Truth or Myth - Should Sports Massage Be Painful?

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I have quite a few clients who often say that they are expecting their treatment to be painful or that they believe in the "no pain, no gain" approach to their treatment.  If it doesn't hurt then it can't be doing any good right?


  • Remedial means to apply a remedy - so Sports & Remedial Massage is about supporting the body in order for it to heal from injury tension or pain not create pain.

 

  • The aim of massage should be to relax muscles that are under tension which may be a result of injury, bad posture or stress and not cause discomfort.
    • PAIN is the body's way of indicating that something should stop.  When we feel pain the body's natural reaction is to tense up to protect the area of pain.  This is the opposite of what we as massage therapists are trying to achieve.
    • In order for a massage to have a beneficial effect then the client should be able to relax in order for the muscles to be able to release tension.
  • There is also the small matter of Connective Tissue (also known as Fascia)...
    • This is a sheet of connective tissue that is just beneath the skin and attaches, stabilises and separates muscles and other internal organs.
    • When pain is caused or felt by the body then this connective tissue will harden into a protective state - this can affect other parts of the body other than that which the therapist is working and therefore create more tension throughout the whole body.
  • Can certain techniques cause pain for example Neuro Muscular Therapy (NMT) which is a deeper treatment
    • If there is a need to use this technique which uses a deeper pressure on a particular part of the body to help release tension (Trigger Point) then the top layer of tissue needs to be warmed up and relaxed to enable the deeper technique to work effectively.  This will allow the tissue to relax and enable the technique to be used without causing pain.
    • If a therapist suddenly digs an elbow into a muscle this will immediately cause discomfort and the body will tense up around this area and access to the deeper tissue will be denied.
  • Will you feel sore after a Sports Massage?
    • There may be some residual tenderness if you have had a Sports Massage as the muscles are getting a bit of a workout during your treatment espeically if stretching techniques are used (Active Release) but no pain or bruising should occur.  
    • Everyone responds differently to massage treatments but most people sleep well after a massage and some may feel more of the benefits of the massage over the next couple of days.

In Summary... 

  • Sports Massage shouldn't be painful during the treatment but you may feel some slight tenderness the day after a treatment which is perfectly normal.  So next time you have a Sports Massage you now know that you don't need to feel pain for it to be beneficial.

 

 

 

Shoulder Impingement

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What is Shoulder Impingement? 

 

This is a condition where the shoulder's tendons or bursa are being compressed or pinched during shoulder elevation movements which then causes inflammation.  

 

This can be a result of instability of specific muscles around the shoulder joint due to an imbalance which leads to incorrect movement of the shoulder.  Certain muscles may be moving too much or too little which then impacts on the way in which the shoulder joint moves.

 

The onset of pain ususally is gradual due to the way in which you move and can then become chronic over time as the body starts to move away from its natural movement patterns and increased inflammation occurs.

 

What Can Cause Shoulder Impingment?

  • A traumatic injury such as a fall
  • Rounded Posture 
  • Repeated overhead movements such as swimming or throwing sports like cricket
  • Jobs that require the shoulder to be elevated for long periods e.g. plastering/painting


What are the symptoms of Shoulder Impingment?

  • Clicking of the shoulder when you reach behind
  • Pain when lying on the sore shoulder
  • Muscle weakness in the arm
  • Pain in the shoulder or arm when lifting or reaching overhead

 

How to Treat Shoulder Impingment?

 

 Intial treatments can include:-
  • Kinesio tape - tape can be applied around the shoulder to encourage better posture and movement patterns.  K-Tape also should help reduce pain as it de-compresses the area where it is applied and allows the nerves, and muscles to move more freely
  • Pain Relief - Ice should be used if there is inflammation to help reduce this.  Heat can be used when the inflammation has reduced to help bring fresh blood flow to the area
  • Massage - Soft Tissue Therapy can help relieve the tension in some of the local muscles
  • Sports Therapist Assessment - You should make an appointment with your local Sports Therapist/Physio/Sports Massage Therapist to have a thorough assessment and they will provide you with advice to support rehabilitation longer term
  • Exercises - It may be that there are specific muscles that aren't functioning as well as they should and that strengthening exercises need to be provided to enable better overall movement.

Below are a couple of exercises below that can help with better movement through a combination of control and mobilisation.

 

1. Shoulder blade control

 

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- Lean forwards onto a wall taking some weight through your elbows and forearms

- Keeping the body still and the shoulders away from your ears and chest away from the wall slide the arms up and down the wall

- Do this exercise 10 times 3x a day

 

2. Thoracic spine mobility

 

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- Roll up a towel and lie on it so that it runs down the centre of the spine from the base of the neck to the bottom of the mid back

- Support your head on a pillow and have your legs bent with your feet on the floor

- Lie there for 10 minutes each day to stretch out the spine

 

 

Sometimes it may be necessary to have further investigations if the initial treatment is not relieving the pain and your therapist should refer you on.

 

Longer term it is important to keep stretching, ensure good warm up and cool down post exercise, continue doing the mobility and strengthening exercises.

 

Always be mindful of your shoulder position whether you sit at a desk or play a competitive sport to avoid any reoccurence of Shoulder Impingment.

 

 

Most Common Running Injuries and How To Treat Them

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According to the statistics around 80% of runners will pick up an injury at some point throughout the year!

 

Increased or a change in training or just general overuse can change the forces going through the body and can cause injury.  It is key when increasing your training, for example if you have decided to run a marathon, to start slowly and build up the mileage (10% increase per week is advised).  

 

Recovery is also key and should include proper nutrition, adequate rest and active recovery.  It is also recommended to mix up your training schedule to include other cardio activities and strength training to both maintain fitness and to give your body a break from running.

 

Below are some of the most common injuries amongst runners and some tips on how to avoid and treat them.

 

As always if you aren't sure what injury you may have ensure you seek professional advice before starting any rehab.

 

Plantar Fasciitis

This is inflammation of the tissue underneath the foot.  You may experience more pain in the morning and discomfort can be felt both under the foot and the heel.  Overuse, incorrect footwear (hard soled shoes & flip flops are key culprits), and tight calves can all contribute.

 

Initial treatment is use ice on the affected area, roll a golf ball or rolling pin underneath the foot to help relax the tissue.  Stretching and mobilising the calves, and the big toe.  Kinesio Taping can help ease pain along with massage (when not in chronic state).

 

Shin Splints

Acute pain or a stabbing sensation can be felt on the inside of the shin bone caused by inflammation of the muscles and tendons around the shin.  Can be caused by overtraining especially on a hard ground.  

 

Ice the area (15/20 minutes) to help reduce the inflammation and elevate the leg where possible.  Try to rest as much as possible to give the area a chance to heal.  Check your shoes to ensure that they are the right fit for your style of running (gait analysis) and check that they are not too worn.  Avoid hills intially when you go back into training to reduce the strain on the front of the leg.

 

Achilles Tendinitis

Pain at the back of the heel and there can be some swelling around the achilles.

 

Can be caused by tight calves, improper footwear or increasing mileage too quickly.

 

Apply the PRICE strategy (Protection, Rest, Ice, Compression, Elevation), ensure you warm up effectively before training to get the blood flow to the area and wear supportive shoes.

 

Runners Knee (Patellofemoral Pain Syndrome)

Pain can be felt behind or around the knee and is one of the most common complaints amongst runners which is why it is known as "runners knee"!

 

Constant road running, downhill running and muscle imbalance can all contribute to putting stress through the kneecap.

 

Kinesio taping can help with pain relief and help stabilise the knee.  Rest or a reduction in mileage is advised when in pain.

 

Try to opt for softer surfaces where possible when in recovery and seek professional advice to assess your muscle movements.

 

Ankle Sprain

This injury occurs when the ankle rolls inward or outwards putting strain through the ankle ligaments stretching them.

 

Uneven ground, pavements or an akward landing can all be a hazard.

 

Initial rest and apply the PRICE protocol and elevate the affected leg to help reduce the swelling.

 

Light stretching and balance exercises should be introduced after the acute phase.  Kinesio taping is useful at all times through the recovery phase; to help reduce pain and provide stability to the ankle joint.

 

Muscle Strain

When a muscle becomes overstretched whether through overload or excessive force the muscle fibres (and sometimes tendons) can tear.  Calf and Hamstring strains are common in runners due to the load being put through these particular muscles.

 

Forgetting to warm up properly, lack of proper recovery (foam rolling, stretching, massage) or running through an existing injury  can put increased strain through muscles.

 

Ice the affected area and start with gentle stretching before moving on to strengthening exercises.

 

Ensure you warm up properly before running (include dynamic stretching), recover properly including a good cool down.  

 

Seek advice if you think you have a strain as you will need to rest and start a program of rehab to ensure that the muscles heal effectively.

 

Tips to help avoid injury!
  • Ensure your footwear is not too worn and appropriate for you.
  • Cross train - you can still keep your fitness and strength but give your legs a break from the pavement pounding.
  • Stick to the 10% rule - Don't increase your mileage by more than 10% each week.
  • Make time to warm up and cool down.
  • Make sure you factor in Recovery.  This is often missed out and can hinder training.
  • If you start to feel that you are aching more or feeling any pain ensure that you book an appointment with a therapist to get an assessment to avoid a more serious injury.

Safe Running!

Piriformis Syndrome - What is it and how to treat it

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What is Piriformis Syndrome?
  • Piriformis Syndrome is an overtight Piriformis muscle which then presses on the Sciatic Nerve causing pain and tightness in the buttock sometimes with tingling and burning sensations which can radiate down the back of the leg.  Often people will assume that they have Sciatica due to the similarity of symptoms.

 

Causes of Piriformis Syndrome?
  • It is usually caused by overuse of the muscle which causes an over tightening of the Piriformis Muscle resulting in pressure on the sciatic nerve.
  • Tight muscles on the inside of the leg (adductor muscles) creating tightness can also inhibit the correct movement of these muscles thereby putting more strain on the Piriformis Muscle.

 

Treatment
  • In the intial stages the goal is to reduce pain.  Ice can help reduce muscle spasm and nerve pain in the first day or so.  However longer term heat application is more beneficial as it helps bring fresh blood to the area and helps relax this muscle.
    • Heat should not be applied if there is a suspected muscle tear.
    • If heat is used then it should be applied for 15/20 minutes 2-3 times per day.
    • Do not apply heat pads directly to the skin.
  • Massage
    • Light massage can help release muscle tension and active techniques can be used to stretch the muscle.
    • Massage on the muscles around the Glutes can be beneficial as compensatory tension can arise through changed movement due to pain.
    • At the very least two to three sessions at the start of rehabilitation is a good idea. As the condition improves massage can be performed deeper, but the deeper the massage the longer it should be left between sessions as the muscle will need to recover in the same way as it does with heavy strengthening exercises.
  • Stretching
    • Hold this stretch for around 20-30 seconds and repeat as often throughout the day as possible (2-4 x recommended).

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  • Foam Rolling
    • This can help release the Piriformis Muscle.

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  • Strengthening
    • Strengthening  should be done on a daily basis immediately followed by stretching exercises as the muscle will be more likely to relax into a stretch if it has been worked and warmed up.

    • The more that you sit then the more often this exercise should be done.  At least 3 times a day.

    • Strengthening the piriformis muscle itself and also the other hip abductor muscles can be helpful in preventing piriformis syndrome recurring.

    • Clam exercise - Lay on your side, bend the knees and position them forwards so that your feet are in line with your spine.

    • Make sure your top hip is directly on top of the other and your back is straight. Keeping the ankles together, raise the top knee away from the bottom one. Work until you feel the muscle starting to fatigue but do not overdo it especially in the early stages. Slow controlled movements are important.

 

As always if you are unsure of your condition then please seek advice from a professional.

THE ITB.. FOAM ROLLING MYTH BUSTED.. AND HOW TO TREAT ITB SYNDROME

What is the ITB?

The Iliotibial Band or ITB is a thick band of of fascia which connects the outside of the knee to the outside of the pelvis and plays a key role in the movement of the thigh.   Some of the glute and hip muscles attach to it and the ITB co-ordinates how these muscles work and stabilises the knee.

 

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Should you Foam Roll it?

I often get clients who say they have been regularly rolling their ITB and it is so painful.. so it must be doing some good?  Pain does not equal effectiveness.  In fact if an area is painful it is better to avoid this and use the roller around the area rather than directly on it which could potentially cause more inflammation.

 

The ITB is fascia and not muscle.  Fascia is dense connective tissue made up of collagen fibres which is one of the strongest protein to be found.  The ITB is supposed to be tight as it helps keep the knee in the correct position.   The idea that you can release or relax the ITB through Foam Rolling is therefore a misconception.  What needs to be done is foam roll the muscles surrounding the ITB such as Glutes, Tensor Fascia Lata, Hamstrings and Quads.

 

Below is a link to some useful tips on how to foam roll.

Top Foam Rolling Tips

 


What is ITB Syndrome?

This is a condition that is usually caused by friction of the ITB moving across the outer part of the knee due to an area of tension in the hips.  Usually pain comes on during activity and gets worse until it is rested. 

 

Treatment of ITB Syndrome

 

Obviously it is important to seek professional advice to ensure that you have a correct diagnosis before you start any rehabilitation programme.

 

  • Rest and ice around the knee for a few days.
  • In order to maintain fitness do some cross training e.g. swimming to avoid irritating the knee further.
  • Have a sports massage to release any tension around the hips and leg muscles.
  • Stretch often to help keep hips tension free.  This is an important part of the treatment and prevention of ITB Syndrome.

Example Stretch..

TFL Stretch

This stretch lengthens the tensor fascia lata muscle which is found on the outside of the hip. Sit on the floor with one leg out straight. The leg to be stretched is bent and the foot placed on the outside of the other knee as shown. Use your hands to apply pressure as if trying to pull the bent knee across the other one. Hold for 30 seconds and relax. Repeat 3 to 5 times.

 

 

Check List To Prevent ITB In The Future

  1. If you haven't already get your running gait checked.  Your style of running could be contributing to tension around the ITB in the hips and glutes
  2. Ensure that your shoes are fit for purpose.  Are they supportive in the right way?  When you have your gait analysed they will tell you which shoes are best for you.
  3. Book an appointment with your Sports Massage Therapist or Physio to check to ensure that weak hips aren't a contributing factor.
  4. Stretch regularly to help lengthen muscles around the hip and glutes.
  5. Build in time for regular Sports Massage to help keep the muscles around the ITB tension free.