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Sports Massage, Aquatics and the Olympics

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Sports Massage, Aquatics and the Olympics by Susan Findlay

Olympic Fact:  A total of 1,350 athletes will compete to win 46 gold medals across the four Aquatic disciplines at the 2012 Games.

The aims of sports massage are to keep athletes performing at their top level by working to aid recovery, prevent injury and encourage their development.  The essential elements necessary to do the job include having an understanding of the sport and a relevant qualification alongside advanced remedial techniques.

This article aims to give you a glimpse into the background of aquatics, the common massage principles that apply, the role of sports massage in pre, post and intra-event work. The overall intention of the article is to give you a broad overview of the sport, common injuries, a range of soft tissue skills and techniques that can be used in both rehabilitation and prevent of injuries.


Aquatics – a bit of background

Diving – was first brought in during the 1904 Olympic Games in St. Louis and has been a regular feature since.  Competitors dive from either a springboard or a fixed platform at heights of three and ten metres.  Each competitor performs a series of dives and is judged on the degree of difficulty based on the number and types of manoeuvres within the dive, such as tucks, twists and somersaults.  

Terminology Corner:

Arm Stand dive: a dive that begins from a handstand position, used only in platform diving.  

Come-out: or a kick-out is a technique used by the diver to stop the somersault and prepare for the entry.  

Pike Position: one of the four diving positions where the body is bent at the hips with the legs straight.  

Riding the Board:  whereby a diver works in a concerted effort with the board to obtain maximum height.  

Swimming – traditionally swimming included distances from 50m to 1500m until 2008 in Beijing a 10km marathon swim was added.  Unless the event is freestyle (or front crawl) the other strokes include the breaststroke, butterfly and backstroke.  

At the Paralympics the swimmers are classified according to their functional ability to perform each stroke. Classifications S1-S10 are for athletes with a physical disability (S1 being the most physically disabled athletes and S10 the least) and classifications S11-S13 refer to blind athletes (S11) and those with visual impairments (S12 & S13).

Terminology Corner:

Hypoxic breathing: controlled breathing i.e. a breath is taken every fifth or seventh stroke in a front crawl.  

A medley: when all four strokes are used during a race, it is often in the form of a relay with each person on the team doing one of the four strokes.  

Tumble turn: when the swimmer doing either a front crawl or a back stroke comes to the end of their lap they roll underwater pushing off the wall of the pool with their feet.  

Negative split: this is part of a swimmers race strategy in which they are faster on the second half of their race.  

Synchronized Swimming – was originally a sport for men but is now one of the two Olympic events that are for women only, the other being rhythmic gymnastics.  Synchronized swimming requires great grace, flexibility and endurance and is often referred to as “Water Ballet”.  It demands advanced water skills that require immense precision, timing as well as an exceptional breathing ability while under water upside down.

Terminology Corner:

Sculls: are hand movements used to propel the body to either control the swimmer while they are upside down or right side up.  

Eggbeater: is a form of treading water that allows the swimmer to hold themselves above the water usually around chest level but can also be used to propel themselves up out of the water.  This technique is also used in water polo.  

Water polo – we recently saw the introduction of woman’s water polo being added to the Games in Sydney 2000, up until then it was a male only dominated sport.  It is a water based version of handball that has two teams with seven players in the water at any given time.  The players are not allowed to touch the bottom of the pool and must tread the water the whole time.  Each team has 30 seconds to hold onto the ball before they have to attempt to score otherwise the ball passes to the other team.  It is a fast game that requires a great deal of strength and stamina.   It’s a very physical sport and has a reputation for being an aggressive and sometimes fierce game.

Terminology Corner:

Ball Under: a foul that is called on a player for holding onto a ball underwater while being tackled.

Dry Pass: when the ball is passed without touching the water.  

Wet Pass: the ball is passed on the water.

Common Injuries

Each of the modalities within the aquatic events have associated and common injuries.  For instance a typical injury in water polo would include impact fractures to the face and hands but within the whole of aquatics, shoulder injuries such as “Swimmers Shoulder” is a common injury.  Others conditions include Breaststroke Knee, Butterfly Back injury and eye irritations due to the chlorine.  More often than not injuries are due to the nature of the training rather than the conditions in which they swim.  In any competitive sport there are elements of repetition which leads to sport specific injuries such as “Swimmer Shoulder” or otherwise known as painful arc/ rotator cuff tendinitis, or shoulder impingement.  

The adductors and internal rotators of the shoulder are heavily relied upon to generate the propulsive force of the swimmers movement.  Together with the number of circular repetitions required (it is estimated that a swimmer can perform over 16,000 circular repetitions in one week, Pink and Jobe 1996) micro trauma is inevitable. 

Swimmers Shoulder

Symptoms
  
•    Symptoms include a slow onset of pain, initially deep within the shoulder.

•    Swimmers will often feel a clicking noise with overhead movement.

•    A classical sign of impingement is the painful arc on resisted abduction between 70 – 120 degrees.

 
Possible Causes

•    Faulty mechanics

•    Muscle imbalances i.e. weakness or tightness of the posterior cuff muscles

•    Hypermobile or lax shoulder joint

•    Overuse or a high level of experience

•    Sudden increase in FITT (frequency, intensity, time and type) of training

•    Using external devices such as hand paddles

•    Not enough rest
    
The symptoms can be due to the effects of the changes within the shoulder that come from the narrowing of the space between the acromion process of the scapula and the head of the humerus.  This then causes the tendons of the rotator cuff muscles (in particular the supraspinatus) to become irritated and inflamed as they pass through the subacromial space.  

Swimmers Shoulder is due to a movement related function but there are other factors that influence the onset of shoulder injuries such as the added physical impact that the body endures when a diver hits the water.  This can be as much as 30 mph.  Unless the execution of the dive is perfect then the impact will place stress on the shoulders, triceps, the neck including down the length of the spine.  As well, platform dives are more stressful on the body than the springboard due to the structure of the board and its effect on the musculoskeletal system.  For this very reason Tom Daley made the decision after he picked up a triceps injury at the European Championships to opt out of the 10m platform event but competed on the 3m springboard at the Youth Olympics.  

One of the jobs of a sports massage therapist is to be aware of any negative changes that might be accumulating and assist in maintaining a strong, freely moveable shoulder joint that is functionally balanced.  Specific techniques to help maintain mobility and proprioceptive balance are Muscle Energy stretches, or soft tissue release techniques that are supported by mobilization and general work (i.e. effleurage, petrissage, and vibrations etc).  

Homecare

Homecare might include advice about strengthening specific muscles and stretching others, as well as nutrition, hydration and possibly training.  It is important that you have the appropriate educational background to offer this kind of advice otherwise it is recommended that you work alongside other modalities and refer as required.  

Homecare for Swimmers Shoulder should include stretches and strengthening exercises to support the soft tissue work between sessions.  The rule of thumb when giving exercises for clients is not to overload them, try to keep it to a maximum of three different ones.  To ensure that they have an understanding of what is being asked of them, ask them to show you what they have been given just before they leave.  Encourage your client to repeat the exercises/stretches within the next couple of hours, this will help to establish and reinforce the correct method of application.

Suitable stretches would focus on the pectoralis major, anterior deltoid and latissimus dorsi.  (See diagram 1, this is 013 in Brad’s book) It can be difficult to stretch the anterior deltoid and our work is invaluable at being able to target difficult areas such as this. Areas to strengthen might include the lateral rotators to balance the head of the humerus, lower trapezius to assist with the depression and retraction of the scapula. 
    
The Role of Sports Massage at Swimming Events

During an event the focus of sports massage is to maintain range of movement, minimize joint and muscle stiffness and to aid in the recovery of soft tissue between the preliminaries, semi’s and the finals.  This is not usually the time for treatment unless you are an experienced therapist and are the athlete’s primary sports massage therapist. Even then treatment should have a more superficial and temperate approach.

Each athlete will have individual objectives and as a sports massage therapist you will need to understand what these are.    If it is for recovery then your techniques might include gentle compression, petrissage, effleurage, stretching techniques, lymphatic drainage, keeping your general working depth more superficial.

At most larger events like the commonwealth games or the Olympics there will be a support team that could include a doctor, physiotherapist, osteopath, coach, sports therapist or sports massage therapist and/or a combination of them.   It is quite different from working on your own and does require good communication skills.  There will often be a debriefing session at the end of the day and sometimes at the start.  If there is not it is important that you do not work in isolation and convey your findings or what you have done to the appropriate team members. 

Special Feature  - Tom Daley

Tom Daley from Plymouth is a talented under 18 diver whom at the age of 12 was given a special dispensation to compete at the 2007 Australian Youth Olympics. He has an impressive record of international successes and is one of our 2012 Olympic hopefuls.  He currently competes in 10m individual, 3m springboard and synchronized diving.  Some of his newest dives that we might be seeing at the Games are the Twister (2 ˝ somersaults with 2 ˝ twists), Back arm-stand ripple pike, Back 3 ˝ somersault pike and the Front 4 ˝ somersault with a tuck. Latest News: 2010 commonwealth games in New Delhi,  Tom won the gold medal for Synchronised 10m Platform competition with teammate Max Brick.  He also won gold in the 10m Individual Platform competition.  

How to get involved: 

Start by developing an understanding about the sport that you wish to get involved with. Suggestions include taking some lessons yourself, observe training sessions, research it in books and videos, on the internet, ask an experienced swimmer or coach, volunteer your services at your local pool or swim club.  Understanding is the first step in making appropriate decisions about your clients needs.


Useful websites include:

http://www.swimming.org/britishswimming

http://www.activeplaces.com


http://www.fina.org

http://www.paralympic.org

http://www.london2012.com/games/olympic-sports/aquatics



By Susan Findlay BSc RGN, Dip SMRT
All rights reserved. Any reproducing of this article must have the author name and all the links intact.
Susan Findlay BSc RGN, Dip SMRT

Author: BSc RGN, Dip SMRT

Biography: Susan Findlay is the lead tutor and Director of NLSSM. She is Chair of GCMT Communications working to develop high standards of practice within the industry. She has been part of the selection committee for the medical team at the London Olympics 2012. She currently is the Sports Massage feature writer for Massage World. She is also the author of ‘Sports Massage’ a practical book for all massage professionals wanting to work more effectively as a sensitive and deep tissue therapist. She keeps her hands in as a Sport and Remedial Massage Therapist in North London.

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