Greetings from the NCAA Championships!

I have been invited to provide sports massage this week for the University of Michigan Track & Field athletes at this year’s NCAA championships (my 5th championship trip).  The location changes year-to-year.  This year they are held in Fayetteville, Arkansas.  The track and field championships run from Wednesday through Saturday, with the athletes competing in preliminary rounds over the first two days to qualify for the finals on Friday and Saturday.

My job here is to help the athletes recover between each round, keeping their legs loose and feeling fresh.  If an athlete competes early in the day, I will give them a post-event “flush-out” massage and assisted stretching at the sports medicine area next to the track facility, but the majority of my work is done back at the hotel in the evening after each day’s events (I usually work until about 11:00pm).   I will also perform pre-event sports massage in the mornings if an athlete has a late evening competition, so I really find myself on-call all day during this week.

Because the athletes compete so often, I do not perform any deep trigger point work while I am here.  Instead, I use broad pressure massage and light stretching techniques to ensure I do not cause any soreness or muscle inhibition the following day.  I also keep the duration of these sports massages brief, about 20 minutes on average — just enough time to loosen their legs.

A key component of this work is that the athletes have received sports massage from me throughout the season, and their bodies have become accustomed to my techniques.  This ensures they will not feel sore from the massage as well as not feel I am doing anything new or unfamiliar to them before the biggest competition of their career.

As I tell the participants in my sports massage courses, a great perk of working an event like this is the opportunity to meet with other massage therapists and sports medicine professionals, something I plan do do as much as possible this week.  There is always more to learn, and I enjoy looking for new techniques and tips from the other therapists at these events.

Working a NCAA Championship is a fantastic experience, and I feel very fortunate to be here.  I can’t tell you how great my job is when I am able to work with an athlete all season and then see them fulfill their dreams of winning a national title!

I’d like to share with you a simple technique to assess if the scapular movement is to blame in a painful shoulder.

Let’s say you have a client who comes in for a sports massage complaining of shoulder pain.  They state they have pain when they raise their arm overhead in either full shoulder flexion or abduction (remember the difference?  Flexion is raising the shoulder forward & abduction is raising it out to the side).

The first step is to have your client lie supine (face up) on the massage table.  This will stabilize the back and eliminate any compensatory movement.  Now have them slowly raise their arm fully overhead in shoulder flexion.

If they experience pain with this movement, you then have them return their arm to the starting position.  They will repeat the motion, but this time you will assist their scapula in its normal movement.  Sit or kneel at the side of the table and slide one hand under the lower part of the client’s scapula, hooking your fingers as best you can on the medial (vertebral) border.  Now instruct the client to raise their arm overhead once more, but as their shoulder flexes, gently pull their scapula into abduction and outward rotation.  Chances are good that the pain will be reduced or eliminated completely.

Assisting Scapular Motion

Why?  Because a significant percentage of shoulder injuries are due to scapular movement dysfunction.  In a previous post, I mentioned that the scapula needs to abduct and rotate outward when the shoulder flexes or abducts.  When the scapula cannot properly move, the glenohumeral joint will try to increase its movement to compensate for the loss, leading to impingement of the supraspinatus tendon or other soft tissue under the acromion.

Working at the site of the pain will simply be treating the symptom, and the client will not show significant improvement until the supporting musculature are addressed.

So, if you find yourself with a client who fits this scenario, you need to work on releasing the muscles that prevent the abduction and external rotation.  Namely, the levator scapula, pectoralis minor and rhomboids.  In addition, these clients will often show weakness in the serratus anterior muscle, which has the job of scapular abduction and outward rotation.

You can also use the assessment test as a means of training the client’s muscles to fire correctly.  Simply have them perform slow, full shoulder flexion while you assist the scapular movement into abduction and outward rotation.  Over time, these repeated movements will re-educate the muscles (and nervous system) to how active they should be during shoulder flexion.  Just be sure this movement remains pain-free!

As my personal massage practice grew, I became quite concerned over the mechanics of my hands, particularly my thumbs (no big surprise there!).  Every time I performed muscle stripping techniques, I could feel the strain on my joints & wondered if each time I was shortening my career.  In addition, my thumbs and some fingers hyperextend, which increased my concern over my longevity as a massage therapist.

So, I began experimenting not only with my hand mechanics, but also with the use of hand tools.  Today I would like to share my independent review of three common massage tools on the market.

Knobble II (Company Link)
This was the first hand tool I purchased, with hope that it would allow me to use my entire hand to deliver the pressure.  I chose this over the Original Knobble because I did not want to use a wood product.  I don’t care what anyone says about the benefits of using wood, it is a porous material and I don’t wish to use it directly on the client’s skin.

Pros:

• Smooth, hard material
• Easy cleanup between clients
• Easy to generate deeper pressure

Cons:

• The handle caused too much stress on my wrist
• I found it difficult to perform trigger point work with the ergonomics
• Because it is held in the palm, less than ideal tissue “feel” is transmitted through the tool to my hand

Thumbsavers (Company Link)
I next found an ad for the Thumbsavers in a massage journal and thought this would be an interesting device.  By splinting the thumb, I would be able to perform very specific trigger point work with hopefully better feel of the tissue.

Pros:

• Very good transmission of tissue feel to my hand
• Prevents hyperextension of thumb
• Easy cleanup (soft plastic material)

Cons:

• With prolonged use, I felt some compression strain in the interphalangeal joint of my thumb
• Also felt more strain at the base of the first metacarpal joint (at the wrist)
• Base of the tool will rub and sometimes irritate the webbing of my thumb

Therapist’s Thumb (Company Link)
I found this tool when searching the web for other available massage tools & became intrigued.  The design seemed straightforward & effective, as I could still use my thumb for feel and precision, but the force would be generated by the hand grip.

Pros:

• Very good transmission of tissue feel (about equal to the Thumbsavers)
• Smooth hard plastic (easy cleanup between clients)
• Able to generate good pressure (Although since it is still using the thumb I could not safely generate as much as the Knobble II)
• Pressure is disbursed into the hand grip

Cons:

• Two sizes-fit all — The design still causes my thumb to hyperextend slightly when using this tool.
• Squeezing the hand grip with pressure can cause some strain to the finger flexors
• Because of the length of the tool, it is difficult to effectively work in some parts of the upper shoulders and neck

For my body mechanics, I do still brace by thumb even if it is using a hand tool.   The best thing I have done is monitor my body mechanics to use my thumbs and braced fingers as little as possible.  I now mostly use knuckles, elbows and forearms to release the tissue (as well as stretching), and then utilize braced thumbs or hand tools to work out any lingering problem areas.

All in all, I find myself returning to the Therapist’s Thumb more than the other two massage tools when my client needs muscle stripping.  I don’t believe there is one “perfect” massage tool out there, but I will continue to experiment with others as they catch my attention.  So if you have suggestions for my next trials, please let me know!

A physical therapist I know showed me this fantastic resource for learning the details of common orthopedic surgeries.  I have found it very helpful to review the surgical procedures before I work on my post-operative clients.  Check it out!

http://www.orthoillustrated.com/

When working with a teenage (adolescent) athlete, the very first thing I ask them is “how much have you grown in the last year?”.  Here’s why…

The peak muscle growth takes place about 1 year after the adolescent male has his peak skeletal growth rate.  So basically their muscles and fascia are being stretched from the inside of their body like an internal torture rack!  Decreased flexibility from growth spurts will invariably lead to hamstring and low back strains, and tendonitis in the achilles and patellar tendons.

How can we help with massage?  First with slow, broad myofascial release in the fiber direction of the muscles and connective tissue.  By applying a broad, sustained force on the connective tissue, it will trigger a deformation of the tissue to a new resting length.  I will work the structures involved with the client’s complaint, but will also include work on the thoracolumbar fascia, obliques, lumbar erectors, quadratus lumborum, and glutes.

Once we have achieved a release of the tight myofascia, I recommend gentle stretching to improve overall muscle resting length.  Key muscles to stretch are the gluteus maximus and medius, hamstrings, hip flexors, adductors and quadriceps.  Improving flexibility in these muscles will free-up the pelvis and remove tension off the low back.  Keep in mind they will be very stiff at the beginning, and stretching will probably feel uncomfortable.  I prefer a mixture of gentle muscle energy techniques and static stretching to keep the discomfort to a minimum.

Be patient with the progress.  You will often find a client who has grown 4-6 inches in less than a year.  The muscles will catch up and you can help reduce their discomfort and chance of injury along the way.