Injury in General

Chapter 15


Injury in General




Objectives


After completing this chapter, the student will be able to perform the following:


1 List the common causes of physical activity injuries.


2 List injury prevention strategies.


3 Define trauma.


4 List the three healing phases.


5 Describe acute and chronic inflammation and relate the inflammation process to the three stages of healing.


6 Define illness.


7 Estimate general healing time for various injuries and illnesses.


8 Perform PRICE application.


9 Create effective strategies for massage application for acute, subacute, and remodeling phases of healing to support the recovery process.



Key Terms






















































The focus of the first unit of this book was on sport function and fitness, including an anatomy and physiology review and research relevant to sports and fitness massage. Unit Two covered the benefits of massage for recovery, performance enhancement, and injury prevention, and provided a detailed series of massage applications. This third unit describes the application of massage therapy for sport injury recovery, including rehabilitation protocols featuring massage. All methods that will be used to address the injuries in this unit were presented in Unit Two, and specific sequences for applying these methods are found in this unit.


Unfortunately, athlete injury is common. Various injuries are the major reason why persons participate in physical rehabilitation programs. Those who are deconditioned; who overtrain, especially when fatigued; or who practice and play fatigued are more prone to injury and illness.


The usual experience in conventional treatment is to restore normal function when someone is injured. But in sport, there is no acceptance of “normal” function in terms of strength, speed, or movement. Most athletes continually try to push themselves to new limits, and no matter how carefully they train, they inevitably will be injured from time to time.


Actual treatment of an injury may be the same for athlete and nonathlete if the pathologic condition is the same, but the thinking behind treatment of a sports injury is different. If someone sustains an injury falling downstairs, the event probably will not happen again. Once healing occurs, the injury event can be forgotten. However, if an overuse injury is caused by some component in a sports activity, or if a traumatic injury such as an ankle sprain occurs, effective treatment alone will not necessarily prevent it from recurring. Identification and changing of any component of training that may be causing the overuse or injury potential is vital to prevent recurrence of the injury. In many ways, this is the most challenging part of the massage therapist’s assessment process, because it requires careful questioning and a detailed understanding of the training methods used.


Most athletes hope to reach a level of performance slightly beyond that which they will ever actually achieve. They want to be “better,” not “normal,” and the massage therapist must be aware of this goal of the athlete. The overall aim of treatment therefore must always be to strive to enhance performance, regardless of the current status of the athlete. A major risk in the quest for enhanced performance is injury.


The primary therapeutic massage outcome is prevention of injury, as described in Unit Two. Sports massage has great potential in this area. This is why many top competitors use it as an integral part of their training regimen. With regular massage treatment, the athlete is more able to sustain high levels of performance without getting injured. The massage therapist should measure success not by how well he or she treats an injury, but by how few actual injuries the therapist treats. The great preventative benefits of massage are not yet widely exploited by the recreational athlete. This is something that needs to be promoted through education and greater public exposure.



Common Causes of Physical Activity–related Injuries





Inappropriate Training


Inappropriate training occurs when a particular aspect of training leads to injury. The best training for a particular sport is to actually do that sport, because the musculoskeletal system naturally develops in a balanced way in relation to the demands placed on it. Weight training or other gym work that adds to the particular strengths and skills needed for that sport is also recommended. Problems occur if the main power muscles have been strengthened, but the smaller muscles, which have a synergistic or stabilizing function in the activity, have not also been strengthened. Injury occurs because the increased demands cause fatigue, and natural movement patterns are affected, leading to other problems. Many of these problems are due to compensatory patterns that develop.


Injury potential increases when athletes mix their training styles. Endurance athletes, for example, often do some anaerobic training to improve their speed, or sprint athletes may do some endurance training to improve their stamina. However, if this is overdone, damage may result from using different energy systems and working the muscles in a way that might not be best suited to them.


Doing different types of exercise is certainly not a bad thing and is a vital part of many athletes’ training schedules, but they need to be incorporated appropriately. This situation also is seen when a person participates in two or more different sport activities—for example, basketball and golf, or soccer and bowling.





Postural Deviations


Postural deviations are often a major underlying cause of sports injuries. Postural misalignment may be the result of unilateral (one side of the body) muscle and soft tissue asymmetries or bony asymmetries. As a result, the athlete engages in poor mechanics of movement (pathomechanics).


Common postural imbalances include the following:



• Cervical lordosis: short upper erector spinae. This usually occurs as a postural compensation for a thoracic curvature. The sternocleidomastoid muscles may not be weak, although they may shorten and become tense.


• Thoracic kyphosis: weak erector spinae; short abdominal and sternocleidomastoid


• Lumbar lordosis: short lower erector spinae; weak abdominal muscles


• Forward-tilting (anterior) pelvis: short gluteus maximus and rectus femoris; weak abdominal muscles, hamstrings, and iliopsoas


• Backward-tilting (posterior) pelvis: short hip extensors, abdominal muscles, iliopsoas, and hamstrings; weak rectus femoris


• Rotated (left or right): short and tight structures in concave areas; long, taut, and inhibited muscles and structures in convex areas


• Swayback (hyperextended) knees: short calf muscles and rectus femoris; weak hamstrings


Distortions can occur as well in many lateral and rotational directions. These distortions involve imbalances between postural muscles on either side of the body, as well as reciprocal imbalances in muscles of the torso. None of these postural imbalances occurs in isolation. An imbalance in one area generally leads to development of imbalances in adjacent areas as they compensate. Combined positional distortion patterns include upper crossed, lower crossed, and pronation distortion syndrome. These patterns can occur singularly or in combination with each other (see Chapter 10).


Muscle imbalance can lead to problems in bone structure. Structural bone problems lead to muscle imbalance. Both problems need to be addressed, and although the massage therapist cannot treat bone structures directly, working with soft tissue can be beneficial.


No single answer has been found for these postural problems. Significant improvements usually require a variety of specialized skills to achieve muscle balance, structural alignment, and joint function.



Muscle Weakness


Muscles may become weak because of a combination of injury, lack of use, and nerve inhibition. Once the root cause of the muscle weakness has been resolved, normal use, or exercise, should be able to restore muscle strength. However, the body learns to adapt and compensate for small areas of weakness. Because of the complexity of the muscular system, altered movement patterns avoid use of weak muscles but still allow performance of daily activities. The weak muscle does not get the exercise it needs and does not improve.


Whether nerve stimulation is the cause or the consequence, nerve stimulation to a weak muscle is reduced, and eventually nerve function becomes poor. Nerve conductivity improves quickly when the muscle is stimulated. This is why great improvement in apparent strength occurs at first when one starts a new sport or activity. Increased nerve stimulation, rather than true strength, is responsible. When the specific muscle that is weak is isolated and is made to work, the nerves are stimulated, and this rapidly improves its function. In fact, real improvement usually can be felt after only four or five contractions, and the functional effect sometimes can be remarkable. The client immediately feels better movement and therefore uses the muscle(s) more normally. Correcting gait reflexes and firing patterns as described in Unit Two is an example of neural stimulation.


In the long-term situation, nerve conductivity may have become so poor that the client has real difficulty in creating any movement and feels that he or she does not even know how to move the area. It becomes necessary to address the situation with passive movements, with the client feeling and experiencing the movements. The massage therapist moves the area with the client assisting and watching the movement before progressing to the full active method.



Lifestyle


The general environment in which the athlete lives, practices, and plays can involve unduly high levels of stress, and this can have a direct effect on the structure of the body and can contribute to injury. Increased mental demand and worry can drain energy, leading to muscular fatigue and tension. A poor practice or a competitive environment that is cold, damp, or noisy can add to the physical stress. Inadequate or ill-fitting equipment also can be a factor. A history of previous injury creates the potential for future reinjury. Lack of sleep, distraction and unrealistic performance expectations, poor nutrition, and use of dangerous substances such as ephedra can increase the potential for injury. Any and all aspects of life may contribute to an injury situation.



Psychological/Emotional Factors


Psychology and emotion play a part in all aspects of life, and injury is no exception. In some clinical situations, despite good and apparently effective treatment, the client continues to suffer painful symptoms. Some persons seem to suffer continually from one injury or another. A person may hold onto an injury because it satisfies other needs (secondary gain). The injury may provide the client with support and sympathy from persons around him or her. Injury also may provide an excuse to avoid activities or to avoid failure. It makes a good excuse for poor performance as well. Continuing in the sport or activity despite the pain makes the athlete appear to be a martyr. Therefore, these clients will have had the problem for a long time and will have already seen other therapists. Massage treatment alone may lead to slightly improved symptoms for a few sessions, but then the client usually moves on to another therapist and starts again.


Although there may be physical or medical reasons for the client’s symptoms, underlying psychological factors also may be influencing the situation. This is not an area in which the massage therapist should attempt to work; however, it is important to be aware of the possible effects of these emotional influences. The massage therapist must accept that the pain the client feels is usually real, and to say that there is not a problem would be wrong. The massage therapist should not attempt to deal with the psychological aspect of the injury and should refer the client to the appropriate specialist. However, having an empathetic listener sometimes can help the client see the problem for himself or herself.

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Jun 22, 2016 | Posted by in MANUAL THERAPIST | Comments Off on Injury in General

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