HAVE YOU EVER HAD JAW PAIN?? READ BELOW THEN

I recently met a friend for a coffee to find out he had been diagnosed with temporomandibular joint disorder (TMD) by his doctor.

He had been on painkillers and anti-inflammatories for several weeks and although the pain had eased off slightly he was still in quite a lot of discomfort. He had also been prescribed with antidepressants in order to treat his anxiety levels as according to the doctor the cause of the problem was stress related.

Although I was familiar with the condition and I had had clients asking me to treat their jaw and facial muscles,  this was actually the first time I was treating a client specifically diagnosed with TMD.

Basically this disorder affects the jaw joint and the muscles that control jaw movement. Well.. I thought.. As a sports massage/soft tissue therapist, technically a more correct term to describe my role, I do manipulate and mobilise soft tissue structures (muscles, tendons, ligaments and connective tissue) in order to regain functionality of injured joints. So I thought.. Let’s give it a go!

I explained to my friend that using some simple, non invasive and safe techniques could actually help him with the symptoms and the following day he came to visit me for a brief consultation.

It was just a 20 minutes session. All I did was basically using a technique called “soft tissue release” which involves stretching small areas of soft tissue. This technique usually helps me to “move things around”.. What I mean is that after an injury, trauma or stress caused by repetitive movement some fibers end up adhering to each other creating adhesions or more commonly known as “knots”.

In this  case the attachments of the joints were very tight. It just felt to me that the joints needed stretching.

It is now 2 weeks since the session and the pain has completely gone. He is aware that needs to keep an eye and if pain recurs he might need to visit a specialist to discuss ways of stopping grinding his teeth.

There are many conditions that cannot be just treated with some soft tissue work.. We all know it is not that simple.. If only.. But my experience tells me that when it comes to muscular and joint pain it is advisable to try alternative therapies and look for a second opinion before ending up taking several tablets per day for several days, weeks or even months.

Soft tissue therapy can ease off symptoms and decrease or eradicate pain completely allowing soft tissue structures to heal in a quicker and a more functional way.

Want to swim like a fish? Benefits of Sports Massage for swimmers

I recently treated a 19-year-old male client who is a regular swimmer. He was complaining from pain and stiffness in his right shoulder. The affected joint presented stiffness and tension at the insertions of some muscles crossing over the joint. Range of Motion (ROM) test on different planes confirmed restriction of movement.

It is common on swimmers to suffer from rotator cuff tendonitis or shoulder impingement due to a combination of factors such as overtraining or/and lack of rest, poor stroke mechanics, lack of stretching and/or warm up, insufficient “off-pool” activities such as weight lifting to strengthen rotator cuff muscles, etcetera.

Repetitive motion of the shoulder when performing backstroke, freestyle and butterfly strokes is the most common factor that contribute to this type of injury. When the joint gets overused muscles such as deltoids, rotator cuff, trapezius, latissimus dorsi and pectorals may be badly affected. The tissue becomes rigid and the fibers of the muscles adhere to one another due to the reasons mentioned above. It is important to treat the affected tissues as soon as possible to prevent further injury.

In this case client’s shoulder presented restriction on lateral rotation. Palpation revealed the existence of adhesions along some fibers of the pectoralis minor as well as tenderness of the subscapularis muscle. These 2 muscles internally rotate the shoulder and when they are tight they can limit external rotation of the joint.

It is important to emphasize that massage is contraindicated directly on the injured area in the acute phase. The patient often presents pain, the tissue is inflamed and the existence of fluid around the affected structures is common. However the surrounding tissues can be massaged as this will reduce edema and inflammation.

The strokes are best applied from distal to proximal starting above the swelling which will decrease the amount of fluid in the area. Once inflammation has decreased more invasive techniques (see below) can be used.

Techniques such as friction are effective in breaking down adhesions and scar tissue which restrict movement of the joint, loosening tight tissue and increasing blood circulation.

Muscle Energy Technique is another useful technique that helps to stretch and strengthen muscles as well as to break down adhesions whereas Soft Tissue Release (STR) relieves tissue congestion, improves elasticity and increases muscle length, making the muscle more mobile and increasing joint functionality.

Applying these techniques over a few sessions along some strengthening and stretching exercises for the shoulder allowed me to get the client back to the pre-injury state. The tissue of the affected joint became looser and more mobile, adhesions were broken down and those shortened muscles were lengthened.

Client confirmed by the end of the treatment sessions that he can now swim pain free.

I advised client to have regular treatment sessions not only to prevent injury but to maintain his muscles, tendons and ligaments in good health.

Remember Sports and Remedial massage can improve the quality of muscle tissue meaning less tension, less pain, less stiffness, more functionality, better performance… and the last but not the least: better quality of life!

 

Diabetes and Sports Massage – What do you need to know?

Diabetes and  Sports Massage

People suffering from diabetes are prone to nerve compression syndromes, prolonged gripping or direct nerve compression during weight training, cycling, running, jumping and other activities.

Long-term elevations of blood sugar can cause oxidative stress, damage and structural changes in joints. It may also cause imbalances between strength and flexibility around joints, for example, quadriceps versus hamstrings.

Some studies suggest Type 1 diabetes might have an impact on young athletes’ performance as a result of dramatic changes in blood sugar levels. It is also associated with heart disease. Hypoglycemia is a condition which can cause dip in blood sugar levels. Physical activity itself is also one of the factors which can cause dip in blood sugar levels.

Regular exercise can have a beneficial effect on people with diabetes however intense physical activity can make glycemic control challenging. Also sensation of pain diminishes in people suffering from diabetes.

Type 1 diabetes is treated with daily insulin injections as an individual suffering from this condition is unable to produce insulin.
Daily insulin injections can cause micro-traumas in the skin which could become a chronic issue. If insulin is injected into the same spot too regularly lipohypertrophy can occur as a result of accumulation of fatty, tough lumps underneath of the skin. Massage can help to alleviate these symptoms but as a preventive measure injection sites should be rotated. Regular massage will be able to improve the condition of that tissue which is not in the acute phase.

Sports and Remedial Massage may also help to improve the condition of an individual suffering from diabetes due to the following reasons:

  • it improves blood circulation and tissue fluid;
  • eradicates pain;
  • releases tension on affected tissues, and
  • decreases muscle hypertonicity.

It may also help to restore balance between those muscles around those joints affected by long-term elevations of blood sugar, improving their ROM (range of motion). Weak muscles can be strengthened and, at the same time, shortened muscles can be lengthened and stretched.

 

Watch out runners!

Ankle sprain

Ankle Sprains & Sports Massage

Factors that can increase the risk of this type of injury:

  • Poor ankle flexibility.
  • Weakness of soft tissue structures (muscles/tendons/ligaments) that cross the ankle joint.
  • Running on uneven surfaces.
  • Inadequate trainers or trainers “past sell by date”.
  • Previous injuries, especially those which were not rehabilitated properly.
  • Overtraining and lack of rest.
  • Gait imbalance.
  • Improper warm up and lack of stretching.
  • Inadequate joint proprioception and slow neuron muscular response to an off-balance position.
  • Poor hydration and inadequate training.

Assessing running technique, ensuring rest days are incorporated into routine and following a well-balanced diet can minimise the risk of re-injury. Warming up, stretching as well as using adequate running shoes may also help to prevent any further injuries.

The rehabilitation plan to get an injured ankle back to its full functionality should include the following steps:

Stage 1: Acute phase (Days 1 to 3)

Treatment at this stage consists of protection, rest, icing, compression and elevation (PRICE).
This helps to control and support the effects of inflammation.

The massage intervention should include passive movement mid-range, general massage and lymphatic drainage with caution, proximal to the injured area.

  • Support rest with full-body massage.
  • Strapping if necessary.
  • If the ankle does not improve after 3 days, medical assistance should be required.

Stage 2: Sub-acute stage – Repair and healing (Days 3 to 21)

  • Hot and cold therapy.
  • Controlled motion – Range Of Motion active and passive in mid-range – It helps to identify any compensation patterns.
  • Cautious and controlled soft tissue mobilisation of scar tissue along fiber direction towards injury – It promotes development of scar tissue.
  • Soft and light friction (not too early in sub-acute stage) can help to break down adhesions.
  • Light stretching, especially at the end of the sub-acute stage, may result effective in creating movement and increasing flexibility of the injured tissue.
  • Support healing with full-body massage

Stage 3: Remodelling

  • Active and resisted Range Of Motion (full range) along with progressive stretching.
  • Friction on injured site to break down adhesions and support alignment of scar tissue.
  • Full body massage to support rehabilitation activities.

It is important in all 3 phases to address muscle imbalances and compensation patterns. It is also vital in the rehabilitation process to decrease pain, reduce inflammation, increase ROM and regain strength and flexibility to prevent further injury.
Appropriate exercises immediately after sprain will improve function and recovery. Strengthening and stretching exercises, for instance, will help to improve ankle mobility.

During the rehabilitation process it is convenient to perform alternative activities (ensuring the injured tissue does not get involved) so the client can maintain their fitness levels. For example if a lower extremity injury occurs pool activities can be suitable. This will allow the client to start mobilising the injured tissue progressively.

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Why do some injuries take longer than others to heal?

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Keep reading and find out more about the physiological differences between different tissue types and how they affect the following conditions:

MUSCLE TEARS

Skeletal muscles are formed by millions of fibres. Some of them are called red fibres as they have a great capillary density, large amount of myoglobin, many mitochondria and large amount of glycogen.

Muscle fibres are arranged in bundles. Endomysium is connective tissue which fills the gaps between the fibres. The bundles are surrounded by connective tissue called perimysium. Arteries and capillaries enter the muscle at its ends and spread into the perimysium forming a perfect circuit which allows blood flow to enter into the muscle cells.

These fibres are designed to stretch and contract in order to allow a specific Range Of Motion. Tears will occur if we go beyond this range causing muscle damage.

Unlike tendons and ligaments muscles have certain characteristics such as excitability, contractibility, extensibility and elasticity, great good blood supply and the existence of millions of fibres within each muscle. All this means not only that the probability of muscle injury is lower but skeletal muscles have a greater capacity to repair themselves than ligaments or tendons.

TENDON STRAINS

Of all the tissues, tendons are the least elastic. Tendon attachment is the most important as it could be found everywhere where the muscle exerts its force of contraction across a joint.

A tendon is collagenous tissue that is highly resistant to extension but it is relatively flexible around bones or joints. It consist of fascicles of collagen fibres which run parallel to the long axis of the tendon. It is surrounded by white fibrous sheath called epitenon and there is also loose connective tissue between the strands in a tendon called endotendon which provides a route for vessels and nerves.

The most frequent site of injury in muscle strains is the myotendinal junction because of increased collagen content at the transition zone of muscle sheath to tendon. This area seems to suffer a lot of stress as it has decreased extensibility.

A tendon is surrounded by synovial sheath in areas where the tendon passes under a ligamentous band.

There is some synovia (just a few drops) within the tendon which function is to reduce friction between the inner and outer surfaces of the tendon. Although sparse there is sufficient blood supply provided by small arterioles entering the tendon from the adjacent muscle, veins and lymph vessels.

Unlike muscles, tendons and ligaments are passive structures that inherently do not produce movement so basically their tension depends mainly on their length. This means injuries involving tendons and ligaments are more common. At the same time lack of movement and elasticity means their healing response is not as good as the one happening in muscles.

When a tendon is strained inflammation occurs. A protein called fibrin is deposited between the layers of the tendon and the surrounding structures such as sheaths. The purpose of this inflammation is to mobilise and transport leukocytes (defence cells) to the injured area. This is the beginning of the healing process. Fibroblasts from surrounding connective tissue migrate into the injured area and assist to build collagen needed for formation of scar and therefore healing.

When a tendon end is left apart in loose connective tissue new fibrous tissue is formed to then surround the loose tendon which will blend with the connective tissue surrounding the tendon and tendon bundles.

However if a tendon is overstretched to the point of failure it will not be able to return to the original length and surgery will be required.

LIGAMENT SPRAINS

Ligaments are composed of connective tissue in which the fibres form a thick bundle. This tissue is mainly collagenous and is slightly elastic. The collagen fibers may run parallely or on all directions. They are very thick and tough.

Ligament sprains occur when the ligament is overstretched. As it happens with tendons when a ligament is overstretched to the point of failure it will not be able to return to the original length and surgery will be required.

As mentioned previously tendons and ligaments are collagenous which means they are harder, tougher and less mobile than muscles. At the same time their blood supply is not as good causing their healing response to be slower once injury occurs.

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