Massage & Bodywork

January/February 2013

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Because ligaments are located around joints where thick muscle tissue is minimal, they are easy to access and ligament damage can often be detected with palpation. Consequently, the practitioner's knowledge of anatomy is key for identifying which specific ligament may have been damaged. Special orthopedic tests also exist that identify joint hypermobility that may result from a ligament sprain. These tests are highly valuable in determining the level of severity of a ligament injury and can help the practitioner make an appropriate decision about treatment or referral to another health-care professional. A primary role of massage in treating ligament sprains is to encourage fibroblast proliferation in the ligament so tissues heal faster. In addition, deep transverse friction also encourages mobility between the ligament and adjacent tissues. In many instances, massage treatment reduces tightness in the adjacent muscles that become hypertonic as a result of a sprain. In some cases, however, reducing tightness in surrounding muscles is not the best strategy. With moderate or severe ligament sprains, joint stability is compromised. Muscles then play an important role in helping to maintain joint stability in a hypermobile joint by becoming tighter around that joint. In this case, it is more valuable to work on the ligament itself to encourage lymphatic drainage to reduce swelling and work on opposing muscles, but not address the muscles in question. Muscle Strains A strain is a tensile stress injury to the muscle tendon unit that occurs when it is pulled beyond its capacity to withstand the tensile load. Strains occur in either the muscle or tendon 108 massage & bodywork Hamstring muscle group crossing two joints 4 The hamstring muscles are an example of a multiarticulate muscle group susceptible to strain because they cross more than one joint. 3D anatomy images. Copyright Primal Pictures Ltd. www.primalpictures.com. fiber; however, tendon fiber is far more resistant to high tensile loads, so more often the injury occurs in the muscle belly. It is also common at the musculotendinous junction where the two tissues interface with each other. Strains occur both as a result of chronic, repetitive loads, as well as sudden, high-force loads in an acute injury. Keep in mind that muscles are under high loads when they are shortening in a concentric contraction as well as when they are lengthening in an eccentric contraction. In many cases, strains are more likely to result from eccentric overload. january/february 2013 Consequently, it is valuable to identify if injury factors involved concentric contraction, eccentric contraction, or passive lengthening of a muscle. A chronic strain can result from lower-level forces repeatedly applied to a muscle over time until the muscle finally reaches fatigue and tears. In acute strains, the muscle injury results from a sudden, overwhelming force load that is more than the muscle fibers can withstand. Similar to ligament sprains, muscle strains are classified into three grades of severity: first degree (mild), second degree (moderate), and third degree (severe). Strains can happen to any muscle, but certain muscles are more susceptible than others because they are biomechanically more vulnerable. For example, multiarticulate muscles, such as the hamstring group, are those that cross more than one joint (Image 4). These muscles can be put under severe compromised tensile loads if both joints are in a position to stretch the muscle at the same time. If an individual is forced into a position with hip flexion and knee extension occurring simultaneously, as in a fall, there is far greater tensile load on the hamstrings than if that person is forced into hip flexion or knee extension alone. Muscle strains produce greater bruising because of damage to the highly vascularized muscle tissue. However, if the injury is at or near the musculotendinous junction, bruising may be limited, as that area has less blood supply. The pain of a muscle strain will be reproduced with active contraction of the muscle tendon unit during a manual resistive test (Image 5). Ligament sprains, on the other hand, are not painful during a manual resistive test because there is no significant stress placed on the joint during the movement. Muscle strains are also

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