Athletes Treating Athletes

In the last post, we talked about how to manage the common symptoms of overuse injuries. This included using Rest, Ice, Compression, and Elevation (aka R.I.C.E.) to reduce pain and swelling. We also reviewed what A-T-A techniques are best for treating this type of injury. The key to treating overuse injuries is to remember that these are injuries that build over time and involve changes not only to the injured muscle but also to the muscles around them. This means that you really have two things to treat- the injury and what actually caused that part of the muscle chain to break. To effectively treat this injury it is important to pay attention to joint range of motion (ROM) and the opposing muscle group (muscles work in pairs, if one is hurt, the other can be a big part of the problem).

To review, typical treatment for an overuse injury looks like this:

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

2) Start with the injured muscle group. Begin using the foam roller AROUND the injured area. 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 injured area to tolerance. The order should be foam roll around injury-> over injury -> stretch -> RICE.

4) Now that there is slack in the injured muscle, we can go back and assess range of motion (ROM). Are there limitations? Do you feel pressure in the joint? This is where you will add in the joint mobilization techniques. The order should be: foam roll around the injury -> foam roll over the injury -> joint mobilization -> stretch -> RICE

4) Begin using the tennis ball for active mobilizations. The order should be foam roll around injury -> over injury -> joint mobilization -> active mobilization with the tennis ball -> stretch -> RICE.

5) Begin using the tennis ball for cross friction + trigger point. These are the deepest of the soft tissue techniques so you want to save them for last to target specific adhesions and restrictions. Consider this your fine tuning step.

6) That was for the injured muscle. Now you must go back through and repeat steps 2-5 for the opposite muscle group. Go easy! You may find some rather sore spots and areas in these muscles as well. Remember- only progress through the levels when you can do so pain free.

Range of Motion + Muscle Pairs For the Upper Body

For each joint, you will find pictures of what normal ROM looks like, what muscles provide it and what the opposing muscles are. For the latter two, I will include links back to the specific muscle massage posts that best apply.

The Wrist

Number of motions: Four (extension, flexion, radial deviation, ulnar deviation). This gives you two muscle pairs at the wrist. Due to the overlap of muscle function and location, we can focus on the main two.

#1 Extension- pulling the hand back (bending it at the wrist).

Key Take Away- you should be able to pull your wrist back like the picture above. If you can’t, you will be unable to comfortably get into a push up/weight bearing position on your hands. It’s very common for this motion to become restricted with prolonged typing/writing and repetitive hand use (all involve extended time in a flexed wrist position). In the case of elbow/forearm pain, this is a key area to look at.

Muscles responsible for this movement = wrist extensor muscle group (located along the top of your forearm; includes extensor carpi ulnaris, extensor carpi radialis, and extensor digitorum)

Opposing muscle groups = wrist flexor muscle group (restrictions here will prevent you from pulling your hand back all the way; includes flexor carpi ulnaris, palmaris longus, and flexor carpi radialis).

#2 Flexion- pulling your hand down (bending it at the wrist).

Key Take Away- you should be able to pull your wrist back like in the picture above. It is very common for this motion to become limited from activities that require strong grip (such as tennis where the wrist is kept in an extended position).

Muscles responsible for this movement = wrist flexor muscle group (restrictions here will prevent you from pulling your hand back all the way; includes flexor carpi ulnaris, palmaris longus, and flexor carpi radialis).

Opposing muscle groups = wrist extensor muscle group (located along the top of your forearm; includes extensor carpi ulnaris, extensor carpi radialis, and extensor digitorum)

Elbow

Number of motions: four (flexion, extension, supination, pronation). This gives you two muscle pairs to focus on (1) flexion + extension and 2) supination + pronation).

#1 Flexion

Key Take Away- you should be able to bend your elbow up like in the picture above. Limitations here will prevent you from you from locking your elbow out straight for weight bearing activities, as well as, from fully extending it for push/pull motions.

Muscles responsible for this movement= Biceps, Brachialis, Brachioradialis (located along the front of you upper arm between the shoulder and the elbow crease).

Opposing muscle groups = Triceps (located along the back of your upper arm between the shoulder and the elbow).

#2 Extension

Key Take Away- you should be able to straighten your elbow like in the picture above. Limitations here will limit elbow flexion, as well as, shoulder mobility and overhead reach (restrictions in the back will restrict how far up you can bring the arm over shoulder height).

Muscles responsible for this movement = Triceps (located along the back of your upper arm between the shoulder and the elbow).

Opposing muscle groups= Biceps, Brachialis, Brachioradialis (located along the front of you upper arm between the shoulder and the elbow crease).

#3 Pronation

Key Take Away- Pronation and supination involve twisting of the two forearm bones to rotate which way the hand is facing (up towards the ceiling or down towards the floor). Unlike flexion and extension which occur at the elbow joint, these two occur at the two attachments of the radius and ulna. To assess this motion, keep your elbow tucked against your side (this prevents the larger muscles from helping). It is important to look at these motions since restrictions here will limit overall elbow mobility. Restrictions here commonly play a role in epicondylitis and tendonitis at the elbow.

Muscles responsible for this movement = Pronator Teres (located on the front of the arm starting inside above the elbow and crossing diagonally over the joint)

Opposing muscle groups = Supinator (located on the back of the arm and deep to the tricep muscle)

#4 Supination

Key Take Away-Pronation and supination involve twisting of the two forearm bones to rotate which way the hand is facing (up towards the ceiling or down towards the floor). Unlike flexion and extension which occur at the elbow joint, these two occur at the two attachments of the radius and ulna. To assess this motion, keep your elbow tucked against your side (this prevents the larger muscles from helping). It is important to look at these motions since restrictions here will limit overall elbow mobility. Restrictions here commonly play a role in epicondylitis and tendonitis at the elbow.

Muscles responsible for this movement = Supinator (located on the back of the arm and deep to the tricep muscle)

Opposing muscle groups = Pronator Teres (located on the front of the arm starting inside above the elbow and crossing diagonally over the joint)

Shoulder

Number of motions: six (flexion, extension, abduction, adduction, external rotation, internal rotation). This gives you three muscle pairs to focus on (1) flexion + extension, 2) abduction + adduction, and 3) internal rotation + external rotation).

#1 Flexion

Key Take Away- Moving your arm overhead requires movement of both the humerus (upper arm bone) and rotation of the scapula (shoulder blade). Together they provide the full range of motion. If one is restricted, the other will be impacted. I won’t bore you with a kinesiology lecture, but remember- it’s all connected. If you can’t get your arm overhead and it only hurts in the front of the shoulder. Don’t forget the back of the shoulder. When measuring flexion range of motion, hand position is key. Start with your elbow straight and thumb up towards the ceiling. From here, lift the arm straight up in front of you and overhead.

Muscles responsible for this movement = Anterior Deltoid, Bicep (long head), Pec Major.

Opposing muscle groups = Posterior Deltoid, Tricep (long head), Latissimus Dorsi, Teres Major.

#2 Extension

Key Take Away- When moving your arm backwards to look at extension, stand up straight (good posture!) and make sure you don’t bend forward at the waist.

Muscles responsible for this movement = Posterior Deltoid, Tricep (long head), Latissimus Dorsi, Teres Major.

Opposing muscle groups = Anterior Deltoid, Bicep (long head), Pec Major.

#3 Abduction

Key Take Away- Moving your arm overhead requires movement of both the humerus (upper arm bone) and rotation of the scapula (shoulder blade). Together they provide the full range of motion. If one is restricted, the other will be impacted. I won’t bore you with a kinesiology lecture, but remember- it’s all connected. If you can’t get your arm overhead and it only hurts in the front or side of the shoulder. Don’t forget the back of the shoulder. When measuring abduction range of motion, hand position is key. Start with your elbow straight, arm at your side (in a “T” position) and thumb up towards the ceiling. From here, lift the arm up to your ear as pictured above.

Muscles responsible for this movement = Middle Deltoid, Supraspinatus.

Opposing muscle groups = Teres Major, Pec Major, Latissimus Dorsi

#4 Adduction

Key Take Away- This is an easy one. With your elbow straight, you should be able comfortably press your arm against your side (as pictured above). From here (keeping the elbow straight), bring the arm forward and across your chest. At shoulder height and with your elbow straight (palm down) you should be able to reach across your chest far enough that your thumb is just past your opposite shoulder. This is 45 degrees of adduction. Sorry. Forgot a picture for this but will add soon!

Muscles responsible for this movement = Teres Major, Pec Major, Latissimus Dorsi

Opposing muscle groups = Middle Deltoid, Supraspinatus

#5 External Rotation

Key Take Away- Internal and external rotation at the shoulder are where the rotator cuff comes into action. There are four tiny little muscles that perform these motions and they are commonly injured by imbalances in the shoulder muscles as well as muscle and joint restrictions. To test range of motion for these, lay flat on your back and keep your shoulder blades down. You should be able to rotate your arms all the way back with your arm at shoulder height and elbow bent to 90 degrees as pictured above.

Muscles responsible for this movement = Infraspinatus, Teres Minor, Posterior Deltoid

Opposing muscle groups = Subscapularis, Teres Major, Anterior Deltoid, Latissimus Dorsi, Pec Major

#6 Internal Rotation

Key Take Away- Internal and external rotation at the shoulder are where the rotator cuff comes into action. There are four tiny little muscles that perform these motions and they are commonly injured by imbalances in the shoulder muscles as well as muscle and joint restrictions. To test range of motion for these, lay flat on your back and keep your shoulder blades down. You should be able to rotate you arm down towards the table with your arm at shoulder height and elbow bent to 90 degrees as pictured above.

Muscles responsible for this movement = Subscapularis, Teres Major, Anterior Deltoid, Latissimus Dorsi, Pec Major

Opposing muscle groups = Infraspinatus, Teres Minor, Posterior Deltoid