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Massage Today
February, 2001, Vol. 01, Issue 02

A Sense of Direction

By Myk Hungerford, PhD, PT

To obtain peak performance in sports massage, an understanding of the sport, the athlete and the phase of the sport are essential.

On first observance of the athlete, note gait and posture, and gain a general sense of direction.

Posture will always play an important role in the athlete's performance and sense of well-being. Hans Selye, MD, Nobel Prize laureate, proclaimed, "Postural distortion is the beginning of the disease process"; Ida Rolf stated, "Gravity is a therapist, if we are functioning with gravity properly."

Dr. Jeff Rockwell refers in his lectures to the two types of sensory receptors: proprioceptors and nociceptors. Proprioceptors give information regarding muscle motion and position in space: whether the body is posturally correct. A nociceptor is a peripheral mechanism for reception of painful stimuli. Both proprioceptors and nociceptors send messages to the central nervous system. Proprioceptors travel at 120 meters per second, while nociceptors travel at .5 meters per second. Therefore, proprioceptive impulses reach the spinal cord much faster than nociceptive impulses.

We have ascending and descending nerve tracts in the spinal cord. These function to assure that we have normal posture and normal structure. Cumulative trauma such as birth trauma, repetitive motion, and repetitive use syndromes affect these sensory receptors, inhibiting them from firing into the brain. The result is alteration in our body posture. If there is not enough stimulation from mechanoreceptors (a special type of proprioceptor) due to quality of motion, there is not enough sensory input into our brain.

Pleasure feelings from proprioceptors, fired into the spinal cord, block nociceptor impulses. This is known as the gate theory, postulated by Melzak and Wall. The ascending tract filled with proprioceptive information blocks nociceptive impulses from ascending into the cerebellum.

There are eight phases of sports massage:

  1. pre-race;
  2. post-race;
  3. pre-event;
  4. post-event;
  5. inter-competition;
  6. intra-competition;
  7. restoration/rehabilitation; and
  8. training/conditioning.

Training/conditioning encompasses all seven of the other phases. Training and conditioning occurs when the athlete is competing against him/herself for PR (personal record) or PB (personal best). This article will concentrate on restoration and rehabilitation of the skeletal, muscular and nervous systems. The techniques may be used for prevention against injury and to keep an existing injury from exacerbating. Used in the pre-event phase, these techniques are adjunct to the warm-up regimen and help to prevent biomechanical dysfunction and imbalances. The outcome is enhancement of mental state; increased flexibility and neuromuscular responses; and kinetic system connective tissue and neuromuscular junction flexibility.

On Swimming

The more common injuries for swimmers are due to an overuse phenomenon. Other than diving injuries and bumping into other swimmers or the side walls of the pool, most injuries are overuse-related. Occasionally, failure to warm-up properly is also a contributing factor.

The most common injury in swimmers is a rotator cuff problem. The rotator cuff muscles hold the head of the shoulder in the joint; they are not meant to be overstressed by having the arm at an angle above parallel to the ground. All swimming strokes except the breaststroke place the arm in this overhead position, stressing these muscles as they are pulled through the water. The stress on the rotator cuff muscles is similar to that imposed by the throwing motion in baseball, or the serve in tennis.

When the swimmer's arm is in a full overhead position, the small rotator cuff muscles become stretched, allowing the head to slip around in the shallow socket. As it slips, the head catches the biceps tendons, pinching them and eliciting pain.

Hydrotherapy is highly productive with rehabilitation orthopaedic massage therapy. An hour of exercise in the water equals two or three hours on land. Horse trainers were among the first to recognize the benefits of hydrotherapy. They had thoroughbreds with sore ankles run through the surf. Also some professional baseball players swing a bat underwater to increase their strength, since water offers 12-14 times the resistance of air.


  • Sports Injury Handbook, Alan M. Levy, MD, team physician for the New York Giants).

On Cycling

Cycling with the body in a horizontal position puts all the weight at the cycle's saddle on the ischial tuberosities, the home of the hamstrings. As the seat is pressed into the saddle, the glutes and piriforms are squeezed. Padded cycling pants are helpful in this regard.

Penile numbness also may occur. The nerve behind the scrotum can be compressed against the cycle saddle. This is due to the front of the saddle being too high. The seat should be lowered; however, do this by small increments each week, not all at once. The sciatic nerve is often affected, causing pain in the buttock and sometimes radiating into the thigh and leg, causing sciatica. Sciatica is a condition, not a disease.

(Ilio Tibial band syndrome has been described as an overuse injury caused by friction of the iliotibial band over the lateral eipcondyle of the femur. Tenderness is felt, especially at 30 degrees of knee flexion. The ITB is both an abductor of the hip and a knee flexor and extensor. The ITB contributes to knee extension during the first 30 degrees of a complete circle, and will contribute to the last 30 degrees of knee flexion. At 30 degrees of knee flexion, it will cross over the epicondyle of the femur. Shortening or "tightening" of the ITB will affect mechanics of the knee, limiting internal rotation. When pedaling through a "12 o'clock to 12 o'clock" cycle, the knee travels once each through flexion and extension, forcing the ITB to cross over the lateral femoral epicondyle twice per 360 degrees of rotation. This continuous motion of the ITB over the epicondyle subjects the ITB to cumulative trauma.

Triathletes who crosstrain cycling and running are most susceptible to cumulative trauma leading to ITBS (iliotibial band syndrome).

Mechanisms contributing to irritation of the ITB include dysfunctional patellar tracking; excessive foot eversion with resultant pathomechanic knee rotation; increased Q-angle with resultant knee valgus stress; and a physically shortened ITB. These pathomechanics, in combination with repeated flexion/extension, can create ITBS.


  • ACA Endurance Sports Symposium, 1998, Kona, Hawaii.

On Running

More than 25 million Americans run regularly, with 70 percent sustaining an injury sometime during their running careers. Anatomical flaws, especially in the feet, lead to a great majority of problems. The surface you run on, the shoes you wear, and the way you train also influence your risk of incurring a running injury.

In general, sprinters suffer hamstring strains and tendonitis; middle distance runners commonly have backaches and hip problems; and marathoners complain of foot and leg problems.

Lower back pains are often caused by an anterior spinal muscle, the psoas. Pain may also be caused by a difference in leg lengths. Back pain is usually felt on the side of the longer leg, which takes more pounding.

When a runner with back pain has a pronating foot on one side and a supinating foot on the other side, suspect a leg length discrepancy. The body is trying to compensate by shortening the long leg with pronation and lengthening the shortened leg with supination.

The hamstring is the main driving force in running, making a hamstring pull one of the more common muscle pulls. If warm-up is not part of the athlete's program, the athlete is also at risk for a calf muscle pull.

"Shin splints" is a common catch-all term, used to describe pain on the inner side of the shin. True shin splints are caused by overuse of the posterior tibialis, the muscle that pulls the arch back up. This muscle contracts with every stride in response to stretching of the attached tendon. About 75% of shin splint pain is due to overuse of this muscle. Every time the foot is put down, the posterior tibial muscle strains to hold the arch up. In running a mile, the muscle is stressed 50-70 times per minute for each foot. Compression approximation is the treatment of choice. Place the palm of one hand above the pain and the other palm below the pain, press posterior, then approximate (pushing the hands toward each other).


  1. Sports Injury Handbook, Alan M. Levy, MD.
  2. Sports Health - The Complete Book of Athletic Injuries. W.M. Southmayd, MD, and Marshall Hoffman.

Costa Mesa, California (714) 642-0735


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