For
some reason, massage therapists that specialize in treatments of sport
related injuries are calling this method sport massage. In my opinion, if
someone sprains/strains the lower back, upper back, shoulder, knee, etc.,
by playing sport or working at home, or at the workplace, the pathology
that will be developed due to kind of injury disturbing orthopedic status.
Utilization
of massage in cases of back and limb disorders we call orthopedic massage.
There is no doubt that there is huge room for orthopedic massage available
in sport rehabilitative medicine. It is proven that orthopedic massage
therapy is a very effective tool in treating sport-related, industrial
injuries, as well as helping people experience less pain in cases of
degenerative diseases of the support and movement systems such as
osteoarthritis, degenerative disc disease and other types of spondylosis.
Indeed, sport massage that is utilized only in industry of sport is a
pre-event sport massage and post-event rehabilitative sport massage. These
two types of massage therapy are very important efforts in order to
improve the athletes performances, to prevent to a maximum extent, sport
related injuries, as well as to eliminate side effects of exercise
stress/overtraining.
20 years ago, training in sport massage was limited
to massage therapists who worked with professional teams, Olympian teams,
etc. Nowadays, sport massage has value not only for professional athletes,
but also for the modern fitness enthusiast. If you will pay attention to
the behavior of today's gym members, you will see people who are working
out as if they are preparing themselves for competition. It is obvious
that most of them are pushing themselves to the limit. In most cases,
people don't or forget to ask themselves, (Why am I in the gym? If you
will ask them this question, no doubt their answer will be (to keep
(themselves) in shape and to contribute to (their) health. But the manner
of working out like a professional athlete in the long run causes more
harm than good. What a lot of people do not realize is that professional
sport-like training is not contributing to health. Professional sports
actually is a tough rough show business and nothing else. I personally
don't believe that we are capable of changing the minds of gym enthusiasts
that vigorous exercise (which most gym enthusiasts are engaging in) is not
a good idea. But there is no doubt that post-event rehabilitative sport
massage can be of tremendous help to the health of these gym enthusiasts.
The post-event rehabilitative sport massage that I offering to you today
was initially developed and proposed by professor Alexander Dembo, MD,
PhD, former Leningrad, now Peterburg School of Medicine in 1964.
It is important for us to understand the side effects of vigorous
intense exercise. They are:
1. Accumulation of higher resting
tonus in the muscular structures all over the body leads to disturbances
of microcirculation that causes soreness and/or pain in muscles, and
disturbances of biomechanics. Biomechanical imbalances lead to
compensatory movement which starts a chain reaction of negative factors,
building like a snowball and leading to higher susceptibility to
sport-related injury, development of myofascial pain syndromes, and more.
2. Vigorous exercise always causes microtrauma that naturally
leads to small scar formations which means adhesions of the soft tissues,
etc. If these mini-scars will not be managed right, soft tissue loses
elasticity accumulating deposits of calcium, functionally shortness of
muscles happen, etc. As you can imagine, any attempt at fast movement in
the presence of the above mentioned condition can cause significant tears
in muscles, tendons, ligaments, herniation of discs, subluxations of the
facet joints, etc.
3. At nighttime, over-tensed muscles,
especially those of the lower and upper extremities cause a significant
increase of peripheral vascular resistance. Peripheral vascular resistance
is the main opposition to left atria cardiac work. The harder the cardiac
work will be the more stress hormone production will be stimulated.
Studies show (A. Dembo, 1962) that increase of peripheral vascular
resistance occurs mostly between the hours of 1am-3am. As you understand,
if this phenomenon will not be eliminated, it is hard to believe that
people will rest at night as they are supposed to. Insufficient quality of
rest causes development of chronic fatigue syndrome and can even initiate
depression. Constant higher resting tonus of the muscular structures
responsible for joint & spine stabilization and movement causes
exhaustion of the joint cartilage, (fissuring of the cartilage, erosion),
and can lead to significant arthritis development at an
uncharacteristically young age of athlete. With time, an overworked heart
can even exhaust the muscles and connective tissues of the cardiac
structure.
The evidence of overtraining is that in the
morning when the gym enthusiast is waking up he/she feels a kind of
tension and aches all over the body and feels tired. It takes a while for
this person to walk themselves out of this kind of condition, and they
often need a warm shower, coffee or other energy boost drinks, etc. The
next session of vigorous exercise for them is like medicine. They begin to
warm up, stimulating circulation, (loosening up¦ their tight muscles, and
they start to feel better as the exercise stimulates endorphins
production. They become psychologically and physiologically dependent upon
maintaining this hard regimen in order to feel good. It is very important
to incorporate stretching techniques in full-body post-event sport
rehabilitative massage. Full-body stretching techniques play a very
important role in maintenance of the results that we achieve by providing
massage therapy. The importance of the role of fascia in our function is
hard to overestimate. Stretching significantly helps to maintain normal
tension in fascia and muscles, ultimately translating to stabilized
metabolism, which is condition for good health.
Goals
1. Reduce the tension in muscles and connective tissue.
2.
Accelerate the drainage of venous blood as well as lymphatic fluid.
3.
Reduce peripheral vascular resistance.
4. Balance the activities of
the sympathetic and parasympathetic nervous system.
Protocol
1. The duration of the treatment has to be between 40 minutes -
one hour. During this time massage must be performed on the athlete’s
whole body with special attention to the muscular groups which were
overloaded during exercise or competition
2. Post-Event Sport Massage
must be started no earlier than 2 hours after the event.
3. It is best
to use a combination of effleurage, freccion, compression, and long range
shaking, however, at least 40-50% of the time must be spent on kneading.
4. Pressure- The pressure must be significant, but must be applied
gradually, in a way that will not activate the pain analyzing system. The
client’s threshold of pain may vary from one part of the body to another,
or even within the borders of the same massaged segment. Therefore, the
pressure must be continually adjusted.
Lesson #1 (the
Back)
Treatment sessions will vary from one client to another,
therefore, the therapist must be able to adapt and improvise on how much
time to spend performing each technique, staying within protocol (kneading
techniques = 50% of massage time). Use lubrication unless otherwise
indicated.
1. With flat palm of one hand, using large circles in
the speed of 70-80 movements per minute, gradually increasing pressure,
perform massage on all areas of back.
2. Continue this movement for
the lateral/posterior neck muscles, making sure to support the neck with a
flat hand on the opposite side.
3. With the ulnar side of the hand,
using slightly smaller circles, gradually increasing pressure, perform
massage all over the back.
4. Continue in a hand after hand manner
with the ulnar sides of both hands, using smaller circles, gradually
increasing pressure through several kneadings on each location. In each
location, when the muscles allow you to go as deep as possible (sometimes
almost to the periosteum of the skeleton) pause the kneading, fix the
tissue, and then perform a fast slicing cross-fiber action.
· Use
ulnar sides of both hands together to perform large, heavy circles all
over the back.
· Stand in front of the client’s head. With both hands
use the backs of the fingers to knead the lateral sides of the neck at the
same time.
· Perform petrossage #5 (elbow kneading) on all areas of
the back.
· Use power thumb strips technique for the quadratus
lumborum muscles and lumbodorsal fascia. These strips may be continued
into the gluteal areas.
· Starting from the lower back area, create a
fold of skin between thumbs and fingers and perform rolling-fold skin
mobilization techniques (parallel to the spine) on the entire area of the
back. Perform rolling skin fold technique from the lateral side of the
back - push with the palms and heels of the hands to create the fold of
skin moving at an oblique angle towards the spine,
· With the back of
the fingers, under freccion action, massage all areas of back.
· With
the back of the fingers, by combination of stretching and knuckle
compressions, massage all areas of the back.
Techniques to
influence the spinal erectors (in especial: the spinal rotators)
·
Using one hand, place the back of the fingers in the midline of the
client’s back such that the spinous processes sit in the groove between
the index and middle knuckles (metacarpophalangeal joints) and fingers
(phalanges).
· Stretch the skin and connective tissue up towards the
client’s head.
· With the free hand, separate the index and middle
fingers of the working hand, so that they sit on either side of the
spinous processes.
· Without letting the stretched tissue jump back,
keep the middle and distal phalanges secured to the client’s back while
raising the proximal portion of the phalanges off the back. The final
position of this is that the hand and arm are sort of “standing up” on the
knuckles (interphalangeal joints)
· Keeping the wrist straight, apply
gradual pressure, thereby influencing the small, very deep spinal rotator
muscles. (Therapist may use the other hand for additional
support/pressure/control)
Lesson #2 (the
Hamstrings)
·
With flat palm of one hand, using large circles in the speed of 70-80
movements per minute, gradually increasing pressure, perform massage on
all posterior areas of thigh.
· With the ulnar side of the hand, using
slightly smaller circles, gradually increasing pressure, perform massage
all over the posterior areas of the thigh.
· Continue in a hand after
hand manner with the ulnar sides of both hands, using smaller circles,
gradually increasing pressure through several kneadings on each location.
In each location, when the muscles allow you to go as deep as possible
(sometimes almost to the periosteum of the skeleton) pause the kneading,
fix the tissue, and then perform a fast slicing cross-fiber action.
·
Using the elbow and posterior portion of the forearm (and try to use as
proximal a portion of the ulna as possible), apply squeezing techniques
directly on top the hamstrings, moving from bottom up.
· With the arm
half flexed, place the elbow (about 2 inches of the proximal part of the
ulna) in the center of the hamstrings (between the biceps femoris and
semitendinous muscles) above the back of the knee. Gradually apply
pressure and use this elbow technique to separate the muscles by slowly
moving up the leg.
· Perform petrossage #5 (elbow kneading) on all
areas of the hamstrings.
· With the back of the fingers, under
freccion action, squeeze hamstrings from bottom up.
· With the back of
the fingers, perform combination of stretching and knuckle compressions on
hamstrings.
Lesson #3 (the
calf)
· Place the palms on both
sides of the heel and use a circular freccion to massage the heel.
·
With flat palm of one hand, using large circles in the speed of 70-80
movements per minute, gradually increasing pressure, perform massage on
all areas of the calf muscles.
· With the ulnar side of the hand,
using slightly smaller circles, gradually increasing pressure, perform
massage all over the calf muscles.
· Continue in a hand after hand
manner with the ulnar sides of both hands, using smaller circles,
gradually increasing pressure through several kneadings on each location.
In each location, when the muscles allow you to go as deep as possible
(sometimes almost to the periosteum of the skeleton) pause the kneading,
fix the tissue, and then perform a fast slicing cross-fiber action.
·
Using both hands at the same time, with the back of the fingers, under
freccion action, squeeze the calf muscles evenly (over both heads of the
muscle) from above the heel up. (Stop the move and disconnect before
reaching the back of the knee)
· With the back of the fingers, perform
combination of stretching and knuckle compressions on the calf muscles.
· Stand at 2nd position in front of the calf. With both hands grab and
lift the calf muscles between thumbs and fingers. Make sure the tissue is
secure in your hands and squeeze the calf muscles by applying even
pressure from thumbs and fingers. Option: In a situation where the
client’s calf is very large, the backs of the fingers can be used to apply
this technique. Use the backs of the fingers to lift the calf initially,
and then evenly press together to apply pressure from both sides of the
calf.
Lesson #4 (the
front Thigh)
· With flat palm of one
hand, using large circles in the speed of 70-80 movements per minute,
gradually increasing pressure, perform massage on all areas of the thigh.
· With the ulnar side of the hand, using slightly smaller circles,
gradually increasing pressure, perform massage all over the thigh.
·
Now use this movement in a hand after hand manner with the ulnar part of
both hands, using smaller circles, gradually increasing pressure through
several kneadings on each location. As the muscles allow you to go as deep
as possible (sometimes almost to the periosteum of the skeleton) use the
ulnar part of the hands to perform a slicing cross-fiber action to finish
the kneading in each location.
· Using the elbow and posterior portion
of the forearm (and try to use as proximal a portion of the ulna as
possible), apply squeezing techniques directly on top the thigh, moving
from bottom up.
· Perform petrossage #5 (elbow kneading) on the thigh
muscles.
· With the back of the fingers, under freccion action,
squeeze the thigh from bottom up.
· With the back of the fingers,
perform combination of stretching and knuckle compressions on the thigh.
The massage techniques for the rest of the body are mostly the
same as our stress-management massage techniques, but the therapist should
try to avoid initial pinpoint pressure (like thumb strips). When massaging
the foot, utilize inter-osseous muscles mobilization techniques as well as
the regular stress-management sequence. Power thumb strips may be utilized
for the tibialis anterior muscle on the shin, & please perform
stretching & compression on the lateral sides of the lower leg.
Abdominal massage is the same as the stress management sequence. The chest
massage also stays the same, but it is helpful to incorporate some
petrossage techniques. (However, the stretching techniques will influence
the pectorals much more than massage). Leave out thumb strips on the arms
but make sure to include stretching/compression at the end of the sequence
for lower and upper arms. (Simultaneous compression should be done for the
biceps & triceps). Elbow techniques such as petrossage #5 are also
recommended for the glutes, and it is also possible to incorporate
techniques from the orthopedic massage for the lower back.
Like
stress-management massage, full-body post-event sport massage begins with
the toes of the left foot. But like many of the When working in a regular
schedule of sessions, it is best to begin with the client on his/her
stomach for the first few treatments (starting with the back). After these
first few sessions, the therapist may start the massage with the toes,
with the client supine (like stress management massage).
Full-Body
Stretching
Neck Stretches (seated chair position)
Head
Rotation
1. Stand behind the client, and make sure the client’s
spine is fully upright.
2. With your right arm extended and draped in
front of the client’s right shoulder, place the extended arm elbow against
his/her shoulder (where the deltoid meets the pectorals).
3. Assess
ROM by gently rotating client’s head to the left (hand on top of head).
4. Wrap your left arm around client’s head so that it is secured
between your chest and arm.
5. Apply stretch by rotating client’s head
to the left while securing the shoulder with your right arm. It is
beneficial to stretch the client with the exhale.
6. Repeat for other
side.
Lateral Neck
Stretch
1. Assess ROM by bending neck
laterally to the left.
2. Place right extended elbow on top of
client’s shoulder (slightly anterior, where the upper deltoid meets the
trap).
3. With your left arm, hook your 3rd & 4th fingers under
the client’s right-side mastoid process and rest your forearm on top of
client’s head.
4. Apply stretch by pulling your flexed elbow (on top
of head) down to the floor in a lateral motion while securing the
shoulder.
5. Repeat for other side.
Upper Trapezius
Stretch
1. Assess ROM.
2. With your right arm extended and draped in
front of the client’s right shoulder, place the extended elbow against
his/her shoulder (where the deltoid meets the pectorals).
3. Place
your left hand on top/ behind the client’s head.
4. Apply stretch by
extending client’s head simultaneously forward and to the left while the
elbow slightly pulls the shoulder back.
5. Repeat for other side.
Back
Stretches
Seated Position Twist
1. Seat
client on the front half of the chair, feet shoulder-width apart, with
his/her hands locked behind the occipital, elbows out to the sides.
2.
On the client’s right side, stand perpendicular to the client, and secure
the right leg with your own right leg.
3. Place your right flexed
elbow against the client’s right scapula, and cup your left hand under the
lateral edge of the client’s left scapula. You may secure your arms in
this position by hooking your right hand over your left forearm, close to
the elbow. This position allows you to fix the client’s body for maximal
control during the stretch technique.
4. Ask the client to straighten
his/her spine, then relax all back muscles. Make sure to hold the client’s
back in this upright position.
5. Apply stretch by turning the
client’s upper body to the left as he/she exhales. Maintain the straight,
upright spine throughout the duration of this stretch.
6. Repeat for
other side.
Upper Back/ Torso
Stretch
1. Stand behind
client. Place a pillow against the back of the chair, and have the client
sit all the way back in the chair, hands clasped behind occipital, elbows
out to the sides.
2. Fold elbows forward and together, then apply
stretch to the upper trapezius by pushing the elbows down to the floor.
(Do not flex the lumbar spine).
3. Slowly bring client back to an
upright position, opening up the elbows and continuing the back extension
until client’s spine is fully extended. Make sure at the end of this
motion that the C-spine is being extended by asking the client to tilt
his/her chin up.
4. A slight additional stretch may be applied by
lightly pulling the elbows apart. Use just one or two fingers on each
elbow. If performed, this should be very slight in effort and amount of
additional stretch.
Hamstring
Stretch
1. With the
client laying on his/her back, both legs straight and flat on the table,
assess ROM by asking the client to raise his/her right leg as high as
possible while maintaining full knee extension.
2. Have the client
positioned close to the edge of the table, with the left leg bent.
3.
Secure the right leg against your shoulder and support the extension of
the knee and the neutrality of the foot.
4. Apply stretch by slowly
moving forward.
5. Repeat for other side.
Universal Back
Stretch (active and passive stretch)
1. Client grabs the lower
legs to bring both knees up towards chest.
2. Place one hand under the
client’s head, and the other hand on top of the knees/ lower legs.
3.
Ask the client to curl up in a ball as much as possible, then relax all
muscles, while you continue to curl the client in by applying pressure
with both hands. (This should be done in one continuous motion)
4.
Repeat 2-4 times.
Sacroiliac
Stretch
1. Have the client
bring both knees to a bent position, feet flat on table.
2. With your
left hand secure the client’s left ankle to the right knee.
3. Place
your right palm on the medial side of the client’s left knee joint.
4.
Apply the stretch to the left-side SI joint by pressing the client’s bent
left knee away (in the direction of the length of the table). It may help
to apply the stretch with the client’s exhale.
5. Repeat for the other
side.
Groin
Stretch
1. From the bent-knee position, have
the client open the knees laterally and place the plantar surface of the
feet together.
2. Apply the stretch to the groin by gentle hand
pressure on the medial sides of the bent knees.
Pectoralis
Stretch
1. Have the client lay close to the edge of the table so that the
left shoulder joint is free to move. (Client must be able to drop the
upper arm down past the table height.) Assume a kneeling position next to
your client’s left side (face towards the head side of the table.)
2.
Extend the client’s left arm laterally at least 90 degrees from the body.
3. With your right arm and hand, fix the client’s extended arm by
squeezing it against your chest (You may support the elbow extension with
your hand.) Use your left forearm to support the client’s left shoulder
joint.
4. Apply the stretch to the pectoralis muscles by bending down
(lead with your head). It may help to apply the stretch with the client’s
exhale.
5. Repeat for the other side.
Subscapularis
Stretch
1. Stand at the head of the table
2. Raise the client’s left
arm, with the elbow at 90 degrees, above his/her head.
3. Place your
left palm over the medial side of the client’s elbow, and wrap your right
hand around the client’s wrist.
4. Apply the stretch to the
subscapularis muscles by flattening the client’s elbow to the table,
pulling the client’s hand to your (therapist) horizontal right.
5.
Repeat for the other side.
Quadriceps
Stretch
1. Lay the
client on his/her stomach.
2. Apply the stretch to the quads by
bending the client’s leg at the knee, bringing the heel towards the
glutes. You may use one hand to secure the client’s glute/lower back area
on the stretched side.
3. Repeat for the other side.
Abductors/
Adductors Stretch
1. Bring the client’s left
knee to a 90 degree angle.
2. The upper leg should maintain its
position in-line with the body. You may use one hand to fix the hip joint
(in the upper glute region) to the table.
3. Rotate the upper leg by
bringing the client’s foot lateral, away from the table, to apply the
stretch for the abductors.
4. Apply the stretch for the adductors by
bringing the foot to the other direction. (The client’s lower leg will
cross over the right leg)
5. Repeat for the right leg.
Plantar Fascia
Stretch
1. Flex the client’s knee to 90 degrees, secure the
heel with one hand, and grasp the ball of the foot with the other hand.
2. Stretch the sole of the
foot by pulling the ball of the foot in a downward motion.