Huang, SY, Di Santo, M, Wadden, KP, Cappa, DF, Alkanani, T, and Behm, DG, Short duration massage at the hamstrings musculotendinous junction induces greater range of motion. J Strength Cond Res 24(7): 1917-1924, 2010.

The massage technique performed was slow, circular friction at a pace of 1 repetition per second.  The subjects were supine, with their knee straight, and massage was performed to the distal hamstrings with the fingertips wrapped around the thigh.

Before and after the massage, they measured the EMG activity of the hamstrings as well as the passive muscle tension.  Tension was measured as the torque force produced at the posterior knee at the point of discomfort during stretching.

There were a few interesting results from this study.  First, the massage was performed only to the musculotendinous junction, targeting the golgi tendon organs, and not the muscle belly and attachments.

Next, the increased range of motion did not create an increase in either muscle tension or EMG muscle activity.  The investigators suggest the massage increased the range of motion through a modified stretch perception or increased compliance of the hamstrings.

The suggested practical application of this research is to use slow, circular friction massage to the musculotendinous junction of a muscle either before stretching or after activity to improve range of motion.  This work can be applied to a sports massage therapist’s toolbox, or to teach an athlete for self-care of a chronically tight muscle.

The technique that I most often turn to in this situation is Muscle Energy Technique (MET).  With gentle activation of the guarding muscles, you can utilize the post-isometric relaxation (PIR) response to “turn off” the guarding muscles and increase the client’s ROM.

I usually start with the client in the mid-rage of their ROM and instruct them to use very gentle force (about 10% of their maximum) against my resistance for about 10 seconds.  At the very end of the 10 seconds, I will slowly decrease my resistance while the client is still pressing against my hand, allowing the client to move their joint further.  After a brief, 5-second hold in the new position, I have the client move against my resistance in the opposite direction following the same steps and repeat this back-and-forth MET for about 10 repetitions.

For example, a client with guarding in shoulder external rotation will attempt to externally rotate their shoulder against my gentle resistance for 10 seconds.  After 8 seconds, I will decrease my resistance slightly, allowing the client to overcome my force and take the arm into a few more degrees of external rotation.  I then repeat these steps against internal rotation to activate the antagonistic muscle groups.

By allowing the client to slightly move the joint at the end of the resistance, they begin to overcome the fear of movement, all the while working within their pain tolerance.

Streepey, JW, Mock, MJ, Riskowski, JL, VanWye, WR, Vitvitskiy, BM, and Mikesky, AE.  Effects of Quadriceps and Hamstrings Proprioceptive Neuromuscular Facilitation Stretching on Knee Movement Sensation.  J Strenth Cond Res 24(4): 1037-1042, 2010.

I found this to be a very interesting study, as most previous studies on the effects of stretching focused on its effect on the muscle’s ability to contract or generate power.  As this study shows a decrease in the proprioception of the knee position, it shows a potentially dangerous effect of static stretching before sports involving rapid start and stop or lateral movements, as the muscles must be able to sense and control the joint position to prevent damage to the joint structures.

However, the authors of the study do note that the proprioception was tested with the subject’s leg hanging in a non-weight bearing position, where in a weight-bearing situation, the quadriceps and hamstrings would be actively contracting and not completely relaxed.

So, further testing needs to be performed to identify a true risk, but the study did show a slowed response of the body to identify a change in position of the joint angle following a contract-relax PNF stretch, and shows another reason to avoid holding a stretch for long periods before athletic activity.

Traditionally, the treatment for a muscle cramp was to apply a stretch to the muscle.  However, this is inefficient and potentially dangerous.  It is inefficient in that it is difficult to apply enough force to overcome a strongly contracting muscle.  Dangerous, because the force required to stretch a cramping muscle can cause damage to the muscle fibers!

A far easier way is to use a technique called reciprocal inhibition.  This involves the athlete to contract the muscles that are antagonistic (opposite) to the cramping muscles.  For example, for a calf cramp (the ankle plantarflexors), instruct the client to strongly dorsiflex their foot (“pull your toes to your nose”).  This will activate the tibialis anterior and its assisting muscles, that triggers the nervous system to inhibit the contraction of the cramping muscle.  You can provide some manual resistance to the dorsiflexion to help strengthen the inhibitory response.

Once the cramp or spasm has stopped, you can then utilize compression, petrissage and stretching to help the muscle fully return to its resting state.

Overview

Of all sporting activities, the golf swing is one of the most analyzed movements.  It is very common to see computer motion analysis offered at driving ranges and practice facilities.  Can you think of another sport where this high-tech analysis is readily available?  For my purposes here, the golf swing will be broken down into 3 phases:  the backswing, downswing, and the follow-through.

At my massage clinic, I will often ask my golfing clients to demonstrate their swing for me, so I can see which of the movements described below are limited.

The starting position of the golf swing has the golfer standing with a slight knee bend, bent at the waist to maintain the lumbar curve and their arms hanging relaxed in front of them holding the club just behind the ball.  The golf swing then involves a slow trunk rotation away from the ball to generate muscle tension (a “pre-stretch”) and weight shift, followed by an explosive trunk rotation toward and through the golf ball, ending with the weight shifted to the front leg.

This trunk rotation generates power that is transferred into the arms and down the golf club into the golf ball upon contact.

(NOTE:  The description of movement is for a right-handed golf swing)

Backswing

From the starting position, the trunk rotates to the right, as the right hip internally rotates and the left hip externally rotates.  Meanwhile, the left shoulder will horizontally adduct and internally rotate as the right elbow bends and the right shoulder externally rotates to allow the golf club to move around the body into the top position.  As the shoulder rotates, the right scapula retracts (adducts) and the left scapula protracts (abducts).  At the end of the backswing phase, the golf club is held above the head, with the left elbow straight and the left shoulder horizontally adducted so the left humerus is under the chin.

Common Muscular Problems with the Backswing

Legs & Hips (Right Internal Rotation, Left External Rotation, Right Pelvic Rotation)
Problem:  Limited hip rotation to the right
Action:  Release right gluteus maximus, medius and piriformis, left adductors, left TFL

Trunk (Right Trunk Rotation)
Problem:  Limited right trunk rotation
Action: Release left abdominal obliques and left quadratus lumborum

Shoulders (Left Horizontal Adduction & Internal Rotation, Right External Rotation)
Problem:  Limited left shoulder horizontal adduction
Action:  Release left posterior and medial deltoids, infraspinatus and teres minor, latissimus dorsi, and left rhomboids and middle trapezius

Problem: Limited right shoulder external rotation
Action:  Release right subscapularis, right pectoralis major, and right serratus anterior

Downswing and Follow-Through

The downswing phase generates club head speed and power to transfer massive energy to the golf ball.  The real power is generated by a “kinetic chain” in which the sequential motion of the legs, hips, torso, and then arms will occur.  This sequential firing of the body segments creates whip-like energy, much greater than if one body segment moved in isolation.

First, the muscles of the legs and hips will fire, with the right hip quickly moving into external rotation, turning the pelvis to the left, over the stationary left leg.  This rotation of the pelvis will transfer up into the trunk, which will powerfully rotate to the left.  Finally, the arms will begin movement, starting with the left shoulder horizontally abducting and externally rotating as the right shoulder internally rotates and the right elbow extends to drive the head of the golf club down to the golf ball.

The follow-through phase in the golf swing occurs after contact has been made with the golf ball.  This phase involves the deceleration of the body and is for the most part passive, with the exception of the core stabilization muscles.

Common Muscular Problems with Downswing and Follow-Through

Legs & Hips (Right External Rotation and Left Internal Rotation, Left Pelvic Rotation)
Problem:  Shooting sciatic sensation down left leg
Action:  Client is most likely swinging too hard, causing compression on sciatic nerve by the piriformis muscle

Problem:  Left lateral knee pain
Action:  Release the muscles involved with the IT Band (gluteus maximus and tensor fascia latae).  Also make sure client is rotating their torso and not shifting their body too much to the left

Problem:  Limited hip rotation to the left
Action:  Release left gluteus maximus, medius and piriformis, right adductors, right TFL

Trunk (Left Rotation)
Problem:  Limited left trunk rotation
Action:  Release right abdominal obliques and right quadratus lumborum

Shoulders (Left Horizontal Abduction and External Rotation, Right Horizontal Adduction and Internal Rotation)
Problem:  Pain in right medial epicondyle, especially upon contact with golf ball
Action:  Address right forearm flexor musculature.  This is a sign of medial epicondylitis (“golfer’s elbow”).

Problem:  Limited right shoulder horizontal adduction
Action:  Release right posterior and medial deltoids, infraspinatus and teres minor, latissimus dorsi, and right rhomboids and middle trapezius

Problem: Limited left shoulder external rotation
Action:  Release left subscapularis, left pectoralis major, and left serratus anterior

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