Athletes Treating Athletes

In the previous “How To” post we talked about the six different techniques covered so far on this site (foam roller, cross friction, trigger point, active and joint mobilizations, and stretching). We reviewed the techniques and also briefly talked about what kind of injuries each technique was best suited for. In this post, we’re going to talk specifically about muscle spasms, knots, and trigger points.

Since terms like muscle “knots”, “spasms”, and “trigger points” are often used together and interchangeably, lets take a minute to differentiate between the three.

1) A muscle spasm is a strained muscle that involuntarily contracts and remains stuck this way. This is usually very painful and can last for a few seconds (which is the typical duration) or for much longer (as in the case of acute low back spasm that requires medical attention).  The key difference between a true spasm and knots/trigger points is that the full muscle locks up, not just part of it.

2) A “knot” describe a smaller, less painful, and more persistent tightening of muscle. They typically involve only part of the muscle and can be felt through palpation as a bump or ball under the skin.

3) A “trigger point” is technically a muscle knot. However, trigger points are specific problem areas that exist in every muscle of the body. These areas are pain free with normal muscle function and mobility and can become painful through repetitive muscle use/abuse. You may have even seen books dedicated to this topic that discuss the specific areas in great detail.

Managing Muscle Spasms, Knots, and Trigger Points:

Step 1- Traditional R.I.C.E. treatment:

Rest: This may sound obvious, but I’m going to say it anyway. An injured muscle/joint will require a decreased activity level to fully heal. The severity of the injury will determine if this is a full rest or more of an active recovery.

Ice: while heat may feel better on stiff and sore muscles, ice only during the first 7 days following injury. This will help to decrease swelling, inflammation and pain. 10-15 minutes is sufficient and you can perform every hour as needed. Avoid direct ice to skin contact. As you move past the initial 7 day window, you can begin to use heat on the injured area as long as there is no swelling.

Compression: thanks to the recent explosion of compression sleeves, tights, shorts, etc, you have several options in this department. Ideally you want something that is snug without being uncomfortably tight (think recovery tights if you’ve ever worn them). You can also use a store brought ace wrap to accomplish this. Start the wrap below the injury using good tension on the bandage and move up above the injury. This will help keep swelling from moving down the leg.

Elevation: This is critical in the early days following acute injury where swelling may be present. In the case of an ankle injury for example, elevate the leg so that it is above chest level. This can be accomplished by laying down and propping for your foot up on the arm of the couch with pillows.

Step 2-Self Treatment Options

The first and most important goal is always to decrease pain and any swelling that may be present. In other words, we want to decrease inflammation. That means ice is mandatory. Absolutely no heat no matter how good it feels. Even if it only hurts to run or swim and feels fine the rest of the day, you still need to be icing minimum 3x/day. 10 minutes and done. Don’t short cut this stuff. It’s boring but it works, especially if your symptoms worsen as the day goes. It’s now easier than ever to smuggle an ice pack into the office fridge and wear compression gear under your dress clothes. Use that to your advantage when working to heal an injury!

The second goal is going to be to loosen up the injured area. Below I have the treatment techniques set up in levels. As a rule, you must be able to complete #1 without pain to progress to the next level. Be smart! The muscle needs to heal! Don’t overdo it in an attempt to speed up your recovery.

1) R.I.C.E. + gentle stretching. There should be no pain with stretching.

2) Begin using the foam roller AROUND the injured area (knot/spasm). The goal here is to start getting slack into the muscle without aggravating the injury itself. No tennis ball work or active/joint mobilizations. The order should be foam roll around injury -> stretch -> RICE.

3) Begin using the foam roller over the knot/muscle spasm. The order should be foam roll the muscle around the knot/spasm-> over the knot/spasm -> stretch -> RICE.

4) Begin using the tennis ball for trigger point release. Remember, you want to let the tennis ball sink into the muscle, apply pressure, and then hold it there without moving. You’re waiting for the muscle to release. Try for 30-60 seconds and then remove the tennis ball. Repeat 2-3 times. If it’s too painful- wait and try again the next day. The order should be foam roll the muscle around the knot/spasm -> over the knot/spasm-> trigger point -> stretch -> RICE.

How long do you need to R.I.C.E for??? Until it’s 100% gone.

Step 3: Training Modification Tips

More often than not, the first question I get is not- what do I do to get this better? It’s what can I do while I get this better? To answer this question, I put together a chart that will help you grade the severity of your injury based on your symptoms, make appropriate training modifications, and determine what course of action is best in terms of medical treatment. Think of it like a giant thermometer. The higher up you move on the chart, the more important action is and the more likely your training and racing will take a hit.

***I can’t stress this enough- use common sense when using this chart. This is not all encompassing and it is not designed to keep you from your healthcare team. If you are experiencing symp- toms like numbness/tingling, swelling, scary dark/purple bruising,inability to stand/weight bear, lift your arm over your head, etc please call your Doctor.***