Injury Management



I was not there last week when some of the students were doing post-event massage for members of a cricket club, but I learnt that one of the players had a severe groin strain, so much so that the best of efforts at massage almost seemed futile as there was still much tension in the area when the student was finished.  The severity of a groin strain varies from mild discomfort to pain when walking.  Some persons experience spasm in the muscles and swelling along with the pain which can limit their activity.  Among other things excessive training and previous injury to the area can contribute to this.  As Therapists we need to remind ourselves and our clients that while an injury may occur in an instant, it may not be reversed as quickly.  Several massage and muscle-strengthening sessions per week may be necessary to bring about desired results, but painkillers are more often used instead.  Athletes should be reminded that it is their responsibility to engage in exercises to strengthen their core and adductor muscles.  A destabilized pelvis is a recipe for disaster in sports.

In the average organization a manager is a significant person.  Even when not respected because of their personality, respect is shown for the office they hold as the smooth running of the company is dependent on their performance.  Some managers are so important that they have lifetime contracts.  On the other hand, outside medical means, it is somehow felt that injury management requires calling in a Therapist for two or three sessions, during which time the condition should be remedied, if not the Therapist is considered incompetent.  Long-term contracts are seldom awarded to ensure consistently improved performance of the athlete.  I’m not sure that it is clearly understood that injury management exceeds remedial massage and that there is need for preventative maintenance as well as the client following the advice of the Therapist…which many professional athletes disregard as they are only interested in a quick fix that gets them back into their game.

The day after work was done at the cricket club we worked with a football team starting out with inter-event massages.  The Coach released a few players on whom we did massage then they returned to the game and a few more came.  There were two cases of groin strain here too.  The student who worked with one of the young men had him hold his genital while she worked the area.  Some of his teammates teased him.  This was not done because something may have jumped out at her, but rather because it is proper protocol.  It is always okay to get our kicks when we are not in pain, and in the name of contraindication it is okay for Therapists to consider massage of the groin as taboo, but it would have to be a waste of studying Anatomy and Physiology if we are not going to be able to help a client who has strained muscles in the groin because such might result in arousal.  I worked with the other player who had a similar problem.  After general effleurage I massaged the muscle attachments around the knee before going up to the groin which was very painful.  I also had him lift his leg while I palpated for the psoas muscle.  My intention was to release some of the tension in it from abdominal attachment and not just the leg.  Both players felt some ease and returned to their game.

The footballer with whom the student worked also suffered from back pains, so she attended to that as well.  As she did she brought to my attention that he had a curve in the lower spine.  The more we practice the greater sensitivity develops which allows us to observe abnormalities quicker and easier, this then enables us to plan and execute suitable treatment in the shortest time possible.  Exactly what is needed in sports massage.  When I was through with my client I went over see what she was talking about and did notice that the spine formed a C shape from the lumber area going into the sacrum.  One of the Coaches enquired what could be done to help.  What we were already doing, massage.  The team cannot afford to enlist a full-time Therapist, so I suggested that the young man maintain a fairly regular stretch routine and do self-massage as often as is convenient or get a family member involved.  Also, whenever such becomes economical, I recommended that he sees a Chiropractor.  Being involved in sports and having a slim structure have greatly aided his position, but in the long run his condition could result in early degeneration of the discs in that area.

Another young man I worked with had what he called dry skin.  His arms and legs had thick rough skin and he said he uses a prescribed cream for it.  Cream?  I have opted for oil.  The body is supposed to naturally produce oil, or sebum, to moisturize the skin, so dry skin would mean that the production system is defective.  An aromatherapy blend would be ideal, but this might be asking too much given the financial resources of low-income households; but maybe not, as these are the very people who find money to buy brand-name accessories.  And since we have great faith in Doctors, I am sure that had aromatherapy been recommended to his parents they may have made the effort to get the products.  Tea Tree oil which is sold in Pharmacies without a prescription could have been added to any base oil and used, and would have outlasted the many tubes of cream he has used, with consistently effective results.  Maybe the Doctor did not want to appear to be supporting natural alternatives, in which case he/she could have recommended it in the name of supporting the neighbourhood Pharmacy.

There is so much scope for Massage Therapists to be involved in health care yet we are not recognized on a scale that permits us access.  We are not trying to substitute, but rather complement the medical system.  The Pituitary gland and the Nervous system play significant roles in the production (or lack) of sebum.  Massage effectively balances both the Endocrine and Nervous systems, and in this client’s case, can result in the reversal of the undesirable condition of dry skin.  But this is what we have studied while the Doctor would have studied the pharmacological control of sebaceous activity and made recommendations along that line.  Hence much volunteer work has to be done to provide proof that massage works.  But even with the best of intentions not every Therapist is available to do volunteer work, so it would be most kind if the relevant authorities could be open to understanding the various ways in which we could be of help and provide compensation to encourage our participations.  Let’s remain hopeful that that day will come.

While sports massage has been around for ages, many athletes still don’t benefit from it, and the attitude of their superiors partly contributes to this.  I have heard one Coach express the opinion that athletes these days are too pampered.  In his time there were no massages.  Injury management basically involved sports psychology – the kind where the athlete went home after a game, got out his knife and fork, sat at his dining table, and heartily ate his pain while reminding himself that he is an important part of the team, his team mates need him to do his best, and challenge himself to mentally focus on the upcoming game which the team is expected to win.  All this massage stuff is dulling the senses and the winning streak that was a norm when players played for no or less money, with no or less Therapists flitting about, is no longer prevalent.  I hear him loud and clear.  In his book, stretching is good enough.

True, stretching is very good.  Warm-up and cool-down stretches are necessary for the athlete, but tight muscles can persist even after stretching which can increase the possibility of injury during a game, so pre and post-event massages are also important.  In the name of health I do my share of stretching often enough.  Tai Chi is my preferred method.  On Easter Monday I headed out at 5am doing some walking Quigong.  I use Quigong as a warm-up to Tai Chi as I had mistakenly (on several occasions) underestimated the extent of the stretching Tai Chi requires and strained a few muscles.  So there I was walking down the road executing the postures when in the distance I saw a lady walk of a street and stood at the corner waiting for transportation.  As I got closer I could see that she seemed afraid.  Closer still, I was able to hear her saying: ‘In Jesus name.  In Jesus name’ and behaving as if danger was imminent.  Maybe she should have said: Jesus, lover of my soul, let me to Thy bosom fly  and she might have been zapped from the road corner all the way to Heaven.  I continued what I was doing and left her to work out her salvation.  It is always interesting how things that are outside our frame of reference can be deemed evil.

Diet is also to be considered in injury management.  It is the responsibility of the Massage Therapist to be aware of what is taking place in the world of nutrition so that he/she can offer sound advice to the client.  This information is not to be solely based on what is read or seen, but also that which occurs in one’s body.  Detoxifying is suddenly relegated to spa treatments and services offered by the upsurge of health clinics, but the body cannot wait until our next appointment to detoxify, so a little must be done each day to relieve the body of toxins which delay the healing process.  Our systems were built to function in the Garden of Eden where there was no concept of waste.  Back there whatever was eaten cycled several times within us until it was all absorbed; given the current state of our environment, and our eating habits, this default system is no longer the best thing for us.

‘Re-hepatic uptake’ as it is called, allows the liver to reabsorb the toxins it would have dispelled 8-10 time before the waste reaches the anus.  The longer the transit time in the intestine, the more junk ends up back in our blood stream.  So by the time we would have had a bowel movement, we are sure candidates for detoxification.  Laxatives work well, but must be limited as they strip our bodies of electrolytes.  Quite a plight, which certainly gives us an insight as to just how ‘cursed’ we are outside of the Garden.  And while many continue to blame Eve, I blame Adam, because Eve was just a projection of himself.  Whatever she did was what he wanted to do all along but the self-righteous side of him dared not.  I could only imagine how glad he was at the opportunity to be able to make mischief through her in hope of not having to face personal consequences.  I guess he did not know his God too well.  Anyway, when we are done blaming, we are still stuck in these bodies which we have to learn to manage, and in turn assist our clients with theirs.  We can explore herbs that heal and cleanse the body, as well as consider enemas.

When Adam moved from a state of perfection to imperfection that could have been considered an injury that required serious management; so serious that we are still making efforts to manage it today.  Instead of seeking the solution in his Creator he opted for denial – an unnatural option.  And so it is with us, and even with some of our clients, in a split second injuries are sustained that could have been avoided because we knew better, and to add insult to injury we reach for synthetic solutions, clearly demonstrating that we are all projections of a flawed man, which means Adam is now a total schizophrenic with the billions of personalities he has.  Like him we too go into denial or engage in further injurious behavior after we are injured.  Thankfully, though we are no longer in the Garden we still have access to natural means of recovery – massage being one of them.  And so we make the effort to help our ‘fellow man’ up from a fallen/injured state recognizing that I am you and you are me, and in helping you I am helping myself to heal.  It is in this understanding that compassion flows through us and adds quality to our touch to facilitate healing.  Compassion make us less paranoid about the transference of negative energy…less preoccupied with technique…more willing to be patient with the process…more hopeful that our combined intentions will result in the desired outcome, that being the return to a perfect (perfectly flawed) state.