In this hour I treated a client who plays for the ladies British Universities and Collages Sport (BUCs) hockey team. They requested a pre-event massage and Muscular Energy Techniques (METs) on the hamstrings, in order to prepare themselves for the game on Wednesday. The aim of the session was to decrease muscle tightness and increase flexibility of the hamstrings.
Before I began the treatment, it was important to check to see if the client had any contraindications. Marjon Sport & Health Clinic use the acronym THREADS (thyroid cancer, heart, rheumatoid arthritis, epilepsy, asthma, diabetes, steroids) as a guideline to check for any possible conditions, that presents a treatment undesirable or improper (Batavia, 2004). It is also vital to be aware of any allergies the patient may have to the massage mediums. Once I began the soft tissue treatment on the hamstrings, I mainly used effleurage and petrissage, as I did not want to cause pain. This is because it is a pre-event massage so it is best to avoid deep tissue work. Effleurage stimulates the flow of lymph fluid that leads to increased drainage of waste products, as well as inducing relaxation and reducing abnormal muscle contraction so this method was chosen (Keperawatan, Petpichetchian, & Chongchareon, 2013). Keperawatan et al (2013) also stated that “all petrissage movements enhance blood flow”. Increasing blood flow transports more oxygen and nutrients to the tissues and removes waste products, promoting an efficient system while reducing muscle tightness (Findlay, 2018). I then used METs as they are designed to improve musculoskeletal function, pain relief and increase range of motion (ROM) (Dhinkaran, Sareen, & Arora, 2011). Before beginning, I checked the ROM by eyeballing each hamstring, so I can see if the treatment provided is effective in achieving the aim. Post isometric relaxation (PIR), which was used on the hamstrings, consists of performing a passive stretch, immediately after an isometric active contraction (Popa, 2014). There were two main reasons why I chose to used PIR over reciprocal inhibition (RI); the athlete did not have an injury so it was important to activate the target muscle/agonist and a study by Agrawal (2016) concluded that PIR is more effective in improving flexibility. Once I had performed METs on both hamstrings, 3 times, I checked ROM again. This concluded the session.
Areas for further improvement
As part of the treatment process, it is important to complete the clinical consultation form, so you can be aware of the clients subjective and objective history. In this session I did not carry this out because the client had specific treatment that they wanted me to conduct. In the future, I should consider completing the form, as it may show up other pathologies that are affecting the hamstrings or other areas. If I am aware of this it will allow my choice of treatment to be more precise, improving the effectiveness of it. To understand the effectiveness of the treatment, it is important to reference outcome measures. I did check the client’s ROM passively when using METs, but it should have also been done at the start and at the end of the session. I could have used the VAS pain scale to get an accurate representation of the amount of pressure I was applying when carrying out soft tissue massage.
Things to remember:
Agrawal, S. S. (2016). Comparison between post isometric relaxation and reciprocal inhibition manuevers on hamstring flexibility in young healthy adults: randomized clinical trial. International Journal of Medical Research & Health Sciences, 5(1), 33-37.
Batavia, M. (2004). Contraindications for therapeutic massage: Do sources agree? Journal of Bodywork and Movement Therapies, 8(1), 48-57.
Dhinkaran, M., Sareen, A., & Arora, T. (2011). Comparative analysis of muscle energy technique and conventional physiotherapy in treatment of sacroiliac joint dysfunction. Indian J Physiother Occup Ther, 5, 127-30.
Findlay, S. (2018). Sports massage. Champaign:Human kinetics
Keperawatan, C., Petpichetchian, W., & Chongchareon, W. (2013). Does Foot Massage Relieve Acute Postoperative Pain? A Literature Review. Nurse Media Journal of Nursing, 3(1), 483-497.
Popa , C. E. (2014). Study Regarding the Effectiveness of Muscle Energy Techniques in Treating Cervicalgias. Sports Society International Journal of Physical Education, 14(SP), 61-71.