This essay will explore the value of massage in the overall management of an athlete with lateral knee pain, and a diagnosis of Ilio tibial band syndrome. It will explore the use of massage generally then focus on specific techniques used in myofascial pathologies. It will also describe the techniques employed, the clinical reasoning for their choice and the relevant supporting evidence. The relevant anatomy will be discussed as well as the proposed influences of massage on these structures using current literature to support these hypotheses.
Massage has been used around the world for thousands of years for rehabilitation and relaxation (Weerapong et al, 2005). Massage is the treatment and practice of manipulation of the soft body tissues with physical, functional, i.e. mechanical, medical/therapeutic, and in some cases psychological purposes and goals. Massage has been defined as “a mechanical manipulation of body tissues with rythmical pressure and stroking for the purpose of promoting health and well-being” (Cafarelli and Flint,1992). Massage is widely used by the athletic population for a variety of purposes such as injury prevention, recovery from fatigue, relaxation, and to increase performance (Hemmings, 2001). Galloway and Watt (2004) report that at Major Athletic events on average 45% of physiotherapeutic treatment time was spent on massage, 80% of which would come under the ‘sports massage’ category. This led to the suggestion that specifically trained sports masseurs be included in the medical support team.
The popularity of sports massage is not in doubt; however Weerapong (2005) is clear in stating that there is “no evidence that massage can actually improve performance, enhance recovery or prevent muscular injury” (P246). The supporters of massage claim it benefits the individual via biomechanical, physiological, neurological and psychological mechanisms (Cash, 2000). Despite the evidence athletes, coaches and medical personnel continue to believe in its benefits, mainly due to anecdotal evidence and feedback. Whether that belief is misguided or the research has yet to pinpoint and measure the exact mechanisms of its actions is debatable (Moraska, 2005). Massage could be compared to stretching- the vast majority of sports men and women use stretching as part of their regimes, but the evidence behind it is also suitably vague (Gleim and McHugh, 1992, Thacker et al, 2004).
The use of massage in injury management is less contentious, and its use is widespread in addressing increased muscle tone, myofascial trigger points (MTrP) and abnormal thickening of connective tissues (Brukner and Khan, 2006). The existence of myofascial trigger points was observed by Travell and Simons (1998) and described as discrete hyperirritable spots in a taut band of muscle. These MTrPs may reduce muscle power and endurance and lead to abnormalities of muscle activation (Brukner and Khan, 2006). Gerwin et al (1997) showed, after training, successful interrater reliability in the diagnosis of MTrPs. These MTrPs can be treated by forms of massage, usually digital ischaemic pressure or sustained myofascial tension (Brukner and Khan, 2006). Lucas et al (2004) showed that by addressing these points massage plays a role in correcting the inhibition of optimal activation patterns.
Within this case study I have focused on two massage techniques; sustained myofascial tension (or release) and digital ischaemic pressure (trigger point release). Both of these techniques are described by Brukner and Khan (2006) P147-148.
Following an assessment (Appendices 1&2) a diagnosis of ilio-tibial band syndrome (ITBS) was made. It is generally acknowledged that this is the most common cause of lateral knee pain in athletes (Cash, 2000; Ellis et al, 2007; Fredericson and Wolf, 2005 and Noehren, 2007). It affects up to 12% of runners per year (Messier et al, 1995). The ilio-tibial band (ITB) is a thickening of the lateral fascia of the thigh,...
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