Course Flashcards
What is massage?
The scientific manipulation of soft tissues of the body for the purpose of normalising those tissues
What is the purpose of sport massage?
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
What is a sports injury?
Sport injuries result from acute trauma or repetitive stress associated with athletic activities. Sport injuries can effect bones or soft tissue
Total contradictions of sports massage
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
Localised contradictions and where consent is required from the patient for sports massage
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
When is it most important to rest?
In response to acute injury in the first 24-48 hours
Risks if injuries are not rested
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
Risks of total rest
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
The benefits of cryotherapy (ice)
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
How long is ice administered for and when?
10-15 minutes to cool it, allow the injured site to warm up naturally and repeat several times over 24-48hr period
When are Ice baths uses
Post exercise to reduce inflammation and flush metabolic debris from muscle
Precautions of ice
Frostbite
Compromised or poor circulation
Diabetes
Cold sensitivity (can conduct a cold sensitivity test to see if the patient is intolerant to extreme cold
Why should we avoid prolonged use of ice?
After 20-30 minutes depending on the tissues blood supply and vascular status blood flow to the area increases (Lewis hunting phenomenon)
Compression aims And precautions
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
Swelling issues
some swelling is inevitable but too much results in significant loss of function, excessive pain and eventual slowing of blood flow
Elevation- why and when?
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
What is thermotherapy
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.
What does damage to muscles result from?
Direct trauma (impact) Or indirect trauma (overstretch or overload)
Comprehensive assessment plan
Visual assessment Palpating Identify location of pain R.O.M Active resisted movement
Grade 1 muscle injuries
10% of fibres torn
Non palpable
2-3 weeks recovery
Pain but no weakness or loss of function
Grade 2 muscle injuries
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
Grade 3 muscle strain
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
Scar tissue
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
Cramp
Painful involuntary contraction of a muscle or muscles typically caused by fatigue or strain
The 2 theories of a stitch
Lack of blood flow to the diaphragm and ischemic pain
Or
Pulling on the ligaments attached to the diaphragm
What are the 4 tendon pathologies?
Tendonitis
Tendonosis
Tendosynovitis
Tendoperiostitis
Tendonitis
Inflammatory process
Tendonosis
Degenerative process
Tendosynovitis
Inflammation of tendon sheets
Tendoperiostitis
Inflammation of periosteal attachment
Types of ligament stability
Active stability- maintained by muscular activity
Passive stability- maintained mainly by ligaments
Common sites of ligament injuries
Knee
Ankle
Fingers
Shoulder
First degree ligament sprain
Fibres of the ligament are stretched, small tears (minor)
Second degree ligament sprain
Larger incomplete tear, from a 3rd to almost all fibres, (partial tear)
3rd degree ligament sprain
Complete rupture of the ligament, sometimes avulsing a piece of bone
Types of bursitis
Frictional, chemical and septic
Frictional bursitis
Occurs when a tendon repeatedly moves over a bursa
Chemical bursitis
Caused by a substance formed as a result of inflammatory or degenerative condition of tendons
Septic bursitis
Caused by a bacterial infection either from blood or from external environment
What are the stages of the healing process?
Inflammatory phase (4-6 days), proliferation/ repair phase (4-24 days), remodelling (21 days- 2 years)
Duration of the inflammatory phase
72 hours
Inflammatory phase is characterised by the cardinal signs of inflammation which are?…
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
Proliferation and repair phase up to 3 weeks
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)
Proliferation/ repair phase 6 weeks- several months
Protein fibres and scar tissues orientate themselves in the direction that pressure is applied, may take months to fully mature and achieve full strength
Chemical physiological effects of effleurage
Vasodilation and local blood flow are increased as a result of histamine
Mechanical physiological effects of effleurage
Increased Venus flow, increased lymphatic flow and reduction in oedema
Reflex effects of effleurage
Stimulates local cutaneous mechanoreceptors that moderate pain, initially increases blood pressure then decreases it
Light and slow effleurage does what
Good for lymphatic drainage
Medium to heavy pressure/ speed effleurage does what
Circulation and relaxation
Therapist contact points
Single handed Double handed Single reinforced Forearm Double alternating
Patient/ therapist relationship
Introduce touch to client Increase blood flow Warm the tissues Putting the client at ease Muscle relaxation Palpating tissue
Use of petrissage
Used on deeper tissues for mobilising fluids, stretching muscle fibres and inducing relaxation
Different forms of petrissage
Muscle compressions Kneading Wringing Picking up connective tissue massage/ skin rolling
Types of kneading petrissage
Palmar Thumb Fingertip Knuckle Open-c
Effects of kneading
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
Muscle compressions
Pressing and releasing soft tissues with fingers and Palm of hands
Muscle compressions effects
Empties venous beds
Increase capillary flow
Relaxation of hypertonic muscles
Increase parasympathetic stimulation
Wringing
Applying equal pressure on opposite sides of the tissue structure, lifting and pushing in opposite directions
Effects of wringing
Decrease stiffness due to ischaemia Loosens adhered tissues Stretches muscle fibres Maintains/improves muscle tone Improves circulation to nerves
Picking up
Applying equal pressure on the sides of the tissue structure and lifting away from the body
Picking up effects
Loosens adhesive muscle fibres
Stretches muscle fibres
Maintain/improve tone
Increase circulation to nerves
Connective tissue massage/ skin rolling
Cutaneous and subcutaneous tissues are grasped and lifted away from underlying tissue and then rolled between fingers and pressure towards underlying structures
Effects of skin rolling
Loosens adhered cutaneous and fascial layers
Stretching fascia
Superficial vascular flow
What is tapotement
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
Effects of tapotement
Stimulates muscle
Helps maintain muscle tone
Helps improve muscle tone
Types of tapotement
Cupping
Hacking
Pounding
Shaking and jostling
A course of vibration applied to a muscle group or limbs
Rolling
An introductory or ending rhythmical oscillating massage technique applied to the body
Effects of deep friction
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
Aims of pre event massage
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
Guidelines for pre event massage
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
Maintenance/ preventative massage
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
Aims of post event massage
Assist in the cool down process Relax tight muscle groups Stimulate circulation Reduce potential soreness Spread muscle fibres to minimise fascism adhesions
Techniques used for post event massage
Effleurage Light petrissage, wringing, muscle compressions Picking up Shaking/ rolling Traction Passive stretching
Guidelines for maintainance/ preventative massage- post event massage
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
Hyperthermia and massage
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
Posture and postural assessment
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
Reasons for doing a postural assessment
To get more information
To save time
To serve as a benchmark
To demonstrate caring/ professionalism
How long does a postural assessment take
20 mins for a full assessment but it may not be appropriate to assess the entire body, with practice assessments also get quicker
How to do a postural assessment
With client consent in a warm environment with the client standing in a relaxed position using a checklist
Postural assessment checklist
Head/ neck tilt/rotation Shoulder level and bulk Scapular distance from spine Spinal alignment Distance of arms from body and elbow position Footpostion Hypoextension
What is a STR technique
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
What is fascia
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
About fascia, scaring and roles
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
Characteristics of trigger points
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
Potential causes of trigger points
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
Classification of trigger points
Potential
Active
Latent
Potential trigger points
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
key trigger point
Has a pain referral pattern along a nerve pathway that activates or creates a latent trigger point
Satellite trigger point
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
Muscle energy techniques
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
Indications for use of Mets
To mobilise restricted joints
Lengthen tense muscles and fascia
Improve circulation, respiration and neuromuscular relationships
Frequently used to prepare tissues for HVLA
Post-isometric relaxation
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
What does the isometric contraction of the stretched muscle accomplish in METs
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
Met technique
20-30% effort
3-4 times repeat
Hold each for at least 6 seconds and last for 20
3 energy systems
Creatine phosphate system
Anaerobic respiration
Aerobic respiration
Creatine phosphate system
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
Anaerobic respiration duration
Lasts 1-3 minutes
Oxygen debt
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
Why is aerobic respiration more efficient than anaerobic
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
Rates that effect the body’s ability to produce energy aerobically
Rate of gaseous exchange (rate that lungs can absorb oxygen)
Rate at which the heart can deliver oxygen (cadiac output and stroke volume)
The parts of the spine
Chris tarrant loves sport cars Cervical Thoracic Lumbar Sacral Coccyx
Types of muscles
Skeletal
Smooth
Cardiac
Features of skeletal muscle
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
Skeletal muscle structure
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
Fibre types and performance
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
Smooth muscle structure
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
Cardiac muscle
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
Ligaments in the knee
Medial and lateral collateral ligaments
Anterior and posterior cruciate ligaments
Symptoms of grade 1 ligament sprain
Tenderness over area
No swelling
Pain when ligament is stressed
1-4mm joint opening
Grade 2 ligament sprain symptoms
Significant tenderness over area
Swelling over area
Pain and laxity when joint is stressed
5-10mm joint opening
Grade 3 ligament sprain symptoms
Complete tear of ligament
Pain can vary, sometime less than grade 2
Instability
10-15 mm joint opening
Synovial joints
A particular type of join that allows for movement in the articular bones
Hyaline cartilage
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
Bursa
Fluid filled sac that reduces friction around a joint
Principles of training
Speed
Stamina
Suppleness
Skill
