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Flashcards in Course Deck (116):
1

What is massage?

The scientific manipulation of soft tissues of the body for the purpose of normalising those tissues

2

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

3

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

4

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

5

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

6

When is it most important to rest?

In response to acute injury in the first 24-48 hours

7

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

8

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

9

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

10

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

11

When are Ice baths uses

Post exercise to reduce inflammation and flush metabolic debris from muscle

12

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

13

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)

14

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

15

Swelling issues

some swelling is inevitable but too much results in significant loss of function, excessive pain and eventual slowing of blood flow

16

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

17

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.

18

What does damage to muscles result from?

Direct trauma (impact)
Or indirect trauma (overstretch or overload)

19

Comprehensive assessment plan

Visual assessment
Palpating
Identify location of pain
R.O.M
Active resisted movement

20

Grade 1 muscle injuries

10% of fibres torn
Non palpable
2-3 weeks recovery

Pain but no weakness or loss of function

21

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

22

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

23

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

24

Cramp

Painful involuntary contraction of a muscle or muscles typically caused by fatigue or strain

25

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

26

What are the 4 tendon pathologies?

Tendonitis
Tendonosis
Tendosynovitis
Tendoperiostitis

27

Tendonitis

Inflammatory process

28

Tendonosis

Degenerative process

29

Tendosynovitis

Inflammation of tendon sheets

30

Tendoperiostitis

Inflammation of periosteal attachment

31

Types of ligament stability

Active stability- maintained by muscular activity
Passive stability- maintained mainly by ligaments

32

Common sites of ligament injuries

Knee
Ankle
Fingers
Shoulder

33

First degree ligament sprain

Fibres of the ligament are stretched, small tears (minor)

34

Second degree ligament sprain

Larger incomplete tear, from a 3rd to almost all fibres, (partial tear)

35

3rd degree ligament sprain

Complete rupture of the ligament, sometimes avulsing a piece of bone

36

Types of bursitis

Frictional, chemical and septic

37

Frictional bursitis

Occurs when a tendon repeatedly moves over a bursa

38

Chemical bursitis

Caused by a substance formed as a result of inflammatory or degenerative condition of tendons

39

Septic bursitis

Caused by a bacterial infection either from blood or from external environment

40

What are the stages of the healing process?

Inflammatory phase (4-6 days), proliferation/ repair phase (4-24 days), remodelling (21 days- 2 years)

41

Duration of the inflammatory phase

72 hours

42

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

43

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)

44

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

45

Chemical physiological effects of effleurage

Vasodilation and local blood flow are increased as a result of histamine

46

Mechanical physiological effects of effleurage

Increased Venus flow, increased lymphatic flow and reduction in oedema

47

Reflex effects of effleurage

Stimulates local cutaneous mechanoreceptors that moderate pain, initially increases blood pressure then decreases it

48

Light and slow effleurage does what

Good for lymphatic drainage

49

Medium to heavy pressure/ speed effleurage does what

Circulation and relaxation

50

Therapist contact points

Single handed
Double handed
Single reinforced
Forearm
Double alternating

51

Patient/ therapist relationship

Introduce touch to client
Increase blood flow
Warm the tissues
Putting the client at ease
Muscle relaxation
Palpating tissue

52

Use of petrissage

Used on deeper tissues for mobilising fluids, stretching muscle fibres and inducing relaxation

53

Different forms of petrissage

Muscle compressions
Kneading
Wringing
Picking up
connective tissue massage/ skin rolling

54

Types of kneading petrissage

Palmar
Thumb
Fingertip
Knuckle
Open-c

55

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

56

Muscle compressions

Pressing and releasing soft tissues with fingers and Palm of hands

57

Muscle compressions effects

Empties venous beds
Increase capillary flow
Relaxation of hypertonic muscles
Increase parasympathetic stimulation

58

Wringing

Applying equal pressure on opposite sides of the tissue structure, lifting and pushing in opposite directions

59

Effects of wringing

Decrease stiffness due to ischaemia
Loosens adhered tissues
Stretches muscle fibres
Maintains/improves muscle tone
Improves circulation to nerves

60

Picking up

Applying equal pressure on the sides of the tissue structure and lifting away from the body

61

Picking up effects

Loosens adhesive muscle fibres
Stretches muscle fibres
Maintain/improve tone
Increase circulation to nerves

62

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

63

Effects of skin rolling

Loosens adhered cutaneous and fascial layers
Stretching fascia
Superficial vascular flow

64

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

65

Effects of tapotement

Stimulates muscle
Helps maintain muscle tone
Helps improve muscle tone

66

Types of tapotement

Cupping
Hacking
Pounding

67

Shaking and jostling

A course of vibration applied to a muscle group or limbs

68

Rolling

An introductory or ending rhythmical oscillating massage technique applied to the body

69

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

70

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

71

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

72

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

73

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

74

Techniques used for post event massage

Effleurage
Light petrissage, wringing, muscle compressions
Picking up
Shaking/ rolling
Traction
Passive stretching

75

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

76

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

77

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

78

Reasons for doing a postural assessment

To get more information
To save time
To serve as a benchmark
To demonstrate caring/ professionalism

79

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

80

How to do a postural assessment

With client consent in a warm environment with the client standing in a relaxed position using a checklist

81

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

82

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

83

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

84

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

85

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

86

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

87

Classification of trigger points

Potential
Active
Latent

88

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

89

key trigger point

Has a pain referral pattern along a nerve pathway that activates or creates a latent trigger point

90

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

91

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

92

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

93

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

94

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

95

Met technique

20-30% effort
3-4 times repeat
Hold each for at least 6 seconds and last for 20

96

3 energy systems

Creatine phosphate system
Anaerobic respiration
Aerobic respiration

97

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

98

Anaerobic respiration duration

Lasts 1-3 minutes

99

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

100

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

101

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)

102

The parts of the spine

Chris tarrant loves sport cars
Cervical
Thoracic
Lumbar
Sacral
Coccyx

103

Types of muscles

Skeletal
Smooth
Cardiac

104

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

105

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

106

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

107

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

108

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

109

Ligaments in the knee

Medial and lateral collateral ligaments
Anterior and posterior cruciate ligaments

110

Symptoms of grade 1 ligament sprain

Tenderness over area
No swelling
Pain when ligament is stressed
1-4mm joint opening

111

Grade 2 ligament sprain symptoms

Significant tenderness over area
Swelling over area
Pain and laxity when joint is stressed
5-10mm joint opening

112

Grade 3 ligament sprain symptoms

Complete tear of ligament
Pain can vary, sometime less than grade 2
Instability
10-15 mm joint opening

113

Synovial joints

A particular type of join that allows for movement in the articular bones

114

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

115

Bursa

Fluid filled sac that reduces friction around a joint

116

Principles of training

Speed
Stamina
Suppleness
Skill