Chronic Injuries and Sports Massage

For many athletes, the injuries that have the greatest long-term impact are chronic injuries or injuries that occur over time with no obvious incident.  Chronic injuries include things like patellar tendonitis (aka Runner’s or Jumper’s knee), Achilles tendonitis, “shin splints”, shoulder impingement, IT Band syndrome, and bursitis to name a few.

With the exception of bursitis, all of these injuries share one common element.  That element is scar tissue as a result of microtrauma.  Microtrauma can occur from repeated overuse as seen in activities like distance running, swimming, jumping, biking, weight lifting, throwing, or any other activity performed numerous times in succession.  It can also be the result of a single injury such as an acute sprain, strain, or bruise that fails to completely resolve and is exacerbated by continued activity.

Once microtrauma has occurred the body begins the cycle of inflammation and repair.  Inflammation on it’s own is not a bad thing.  It is the body’s way of removing damaged tissues and preparing the site for healing.  Inflammation can cause problems when poorly controlled or when the healing is incomplete.  One of the results of this is the development of excessive or bulky scar tissue.  As the body heals it lays down rudimentary scar tissue without concern for future use.  This scar tissue should eventually be removed and replaced by more refined scar tissue and eventually fully repaired tissue.

It is important that old bulky scar tissue be broken down and removed by the body in order to break the chronic injury cycle.  Anti-inflammatory medications can help break the cycle of bad inflammation and pain, but do not actively address the formation of scar tissue in chronic injuries.  Sports massage, or deep tissue massage, is an intense therapy used to assist the body in breaking down scar tissue so that it can ultimately be removed through the normal cycle of inflammation and repair.

In addition, the use of sports massage can help to re-align collagen fibers as healing occurs.  This re-alignment is important to establish future strength in healthy tissues.  Based on Wolff’s law (and the expanded idea of Specific Adaptation to Imposed Demands), which says that tissues will adapt to the stresses placed upon them, increasing tissue stress during healing (carefully!) will result in a better overall recovery.

The other significant benefit of sports massage is that it decreases the overall muscle hardness.  Muscle hardness might best be described as abnormally high tension within the muscle.  This increased tension predisposes the muscle and tendon to injury.  Post exercise stretching can help reduce this (see the post about cool down and stretching here), but once chronic injuries have begun sports massage may be necessary to decrease muscle hardness to the point where stretching can maintain normal muscle flexibility.

Is sports massage something every athlete needs or should have regularly?   Not necessarily.  Some people never experience these types of chronic injuries and many injuries never become chronic because they resolve on their own.  However, if you are experiencing on-going symptoms that fail to resolve, sports massage (along with rehabilitative exercise) may help speed your recovery and may help prevent a re-injury in the future.

Dr. EagarDr. Eagar is a dual credentialed provider with degrees in sports medicine, chiropractic medicine, and exercise science.  Dr. Eagar owns Active Advantage, a private sports medicine practice with an emphasis on rehabilitation and chronic injury management.  He enjoys answering questions and can be reached at activeadvantagechiro@gmail.com.  For more general information you can visit his website http://www.activeadvantagechiro.com.

Shin Splints

Shin Splints TreatmentShin Splints!  This is likely the last thing that a runner wants to think about.  It’s a potentially complex problem with relatively simple treatments that no one wants to do.  With that cheery introduction let’s jump in.  The medical term is Medial Tibial Stress Syndrome and it encompasses everything on the continuum from shin splints, to bone stress reaction (think of it as pre-stress fracture), to stress fracture.  A variety of biomechanical forces can be at work here, but essentially it all comes down to too much, too soon.  You push your lower leg muscles into doing something they are not ready to do.

First you notice a muscle ache along the shin bone (most often on the inside) that lasts longer or is more intense than regular pains after running.  Later, this begins to be something that causes you to shorten or change your route.  It is often associated with increasing mileage or advancing hills (especially downhill) too quickly.

Treatment is relative rest from running, but not necessarily rest from exercise.  Cross-training is great and you really need to strengthen all the leg muscles, but especially those of the lower leg.  These are the muscles that are responsible for ankle motion and some toe movements.  I would like to refer you to a specific website that has a good combination of exercises, but I haven’t found one that I like yet (sounds like another project!).  Don’t forget stretching, a loose muscle functions better.  Ibuprofen in the early stages is helpful.  Ice massage (see Initial Injury Treatment) is a great technique that can help with swelling and prevent scar tissue formation.  When the pain has improved, a gradual increase of mileage and hills is essential to prevent re-injury.  A good rule of thumb is only increasing weekly mileage by 10% each week.Shin Splint Areas

There are a variety of braces and compression sleeves developed to help with shin splints.  Taping has also been used.  The idea is that compression will support the muscles and prevent some of the strain where they attach to the bone.  Individually, some people have improvement with them, but there is no scientific evidence out there that they do anything.  Arch supports may provide more support, especially in heel pronators or people with flat feet.

The MOST IMPORTANT thing with shin splints is DON’T IGNORE THEM!  As I said before, this is an injury that lies somewhere on a continuum.  By pushing through shin splints you can push yourself right into a stress fracture.  Stress fractures can be more difficult to heal than regular, traumatic fractures.  This can translate into months without running.

Matt Evans, MD

Dr. Matt Evans Dr. Matt Evans is a sports medicine doctor practicing with Utah Valley Orthopedics & Sports Medicine. Dr. Evans offers comprehensive Sports Medicine care for athletes and non-athletes alike, and his goal is to treat the whole person without surgery, if possible.