Scraping 

Scraping is my term. It is basically the use of instruments to break down fascial restrictions and scar tissue. There are several brands of these sorts of tools: Graston, SASTM and Gua Sha. All 3 companies (there may be others) provide tools that one moves over an area to rid it of scar tissue.

Many of you may already be familiar with the Graston tools, thanks to your physical therapists. According to the Graston website “The technique utilizes specially designed stainless steel instruments to specifically detect and effectively treat areas exhibiting soft tissue fibrosis or chronic inflammation.”

SASTM stands for Sound Assisted Soft Tissue Manipulation – because yes, you can actually hear (and feel) the adhesions  as the tool is stroked over the skin. These tools are plastic, and very purple. We used these tools in the class that I took.

I have Gua Sha tools. The are also plastic, but have rounded edges that match the rounded contours of the body. I bought these since they were recommended to me, and since they are significantly cheaper than the other 2 brands. Gua Sha is an East Asian technique.

When using these tools over areas of adhesions, one will see redness (often small red dots) arise. Since the class, I have expanded my use of the Gua Sha tools. From my own experience, they are great at breaking up scar tissue around the ankles (as from an ankle sprain).

Cupping

Cupping involves the use of suction to stimulate nerves, increase blood flow and loosen adhesions. I already used this technique on people with severe tightness in their shoulders, and have  increased it’s use to other tight areas of the body.  Massage cupping involves the movement of cups over an area, simulating a massage stroke. Cups can be glass or plastic. I have flexible plastic ones which are easy to use. In areas of severe restriction, the skin will turn bright red with cupping.

Kinesio Taping 

I have been using Kinesio tape since 2007, and actually just wrote an article about it for the May 2012 issue of Running Times. Kinesio tape is a flexible tape that was developed by Kenzo Kase in the mid-1970s. It has recently become more popular, with numerous brands available now for self application.

When applied, the tape microscopically lifts the skin. This is thought to increase blood and lymph flow in the area, increasing circulation and reducing pain. The tape’s stretch properties can be used to assist in relaxing overused muscles and stabilizing joints. For more information see my article (which will eventually be available online at Running Times).

I only use Kinesio tape with specific injuries or on chronic trouble spots – ones that do not respond quickly to massage. Sometimes is appears to help, others not.  When it works, it helps by reducing pain and therefore allowing the client to continue with their activity as they heal. It does not solve the problem, but along with other modalities it can help you manage an injury.

If you have any questions about these modalities, or would like me to include them into your next massage, please feel free to ask. I charge extra for the application of Kinesio tape, to cover the cost of the tape. However, I can easily show you how to tape yourself. Cupping and scraping can also be done on yourself (depending on the body part), once you know how it works.  These are all great tools to keep you healthy and moving.

I was drawn to the the article because it clearly showed 11  stretches that “…have been selected because they are the stretches most likely to help runners increase flexibility and prevent injuries.” Stretches were shown for the legs, hips and low back. The instructions were 1) Contract the muscle group opposite to the area you’re stretching (assisted by a rope or your hands, to guide and then help deepen the stretch at the end).  2) Bring each stretch to the point of “light irritation” (I would say “gentle stretch”). 3) Hold for 2 seconds. 4) Return to the starting position and relax for 2 seconds. 5) Repeat 8-12 times.

AIS was developed by Aaron Mattes. The technique is based on the theory that if one muscle  group contracts, the opposing muscle group will relax. For example, by contracting the quadriceps, one relaxes the hamstrings. And the reason for holding each stretch only 2 seconds, is to bypasses the stretch reflex. The stretch reflex can cause an over-stretched muscle to contract. It is a way for the body to protect the muscles from being overstretched.  According to Mattes “Performing an Active Isolated Stretch of no longer than 2.0 seconds allows the target muscles to optimally lengthen without triggering the protective stretch reflex…”

Phil Wharton, along with his father Jim, studied with Mattes. Eventually the Whartons’ started to help other athletes with their injuries,  which included  introducing them to AIS. This summer a friend reintroduced me to AIS, and to Phil. (If you are interested in reading more about Phil and his work with athletes, please read this great article in Running Times by Scott Douglas).

One can view examples of AIS (or Active Isolated Flexibility as Phil calls it here), facilitated by Phil here. Also, an “Introductory Flexibility Program” of 7 stretches for the lower body can be found on Phil’s website.  Many of the stretches are shown using a rope, however one could use a towel, dog leash, yoga strap, or any other item that could help guide and deepen the stretch. Most of the upper body stretches require only one’s own hands to deepen the stretch.

Over the years I have adapted my stretching program to include AIS, static yoga poses, as well as Proprioceptive Neuromuscular Facilitation (PNF)* stretching. I often change which stretches I do depending on what muscles I am using the most, and find it useful to have lots of stretches (and stretching techniques) in my tool box.

Regardless of what type of stretching you do, please remember : 1) be gentle, 2) breathe, and 3) do at least some stretching every day. If you have questions about AIS, stretching in general, or specific stretches that would be best for you – please feel free to ask me.

*Proprioceptive Neuromuscular Facilitation (PNF) stretching: In PNF, the targeted muscle group to be stretched is positioned so that the muscles are stretched and under tension. The individual then contracts the stretched muscle group for 5 – 6 seconds while a partner, or immovable object, applies sufficient resistance to inhibit movement. The contracted muscle group is then relaxed and a controlled stretch is applied. The muscle group is then allowed  to recover and the process is repeated 2 – 4 times. PNF utilizes the golgi tendon organ, found in muscle tendons, which allows a muscle to more fully relax after is it contracted.

A study published last year tested the hypothesis that one of the ways massage aids muscle recovery from exercise, is by increasing muscle blood flow to improve “lactic acid” removal. It was found that massage actually impairs the removal of lactate (La- and H+) from muscle tissue after strenuous exercise, by mechanically impeding blood flow. This was reported on in the New York Times.

So massage may not help with lactic acid removal. But does that matter? It is now thought that DOMS is not caused by the build-up of lactic acid in the muscles. Instead, DOMS is attributed to inflammation and micro-tears in the muscle fibers. And the current research supports that massage can be effective in reducing DOMS.

But what about the lactic acid (or blood lactate) that we used to blame all our muscle soreness on? As it turns out, muscles make lactic acid to fuel cells not only in the muscle that produced the lactate, but also as an energy source that can be transported to adjacent muscles for fuel. Lactic acid is not simply the end result of an oxygen-deprived muscle, accumulating and resulting in muscle soreness. Rather it is an important intermediary in numerous metabolic pathways within and between cells.

The relevance to athletes is that “endurance training teaches the body to efficiently use lactic acid as a source of fuel on par with the carbohydrates stored in muscle tissue and the sugar in blood. Efficient use of lactic acid, or lactate, not only prevents lactate build-up, but ekes out more energy from the body’s fuel.”

Although more research needs to be done to support all these findings, we can stop blaming lactic acid for the muscle pain we feel after strenuous exercise. Could just be that it is muscle inflammation and micro-tears that are causing that pain – and massage might just reduce that muscle pain.

An article I recently read “Does Massage Have A Benefit To Athletes?” does a nice job of addressing this issue. The article breaks down massage into 1) pre-event, 2)post-event and 3) recovery (I would call maintenance) massage. I have never been a fan of pre-event massage. Few athletes have the patience to lie on the table, at least I don’t.  The massage will relax you, but could cause decreased muscle strength something you don’t want before a big event.

Post-event massage is often provided at races, and I don’t think it hurts, but I also don’t think it helps that much. One study showed that massage immediately post-activity decreased blood flow, and inhibited the removal of lactate and other metabolic byproducts. But in other studies, the results showed that massage may help boost immune function after exercise as well as help heart rate and blood pressure recover to pre-excercise levels.

So you could get a post-event massage if you want, especially if you don’t have to wait long in line. But in general I suggest, as the best way to recover from a race/event, an active post-event cool down (like a short jog) instead of standing in a long line for a quick massage.

It is the maintenance massage that I am most interested in as an athlete and a massage therapist. That is where the real work of going deep and releasing muscle tension can occur.  The temporary loss of muscle strength post-massage, at this time, is inconsequential (unless you plan on doing a hard workout post-massage, which I suggest you don’t).

Overall the data is mixed regarding the benefits of massage as a tool for recovery. Massage has been shown to increase relaxation, decrease muscle soreness (in some studies),  and aid in recovery.  More specifically “Massage did demonstrate specific benefit to aid in the recovery of damage caused by repetitive muscular contractions, such as endurance exercise, as opposed to an acute injury cause by a single motion.”  And of course, many studies have found that massage is relaxing (decreasing heart rate and blood pressure).

In closing, as an athlete (who has received massage for the past 18 years), and as a massage therapist of athletes for the past 7 years, I have found that maintenance massage can greatly benefit the athlete and help keep them healthy.

To continue on this theme, I want to emphasize the importance of healthy glutes for runners. There was an interesting article in the NY Times a few months ago about “Dead Butt Syndrome”. I have never heard of this condition before, but the author was diagnosed with this during her marathon training. As the author explains “The technical name of the condition I have is gluteus medius tendinosis — an inflammation of the tendons in the gluteus medius, one of three large muscles that make up the butt. It’s a very isolated and painful injury that knocked me out of marathon training in January with stabbing pains in my hip.”

Inflammation and scar tissue can develop in muscles that are strained from overuse. Specifically in this case – as a runner fatigues during a run, the stress on the gluteal muscles will increase causing inflammation and scar tissue in the muscles. View the article for a more in depth discussion of the stress on the gluteus minimus and medius muscles with running).

To make things worse, the gluteal muscles of many runners tends to be weak. As a doctor interviewed for the NY Times article explains “Whether they’re recreational weekend runners up to the elite marathoners, the majority of runners I see have weak gluteus medius and gluteus maximus muscles.”

So what to do to prevent gluteal problems? “For about 70 percent of his patients, physical therapy that stretches the muscles in the hip and leg and strengthens the gluteus muscles, along with a temporary reduction in the mileage and intensity of running, resolves the problem. Deep tissue massage, which sends more blood to the area to break up scar tissue, along with strength training may also help to break the cycle of inflammation and scarring.”

If you are having serious butt/hip problems – best to see a PT or other health care specialist first. But for most runners massage (either self-massage with a tennis ball, or massage from a therapist) is great for breaking up the scar tissue. With self-massage (use a tennis ball on the floor or against the wall) make sure you massage all along the pelvis – from the front near the hip flexor, around the side and all along the pelvis to the sacrum. If you have any questions regarding self-massage with a tennis ball, feel free to ask me.

And of course strengthen those glutes now, before problems arise. Some great exercises can be found here. I have done most of these with my own trainer Erica, who I can thank for my strong butt. As a runner I am constantly massaging and strengthening my glutes. It does take time, but it is worth it to keep healthy and running.

Numerous muscles cross over and attach around the knee. If these muscles are tight enough, pain can sometimes be felt where they attach. Please note that I will only address muscle issues that can be helped by massage. For more serious issues involving the inner workings of the knee that cause severe pain and/or swelling, please see a doctor right away.

There are 4 areas where one typically feels pain: the front (anterior) of the knee (in the area of the kneecap and slightly below), the back (posterior) knee, the inner (medial) knee, or on the outside (lateral) knee.

Probably the most prevalent knee problem I see (especially with runners) is pain on the outside of the knee. This is often caused by a tight iliotibial band (IT band). The IT band is a thick sheath of connective tissue that begins at the outside of the hip, continues down the outer thigh and connects at the lateral knee. When tight one might feel pain with activity (running), and tenderness with palpation right at the outer knee. Ice, stretching, massage, and self-massage with use of a foam roller, can be very effective in decreasing the tightness of the IT band and reducing/eliminating the pain. Here is a more in depth description and image of the IT band.

If there is pain just below the inner knee, it could be inflammation of the pes anserine. In the image on the left, the pes anserine is pointed out.

The pes anserine is where the tendons of 3 muscles meet. The sartorius (a muscle that runs across the front of the thigh), the gracilis (an inner leg muscle), and the semitendinosus (an inner hamstring muscle) meet and attach to the tibia at the inner knee. Overuse of these muscles (as with cycling or running) can cause tenderness in this area. Reducing the tightness of these 3 muscles (sartorius, gracilis and semitendinosus) by stretching and massage can reduce pain in this area. Self-massage with a foam roller can be preformed on all 3 muscles, as well as icing the pes anserine. For more info please click here.

Pain in the front of the knee (and slight below) could be related to tightness of the quadricep muscles and the patella tendon The large muscles of the quadriceps join together and form the patella tendon, which attaches right below the knee.

Stretching and foam rolling of the quadriceps can reduce this tightness on the front of the knee.

Pain behind the knee could be due to tight hamstrings or tight calves. The hamstrings cross the back of the knee from above. The gastrocnemius muscle cross the back of the knee from below. If any of these muscles are tight, one may feel tightness behind the knee.

These muscles can be loosened with stretching and massage, and again the foam roller works wonders for this.

There are also muscles in the very back of the knee that can get irritated and tight. I have worked with a number of clients with tightness in their popliteus and plantaris muscles. On the right is an image of where the plantaris is located.

For more information on the popliteus click here.

Unfortunately both muscles are difficult to access, due to the area’s vulnerability (an artery is located in the posterior knee). Please try not to access these muscles on your own. A massage therapist, PT or other health care professional will be able to get in and release the tightness.

This is not a full list of possibilities for those dealing with knee pain, but these are the issues I see most often in my active clients. For the most part, all of the above issues will come on slowly and if caught and dealt with early enough, do not have to cause an injury. If you are interested in a more complete list of possible knee injuries, please consult this site.

In the class I took, along with reviewing the muscles and learning new techniques to loosen them, we also discussed headaches. There are many causes of headaches, one of them being tension in the muscles of the neck and shoulders. Stretching the neck and shoulders is a great way to deal with this on a regular basis, as is massage.

Some examples of neck and shoulder stretches can be found here. This is a cool site because it shows you the specific muscles that are being stretched as well. Whenever doing neck stretches, remember to relax your shoulders down. Actually, remembering to relax your shoulders down on a regular basis is a great way to reduce the amount of overall tension in your shoulders and neck.

We also talked about research done with adults suffering from migraines (a severe type of headache). “The massage therapy subjects reported fewer distress symptoms, less pain, more headache free days, fewer sleep disturbances, and they showed an increase in serotonin levels.” People suffering from migraines have severely decreased serotonin levels, so this increase in serotonin levels is significant. For a look at this abstract and other massage therapy research check out this site. Scroll down to Headache to find the reference to the above research, along with other research finding that massage reduces frequency and duration of non-migraine headaches as well.

So take care of those shoulder and neck muscles. Massage and/or stretching them out now, could prevent more pain in the future.

A recent New York Times article reports on new research regarding muscle cramping. New studies have shown that muscle fatigue probably is the casue, and drinking pickle juice (or vinegar) can help to shortern thier duration (along with stretching).

The article states that certain mechanisms within muscles have been found to start misfiring when a muscle is extremely tired. And pickle juice may help alleviate these cramps, says one of the scientists (Dr. Miller) cited in this article, “by countermanding the malfunction. Something in the acidic juice, … , may be lighting up specialized nervous-system receptors in the throat or stomach, he says, which, in turn, send out nerve signals that somehow disrupt the reflex melee in the muscles. Dr. Miller suspects that ultimately, it’s the vinegar in the pickle juice that activates the receptors.”

Although it is only speculation, it gives us an idea of how to reduce the chances of their occurrence, as well as what to do once they start, if they do occur. They concludes that if muscle fatigue is the cause, “then training properly, building up your mileage slowly and perhaps adding strength training that focuses specifically on muscles that have cramped in the past, may help. In the meantime, if your calf or other muscle suddenly, painfully catches, “try stretching it,” Dr. Miller says. Doing so has been found in laboratory studies to significantly shorten the duration of a muscle cramp, most likely by shaking up and resetting the misfiring muscle and nerve reflexes. And perhaps, if you can stomach the idea, pack a few ounces of pickle juice on your next training session.”

Food for thought as we start the summer – hopefully with no (or less) muscle cramping.

Icing right after you workout is best. But for those of you in a hurry, you might not get to it until you are at work and sitting at your desk. For others it might not be until the evening while watching TV. It is all good. Better to ice later than not at all. Time-wise, the goal is 10-15 minutes of ice, but if you only have time for 5 minutes – 5 minutes it is.

There are a lot of ice packs out there, and it is worth it to invest in one. They come in different sizes and shapes, depending on the area of the body that it is used on. To check out the variety of ice packs available, click here.

I have one of the elasto-gel wrist wraps (for after those long hard hours at the massage table) and really like it. It conforms to the area to be iced (my wrist) and has a velcro band to keep it in place (useful if you are trying to do something else, like work, while icing). They are also nice because you do not need a towel between the pack and your skin. Here is more info about the gel ice/heat packs. Note that these (and many other ice packs one can purchase) can also be used as heat packs.

In general, unless you have specific needs, an all purpose ice pack in the 10” x 15″ range is good. However, one certainly can use a bag of frozen peas or just a plain old bag of ice instead.

In most cases (no need if using one of the elasto-gel packs) it is best to put a towel (not too thick a towel – or you won’t feel the cold) between your skin and the ice, to help you avoid frostbite or frost-nip. My experience with this, is that an area will turn white and hard. So check in with your skin as you ice, especially if you are going for 15 minutes. You can overdo it.

Ice massage is also a great tool. Freeze a paper cup filled with water. When frozen, peel off the top inch or so of paper to reveal the ice. Hold the cup in your hand and use the exposed ice to massage the sore area. Ice massage is great on shins.

Then there is that bucket of ice water for your feet/lower legs. This is great when you have a general soreness in your feet/lower legs – and are not up for a full ice bath.

If you are having plantar fasciitis issues (pain in the arch of the foot and going into the heel) a plastic water bottle filled with water and then frozen, can be great. Use the frozen water bottle to roll under your arch. A little ice massage to to reduce the inflammation and sooth the pain.

Icing can be a great way to reduce post workout/race soreness and pain, but unfortunately it is not a cure-all. If the pain persists and causes you to stop working out, or negatively effects your ability to workout (for example, if you run, it effects your stride so that you run differently), you should have it checked out by your favorite health care professional.

Note: Got some feedback about ice baths. A few personal tips I will pass on:

1) “I fill up the tub and dump in the ice right before I get in, but then I soak a medium-sized towel in warm water in the sink, and tuck it between my legs (kind of like a diaper) to protect certain parts of the anatomy that are most affected by and least in need of an ice bath. It makes the entry SO much easier!!”

2)”I’ve actually been sitting in my ice bath for up to 20-minutes, doing Sudoku puzzles with a heavy fleece on my top!”

I (Julia) read and wear a long sleeve shirt that I don’t care about getting wet. I need something to cover my tender tummy area.

Anything to get you through.

Enjoy!

I break icing down into 2 types: 1) icing a specific area and 2) “large-scale” icing to help general muscle recovery. I’ll deal with the specific area icing, usually applied to deal with a specific injury concern, at a later date. This post will deal with the overall icing of ice baths.

When you push yourself physically, you are stressing your muscles and causing micro-tears. In the long term this is a good thing, because when the muscles heal, they are stronger. However, this muscle damage can cause soreness a day or 2 after the hard effort.

The research that has been done on cold water immersion appears to be inconclusive. The theory is that the cold water helps to reduce the muscle inflammation, relieving the post-race/workout soreness, and speeds up recovery. However, enough people (like me) have tried their own experiments of one and found the cold water to help, hence the reason so many athletes are willing to subject themselves to it.

If you are one of the lucky few who can end their hard workouts near a body of water, getting your legs into the cold ocean/lake/stream/pond is perfect. Wade in up to the tops of your legs and enjoy the cold for as long as you can stand it (5-15 minutes). However, most of us don’t have that luxury. So to the bathroom we must go.

If you have ever attempted ice baths, you know how difficult it is to motivate to actually get in one. Kurt Perham, coach extraordinaire of Personal Best Multisport Coaching, suggests what I think is pretty reasonable, considering this difficulty:

Sit in the tub, with bucket of ice (I am thinking a few trays of ice) next to the tub and allow the cold water to slowly cover your legs. Once the water just covers your legs, turn it off and dump in the bucket of ice. Sit in it for 5 minutes, after which you can get out and drain the tub. However, if you are hard core enough, you will continue to sit in the tub as the water slowly drains out. Total time in ice bath: 10-15 minutes.

Kurt is not the only coach to suggest ice baths to his clients. I know many other coaches who do, as did mine back when I was running marathons. My coach, who lived in Boulder, CO, talked of runners wading into cold mountain streams. Sounded idyllic, but I had to settle with an ice bath in a tub. I should have succumbed to the tub more often. Sometimes in the summer (as lame as it sounds) I would just run the cold hose over my legs for a few minutes. If you can’t do the full 10 minutes in the tub – a few minutes of some sort of cold water is better than nothing, I think.

So, if you are looking for that extra edge that helps you recover quicker – try an ice bath, or ocean/lake soak. If your legs feel better then next day, then great! If not, then at least you can boast to your buddies about how hard core you are.