Athletes go through injuries a considerable amount of times and these injuries often lead to a lot of complications that restrict the body flexibility that these athletes so desperately need. It has to be mentioned in this context that the sports injuries can have a devastating impact on both the fitness and reflex of the athletes, and a very common sports injury that the athletes often suffer from is the lower cross syndrome. This pelvic cross system is the distal distortion of the in the dorsal and ventral sides of the body (Been and Kalichman 2014). However, there are certain advanced sport massage techniques like gluteal activation therapy and deep pressure techniques that can relieve the patients of the complications that are the result of such injuries. This assignment will focus on the lower cross syndrome and the lumbar lordosis associated with it, and how the different advanced sport massage techniques can help the patient recover faster.
In this report, Advance sports massage techniques applied to athletes and how it’s said to enhance and benefit the performance as well as also supporting the rehabilitation of athletes will be known. A discussion on how the therapist applying sports massage techniques can help the recovery of athletes, who have encountered Lower-crossed syndrome (LCS), will also be identified.
When there is a characteristic pattern of dysfunction of musculature tone of the pelvic girdle/lumbosacral region of the body such as the L4-L5, L5 S1, SI joint and the Hip joint, this is considered LCS.Page,(1967) states that tightness of the thoracolumbar extensor on the dorsal side crosses with tightness of the iliopsoas and rectus femoris.
Postural changes that occur as a result of LCS are a slumped posture with a tilt in the pelvis: this then increases the curve of the lower back (increased lumbar lordosis), shift to the lateral lumber, hyperextension to the knee, etc.
Increased anterior pelvic tilt with an associated increase in the lumbar lordosis leads to pelvic crossed syndrome (Janda 1987: Janda, Frank, and Liebenson 2007). Factors that could contribute to LCS include the hip flexors and lumbar extensors in one or more of the joint being shortened or tight also a weakness in the abdominal and gluteal muscles. Leaving muscular imbalances untreated can result in loose mobility in the lower back pelvis and the hip joint.
Janda says that there are two identified subtypes of LCS: A and B.
Patients who fall under type A you see visible hip flexion and extension movement while in mobility, and there is anterior tilt when in a relaxed standing position with flexion also in the hip and knee, whereas type B patients usually have a weak line.
The lower crosses asymmetry is permitted as a result of the weak line B; There is a pull off strong iliopsoas and the erector spinae groups, they are overpowered as a result of the weakened rectus and transverse abdominal muscles.
The “Sacral base angle,” is used to measure the degree of anterior tilt of the pelvis. Along the sacral base, a line is drawn, then a different line horizontal to the first line is drawn, an angle of where the two lines cross is measured; this is known as the sacral based angle.
Often, Upper cross syndrome can develop as a result of the lower cross syndrome posture predisposing the client. The curvature of the lumbar and cervical region of the human spine refers to the term lordosis. Therefore if lumbar hyperlordosis occurs; the weight that was in the center of the trunk posteriorly shifts. Furthermore increased thoracic kyphosis predisposes the two hyperlordosis in the spine of the lower extremity of the cervical spine, to add the upper cervical spine, the head posture and shoulder girdles are protracted with internally rotated arms; otherwise speaking upper crossed syndrome.
It has to be mentioned in this context that there is various predisposing factor that can play a significant role in worsening the condition of the patient further. First and foremost, it has to be understood that the lower cross syndrome is the direct result of the acute muscle strength imbalances in the dorsal and ventral sides of the body. However, the results of this complexity are characterized by the specific patterns of muscular weaknesses and tightness that restrict the patient from mobility reflexes (De Carvalho 2010). The most important factors behind the frequent occurrence of lumbar lordosis are the compressed sitting in the patients. However, in case of the athletes, the most critical predisposing factors in case of athletes is the lack of glutean activation (Kalichman et al. 2011).
The most important fact associated with the lumbar lordosis is the running and similar physical activities. According to the research, the stress generated in the lower back of a runner on the racing tracks has a great impact on the general length of the athlete’s spine; this acute spinal shrinkage is intricately linked with the frequency of lumbar lordosis or lower cross syndrome in general (Rothenfluh et al. 2015). However, in case of the athletes who are associated with heavy weight lifting are much more at risk of developing lumbar lordosis due to the extreme impact of the pressure on the lower back of the athletes that have to lift heavy weights on a prolonged or regular basis (de Oliveira Pezzan et al. 2011).
It has to be mentioned in this context that the mechanical and the musculoskeletal impact of lumbar lordosis or any postural hyperlordosis can lead to any transient overgrowth syndrome where the extensor musculature or abdominal weakness increases further chances of lumbodorsal fascia and can even lead to the occurrences of pelvic displacement. Another very important predisposing factor in the case of this particular disease is the fact that the occurrences of postural lordosis are much more common in the young athletes than the adults, and a contributing factor to that may be the growth spurt during that time (Kalichman et al. 2011).
It has to be understood that the postural distortion like lower cross syndrome affects the muscular flexibility and reflex effectively of the particular individual associated with it. On a more elaborative note, the muscle contraction is a direct result of the upright posture that is associated with the lumbar lordosis in general (de Oliveira Pezzan et al. 2011). There is a significant tightness in the pelvic muscles and adjoining muscles is the main reason behind the distorted muscle tonicity of the patient. A detailed analysis of the muscular details associated with the lower cross syndrome is the fact that the dysfunction caused in the pelvic joint, the adjoining muscles fail to perform the function of lifting the torso upright, and the entire pressure is directed at the lumbar spine (Mendoza-Lattes et al. 2011). The natural curvature of the lumbar spine is associated with the task of lifting the body upright and the lumbar lordosis in the curvature creates a malfunctioning in the joint curvature creating a lordotic curvature (Wang 2013). In this case, maintaining the upright posture, in turn, facilitates extreme pressure on the lordotic curve and the muscle contraction is escalated resulting in acute pain during upright positioning. The result of putting extreme pressure on the lordotic curve results in affecting the joint, the excessive lordosis can result directly onto disc degeneration and joint displacement in severe cases (Piper et al. 2016). In this case, the soft muscles in the surrounding area and the nerve tissues can also be subjected to wear and tear in excessive lordotic conditions (Newton et al. 2010).
It has to be mentioned context that a healthy and functional spine is a necessity in case of an athlete, an athlete, regardless of the domain he or she belongs to, cannot afford to lose the health of the spine. However, postural injuries or conditions are extremely harmful to the athletes as it can result in several functional restrictions that can potentially affect the career progression for the athletes concerned. There are different types of sports injuries like Kyphosis, Lordosis, Scoliosis, and whatnot, and each one has a significant impact on the muscular functionality of the athlete (Rothenfluh et al. 2015). However, the lordosis can be considered as the most common and most frequent type of sports injury and hence the impact of this type is increased as well. On a general note, a lordosis is nothing but an increase in the curve of the spine which restricts the individual from maintaining upright positioning for long. This leads directly to excessive pressure being put on the lordotic curve and the resultant pain that has the capacity to restrict a sports athlete from a number of different athletic activities. First and foremost, a lordotic sports injury affects the runners as athletes effectively and can slow the normal pace that the runner is habituated to die to the increased pressure. However, more than that the runners the impact of lumbar lordosis is much more on the heavyweight lifters. The entire pressure of weightlifting is put on the pelvic and spinal muscles and joints during the initial lifting phase and with a lordotic curve the excessive pressure leads to acute pain and can even lead to joint or disc displacement, altering the weightlifting abilities or potential of the athlete (Wang 2013).
Lower cross syndrome (LCS) is characterised by postural dysfunction of increased anterior pelvic tilt with the hyperlordotic lumbar spine. The following muscles become tight under the lower cross syndrome which is- tensor fasciae latae (TFL), restus femoris, iliacu, psoas major thoracolumbar paraspinals. As commented by Piper et al. (2016), the LCS restricts movements around the thigh and the hip joints as well as flexion of the lower back of the spinal joints.
As argued by Jay et al. (2014), the condition may not be painful often and always. However, the presence of such a condition for a very long time may result in a condition known as facet syndrome. The condition occurs due to the increased pressure of the facet joints upon the lumbar spine. As mentioned by Fritz et al. (2016), in case the facet compression is symptomatic, the pain in the patient will increase with the extension of the lumbar spine.
There has been a gradual evaluation of sports massage techniques in lower cross syndromes. These are manual therapy to Gluteal activation exercises. The benefits of the transition in therapy have been discussed over here. The manual therapy is where a static assessment of the posture of the patient is conducted. The symptoms of LCS will be expressed in the form of slight increase in the thoracic spine as well as the head is slightly protracted (Piper et al. 2016). Digital pressure over the lumbosacral region will produce characteristic pain. However as argued by Fuentes et al.(2016), the range of motion of the lumbar spines are within normal limits. Though the flexion is decreased and extension results in lower back pain in the lumbar region.
The manual therapy prescribes that two one –hour messages be provided to the student per week for 8 weeks. As mentioned by Fritz et al. (2016), depending upon the condition of the patient therapy can be referred to the pilates instructor. The Pilates instructor should emphasize upon correcting the dysfunctional lower cross postural pattern. Additionally, instrument-assisted soft tissue mobilization could also help in reducing the perils of LCS and allow movements around the hip -thigh region. The soft tissue mobilization is performed on the lumbosacral spine’s paraspinal and quadrates lumborum musculature. In manual therapy deep pressure into the lumbar paraspinal musculature using flat palm, contact was applied.
Additionally, gluteal activation exercises for strengthening of lower body tissue shave also been conducted. The muscle group covered under this exercise are-gluteus maximus, minimus and medius. As commented by Piper et al. (2016), these muscle s play a significant role in the stability and mobility of the lower body. The gluteus muscles are responsible for a number of movements such as – hip extension, hip abduction, external and internal rotation of the hip, raising the body from a forwardly displaced position, lifting the body from a bent or stooped position. The loss of strength and size anomaly of glute results in a condition known as gluteal amnesia. It results in the development of debilitating back pain and may not be necessary due to LCS (Fritz et al. 2016). As commented by De Carvalho et al. (2010), the clients suffering from lower cross syndrome needs more optimal pelvic alignment before the glute activation drills are performed. Additionally, the hip thrust also helps in isolating the glute max muscles.
Soft tissues release is used to restore the length of the tissue, release areas of length such as adhesion and help in realigning fibres with the muscles, ligaments, tendons or surrounding fascia. NMT or Neuromuscular therapy is also known as trigger point therapy where static pressure is applied to a specific part of the body to reduce the feeling of pain. It aims at releasing tension and rebalancing the central nervous system and improving the flow of blood through the tissues. Muscle energy technique (MET) is used to lengthen and strengthen areas of adhesion and tight muscles and restore normal function and elasticity around the lumbar paraspinal region (Shamus and Shamus 2015). It uses the gentle muscle contraction of the patient to normalize the joint motion.
A variety of neuromuscular techniques can be followed over here such as – effleurage, petrissage, kneading, inhibition, vibration friction, transverse friction. In Effleurage techniques lubricants used to induce relaxation and reduce congestion by promoting lymphatic movements towards the centre. In petrissage wringing and stretching movement has conducted that assist in circulatory interchange. In inhibition, applications of pressure directly to the attachments of contracted muscles help in the in release of pressure. Vibration technique applied with the help of mechanical devices with varying oscillation rates may affect the tissue differently (Mortazavi et al. 2015). However, as argued by DeLany (2014), the methods need to be applied as per the physical conditions of the patient.
The NMT and MET combination has been seen to work in combination. They have been effective in normalizing the imbalances produced in fibrotic tissues. They help in laying down a foundation for other therapeutic methods such as exercise or soft tissue mobilization. However as argued by Parikh et al. (2015), the NMT laid the foundation for similar methods such are re-education, rehabilitation and home care approaches. It emphasizes upon provision of autonomy to the support users by educating them on ways to self-manage their condition.
The effectivity of the techniques could be discussed in isolation and combination in relieving the lower cross syndrome. Both the techniques have a range of benefits in restoring the mobility or flexibility within the patient. The application of MET develops a tolerance to stretch (Mortazavi et al. 2015). It also changes an individual’s perception of muscle pain apart from producing a long-lasting change. It reduces pain by inhibiting the inhibiting the small diameter nociceptive neuronal input at the level of spinal cord. The NMT, on the other hand, normalizes noxious trigger points which are associated with pain, vasodilation and vasoconstriction around the point. As suggested by Wallden (2014), soft tissue normalization leads to normalization of the joint. However as argued by Fuentes et al. (2016), the reverse can be equally true where the normalization of the joints helps in restoring the mobility patterns.
As commented by Jay et al. (2014), the re-education and body toning exercises need to be pre-poned by NMT which helps in achieving the outcomes. However, the MET exercise can only be administered once the patient depicts measurable improvements in the weak antagonists. As argued by DeLany (2014), both the MET have been seen to produce a much short-term effect compared to NMT which targets the trigger points. Therefore, the MET emphasises upon restoring the normal conditions of the muscle by focussing upon the elasticity patterns. The NMT employs a number of techniques where mechanical devices are used to restore the normal mobility Patterns. Therefore, the application of the NMT is much broad base whereas the MET is more so based on the holistic tissue improvement methods by means of exercises.
A number of referral processes could be used over here where the expertise from a number of different channels can be collaborated to provide an effective intervention. In case of muscle rigidity and acute joint fixtures, a number of surgical interventions as well as holistic approaches are required. This calls for the involvement of a number of support personnel including the orthopaedic, physiotherapist, sports coaches.
The assignment focuses on the rehabilitation and recuperation of a sports person affected with lower cross syndrome. It is a chronic condition and needs a combination of methods for its cure and control. Some of these are basic exercise methods including light stretches to gluteal activation exercises. Therefore, employment of trained sports coach along can help in integrating the exercises well into the daily routines. As commented by Wang (2013), the incorporation of aspirin can help in relieving the pain due to paraspinal restrictions.
The application of methods such as NMT has been found to be equally beneficial in providing long-term relief (Fritz et al. 2015). However, the same should be provided by an experienced physiotherapist. The sports regulations of Australia has emphasized upon the presence of a physiotherapist during the practise sessions (Jay et al. 2014). This is done in order to allow for onsite aid along with swift referral in case of fall or injury.
Conclusion
The assignment deals with the concept of sports massage techniques. Here, the term lower cross syndrome has been discussed in a boarder manner with references to several prognosis and intervention factors. Lower cross syndrome is a common phenomenon in athletes and often develops due to increased stress upon the lower back. It alters the general length of the athlete’s spine and results in thoracolumbar paraspinal restrictions. Additionally, injury to the spines and muscle of the athletes can also result in fixation of the joints which restricts the movement around the lower back.
A number of intervention methods had been discussed over here which includes the NMT along with the MET techniques. Both have proven to be equally effective in treating the LCS patients. However, the NMT has been found to be more effective in providing long-term relief to the patients. The importance of referral system has also been discussed over here which calls for the quick provision of care services in case of emergency trauma or conditions of injury.
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