By Zhenya Kurashova Wine
Originally published in Massage & Bodywork magazine, December/January 2001.
Having covered swimmers, runners, and even musical athletes up to this point, I chose to continue our sport-specific focus with a look at Russia’s (and Canada’s) favorite sport — hockey. While living in Russia, I had the privilege to do some work for the hockey team coached by the legendary Victor Tichanov. In fact, just before my immigration to the United States, the U.S.S.R. had won its second Olympic medal under his coaching. I can say first-hand that our hockey players received wonderful medical attention — preventively, as well as correctively. In fact, since Russian athletes are considered to be national treasures, the care they receive is of the highest caliber. The hockey players are considered to be in a league of their own when it comes to care, so I will offer some ideas for preventive treatments, as well as treatment of injuries we will see specific to hockey.
This past year I had a chance to work with two players from my local United Hockey League team, the Quad City Mallards, to help them solve some physical problems. In both cases, the problem was within the shoulder, and in both cases the shoulder injury was the result of a fall. But after taking a longer case history from the players, I found the shoulder in question had been aching prior to the injury. As I dug deeper into the players’ histories, I learned the aching went on for close to a year, and nothing of great consequence was done about it. Although hockey is definitely one of the most violent sports when it comes to contact, overuse of a body part will always lead to an injury – with or without the contact. Let’s first address the simple overuse injuries we see in hockey and easy ways of dealing with them.
Upper extremities are very important for a hockey player. The precision of the pass and the speed of a shot greatly depend on the strength of the shoulder/scapula and the rest of the upper extremities. The complexity of the shoulder contributes to many different possibilities of overuse. The most common muscles to get overused are deltoid (anterior and middle) and biceps group (although the biceps are quite built up on most hockey players). The shoulder is the area the hockey player will be strengthening in the gym, and the overuse usually occurs if the athlete was not going to the gym in his off-season training. There is a way for you to prevent this overuse by doing a couple of things.
First, make sure you get to see the athlete at least two times a week in the off-season. During this time, it will be up to you to keep the muscle strong. I recommend spending at least 12–15 minutes per extremity doing Russian Sports Massage. This type of sports massage consists of 65 percent kneading technique. If you plan to work on the upper extremities only, then the best, neutral physiological position is with the athlete sitting in a chair with a back. In my practice, I use a medium-sized office chair with rollers, and a pneumatic height adjustment, which allows the client to move easily and be adjusted to your height. I sit opposite the client with the middle of my chair’s seat placed at 45 degrees to the corner of the client’s chair (on the left or the right side, depending on the extremity I am working on). Whereas the client leisurely leans back, I sit on the edge of my chair (another office chair with the back off to act as a stool and positioned slightly higher than the client’s chair). I will use either a rectangular cushion from a cushion manufacturer or a couple of pillows I have in my office. The cushion or the pillows rest on both my and the client’s lap, and the client’s upper extremity is resting on the cushion, flexed at the elbow. This position allows you to have perfect access to the client’s shoulder, upper arm and forearm.
Begin the treatment with gliding motions over the deltoid muscles. Include posterior, anterior and the middle heads of the deltoid. Begin at the head of the humerus and proceed with gliding motions toward the underarm with the clasping hand, and following with the other hand once the first hand reaches the end of the deltoid. After a minute of this gliding you have sufficiently increased blood flow to the area and can now perform deeper motions. Start with the pressure stretching technique of the anterior deltoid and move to the middle and the posterior deltoid heads after 20-30 seconds. The best pressure stretching for the deltoid muscles includes cresting hand and heel of hand techniques. This type of touch will allow you to quickly warm up and stretch the muscle fibers, as well as fill them with arterial blood. This technique can be done in spirals through the muscle, and you may travel toward the shoulder and back to the deltoid attachment in the upper arm.
After a few minutes of pressure stretching of the deltoid, you are ready to move to kneading of the muscle. There are a few things to keep in mind when kneading the deltoid muscles. Do not glide as you perform the kneading, as the kneading technique is used to imitate muscle contraction. If you produce a glide during the kneading, the central nervous system (CNS) will consider the motion relaxing in nature and will change the effects you are trying to produce. As you know, exercise is not considered to be relaxing by the CNS, but rather stimulating in nature. Since we are trying to mimic the exercise effects with the use of kneading techniques, we will also try to stimulate the CNS just as exercise does.
At the same time your motions should have a rhythmical quality. In effect, you will be inching your way up the muscle with continuous kneading motions. The direction of your kneading is toward the shoulder joint (unlike it was in the gliding motion). This technique should be used for the majority of the treatment time, since the main goal of treatment is to strengthen (or to maintain the strength) of the deltoid muscles. You may have to introduce a few vibration techniques to break up the continuous kneading and prevent the muscle from cramping. The best vibration technique to use on the deltoid is moving vibration. To perform this motion, you want to place one hand on the anterior deltoid, and the other hand on the posterior deltoid. Make sure your whole hand touches the muscle, and that the heel of the hand and the pads of the fingers have complete contact with the tissue. Start to throw the muscle from one hand to another at a speed of about 150 motions per minute. When I say throw, I am using the term loosely. What I mean is not to violently throw the muscle, but rather toss it in between the two hands without losing contact with the muscle in the process. This procedure will assure the muscle remains healthy and strong, even if the muscle has not been used or trained for a period of time.
Preparation Before Treatment
At the beginning of the season, make sure you check the complete shoulder structure of the athlete. I recommend spending about one hour in preparing and assessing the shoulder function. The time is needed because there are a few areas to check:
1) Make sure the scapula and rotator muscles found under the scapula are not contracted and are strong. To check the scapular area, place the athlete prone on the table with arms placed by the sides of the body. Palpate the attachments of the scapula first. If you find them to be tight (which is common when the muscles have not been used for a period of time), you might want to increase pliability of the muscles first. This also will allow you easier access to the sub-scapular muscles afterward. Begin with gliding motions starting at the spine and moving over the scapula toward the underarm. Use your whole hand to do this motion in a continuous fashion (one hand begins the motion at the same place only when the other hand has reached its ending destination). After 30 seconds of gliding strokes, proceed to the pressure stretching techniques.
The best pressure stretching to use over the scapula is the heel of hand technique. You may move in spiral motion over the whole scapular area – like going in a circle with the spiral pressure stretching. Your downward pressure should be mild to moderate at first, and increase as the superficial tissue gets more pliable. After 10 minutes of the pressure stretching, you may find the tissue completely relaxed, and you will be able to progress to the sub-scapular muscles. Use the ulnar side of your hand to press under the scapula at a 30 degree angle; continue using the ulnar side of the hand to pressure stretch the muscles under the scapula. You may not have realized it, but you have already affected the sub-scapular muscles by putting the pressure on the scapula with the heel of hand pressure stretching. In fact, the scapula has acted as an instrument in pressure stretching the underlying muscles.
2) After the scapula work, I would seat the client and check the deltoid muscles. Make sure you palpate the deltoid attachments into the acromium process — I find the attachment may have scar tissue or even adhesions which have developed as the result of continuous muscle overuse. To increase elasticity of the deltoid attachments, use the four-finger pressure stretching technique. You may have to spend up to 10 minutes on the attachments alone, if the scar tissue is present, in order to affect some change.
3) This is when I check the athlete’s acromio-clavicular ligament. This ligament connects the acromium process and the clavicle. The normal ligament is quite strong and inelastic. If you find there is some give under your fingers, or worse yet, you feel the tissue having a mushy feeling, then you are dealing with a problem ligament. Increasing elasticity of the ligament will be your goal if there are problems with the tissue. Place your middle and index finger in the space where the ligament is found. Your pressure stretching motions will be very deliberate and slow moving. You will begin at the clavicle and move toward the posterior shoulder. This treatment will take you 5-10 minutes to perform, depending on the amount of damage done to the ligament.
4) After the acromio-clavicular ligament check, you will have to check the condition of the biceps muscles – pay special attention to the attachments. Pressure stretching, kneading and vibration motions should be performed for the biceps. Realize if the athlete has some actual problems with any of the structures I mentioned, they would need care for the problems that are present in order to prevent more serious damage in the future. Most treatments will be done as I’ve outlined here, and should be scheduled every other day for a period of several weeks.
In the next article we will begin to cover American football injuries, their treatment and prevention protocols.