. Following the acute phase, apply effleurage by stroking

upwards in the direction of the heart. Gradually increase

pressure.

3. Proceed to petrissage to help loosen the muscle fibers.

Alternate with effleurage. Continue alternating techniques for

30 minutes.

4. Apply deep friction in a circulation motion to any tight spots to

loosen any knots.

5. Apply trigger point therapy to any trigger point areas.

6. Finish off with petrissage and effleurage.

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PIRIFORMIS SYNDROME:

Overview

The piriformis muscles are located deep in the buttocks and assist in

rotating the legs outward. The sciatic nerves are located within the

region of the piriformis muscles. Piriformis syndrome is a result of the

piriformis muscles becoming inflamed and irritating the sciatic nerve.

This can cause pain in the buttocks and down the leg of the affected

side.

Common Causes and Risk Factors

1. Tight adductor muscles.

2. Tight piriformis muscles.

3. Overuse.

4. Weak abductors.

5. Running uphill or downhill.

6. Running on uneven surfaces.

 

7. Prolonged sitting.

8. Stairclimbing.

9. Long-distance biking.

Signs and Symptoms

1. Pain and tenderness in the buttock region.

2. Tingling or numbness in the buttock region.

3. Pain down the back of the leg.

Prevention

1. Avoid running uphill or downhill.

2. Avoid running on uneven surfaces.

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations.

2. Apply heat.

3. Hip range of motion exercises.

4. Stretching and strengthening of the piriformis muscle.

5. Anti-inflammatory medication.

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy.

2. Following the acute phase, apply effleurage by stroking

upwards in the direction of the heart. Gradually increase

pressure.

3. Proceed to petrissage to help loosen the muscle fibers.

Alternate with effleurage. Continue alternating techniques for

30 minutes.

4. Apply deep friction in a circulation motion to any tight spots to

loosen any knots.

5. Apply trigger point therapy to any trigger point areas.

6. Finish off with petrissage and effleurage.

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PLANTAR FASCIITIS:

Overview

The plantar fascia is a band of fibrous connective tissue that runs

along the bottom of the foot from the calcaneus to the base of the

toes. It provides support for the bottom of the foot while walking and

running. Excessive pressure, trauma, or overstretching of the plantar

fascia may cause inflammation of the fascia leading to the condition

called plantar fasciitis. Sometimes, the fascia can become detached

at the heel and cause a heel spur to develop.

Common Causes and Risk Factors

1. Running on hard surfaces.

2. Running uphill.

3. Obesity.

4. Pregnancy.

5. Inadequate footwear.

6. Sports at increased risk for developing plantar fasciitis include

running, aerobics, basketball, tennis, volleyball, gymnastics,

and ballet.

Signs and Symptoms

1. Pain localized to the undersurface of the foot around the heel.

2. Pain more severe upon arising in the morning.

Prevention

1. Avoid wearing old, worn-out shoes.

2. Maintain a healthy body weight.

3. Avoid any sudden increases in training intensity.

 

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations.

2. Stretching and strengthening exercises for the leg and foot.

3. Rest or reduce activity level.

4. Apply ice to the area.

5. Taping of the foot may be helpful.

6. Anti-inflammatory medication.

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy.

2. Following the acute phase, transverse friction technique may be

applied upwards from the heel to the arch of the foot. Apply

pressure using the thumbs in a downward motion and repeat

the process for approximately 20 minutes. If the athlete

tightens up with pain, you are using too much pressure.

3. Apply deep friction in a circulation motion to any tight spots in

the arch of the foot.

4. Apply trigger point therapy to any trigger point areas.

5. Avoid applying pressure at the point where the calcaneus

meets the fascia as this may cause the area to become

inflamed.

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PERONEUS BREVIS TENDINITIS:

Overview

The peroneus brevis is a muscle that assists in plantar flexion and

eversion of the foot. The muscle and its tendon originate at the

lateral surface of the fibula and attach to the base of the fifth

metatarsal. Peroneus brevis tendinitis occurs when the tendon of the

peroneus brevis muscle becomes inflamed or ruptured.

 

Common Causes and Risk Factors

1. Running on hard surfaces.

2. Overuse.

3. Poor biomechanics.

Signs and Symptoms

1. Pain in the lateral aspect of the foot towards the heel.

Prevention

1. Wear supportive footwear.

2. Proper warm-up and stretching exercises.

3. Avoid running on hard surfaces.

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations.

2. Follow R.I.C.E. guidelines (Rest, Ice, Compression, Elevation)

for the first three to four days following the onset of peroneus

brevis tendinitis.

3. Anti-inflammatory medication.

4. A splint may be applied.

5. Correct biomechanical abnormalities.

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy.

2. Following the acute phase, transverse friction technique may be

applied for 10 minutes with the tendon in the stretched position.

This may assist in preventing scar tissue formation. Apply

pressure using the thumbs in a back and forth motion across

the peroneus brevis tendon, not lengthwise down the tendon.

Lubricant should not be used as there should be no movement

between the therapistís hands and the underlying skin. If the

athlete tightens up with pain, you are using too much pressure.

 

3. Apply effleurage for 10 minutes by stroking upwards in the

direction of the heart. Gradually increase pressure.

4. Proceed to petrissage to help loosen the muscle fibers.

Alternate with effleurage. Continue alternating techniques for

30 minutes.

5. Apply deep friction in a circulation motion to any tight spots to

loosen any knots.

6. Apply trigger point therapy to any trigger point areas.

7. Finish off with petrissage and effleurage.

8. Apply ice to the area.

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QUADRICEPS STRAIN

Overview

The quadriceps are a large group of muscles in the front of the thigh

that assist in straightening out the knee. A strain is a partial tear in

the muscle fibers of the quadriceps group. There are four muscles

that comprise the quadriceps group.

1. Rectus femoris.

2. Vastus lateralis.

3. Vastus intermedius.

4. Vastus medialis.

Athletes involved in violent physical activity and rapid acceleration are

most at risk for quadriceps strains. The most common muscle

affected of this group is the rectus femoris. Quadriceps strains are

graded I, II, or III with III being the most severe. In grade I

quadriceps strains, the muscle fibers are only slightly stretched or

exhibit microtears. In grade II quadriceps strains, the muscle fibers

are partially torn. In grade III quadriceps strains, muscle fibers are

torn completely which can result in severe pain and bruising.

 

Common Causes and Risk Factors

1. Lifting heavy loads.

2. Rapid acceleration.

3. Blunt trauma to the quadriceps.

4. Overuse.

5. Kicking.

6. Muscle fatigue.

7. Training in cold weather.

8. Leg presses during training at the gym.

9. An imbalance between the quadriceps and hamstring muscles.

10. Sports at increased risk for developing quadriceps strain

include weightlifting, wrestling, soccer, tennis, football, rubgy,

squash, and sprinting.

Signs and Symptoms

1. Mild pain and tenderness. (grade I).

2. Moderate pain and tenderness. (grade II)

3. Severe pain. (grade III).

4. Pain aggravated running downhill.

5. Pain at the front of the thigh.

6. Difficulty walking.

7. Mild swelling. (grade II).

8. Weakness of the quadriceps. (grade II).

9. Ecchymosis (grade II or III).

10. A palpable gap in the muscle (grade III).

11. Complete loss of muscle function. (grade III).

12. Moderate to severe swelling. (grade III).

13. An audible ďpopĒ may be heard at the onset of injury. (grade

III).

Prevention

1. Perform proper warm-up and stretching exercises.

2. Perform strengthening exercises.

3. Practice proper biomechanics.

4. Increase training intensity gradually.

 

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations.

2. Follow R.I.C.E. guidelines (Rest, Ice, Compression, Elevation)

for the first three to four days following the onset of quadriceps

strain.

3. Stretching and strengthening exercises.

4. Anti-inflammatory medication.

5. A compressive bandage may be worn to control swelling.

6. Severe tears may require surgical intervention.

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy.

2. Do not perform massage in the acute phase of injury which may

last around two days to one week post injury. Physician should

advise when it is safe to begin massage therapy.

3. Following the acute phase, apply effleurage to the front of the

thigh by stroking upwards from just above the knee in the

direction of the heart. Gradually increase pressure.

4. Proceed to petrissage to help loosen the muscle fibers.

Alternate with effleurage. Continue alternating techniques for

30 minutes.

5. Apply deep friction in a circulation motion to any tight spots to

loosen any knots.

6. Apply trigger point therapy to any trigger point areas.

7. Finish off with petrissage and effleurage.

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ROTATOR CUFF INJURY:

Overview

The rotator cuff is a group of tendons and their related muscles that

assist with raising and rotating the arms. The rotator cuff muscles

originate at the scapula and are attached to a group of tendons that

fuse together at the shoulder joint. The muscles of the rotator cuff

include:

1. Supraspinatus.

2. Infraspinatus.

3. Teres Minor.

4. Subscapularis.

A rotator cuff injury occurs when there is a tear or strain in the

muscles or tendons of the rotator cuff. There are varying degrees of

rotator cuff injury ranging from minor inflammation of the tendons to

severe tears.

Common Causes and Risk Factors

1. Natural degeneration of the shoulder muscles due to aging.

2. Attempting to lift a load that is too heavy.

3. Repetitive overhead movement of the arm.

4. A history of previous shoulder injury may increase the risk of

rotator cuff injury.

5. Poor posture.

6. Falling on the shoulder or breaking a fall with the arm.

7. A history of corticosteroid injections into the shoulder may

increase the risk of rotator cuff injury.

8. Sports at increased risk for developing rotator cuff injury

include baseball (pitching), swimming, weightlifting, and tennis.

 

Signs and Symptoms

1. Weakness of the shoulder.

2. Pain when attempting to raise the arm above the level of the

head.

3. Difficulty moving the arm against resistance.

4. Stiffness of the shoulder joint.

5. Pain worse at night.

Prevention

1. Perform proper warm-up and stretching exercises.

2. Perform strengthening exercises.

3. Do not attempt to lift objects that may be too heavy.

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations.

2. Follow R.I.C.E. guidelines (Rest, Ice, Compression, Elevation)

for the first 48 to 72 hours following the onset of rotator cuff

injury.

3. Following the acute phase, heat can be applied to help increase

blood flow to the area.

4. Stretching and strengthening exercises.

5. Anti-inflammatory medication.

6. Limited corticosteroid injections.

7. In rare cases, surgery may be advised to correct a rotator cuff

tear.

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy.

2. After about 48 hours post injury, apply direct ischemic pressure

to the tendon at itís attachment to the shoulder using a finger or

thumb with enough force to evoke hyperemia (a temporary

ischemic reaction) and discomfort. This method can also be

used to induce relaxation and deactivate trigger points.

Sustained pressure can be applied to any trigger points until the

trigger point is no longer tender to compression. This process

can be performed for up to 60 seconds. Follow with

lengthening of the muscle by gentle stretching and ice.

 

3. When pain from the injury begins to subside, transverse friction

friction technique may be applied to the tendon in the stretched

position for 5 to 10 minutes. If the athlete tightens up with pain,

you are using too much pressure. Lubricant should not be used

as there should be no movement between the therapistís hands

and the underlying skin.

4. Apply light effleurage starting from the mid back, up to the neck

and then down the shoulders.

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SHIN SPLINTS

Overview

Shin splints is a term used to describe tiny tears in the leg muscles at

their point of attachment to the tibia. They can occur both anteriorly

and posteriorly.

Common Causes and Risk Factors

1. Overuse.

2. Poor running technique.

3. Excessive jumping.

4. Running on hard surfaces.

5. Overly tight muscles in the lower leg.

6. A condition known as ďflatfeetĒ may predispose one to shin

splints.

7. Over-pronation.

Signs and Symptoms

1. Pain in the front part of the leg during running or even walking.

2. Pain in the front part of the leg with extension of the foot.

 

3. Tenderness to palpation over the front part of the leg.

 

Prevention

1. Wear good quality, well-fitting footwear.

2. Perform an adequate warm-up routine.

3. Perform an adequate stretching routine.

4. Perform strengthening exercises for the lower leg muscles.

5. Avoid a sudden increase in activity or training levels.

6. Avoid running uphill or on hard surfaces.

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations.

2. Follow R.I.C.E. guidelines (Rest, Ice, Compression, Elevation)

for the first 48 to 72 hours following the onset of shin splints.

3. Following the acute phase, apply heat.

4. Stretching exercises.

5. Anti-inflammatory medication.

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy.

2. Apply effleurage to the anterior lower leg starting at the top of

the ankle moving upwards to the knee. Gradually increase

pressure.

3. Apply transverse friction massage to both sides of the lower leg

working upwards. Do not apply pressure directly over the tibia

bone itself. If the athlete tightens up with pain, you are using

too much pressure. Lubricant should not be used as there

should be no movement between the therapistís hands and the

underlying skin.

4. Finish off with light effleurage to the lower leg area.

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TRICEPS TENDINITIS:

Overview

The triceps tendinitis occurs when the triceps muscles are strained

leading to inflammation. This can be due to either blunt trauma or

overuse of the triceps insertion on the olecranon.

Common Causes and Risk Factors

1. Overuse.

2. Pushing something too heavy.

3. Performing triceps extensions at the gym with too much weight.

4. Falling down and using the hands to break the fall.

5. Sports at increased risk for developing triceps tendinitis include

football, rugby, weightlifting, and gymnastics.

Signs and Symptoms

1. Pain at the tip of the elbow with resisted extension.

Prevention

1. Avoid performing triceps extensions at the gym with too much

weight.

2. Avoid pushing heavy weight.

Possible Physician Recommendations

1. Seek professional medical attention by a physician for

diagnosis and recommendations.

 

2. Rest.

3. Apply ice for the first 24 to 48 hours.

4. Anti-inflammatory medication.

5. Stretching and strengthening exercises.

Sports Massage Techniques

1. Check for contraindications to massage before proceeding with

massage therapy.

2. Do not perform massage in the acute phase of injury which may

last around two days to one week post injury. Physician should

advise when it is safe to begin massage therapy.

3. Apply transverse friction to the tendon with the elbow bent to

help reduce pain and promote tissue repair. Transverse friction

is believed to prevent adhesion formation and help rupture

existing adhesions. The technique involves applying oscillating

pressure using the thumbs, fingertips, or knuckles directly over

the affected area transverse to the direction of the connective

tissue fibers. Lubricant should not be used as there should be

no movement between the therapistís hands and the underlying

skin. Many practitioners recommend transverse friction to

reduce pain and increase strength and mobility. Start gently

and gradually increase pressure. Avoid massaging directly

over the tendon attachment itself. If the athlete tightens up with

pain, you are using too much pressure.

4. Apply effleurage by stroking upwards in the direction of the

shoulder. Gradually increase pressure.

5. Circular friction may be utilized to smooth out any knots.

6. Utilize trigger point therapy to any trigger points.

7. Use effleurage as a bridge between massage techniques.