Decathlon athlete with tight hamstring SPORTS MASSAGE CASE STUDY: 1

SCENARIO....

The case study in question is a 20 year old student who is about to compete in a two day decathlon competition for his universi- ty team. He presents with limited range of movement in his right hamstring 30 min- utes before competing in the first of his ten events, the 100m sprint....do you agree with the approach our practitioner took?

SECTION 1 - PRACTITIONER’S NAME AND PATIENT’S DETAILS Practitioner’s name and clinic (if applicable), patient’s date of birth, name and address, sex, occupation, sport, event, position (where applicable), name and contact details of GP/team doctor.

SECTION 2 AND SECTION 3 - GENERAL HEALTH AND PRESENTATION Reason for visit: Could not achieve full range of movement in right hamstring General health: Excellent, very fit. No known allergies Previous history: Originally tore the hamstring at age 17 and has had problems ever since Previous treatment: Physiotherapy at the time of injury but no follow up or advice Medication: None Any surgery: None

SECTION 4 - ASSESSMENT Questioning: revealed previous history, dislike of doing flexibili- ty exercises and only paying lip service to warm up and cool down. Observation and movement: very fit, well-muscled young man but with slightly stiff movement patterns. Right hip flexion was 20 degrees less than left and the lower musculotendinous junc- tion of biceps femoris was scarred and showing evidence of loss of elasticity. All other ranges of movement could be improved by stretching. Medial rotation of both hip joints was reduced by 20%. Palpation: Sensation was normal, no low back problems, skin temperature normal. No evidence of skin abrasions cuts or rashes.

SECTION 5 - TREATMENT PLAN Treatment considerations: This patient did not stay in the area of the competition and was only going to be present for the two days of the event. Aims and objectives: To try and get enough relaxation into affected muscle tissue to allow safe participation. Explained that long term the damaged area would need to receive intensive care with correct mobilisation and conditioning. Advised to seek phys- iotherapy help at home and given contact details. Treatment: Pre-event - general massage to posterior aspect of right thigh and calf using stroking, effleurage grades 1 to 2, petrissage grade 1 to 3. This was followed by trigger pointing; acupressure grades 1 to 2 on specific areas and ended with

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myofascial release and proprioceptive neuromuscular facilitation. Range increased to allow good pattern of movement with no pain. Massage was administered before each of the five events on day one with ice massage being introduced between events four and five. Post event massage concentrated on gently loosening the tightest area and included use of muscle energy techniques and myofascial release. Day two started with slightly increased range but pain from mid to end. Massage was again administered before each event and post competition, with ice being used on each occasion. Outcome: By end of day two, the musculo-tendinous junction was slightly slacker but active trigger pointing with noticeable attachments to good tissue. Since this event, the patient has received full treatment from a physiotherapist and sports massage practitioner in his own area. He now has equal range in his left and right hamstrings and apart from a small, scarred area, suffers no further problem.

If you have any comments on the massage aspects of the treatment of this athlete - please send your comments to tor@sportex.net making sure you refer to the specific case study on which you are commenting.