As an L.M.T at this time of year I see many clients with multiple running over use injuries (plantar fasciitis, shin splints, patellar tendinitis, IT band syndrome, SI pain/ dysfunction). As runners increase mileage and intensity to reach performance goals it is common to create myofascial irritation leading to compensation pain patterns that inhibits bio-mechanical function. Pain in a single workout that heals with rest and change of training tends to be a simple acute strain and a normal effect of being a hard training athlete. But continued or increasing discomfort with training may lead to a substantial soft tissue injury and should be evaluated by a health care professional.
Sports specific massage therapy can be a good tool to help recover from or even prevent an over use myo-fascial pain or guarding response. Myo-fascial manipulation breaks up adhesions and areas of congestion in muscle bellies and along tendon and ligament attachments. Soft tissue work opens pathways of circulation to help with ischemia (lack of oxygenated blood) and allow drainage of chemicals of inflammation (a byproduct of muscle metabolism) and the stretching of connective tissues to decompress pressure and pain receptors in the nervous system. A skilled sports massage therapist can sculpt myo-fascia along muscle compartments to improve bio mechanical function, increase range of motion at joints, free adhesions of scar tissue and improve tracking of muscles as they contract and expand.
When I work with athletes, I evaluate posture, alignment, passive and active movement, tissue health and areas of tenderness on palpation. Even with a specific diagnosed injury I will treat the whole structure to prevent secondary compensations that form with favoring the injured area.
A common injury of over use with runners is ilio-tibial band friction syndrome. The superficial, thick IT band runs down the lateral side of the leg over the vastus lateralis (outside quad muscle) and attaches on the tibia (lower leg) and is a stabilizer for both the hip and knee joints. Pain is usually at the outside of the knee but can also run up into the hip (flexor point). The muscle that actually contracts the IT band is at the anterior hip, the TLF, tensor fasciae latae. Gluing of the IT band on the quads can cause the knee to track lateral (to the outside) which rotates the leg and leads to compression and mechanical disadvantage.
The treatment calls for freeing the IT band along the quad, decompressing the anterior hip and knee, improving resting tension of myo-fascia in the legs. After warming the muscles (preparing for deeper pressure work) I perform specific myo-fascial release therapy on the quads to force the muscle bellies to the inside of the leg improving alignment along the upper leg, patella and knee joint. The goal is to basically move the connective tissue back to where it belongs (functional, anatomical position) and to maximize space. Expanding the connective tissue will maximize blood flow to the ischemic tissues and facilitate faster healing. After alignment work I treat any trigger points (myo-fascial knots) and create multi-directional friction to further free muscle fibers. A positive treatment should create pain free movement through full range of motion. The client should have a sensation of being looser, lighter and longer.
I will always treat both sides to create symmetry and prevent compensation and also coach the client on self treatment, stretching and strengthening exercises to keep the benefits of the session. A good sports massage session should include a client history with medical diagnosis from physician, functional assessment, treatment plan and execution and a rehab plan for the client.
I plan to have video of treatments of different common running injuries on the web site soon.
by Nate Graven – Licensed Massage Therapist | Sports Massage Specialist