Pectoralis Stretch - Medical Massage

Pectoralis Stretch

Post-Event Sports MassageFor some reason, massage therapists that specialize in treatments of sport related injuries are calling this method sports massage. In my opinion, if someone sprains/strains the lower back, upper back, shoulder, knee, etc., by playing sports, working at home, or at the workplace, the resulting pathology due to this type of injury would disturb orthopedic status. Therefore, massage used in cases of back and limb disorders are called orthopedic. There is no doubt that there is a vast room for orthopedic massage available in sport rehabilitative medicine. It is proven that orthopedic massage therapy is a very effective tool in treatment of sports-related, industrial injuries, as well as in helping people experience less pain in cases of degenerative diseases of the support and movement systems such as osteoarthritis, degenerative disc disease and other types of spondylosis. Indeed, sports massage that is utilized only in sports industry is a pre-event sports massage and post-event rehabilitative sports massage. These two types of massage therapy are very important efforts in order to improve the athletes’ performances, to prevent sports-related injuries, as well as to eliminate side effects of exercise stress/overtraining. Twenty years ago, training in sports massage was limited to massage therapists who worked with professional and Olympian team. Nowadays, sports massage is valuable not only for professional athletes, but also for modern fitness enthusiasts. Paying attention to the behavior of today’s gym members, you will see people who are working out as if they are preparing themselves for competition, pushing themselves to the limit. In most cases, people don’t or forget to ask themselves, “Why am I in the gym?” If you are to ask this question, their answer will be “to keep (themselves) in shape and to contribute to (their) health.” But working out like a professional athlete, in the long run, causes more harm than good. Many people do not realize that professional sport-like training is not contributing to health. Professional sports, actually, are a tough and rough show business and nothing else. I don’t believe that we are capable of changing the minds of gym enthusiasts that vigorous exercise (which most gym enthusiasts are engaged in) is not a good idea. But there is no doubt that post-event rehabilitative sports massage can be of tremendous help to the health of these gym enthusiasts. Post-event rehabilitative sports massage that I offer was initially developed and proposed by Professor Alexander Dembo, MD, PhD from Leningrad’s (now Petersburg) School of Medicine in 1964. It is important for us to understand the side effects of intense exercise. They are: 1. Accumulation of higher resting tonus in the muscular structures all over the body leads to disturbances of microcirculation that causes soreness and/or pain in muscles, and disturbances of biomechanics. Biomechanical imbalances lead to compensatory movement which starts a chain reaction of negative factors, building like a snowball and leading to higher susceptibility to sports-related injury, development of myofascial pain syndrome, and more. 2. Vigorous exercise always causes microtrauma that naturally leads to small scar formations, which means adhesions of the soft tissues, etc. If these mini-scars will not be managed correctly, soft tissue loses elasticity, accumulates deposits of calcium and functionally shortness of muscles happen. As you can imagine, any attempt at fast movement in the presence of the above mentioned condition can cause significant tears in muscles, tendons, ligaments, herniation of discs, subluxations of the facet joints, etc. 3. At nighttime, over-tensed muscles, especially those of the lower and upper extremities cause a significant increase of peripheral vascular resistance. Peripheral vascular resistance is the main opposition to left atria cardiac work. The harder the cardiac work will be the more stress hormone production will be stimulated. Studies show (A. Dembo, 1962) that increase in peripheral vascular resistance occurs mostly between the hours of 1am-3am. As you understand, if this phenomenon will not be eliminated, it is hard to believe that people will rest at night as they are supposed to. Insufficient quality of rest causes development of chronic fatigue syndrome and can even initiate depression. Constant higher resting tonus of the muscular structures responsible for joint & spine stabilization and movement causes exhaustion of the joint cartilage, (fissuring of the cartilage, erosion), and can lead to significant arthritis development at an uncharacteristically young age of athlete. With time, an overworked heart can even exhaust the muscles and connective tissues of the cardiac structure. The evidence of overtraining is that in the morning when the gym enthusiast is waking up he/she feels a kind of tension and aches all over the body and feels tired. It takes a while for this person to walk themselves out of this condition, and they often need a warm shower, coffee or other energy boost drinks, etc. The next session of vigorous exercise becomes for them is like a drug. They begin to warm up, stimulating circulation, loosening up their tight muscles, and they start to feel better as the exercise stimulates endorphins production. They become psychologically and physiologically dependent upon maintaining this hard regime in order to feel good. It is very important to incorporate stretching techniques in full-body post-event sports rehabilitative massage. Full-body stretching techniques play a very important role in the maintenance of the results that we achieve by providing massage therapy. The importance of the role of fascia in our function is hard to overestimate. Stretching significantly helps to maintain normal tension in fascia and muscles, ultimately translating to stabilized a metabolism, which is a condition for good health. Goals 1. Reduce the tension in muscles and connective tissue. 2. Accelerate the drainage of venous blood as well as lymphatic fluid. 3. Reduce peripheral vascular resistance. 4. Balance the activities of the sympathetic and parasympathetic nervous system. Protocol 1. The duration of the treatment has to be between 40 minutes – one hour. During this time massage must be performed on the athlete’s whole body with special attention to the muscular groups which were overloaded during exercise or competition 2. Post-Event Sport Massage must be started no earlier than 2 hours after the event. 3. It is best to use a combination of effleurage, friction, compression, and long range shaking, however, at least 40-50% of the time must be spent on kneading. 4. Pressure could be significant, but must be increased gradually, in a way that will not activate the pain analyzing system. The client’s threshold of pain may vary from one part of the body to another, or even within the borders of the same massaged segment. Therefore, the pressure must be continually adjusted. Lesson #1 (the Back) Treatment sessions will vary from one client to another, therefore, a therapist must be able to adapt and improvise on how much time to spend performing each technique, staying within protocol (kneading techniques = 50% of massage time). Use lubrication unless otherwise indicated. 1. With flat palm of one hand, using large circles in the speed of 70-80 movements per minute, gradually increasing pressure, perform massage on all areas of back. 2. Continue this movement for the lateral/posterior neck muscles, making sure to support the neck with a flat hand on the opposite side. 3. With the ulnar side of the hand, using slightly smaller circles, gradually increasing pressure, perform massage all over the back. 4. Continue in a hand after hand manner with the ulnar sides of both hands, using smaller circles, gradually increasing pressure through several kneadings on each location. In each location, when the muscles allow you to go as deep as possible (sometimes almost to the periosteum of the skeleton) pause the kneading, fix the tissue, and then perform a fast slicing cross-fiber action. • Use ulnar sides of both hands together to perform large, heavy circles all over the back. • Stand in front of the client’s head. With both hands use the backs of the fingers to knead the lateral sides of the neck at the same time. • Perform petrissage #5 (elbow kneading) on all areas of the back. • Use power thumb strips technique for the quadratus lumborum muscles and lumbodorsal fascia. These strips may be continued into the gluteal areas. • Starting from the lower back area, create a fold of skin between thumbs and fingers and perform rolling-fold skin mobilization techniques (parallel to the spine) on the entire area of the back. Perform rolling skin fold technique from the lateral side of the back – push with the palms and heels of the hands to create the fold of skin moving at an oblique angle towards the spine, • With the back of the fingers, under friction action, massage all areas of back. • With the back of the fingers, by combination of stretching and knuckle compressions, massage all areas of the back. Techniques to influence the spinal erectors (in especial: the spinal rotators) • Using one hand, place the back of the fingers in the midline of the client’s back such that the spinous processes sit in the groove between the index and middle knuckles (metacarpophalangeal joints) and fingers (phalanges). • Stretch the skin and connective tissue up towards the client’s head. • With the free hand, separate the index and middle fingers of the working hand, so that they sit on either side of the spinous processes. • Without letting the stretched tissue jump back, keep the middle and distal phalanges secured to the client’s back while raising the proximal portion of the phalanges off the back. The final position of this is that the hand and arm are sort of “standing up” on the knuckles (interphalangeal joints) • Keeping the wrist straight, apply gradual pressure, thereby influencing the small, very deep spinal rotator muscles. (Therapist may use the other hand for additional support/pressure/control) Lesson #2 (the Hamstrings) • With flat palm of one hand, using large circles in the speed of 70-80 movements per minute, gradually increasing pressure, perform massage on all posterior areas of thigh. • With the ulnar side of the hand, using slightly smaller circles, gradually increasing pressure, perform massage all over the posterior areas of the thigh. • Continue in a hand after hand manner with the ulnar sides of both hands, using smaller circles, gradually increasing pressure through several kneadings on each location. In each location, when the muscles allow you to go as deep as possible (sometimes almost to the periosteum of the skeleton) pause the kneading, fix the tissue, and then perform a fast slicing cross-fiber action. • Using the elbow and posterior portion of the forearm (and try to use as proximal a portion of the ulna as possible), apply squeezing techniques directly on top the hamstrings, moving from bottom up. • With the arm half flexed, place the elbow (about 2 inches of the proximal part of the ulna) in the center of the hamstrings (between the biceps femoris and semitendinous muscles) above the back of the knee. Gradually apply pressure and use this elbow technique to separate the muscles by slowly moving up the leg. • Perform petrissage #5 (elbow kneading) on all areas of the hamstrings. • With the back of the fingers, under friction action, squeeze hamstrings from bottom up. • With the back of the fingers, perform combination of stretching and knuckle compressions on hamstrings. Lesson #3 (the calf) • Place the palms on both sides of the heel and use a circular friction to massage the heel. • With flat palm of one hand, using large circles in the speed of 70-80 movements per minute, gradually increasing pressure, perform massage on all areas of the calf muscles. • With the ulnar side of the hand, using slightly smaller circles, gradually increasing pressure, perform massage all over the calf muscles. • Continue in a hand after hand manner with the ulnar sides of both hands, using smaller circles, gradually increasing pressure through several kneadings on each location. In each location, when the muscles allow you to go as deep as possible (sometimes almost to the periosteum of the skeleton) pause the kneading, fix the tissue, and then perform a fast slicing cross-fiber action. • Using both hands at the same time, with the back of the fingers, under friction action, squeeze the calf muscles evenly (over both heads of the muscle) from above the heel up. (Stop the move and disconnect before reaching the back of the knee) • With the back of the fingers, perform combination of stretching and knuckle compressions on the calf muscles. • Stand at 2nd position in front of the calf. With both hands grab and lift the calf muscles between thumbs and fingers. Make sure the tissue is secure in your hands and squeeze the calf muscles by applying even pressure from thumbs and fingers. Option: In a situation where the client’s calf is very large, the backs of the fingers can be used to apply this technique. Use the backs of the fingers to lift the calf initially, and then evenly press together to apply pressure from both sides of the calf. Lesson #4 (the front Thigh) • With flat palm of one hand, using large circles in the speed of 70-80 movements per minute, gradually increasing pressure, perform massage on all areas of the thigh. • With the ulnar side of the hand, using slightly smaller circles, gradually increasing pressure, perform massage all over the thigh. • Now use this movement in a hand after hand manner with the ulnar part of both hands, using smaller circles, gradually increasing pressure through several kneadings on each location. As the muscles allow you to go as deep as possible (sometimes almost to the periosteum of the skeleton) use the ulnar part of the hands to perform a slicing cross-fiber action to finish the kneading in each location. • Using the elbow and posterior portion of the forearm (and try to use as proximal a portion of the ulna as possible), apply squeezing techniques directly on top the thigh, moving from bottom up. • Perform petrissage #5 (elbow kneading) on the thigh muscles. • With the back of the fingers, under friction action, squeeze the thigh from bottom up. • With the back of the fingers, perform combination of stretching and knuckle compressions on the thigh. The massage techniques for the rest of the body are mostly the same as our stress-management massage techniques, but the therapist should try to avoid initial pinpoint pressure (like thumb strips). When massaging the foot, utilize inter-osseous muscles mobilization techniques as well as the regular stress-management sequence. Power thumb strips may be utilized for the tibialis anterior muscle on the shin, & please perform stretching & compression on the lateral sides of the lower leg. Abdominal massage is the same as the stress management sequence. The chest massage also stays the same, but it is helpful to incorporate some petrissage techniques. (However, the stretching techniques will influence the pectorals much more than massage). Leave out thumb strips on the arms but make sure to include stretching/compression at the end of the sequence for lower and upper arms. (Simultaneous compression should be done for the biceps & triceps). Elbow techniques such as petrissage #5 are also recommended for the glutes, and it is also possible to incorporate techniques from the orthopedic massage for the lower back. Like stress-management massage, full-body post-event sport massage begins with the toes of the left foot. But like many of the When working in a regular schedule of sessions, it is best to begin with the client on his/her stomach for the first few treatments (starting with the back). After these first few sessions, the therapist may start the massage with the toes, with the client supine (like stress management massage). Full-Body Stretching Neck Stretches (seated chair position) Head Rotation 1. Stand behind the client, and make sure the client’s spine is fully upright. 2. With your right arm extended and draped in front of the client’s right shoulder, place the extended arm elbow against his/her shoulder (where the deltoid meets the pectorals). 3. Assess ROM by gently rotating client’s head to the left (hand on top of head). 4. Wrap your left arm around client’s head so that it is secured between your chest and arm. 5. Apply stretch by rotating client’s head to the left while securing the shoulder with your right arm. It is beneficial to stretch the client with the exhale. 6. Repeat for other side. Lateral Neck Stretch 1. Assess ROM by bending neck laterally to the left. 2. Place right extended elbow on top of client’s shoulder (slightly anterior, where the upper deltoid meets the trap). 3. With your left arm, hook your 3rd & 4th fingers under the client’s right-side mastoid process and rest your forearm on top of client’s head. 4. Apply stretch by pulling your flexed elbow (on top of head) down to the floor in a lateral motion while securing the shoulder. 5. Repeat for other side. Upper Trapezius Stretch 1. Assess ROM. 2. With your right arm extended and draped in front of the client’s right shoulder, place the extended elbow against his/her shoulder (where the deltoid meets the pectorals). 3. Place your left hand on top/ behind the client’s head. 4. Apply stretch by extending client’s head simultaneously forward and to the left while the elbow slightly pulls the shoulder back. 5. Repeat for other side. Back Stretches Seated Position Twist 1. Seat client on the front half of the chair, feet shoulder-width apart, with his/her hands locked behind the occipital, elbows out to the sides. 2. On the client’s right side, stand perpendicular to the client, and secure the right leg with your own right leg. 3. Place your right flexed elbow against the client’s right scapula, and cup your left hand under the lateral edge of the client’s left scapula. You may secure your arms in this position by hooking your right hand over your left forearm, close to the elbow. This position allows you to fix the client’s body for maximal control during the stretch technique. 4. Ask the client to straighten his/her spine, then relax all back muscles. Make sure to hold the client’s back in this upright position. 5. Apply stretch by turning the client’s upper body to the left as he/she exhales. Maintain the straight, upright spine throughout the duration of this stretch. 6. Repeat for other side. Upper Back/ Torso Stretch 1. Stand behind client. Place a pillow against the back of the chair, and have the client sit all the way back in the chair, hands clasped behind occipital, elbows out to the sides. 2. Fold elbows forward and together, then apply stretch to the upper trapezius by pushing the elbows down to the floor. (Do not flex the lumbar spine). 3. Slowly bring client back to an upright position, opening up the elbows and continuing the back extension until client’s spine is fully extended. Make sure at the end of this motion that the C-spine is being extended by asking the client to tilt his/her chin up. 4. A slight additional stretch may be applied by lightly pulling the elbows apart. Use just one or two fingers on each elbow. If performed, this should be very slight in effort and amount of additional stretch. Hamstring Stretch 1. With the client laying on his/her back, both legs straight and flat on the table, assess ROM by asking the client to raise his/her right leg as high as possible while maintaining full knee extension. 2. Have the client positioned close to the edge of the table, with the left leg bent. 3. Secure the right leg against your shoulder and support the extension of the knee and the neutrality of the foot. 4. Apply stretch by slowly moving forward. 5. Repeat for other side. Universal Back Stretch (active and passive stretch) 1. Client grabs the lower legs to bring both knees up towards chest. 2. Place one hand under the client’s head, and the other hand on top of the knees/ lower legs. 3. Ask the client to curl up in a ball as much as possible, then relax all muscles, while you continue to curl the client in by applying pressure with both hands. (This should be done in one continuous motion) 4. Repeat 2-4 times. Sacroiliac Stretch 1. Have the client bring both knees to a bent position, feet flat on table. 2. With your left hand secure the client’s left ankle to the right knee. 3. Place your right palm on the medial side of the client’s left knee joint. 4. Apply the stretch to the left-side SI joint by pressing the client’s bent left knee away (in the direction of the length of the table). It may help to apply the stretch with the client’s exhale. 5. Repeat for the other side. Groin Stretch 1. From the bent-knee position, have the client open the knees laterally and place the plantar surface of the feet together. 2. Apply the stretch to the groin by gentle hand pressure on the medial sides of the bent knees. 1. Have the client lay close to the edge of the table so that the left shoulder joint is free to move. (Client must be able to drop the upper arm down past the table height.) Assume a kneeling position next to your client’s left side (face towards the head side of the table.) 2. Extend the client’s left arm laterally at least 90 degrees from the body. 3. With your right arm and hand, fix the client’s extended arm by squeezing it against your chest (You may support the elbow extension with your hand.) Use your left forearm to support the client’s left shoulder joint. 4. Apply the stretch to the pectoralis muscles by bending down (lead with your head). It may help to apply the stretch with the client’s exhale. 5. Repeat for the other side. Subscapularis Stretch 1. Stand at the head of the table 2. Raise the client’s left arm, with the elbow at 90 degrees, above his/her head. 3. Place your left palm over the medial side of the client’s elbow, and wrap your right hand around the client’s wrist. 4. Apply the stretch to the subscapularis muscles by flattening the client’s elbow to the table, pulling the client’s hand to your (therapist) horizontal right. 5. Repeat for the other side. Quadriceps Stretch 1. Lay the client on his/her stomach. 2. Apply the stretch to the quads by bending the client’s leg at the knee, bringing the heel towards the glutes. You may use one hand to secure the client’s glutes/lower back area on the stretched side. 3. Repeat for the other side. Abductors/ Adductors Stretch 1. Bring the client’s left knee to a 90 degree angle. 2. The upper leg should maintain its position in-line with the body. You may use one hand to fix the hip joint (in the upper glutes region) to the table. 3. Rotate the upper leg by bringing the client’s foot lateral, away from the table, to apply the stretch for the abductors. 4. Apply the stretch for the adductors by bringing the foot to the other direction. (The client’s lower leg will cross over the right leg) 5. Repeat for the right leg. Plantar Fascia Stretch 1. Flex the client’s knee to 90 degrees, secure the heel with one hand, and grasp the ball of the foot with the other hand. 2. Stretch the sole of the foot by pulling the ball of the foot in a downward motion. // <![CDATA[ (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){ (i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','//www.google-analytics.com/analytics.js','ga'); ga('create', 'UA-11229883-5', 'auto'); ga('send', 'pageview'); // ]]>

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Anonymous says:

January 16, 2017 at 11:27 am

Ali

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