1. A Multi Modality Approach to Sports Therapy and Pain Management with Michael McGillicuddy, LMT, NCTMB, CKTI American Massage Conference

2. Introduction Michael McGillicuddy is Nationally Certified in Therapeutic Massage and Bodywork, is the owner of USA Pro-Sports Massage and the Central Florida School of Massage Therapy.

3. Massage Experience LMT 1984 CE Provider 1990 Sports Internship Past FSMTA President Expert Witness Olympic Volunteer

4. Jack Meagher In 1985, I attended a Jack Meagher Sports Massage Workshop. Muscles generate motion. Muscles also restrict motion.

5. Sports Massage Definition Sports Massage is the specific application of massage techniques, hydrotherapy protocol, range-of-motion / flexibility procedures and strength training principles on athletes to achieve a specific goal.

6. Key Principles of Sports Massage: TIMING Pre-event Inter-competition Post-event Recovery Maintenance Injury management

7. Key Principles of Sports Massage: INTENT Assist warm up Return to competition Immediate recovery Re-establish balance Chronic conditions Assist rehabilitation

8. Key Principles of Sports Massage: TECHNIQUES Effleurage Petrissage Compression Broadening Friction Tapotement

9. Key Principles of Sports Massage: CHECK RESULTS Was the specific sports massage goal achieved? How is the athlete feeling?

10. Nociception The word nociception sounds complicated, but it simply means the sensation of pain. Nociception occurs when special injury- sensing receptors in the body are stimulated.

11. The Four Stages of Nociception 1) Transduction conversion of mechanical, chemical or thermal information into electrical activity in the nervous system. Sensory receptors are excited by stimuli in the area they innervate.

12. The Four Stages of Nociception 2) Transmission is the transfer of electrical impulses to the central nervous system which processes nociceptive signals to determine relevant information. What is the meaning of this sensation?

13. The Four Stages of Nociception 3) Perception of pain can be brief or prolonged. Nociceptive stimuli can result from inflammatory tissue damage, peripheral nerve injury or damage to parts of the central nervous system.

14. The Four Stages of Nociception 4) Modulation refers to internal and external ways of reducing pain. The release of endorphins to trigger inhibitory influences or stress, anxiety and fear can amplify pain.

15. Acute Pain Acute pain is of sudden onset from trauma, surgery or an acute disease. It can last days to weeks and is usually caused by tissue injury and inflammation and subsides gradually.

16. Chronic Pain Pain is considered chronic when it lasts beyond the normal time expected for an injury to heal or an illness to resolve. This type of pain affects roughly 100 million Americans. It can last six months to a lifetime.

17. Gate Control Theory Small-diameter afferent C nerve fibers open the gate to noceception. Large-diameter A-a and A-b non-nociceptor fibers close the gate to nociception. Which one is stimulated most?

18. Gate Control Theory Fear, anger, anxiety and stress can increase intensity of pain. Laughter, exercise and self-efficacious beliefs can release endorphins in the brain which can reduce intensity of pain.

19. Pain Spasm Pain Cycle The multiple modality approach to sports therapy and pain management is intended to break the pain spasm pain cycle.

20. Inflammatory Response The inflammatory response is the process by which the body’s immune system responds to irritants, infection, injury, damaged cells, burns or other harmful stimuli.

21. Inflammatory Response Until the inflammatory response is controlled many modalities are contra-indicated.

22. Three Goals of Treating Pain Reduce pain intensity Improve athlete’s ability to function Restore quality of life

23. Myofascial Release It is thought that an extremely high percentage of people suffering with pain and/or a lack of motion may be having fascial problems and most go undiagnosed.

24. Aaron Mattes Human movement is made enjoyable when the body is capable of performing without restriction. Three healthy qualities of muscle tissue are stretch, contractibility and elasticity.

25. Benny Vaughn The majority of complaints presented in the traditional athletic training room environment are minor musculotendinous and myofascial complaints.

26. Functional Disability Source of Irritation Edema Inflammation Fibrous Reaction Restricted Movement

27. Body Types Every individual has a different body type. The pressure used must be comfortable for the person you are treating. If you are going to error then error to the light pressure side.

28. Do No Harm We will be using many modalities in this presentation. Please realize that even effleurage done long enough becomes uncomfortable. Check in often with the person you are working with.

29. Contraindications Fever, Varicose Veins, Acute Inflammation, Acute Pain, Open Sore, Osteoporosis, Rash, Infectious Skin Disease, Skin Problems, Broken Bones, Pregnancy, Hemophillia, Blood Clots, Impairment.

30. Six Steps to Treatment Massage SASTM Cupping Strengthening Stretching Kinesio Tape

31. Condition and Assessment Assessment skills are extremely important to providing effective treatment. Each condition requires accurate identification of the tissue to be treated and which modalities are appropriate.

32. Massage Therapy We will be using typical massage techniques such as effleurage, petrissage, compression, stripping strokes, direct pressure and cross-fiber friction to treat soft tissue conditions.

33. SASTM Instruments effectively break down fascial restrictions and scar tissue. The ergonomic design of these instruments provides the clinician with the ability to locate restrictions by sound.

34. Cupping Massage cupping by creating suction and negative pressure, is used to drain excess fluids and toxins; stimulate peripheral nerves, increase blood flow in muscles, and loosen adhesions.

35. Strengthening Strength training is the use of resistance to muscular contraction for the purpose of building strength, endurance and size of skeletal muscle. It can improve overall health and well-being.

36. Stretching Active Isolated Stretching is a method of stretching that is easily incorporated into massage therapy treatments. For strains, sprains and treatment of trigger points; it is used last.

37. Kinesio Taping The Kinesio Taping Method fosters the body’s natural ability to heal itself by activating neurological and circulatory systems to correct biomechanical dysfunction and pain.

38. Thank You Thank you for allowing me to teach you a multi modality approach to sports injuries and pain management.