Monday, April 16, 2012

Running Ragged

Many runners wait until pain or discomfort has made their running difficult or impossible, visiting a physical therapist to rehab them back into their routine. Instead of waiting until after injury has occurred, sports massage is a preventive secret professional athletes have utilized on a regular basis for decades.
Sports massage relaxes the body, reduces pain, increases flexibility, relaxes the mind and speeds recovery enhancing your athletic performance. The enormous training loads elite runners maintain each week make massage a necessity at least once a week but frequently up to three times a week. 
Massage helps maintain muscles in their normal resting length while prolonging an athletic career. The more activity a muscle undergoes, the greater its tendency to contract in a resting position. Think of your hands and how they curl in resting position. These tight muscles are more prone to injury when the next vigorous workout arrives.
Massage increases blood flow and realigns muscle fibers while breaking up adhesions, which are formations of scar tissue made up of collagen that appear during the tissue healing process. By stimulating and then relaxing the system, massage also flushes toxins from these healing muscles, which speeds recovery with fewer aches. A relaxed muscle enjoys increased blood flow and greater range of motion.

Sports massage also helps to identify problem areas that are as yet not full-blown injuries. The role of a sports massage therapist is to locate and work on minor aggravations, in many cases, trouble spots you didn't even know you had. It is also effective in aiding the recovery from an injury by encouraging better kinesthetic awareness and prompting the body’s natural immune function.
For this reason, it is vital to make the distinction between ordinary massage and sports massage. While Swedish or other conventional massage techniques feel relaxing, they are generally not effective therapy for athletes. Sports massage goes deeper into the musculature, and is more intense than other types of massage. Knowing which sports effect which muscles, sports therapists are trained to find trigger points and adhesions.
When you go in for a sports massage, let the therapist know of old and new injuries. Fresh injuries require a lighter touch than chronic aches, which can benefit from more intense work and breaking up of adhesions. The therapist will then work on related areas of tightness or unbalance that may have contributed to or resulted from the original trauma or overuse. 
Not surprisingly, many runners require the most attention to be paid to their legs and gluteal muscles, but allow the therapist to provide tension relief throughout your body including your arms, head, neck and shoulders. These muscle systems are all interrelated and can contribute to problems in running form that lead to injury or discomfort.
These sessions can be intense but need not be painful. Work with the therapist to find a level of discomfort that is tolerable yet effective. If you're not used to sports massage, you should allow five days or even a week between the session and the next race or hard workout. Runners accustomed to the rigors of massage can leave three days for recovery before the event. Wait at least a day after your race--and up to a week after for marathons--before returning to the therapist. Again, this recommendation applies to deeper work as many marathons offer gentle, stroking massage immediately following the race.

The lowdown on muscle strains

Muscle strains happen when a muscle is pushed beyond it capacity and the muscle fibers start to tear. You will know it is a strain when lifting something, moving something or just moving the wrong way. It is that moment that you get when doing something where you can feel the immediate localized pain.

 People often confuse muscle strains and call them muscle sprains. Sprains happen to ligaments which connect bone to bone. When you sprain your ankle you are tearing the ligaments that hold the bones together and hold them in place while the muscles around them make the ankle and foot move.

 A muscle can be strained from asking it to do too much beyond what it is capable of. When you are doing something which takes the muscle beyond what it is able to do- the fibers have no choice but to tear. Having a muscle that is tight also increases your risk of straining a muscle as it has less range of motion to do what you are telling it to do.

 Muscle strains are often confused with the pain of having muscle knots which are also known as trigger points. A muscle strain will be something that happens and is accompanied with immediate pain. It isn't something that you just wake up with typically or that you get over a period of a few weeks. It will often be red and inflamed or puffy looking. It will feel weak to use or move.

The first thing to do when something like this happens is to apply ICE not heat as some like to do. Ice is necessary to relieve the inflammation.

Massage can help in the healing of strains by reducing the inflammation and helping with the scar tissue formation process by circulating fresh nutrients to the area. When a muscle is strained, the tearing of the fibers will need to heal back together. They will heal better when minimum pressure is applied to the fibers as they heal to reduce the buildup of scar tissue. If you have an old injury you will often feel this spot of scar tissue when the muscle gets tight or you are under a lot of stress.

 There are three grades of muscle strain: first degree or mild, second degree or moderate, and third degree or severe.

Level One- 1-50% tear of the fibers, can hold resistance, and may be painful, some swelling but little to no loss of function. Usually returns to normal activity quickly.

Level 2- 50-99% fiber tear, can't hold against resistance, may hold against gravity, pain, edema (retaining of fluids), swelling and muscle guarding.

Level 3 -100% fiber tear, usually heard snap at time of injury, no resistance possible, pain may be present at site, compensational pain present but can be minimal afterwards because of complete separation, Needs physicians attention immediately.

 Third-degree strains generally require surgical repair. In some instances, surgery is not performed because the muscle does not play a crucial role and the potential dangers of surgery outweigh the benefits. Ruptures to the rectus femoris are an example because the other three quadriceps muscles make up for the strength deficit caused by the strain.

Whitney Lowe, a teacher of orthopedic massage says this about muscle strains:

 The muscles most susceptible to strain injuries are multi-articulate muscles, which are those that  cross more than one joint. The more joints crossed by a muscle, the greater is their vulnerability for  strain injury.

 All involved joints cannot achieve full range of motion at the same time due to limited extensibility of  the muscle tendon unit. If the muscle is stretched across multiple joints at the same time, it's more  susceptible to tearing from excess tensile stress.

Getting regular massage can reduce excess tension that can create extra stress and an increased risk of straining a muscle. This can be helpful for weekend gardeners and hikers as well as professional and amateur athletes.

Wednesday, January 11, 2012

Troubling Tennis Elbow

Tennis Elbow or Lateral Epicondylitis is an extremely common injury that originally got its name as it appeared in a high proportion of tennis players. Nevertheless it commonly manifests in a vast proportion of people who do not play tennis at all. Tennis elbow occurs commonly in the tendon of the extensor carpi brevis muscle below the outer edge of the elbow joint.

Specific inflammation is rarely present in the tendon but there is an increase in pain receptors in the area making the region extremely tender.

Symptoms of Tennis Elbow:

-Pain below the bony area on the outside of the elbow (lateral epicondyle) increased with pressing on the area
-Weakness in the wrist with difficulty doing simple tasks such as opening a door handle or shaking hands with someone
-Pain on the outside of the elbow when the hand is bent back at the wrist against resistance
-Pain on the outside of the elbow when trying to straighten the fingers against resistance

Causes of Tennis Elbow

Tennis Elbow is often caused by overuse or repetitive strain caused by repeated bending back of the wrist (extension) against resistance. This may be from activities such as tennis, bricklaying, excessive use of a screwdriver, typing, and painting.

Sudden onset of tennis elbow occurs in a single instance of exertion such as a late back hand in racquet sports where the extensors of the wrist become strained. This corresponds to micro-tearing of the tendon.

Late onset normally takes place within 24-72 hours after an intensive term of unaccustomed wrist extension.

Prevention/ Treatment of Tennis Elbow

Tennis Elbow may heal quickly within two weeks, but it can last upwards of two years. When the symptoms have settled down it is essential that rehabilitation and strengthening of the elbow take place.

​-Corrective techniques – play the backhand with the whole body not just the wrist. The small muscles and tendons of the wrist and elbow cannot handle the torque of highly strengthened muscles and quick powerful movements.
​-Be aware of too much strain on the elbow when performing repetitive motions for long periods of time.
​-Apply ice after repetitive use to reduce any inflammation early.
​ -Stretch and strengthen muscles of the forearm and elbow before extended use

Massage therapy is one of the leading treatments of Tennis Elbow. Even when the condition has moved to the chronic stage massage is very effective at enhancing circulation, calming strained tendons and muscles, working out knots in the small muscles of the forearm and reducing/realigning scar tissue.

Tuesday, December 20, 2011

Pain: the 4 letter word

Clients suffer from pain in many ways. Pain can rob clients of their lives. They may become depressed or anxious and want to end their lives. Clients are sometimes unable to do many of the things they did without pain, and this pain affects their relationships with others. This can lead to loss of employment or social issues with friends and family.
What is often overlooked is that pain has physically harmful effects. It is often actually physiologically unsafe to have pain.13 The effects of pain on the endocrine and metabolic system, cardiovascular system, gastrointestinal system, and immune system—and the potential for future pain—are but a few of examples of how unsafe unrelieved pain may be.13

Pain causes stress. The endocrine system reacts by releasing an excessive amount of hormones, ultimately resulting in carbohydrate, protein, and fat catabolism (destruction); poor glucose use; and other harmful effects. This reaction combined with inflammatory processes can produce weight loss, fast heart beat, increased respiratory rate, fever, and shock. Unrelieved pain prolongs the stress response, adversely affecting the client’s recovery.13

The cardiovascular system responds to stress of pain by activating the sympathetic nervous system, which produces a variety of unwanted effects. In the postoperative period, these include an excess of blood clotting, increased heart rate, blood pressure, cardiac work load, and oxygen demand.13

Since the stress response causes an increase in sympathetic nervous system activity (fight or flight), intestinal movement and stomach churning slow. This response can cause temporary impairment of gastrointestinal function.13,

Unrelieved pain may be especially harmful for clients with metastatic cancers. Stress and pain can suppress immune functions, including the natural killer (NK) cells that play a role in preventing tumor growth and controlling metastasis.13, 16

Unrelieved acute pain can result in chronic pain at a later date. Thus, pain now can cause pain later. A survey of clients having undergone surgery found a high percentage of chronic postsurgical pain in patients whose acute postsurgical pain was inadequately managed.20

13. Pasero C, Paice JA, McCaffery M. Basic mechanisms underlying the causes and effects of pain. In: McCaffery M, Pasero C, editors. Pain: clinical manual. 2. St. Louis, MO: Mosby; 1999. pp. 15–34.

16. Page GG, Ben-Eliyahu SJ. The immuno-suppressive nature of pain. Semin in Oncol Nurs. 1997;13(1):10–5.

20. Goldstein DH, Ellis J, Brown R, et al. Meeting proceedings: recommendations for improved acute pain services: Canadian Collaborative Acute Pain Initiative. Pain Res Manage. 2004;9(3):123–30.

Tuesday, December 13, 2011

Soothing the Stress Response System

Your Stress Response system (SRS) is what responds to the stress you are under on a daily basis. When it is over taxed it can ruin the best of days. The work piling up on your desk, sitting in traffic on I-5, waiting in lines at the bank, balancing your budget, engaging in a relationship with your spouse or significant other, taking care of children or elderly family members, not having enough time in the day and especially not having enough time for yourself can put too much stress on your body and health.

Having a healthy stress response system will allow you to deal with or respond to the stress in a healthier more efficient way.

What happens to your body when under stress?

Your body responds by sending out more adrenaline and cortisol. Adrenaline increases your heart rate, elevates your blood pressure and boosts energy supplies. Cortisol, the primary stress hormone, increases sugars (glucose) in the bloodstream, enhances the brain's use of glucose and increases the availability of substances that repair tissues.

Cortisol alters immune system responses and suppresses the digestive system, the reproductive system and growth processes as a first response as these systems are not as essential when under stress.

Your stress response system usually will quiet down on its own after the stress has stopped. The thing is that most stress is ongoing meaning the body is always responding to stress. An uncontrolled increase in adrenalin and cortisol can have a negative affect on health.

Over exposure to these and other stress hormones can disrupt almost all your body's processes, increasing your risk of obesity, insomnia, digestive problems, heart disease, depression, memory impairment, physical illnesses and other complications.

A healthy SRS allows reactions that are appropriately gauged to the circumstances: big reactions to big threats; small reactions to small threats. Furthermore, people who have a sluggish SRS also tend to have more stress responses, more often, to less threatening stimuli; those responses have longer lasting effects on the body.

This type of person fumes in a long checkout line, frets in heavy traffic and explodes when the dog gets into the garbage. This person may have a sluggish, but over reactive stress response and a tendency to develop depression.

What Determines the Health of the SRS?

Studies on animals reveal one reason for a sluggish stress response: lack of tactile stimulation, or touch. Touch improves the efficiency of the pituitary-adrenal axis or your stress response system.

Receiving non sexual, nurturing, non threatening touch is one of the most important ways humans and other mammals have to keep a healthy stress response. Massage moves people from a sympathetic to a parasympathetic state. This brings about several physiological and chemical changes in the body, including an increase in serotonin secretion and a decrease in cortisol.

Soothing touch, whether it be applied to a ruffled cat, a crying infant, or a frightened child, has a universally recognized power to ameliorate the signs of distress. How can it be that we overlook its usefulness on the jangled adult as well? What is it that leads us to assume that the stressed child merely needs "comforting," while the stressed adult needs "medicine"?

-- from Job's Body: A Handbook for Bodywork by Deane Juhan

"Jangled" Adults Touch and the Stress Response System By Ruth Werner Originally published in Massage & Bodywork magazine, February/March 2006.

HPA Axis - Wikipedia

Why Zebras Don't Get Ulcers, Third Edition  by Robert Sapolsky.

Saturday, December 10, 2011

The secret of "low back" pain management

It may surprise you to learn that treatment of low back pain does not always occur on the "low back". Each week I meet people who are seeking massage therapy for their low back pain. They come in abundance, the "huddled masses" that have had enough of that nagging ache or that sharp screaming pain that stabs at them continually.

Sports injuries, car accidents, occupational hazards, pregnancy and poor posture are a few of the repeat offenders we see. The cause of their pain is as diverse as their personalities, and so too are the treatments they receive.

Many times, a client's pain is actually caused by opposing muscles in other areas such as hamstrings, quadriceps, psoas, or latissimus. These muscles all have a role to play in the position of the hips. If you think of muscles as pulleys and bones as levers, you can visualize what might happen if one of those pulleys was shortened and the lever was left in an altered position, forcing all the other pulleys to adjust. In essence, there is a "tug of war" going on. If just one muscle is out of balance, the result is pain and/or stiffness.

There are many dynamics that we look at as massage therapists when considering a client's low back pain. In a clinical context, we check posture, position of the hips in relation to one another, and the texture of surrounding soft tissue. Equally relevant information would be the background of the client; health history, prior injuries, pain tolerance, and commitment level in correlation with that clients expectations. That is to say, treatment for low back pain in a 50 year old that is sedentary would differ greatly from an active 30 year old client who has been in a motor vehicle accident.

The patterns of dysfunction and the methods that can treat them are numerous. In massage therapy, we employ techniques such as deep tissue massage including myofascial release, trigger point therapy and neuromuscular therapy, as well as complimentary techniques like kinesio tape, stretching and craniosacral therapy etc. By using one or a combination of these techniques, a massage therapist has a unique role in the treatment of lower back pain through manually elongating shortened muscle fibers and connective tissues to restore balance in the lower back.

There is one common factor in the successful outcome of a massage therapy treatment session, and that is a client who is actively involved in the solution. Clients who are engaged in their care and perform stretches and exercises at home along with ice and/or heat on a consistent basis are much more likely to step out of the pain cycle.