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1
Q

What is massage?

A

The scientific manipulation of soft tissues of the body for the purpose of normalising those tissues

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2
Q

What is the purpose of sport massage?

A

Utalises specific techniques and stretches to help obtain maximum performance and physical conditioning with less chance of injury or pain. It increases power, endurance and flexibility both before and after an event or workout

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3
Q

What is a sports injury?

A

Sport injuries result from acute trauma or repetitive stress associated with athletic activities. Sport injuries can effect bones or soft tissue

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4
Q

Total contradictions of sports massage

A 
Cancer
Acute injury (first 24-48 hrs)
Fever 
First trimester of pregnancy 
Suspected DVT 
Hyperthermia 
Infectious diseases 
Under the influence of alcohol or drugs 
Without consent
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5
Q

Localised contradictions and where consent is required from the patient for sports massage

A 
Skin diseases 
Cuts bruises or sunburn 
Scar tissue 
Fracture sites 
Varicose veins 
Recent operations 
Spastic conditions 
Slipped disk 
Pinched/trapped nerve 
Undiagnosed lumps 
Pregnancy abdomen 
Postural deformities 
Undiagnosed pain 
Cardiovascular conditions 
Diabetes 
Kidney infections 
When taking medication
Cancer 
Medical oedema 
Osteoporosis 
Arthritis 
Nervous/psychotic conditions 
Epilepsy 
Asthma 
Wiplash 
Acute rheumatism 
Dysfunction of the nervous system
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6
Q

When is it most important to rest?

A

In response to acute injury in the first 24-48 hours

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7
Q

Risks if injuries are not rested

A

Without rest continual strain is placed on the area leading to increased inflammation, pain and possible soft tissue injury. It will also cause most soft tissue injuries to take far longer to heal. There is also a risk of abnormal repair

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8
Q

Risks of total rest

A

Total inactivity has been shown to decrease blood flow to the area and hence reduce the amount of metabolic waste from the site of injury. Also results in muscle atrophy and weakness as well as bone decalcification

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9
Q

The benefits of cryotherapy (ice)

A

Decreases or inhibits bleeding as it is a vasoconstrictor
Decreases local tissue metabolism ( damaged tissue produces pain producing substances)
Neutralises local histamine (vasodilator which increases vascular permeability liberated by trauma)
Decreases the muscle spasm by decreasing the sensitivity of the muscle stretch receptor system
Elevates the threshold of pain transmitting nerves

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10
Q

How long is ice administered for and when?

A

10-15 minutes to cool it, allow the injured site to warm up naturally and repeat several times over 24-48hr period

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11
Q

When are Ice baths uses

A

Post exercise to reduce inflammation and flush metabolic debris from muscle

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12
Q

Precautions of ice

A

Frostbite
Compromised or poor circulation
Diabetes
Cold sensitivity (can conduct a cold sensitivity test to see if the patient is intolerant to extreme cold

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13
Q

Why should we avoid prolonged use of ice?

A

After 20-30 minutes depending on the tissues blood supply and vascular status blood flow to the area increases (Lewis hunting phenomenon)

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14
Q

Compression aims And precautions

A

Aims to reduce oedemas swelling that results from the inflammatory process, wrap should be snug but being too tight can increase pain, cause numbness and tingling

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15
Q

Swelling issues

A

some swelling is inevitable but too much results in significant loss of function, excessive pain and eventual slowing of blood flow

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16
Q

Elevation- why and when?

A

Raising the injured area above your heart will allow gravity to help reduce swelling by draining excess fluid, also reduces blood flow to injured area, elevate at 45 degrees or more at intervals during the first 24 hours after acute injury

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17
Q

What is thermotherapy

A

Using heat as a tool to promote blood flow to the region where there is chronic presentation of injury. Heat will also increase elasticity of collagen fibres in connective tissue.
This can be done using direct heat such as warm water or from infra-red lamps.

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18
Q

What does damage to muscles result from?

A 
Direct trauma (impact) 
Or indirect trauma (overstretch or overload)
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19
Q

Comprehensive assessment plan

A 
Visual assessment
Palpating 
Identify location of pain 
R.O.M 
Active resisted movement
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20
Q

Grade 1 muscle injuries

A

10% of fibres torn
Non palpable
2-3 weeks recovery

Pain but no weakness or loss of function

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21
Q

Grade 2 muscle injuries

A

10-50% fibres torn
Palpable
Severity of pain will depend on the amount of fibres torn
3-6 weeks recovery
Pain and weakness but no loss of function

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22
Q

Grade 3 muscle strain

A 
50-100% of fibres torn 
Visible and palpable 
Widespread bruising and balling of the muscle 
Referral and recovery of about 3 months 
Pain, weakness and loss of function
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23
Q

Scar tissue

A

Increases the risk of re injury and decreases the range of motion
Untreated scar tissue is a major cause of reinjury usually months after you thought that injury had fully healed
Scar tissue is made from very brittle, inflexible fibrous material

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24
Q

Cramp

A

Painful involuntary contraction of a muscle or muscles typically caused by fatigue or strain

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25
Q

The 2 theories of a stitch

A

Lack of blood flow to the diaphragm and ischemic pain
Or
Pulling on the ligaments attached to the diaphragm

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26
Q

What are the 4 tendon pathologies?

A

Tendonitis
Tendonosis
Tendosynovitis
Tendoperiostitis

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27
Q

Tendonitis

A

Inflammatory process

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28
Q

Tendonosis

A

Degenerative process

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29
Q

Tendosynovitis

A

Inflammation of tendon sheets

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30
Q

Tendoperiostitis

A

Inflammation of periosteal attachment

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31
Q

Types of ligament stability

A

Active stability- maintained by muscular activity

Passive stability- maintained mainly by ligaments

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32
Q

Common sites of ligament injuries

A

Knee
Ankle
Fingers
Shoulder

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33
Q

First degree ligament sprain

A

Fibres of the ligament are stretched, small tears (minor)

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34
Q

Second degree ligament sprain

A

Larger incomplete tear, from a 3rd to almost all fibres, (partial tear)

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35
Q

3rd degree ligament sprain

A

Complete rupture of the ligament, sometimes avulsing a piece of bone

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36
Q

Types of bursitis

A

Frictional, chemical and septic

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37
Q

Frictional bursitis

A

Occurs when a tendon repeatedly moves over a bursa

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38
Q

Chemical bursitis

A

Caused by a substance formed as a result of inflammatory or degenerative condition of tendons

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39
Q

Septic bursitis

A

Caused by a bacterial infection either from blood or from external environment

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40
Q

What are the stages of the healing process?

A

Inflammatory phase (4-6 days), proliferation/ repair phase (4-24 days), remodelling (21 days- 2 years)

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41
Q

Duration of the inflammatory phase

A

72 hours

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42
Q

Inflammatory phase is characterised by the cardinal signs of inflammation which are?…

A

PAIN- due to chemicals released by damaged cells
SWELLING OR OEDEMA- due to an influx of fluid in the damaged region
REDNESS- due to vasodilation, the widening of blood vessels
HEAT- due to increased blood flow to the area
Chemical mediators- histamine, linings, prostaglandins, resulting in vasodilation and increased permeability of vessels causing oedema

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43
Q

Proliferation and repair phase up to 3 weeks

A

Elimination of debris
Regeneration of endothelial cells
Production of fibroblasts
Collagen and other protein fibres are laid down in a haphazard Manner

(Ice and heat, massage, movement, exercise)

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44
Q

Proliferation/ repair phase 6 weeks- several months

A

Protein fibres and scar tissues orientate themselves in the direction that pressure is applied, may take months to fully mature and achieve full strength

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45
Q

Chemical physiological effects of effleurage

A

Vasodilation and local blood flow are increased as a result of histamine

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46
Q

Mechanical physiological effects of effleurage

A

Increased Venus flow, increased lymphatic flow and reduction in oedema

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47
Q

Reflex effects of effleurage

A

Stimulates local cutaneous mechanoreceptors that moderate pain, initially increases blood pressure then decreases it

48
Q

Light and slow effleurage does what

A

Good for lymphatic drainage

49
Q

Medium to heavy pressure/ speed effleurage does what

A

Circulation and relaxation

50
Q

Therapist contact points

A 
Single handed 
Double handed 
Single reinforced 
Forearm 
Double alternating
51
Q

Patient/ therapist relationship

A 
Introduce touch to client 
Increase blood flow 
Warm the tissues 
Putting the client at ease 
Muscle relaxation 
Palpating tissue
52
Q

Use of petrissage

A

Used on deeper tissues for mobilising fluids, stretching muscle fibres and inducing relaxation

53
Q

Different forms of petrissage

A 
Muscle compressions 
Kneading 
Wringing 
Picking up 
connective tissue massage/ skin rolling
54
Q

Types of kneading petrissage

A 
Palmar 
Thumb 
Fingertip 
Knuckle 
Open-c
55
Q

Effects of kneading

A 
Helps reduce muscle tone 
Loosens adhesions of muscle fibres and connective tissue and stretches tissues 
Increases circulation through tissues 
Helps reduce toxins
Decrease effects of fibrous thickening
56
Q

Muscle compressions

A

Pressing and releasing soft tissues with fingers and Palm of hands

57
Q

Muscle compressions effects

A

Empties venous beds
Increase capillary flow
Relaxation of hypertonic muscles
Increase parasympathetic stimulation

58
Q

Wringing

A

Applying equal pressure on opposite sides of the tissue structure, lifting and pushing in opposite directions

59
Q

Effects of wringing

A 
Decrease stiffness due to ischaemia 
Loosens adhered tissues 
Stretches muscle fibres 
Maintains/improves muscle tone 
Improves circulation to nerves
60
Q

Picking up

A

Applying equal pressure on the sides of the tissue structure and lifting away from the body

61
Q

Picking up effects

A

Loosens adhesive muscle fibres
Stretches muscle fibres
Maintain/improve tone
Increase circulation to nerves

62
Q

Connective tissue massage/ skin rolling

A

Cutaneous and subcutaneous tissues are grasped and lifted away from underlying tissue and then rolled between fingers and pressure towards underlying structures

63
Q

Effects of skin rolling

A

Loosens adhered cutaneous and fascial layers
Stretching fascia
Superficial vascular flow

64
Q

What is tapotement

A

Drumming hand movements on broad areas. This consists of a series of briskly applied percussive movements, using the hands alternately to strike or tap the muscles for an invigorating effect. There are many variations on this stoke, it may be applied with the edge of the hand, with the tips of the fingers or with a closed fist

65
Q

Effects of tapotement

A

Stimulates muscle
Helps maintain muscle tone
Helps improve muscle tone

66
Q

Types of tapotement

A

Cupping
Hacking
Pounding

67
Q

Shaking and jostling

A

A course of vibration applied to a muscle group or limbs

68
Q

Rolling

A

An introductory or ending rhythmical oscillating massage technique applied to the body

69
Q

Effects of deep friction

A

Stimulates fibre orientation in regenerating connective tissue
Prevents adhesion formation and ruptures unwanted adhesions
Induces a traumatic hyperaemia
Stimulates nerve tissue and can tighten loose tissue

70
Q

Aims of pre event massage

A

To create a state of readiness of the muscle by stimulating circulation and generating a fresh supply of oxygenated blood to a specific area
Reducing tension in tight muscle groups
Increasing flexibility of muscle groups
Decreasing anxiety and nervous tension
Enhance a state of focus and concentration

71
Q

Guidelines for pre event massage

A

15-20 mins keep it short
Emphasis placed on muscle group that are going to be used
Rhythm and upbeat pace
Massage techniques should be light
Focus on circulation enhancement
Avoidance of all techniques that require a recovery technique or are painful

72
Q

Maintenance/ preventative massage

A

Given during rest from heavy training I.e. When there is no major training being done. Concentrates on muscles that have been used or are going to be used
Use cross fibre massage strokes to break down adhesions and fibrous tissue. Also working towards releasing muscle tension

73
Q

Aims of post event massage

A 
Assist in the cool down process 
Relax tight muscle groups 
Stimulate circulation 
Reduce potential soreness 
Spread muscle fibres to minimise fascism adhesions
74
Q

Techniques used for post event massage

A 
Effleurage 
Light petrissage, wringing, muscle compressions 
Picking up 
Shaking/ rolling 
Traction 
Passive stretching
75
Q

Guidelines for maintainance/ preventative massage- post event massage

A

Do not massage someone who says they feel ill
He temperature conscious with over heating and chilling
Have water ready to avoid dehydration
Be gentle and keep the pressure light
Massage gradually to loosen and decongest
Do not allow pressure to cause pain
The session should be 10/20 minutes in duration- slightly more if there are real problems to be tackled

76
Q

Hyperthermia and massage

A 
Do not massage someone displaying the symptoms of hypothermia as it could cause added nausea, fatigue and unsteadiness, look for....
Excessive swearing 
Shivering or chilling 
Dry skin 
Nausea 
Throbbing pressure in head 
Unsteady gait 
Lack of focus 
Extreme fatigue 
Excessive cramping
77
Q

Posture and postural assessment

A

Posture is the relationship between different parts of the body and in a postural assessment we observe a client in an attempt to notice what these relationships might be

78
Q

Reasons for doing a postural assessment

A

To get more information
To save time
To serve as a benchmark
To demonstrate caring/ professionalism

79
Q

How long does a postural assessment take

A

20 mins for a full assessment but it may not be appropriate to assess the entire body, with practice assessments also get quicker

80
Q

How to do a postural assessment

A

With client consent in a warm environment with the client standing in a relaxed position using a checklist

81
Q

Postural assessment checklist

A 
Head/ neck tilt/rotation 
Shoulder level and bulk 
Scapular distance from spine 
Spinal alignment 
Distance of arms from body and elbow position 
Footpostion
Hypoextension
82
Q

What is a STR technique

A

Soft tissue release technique is an advanced manual technique used in assessing and stretching soft tissue, targets specific areas of increased tension in a muscle and muscles that are normally difficult to stretch, can be performed both actively and passively

83
Q

What is fascia

A

An embryological connective tissue, 3D continuous web of elastin and collagen fibres surrounded by a viscous fluid called the ground substance.
Fibre types allow it to be very strong yet have a high degree of flexibility
Ground substance is a fluid transport medium and acts as a slide and glide mechanism between structured

84
Q

About fascia, scaring and roles

A

It is suggested that fascia had the ability to contract and relax playing a major role in stability and mobility of joints (tension and resistance rely on each other for stability and function).
Following all trauma and through poor posture fascia scars and hardens in the affected site and along the tension lines imposed on it, causes it to lose its cushioning mechanism and pulling internal structures out of alignment applying pressure on pain sensitive structures

85
Q

Characteristics of trigger points

A

Pain related to a discrete, irritable point in skeletal muscle or fascia, not caused by acute local trauma, inflammation, degeneration, neoplasm or infection
The painful point can be felt as a nodule or band in the muscle and a twitch response can be evicted on stimulation of the trigger point
Palpating the trigger point reproduces the patients complaint of pain and the pain radiates in a distribution typical of the muscle harbouring the trigger point
Pain Cannot be explained by findings in a neurological examination

86
Q

Potential causes of trigger points

A 
Acute or chronic muscle overload 
Activation by other trigger points 
Disease 
Psychological distress 
Homeostatic imbalances
 direct trauma to the region 
Accident trauma 
Radiculopathy infections and health issues such as smoking
87
Q

Classification of trigger points

A

Potential
Active
Latent

88
Q

Potential trigger points

A

About 620 in the human muscles, show up in the same place in every person so trigger maps can be made that are accurate for everyone

89
Q

key trigger point

A

Has a pain referral pattern along a nerve pathway that activates or creates a latent trigger point

90
Q

Satellite trigger point

A

Tp activated by a key trigger point, treating the key will often resolve the satellite by converting it from being active to latent or completely treating it

91
Q

Muscle energy techniques

A

A form of orthopaedic manual therapy in which the patients muscles are actively used on request from a precisely controlled position in a specific direction and against a counter force

92
Q

Indications for use of Mets

A

To mobilise restricted joints
Lengthen tense muscles and fascia
Improve circulation, respiration and neuromuscular relationships
Frequently used to prepare tissues for HVLA

93
Q

Post-isometric relaxation

A

Postulated to work because after an isometric contraction there is a refractory period during which passive stretching of the dysfunctional muscle may be done without strong opposition

94
Q

What does the isometric contraction of the stretched muscle accomplish in METs

A

It helps train the stretch receptions in the muscle spindle to accommodate greater muscle length
The internee muscle contraction serves to fatigue many of the fast twitch fibres of the contracting muscles making it harder to contract in resistance to subsequent stretch
Tension generated by the contraction activates the Golgi tendon organ which inhibits contraction of the muscle by lengthening action

95
Q

Met technique

A

20-30% effort
3-4 times repeat
Hold each for at least 6 seconds and last for 20

96
Q

3 energy systems

A

Creatine phosphate system
Anaerobic respiration
Aerobic respiration

97
Q

Creatine phosphate system

A

ATP breaks down to ADP and Pi to release energy
ADP and Pi must be reformed to continue muscle action
PC provides the energy for the free Pi molecule to be reattached to ADP to form ATP
PC stores in the muscles breaks down anaerobically to form phosphate and creatine which releases energy for the synthesis of ATP
2 Pc molecules to resythesise 1 ATP
The system lasts about 10 seconds

98
Q

Anaerobic respiration duration

A

Lasts 1-3 minutes

99
Q

Oxygen debt

A

Muscles need oxygen to get rid of the lactic acid. This extra oxygen is called the oxygen debt, paid off by gulping air into the lungs
Oxygen debt= amount of oxygen required to get body back to resting rate

100
Q

Why is aerobic respiration more efficient than anaerobic

A

Lasts more than 3 minutes
One molecule of glucose produces 20 x more energy in aerobic than anaerobic
Responsible for energy production up to about 60% of maximum effort then does not produce energy quick enough

101
Q

Rates that effect the body’s ability to produce energy aerobically

A

Rate of gaseous exchange (rate that lungs can absorb oxygen)
Rate at which the heart can deliver oxygen (cadiac output and stroke volume)

102
Q

The parts of the spine

A 
Chris tarrant loves sport cars
Cervical 
Thoracic 
Lumbar 
Sacral 
Coccyx
103
Q

Types of muscles

A

Skeletal
Smooth
Cardiac

104
Q

Features of skeletal muscle

A

Muscles attach to origins and insertions by connective tissue
Fleshy attachments- connective tissue fibres are short
Indirect attachments- connective tissue forms a tendon
Bone markings present where tendons meet bones
Tubercles, trochanters and crests

105
Q

Skeletal muscle structure

A

Composed of muscle cells, connective tissue, blood vessels, nerves
Fibres are long, cylindrical and multinucleated
Tend to be a smaller diameter in small muscles and larger in large muscles
Develop from myoblasts
Striated
Nuclei are peripherally located
Structure of actin and myosin

106
Q

Fibre types and performance

A

Fast fibres- type 2 fibres
Slow fibres- type 1 fibres
Power athletes- sprinters possess high percentage of fast fibres
Endurance athletes- distance athletes have high percentage of slow fibres
Others- weight lifters and non athletes have about 50% slow 50% fast fibres

107
Q

Smooth muscle structure

A 
Innervated by autonomic nervous system 
Visceral or unity smooth muscle 
Only a few muscle fibres innervated to each group 
Impulse spreads through gap junctions 
Whole sheet contracts as a unit 
Often auto rhythmic
108
Q

Cardiac muscle

A

Found only in heart where it forms thick layer called the myocardium
Striated fibres that branch
Each cell usually has one centrally located nucleus
Fibres joined by intercalated disks which are composites of demosomes and gap junctions
Allow excitation in one fibre to spread quickly over adjoining fibres
Under control of ANS and endocrine sYstem
Some cells are autorhythmic
Fibres spontaneously contract

109
Q

Ligaments in the knee

A

Medial and lateral collateral ligaments

Anterior and posterior cruciate ligaments

110
Q

Symptoms of grade 1 ligament sprain

A

Tenderness over area
No swelling
Pain when ligament is stressed
1-4mm joint opening

111
Q

Grade 2 ligament sprain symptoms

A

Significant tenderness over area
Swelling over area
Pain and laxity when joint is stressed
5-10mm joint opening

112
Q

Grade 3 ligament sprain symptoms

A

Complete tear of ligament
Pain can vary, sometime less than grade 2
Instability
10-15 mm joint opening

113
Q

Synovial joints

A

A particular type of join that allows for movement in the articular bones

114
Q

Hyaline cartilage

A

Surrounds the end of bones at a joint and is bluish in colour with firm consistency and has a considerable amount of collagen
Reduces friction and acts as a shock absorber

115
Q

Bursa

A

Fluid filled sac that reduces friction around a joint

116
Q

Principles of training

A

Speed
Stamina
Suppleness
Skill

Sport Massage (4 decks)

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