A 10 day period of high pressure has settled over Teton Valley bringing with it crystal blue skies and miles of freshly groomed trails for cross country skiing. The track is fast this week and the first of the winter’s Nordic Ski races are just around the corner. While cross country ski enthusiasts have been increasing their mileage a common complaint has begun to surface.
These endurance athletes, like cyclists, runners and backcountry randonnee skiers, participate in sports that involve repetitive hip flexion and extension performed in the single plane of movement.  Such athletes commonly complain of having a deep ache on the lateral aspect of the hip that may refer to the groin and distally into the lateral thigh.  Pressure on the greater trochanter, such as when sleeping on the affected side, increases these symptoms. While going up stairs many experience a “click” or a sensation that “something” is flipping over the side of their hip. This chronic condition has an insidious onset and often flares up during training cycles of increasing duration (distance) or intensity. Diagnosis from a physicain is often trochanteric bursitis and is an inflammatory condition NSAID’s are traditionally prescribed in addition to rest and ice.Â
In the general population trochanteric bursitis afflicts the middle aged and elderly resulting from muscular weakness and the inability to stabilize the hip during the gait cycle. However, with endurance athletes such as cyclists and Nordic skiers inflammation of the trochanteric bursae is more commonly associated with compression from the iliotibial band. Length of the iliotibial band and therefore its possible involvement in the compression of the bursae, can be assessed with the Ober’s test. Bodywork should include releasing the iliotibial band, tensor fasciae latae and gluteus maximus. Additionally the gluteus medius and minimus are often found to be hyper-tonic in this condition and may have active trigger points that mimic the referral patterns of trochanteric bursitis. Assisted stretching (PNF or AIS) of the medial hip rotators and hip abductors are also indicated in releasing tension and can be easily taught to your client.
Even though trochanteric bursitis is an inflammatory condition and contraindicates direct manipulation, in the endurance athlete, bodywork can be the key to resolving chronic compression the bursae by the iliotibial band.
It looks like Mother Nature finally shook the snow-globe and the energy around Jackson Hole is buzzing with excitement for the upcoming ski season. Teton Pass, one of the only three roads leading into Jackson, has been tattooed with ski tracks for weeks and the smell of wood burning stoves has filled the valley air. Watching the Weather Channel has taken presedence over the big game on my TV and town is simply twitching for a big storm.
Here in Jackson we’re not your average ski bum. Yes, the bus boy is the same guy on the cover of the latest Powder Magazine and your ski school instructor actually does have a PhD from Brown. But there’s also a reason why you never follow a local’s tracks at Jackson Hole Mountain Resort… they most likely will lead you off a cliff.  A “day in the park” here actually means you woke up at 3am and hiked in the darkness, breaking trail through knee deep snow, to the top of 13,000 foot peak in Grand Teton National Park just to ski back down it and still make it to your waitressing job by 4 that afternoon.
So what’s this have to do with a massage blog?
Well it’s all about knowing your target market and understanding who you want laying on your massage table. Maybe you already work with professional ballet dancers in NYC or maybe you are just starting to focus your practice on surfers on the North Shore. Whomever your market is, orthopedic massage is about learning the specific demands your target market puts on their bodies and knowing how to address the sometimes adverse effects of those demands. Orthopedic Massage about educating yourself in the bodywork your target market needs to keep them playing. And it is also about developing a rewarding practice that’s creative and continues to grow.
I love the ski season, not only for the obvious reasons, but also for the challenge each of my clients gives me. When a new client walks through my office door describing her lastest cartwheeling fall on the ski slope, it puts me to the test. How do I assess her injuries to know if she needs to be refered to a physican or if massage is even appropriate? What are her goals and how is massage going to help her reach those goals?
If you are interested in working with sports related injuries I hope that you will join me as we explore the various injuries and related massage techniques inspired by what I see in my own practice. I hope you find new ways of approaching your practice and how you think about the massage you give. I welcome your thoughts and questions as we all have something to learn from each other. Please feel free to share. And stay tuned for my next post on hip pain.
Think Snow!
