Rub out chronic muscle tears with cross-friction massage

Chronic muscle tears can plague athletes for years if not diagnosed correctly  Credit: Gray Mortimore /Allsport
The chronic muscle tear is probably the third most common injury among all groups of runner, writes Dr. Timothy Noakes, the quintessential runner/doctor in his encyclopedic work, The Lore of Running (1991, Leisure Press).

I came across these words in my own frantic quest for an answer to a hamstring injury that had plagued me for nine months. The words that leaped up at me from off the page were the following:

Chronic muscle tears are usually misdiagnosed, can be very debilitating and will respond to only one kind of treatment The characteristic feature is the gradual onset of pain, in contrast to the acute muscle tears dramatically sudden onset of pain. This characteristic matched my problem exactly.

In contract to bone or tendon injuries, both of which improve with sufficient rest, chronic muscle tears will never improve unless the correct treatment is prescribed.

Noakes' book rang another bell for me here, as I had tried taking days off, and later weeks with no running, only to lace up my shoes, hit the road and feel as if, in terms of my injury, an hour hadnt passed. Noakes goes on to say that he was witness to one runner who had struggled with a chronic tear for five years.

Noakes advises that you can identify a chronic tear with the help of a physiotherapist having him or her plunge two fingers deep into the location of the pain and search for a hard and tender knot. Noakes states that if a knot is found, then youre dealing with a chronic tear. In my case, the knot was very easy to find, deep in the belly of the left hamstring and hard as a marble.

Noakes believes that, while the mechanism behind a chronic tear is unknown at this point, specific sites on the body that digest large amounts of pounding (from running mileage), overuse (an endurance-sport given), and high-intensity loads (from speed or power training) are the areas most likely to sustain this type of injury.

Noakes observed that chronic tears tend to show their ugliness when an athlete makes an increase in mileage and/or intensity. In my case, I could jog around forever without much problem, but when I tried to run at any speed faster than seven-minute pace, I found myself rapidly reduced to an infuriating limp.

Conventional treatment, including drugs and cortisone injections, is a waste of time in this injury, writes Noakes, and he goes on to illustrate the technique he deems effective: cross-friction muscle massage, a physiotherapeutic technique detailed in the 10th edition of the British Textbook of Orthopedic Medicine.

The maneuvers are applied directly to the injury site, perpendicular to the injured muscle, and must be applied vigorously. If the cross-friction treatment does not reduce the athlete to tears, either the diagnosis is wrong and should be reconsidered or the physiotherapist is being too kind.

Five to 10 five-minute sessions of cross-friction should correct the problem, says Noakes, but more may be necessary depending on how long the athlete has had the injury.

Runners Worlds Dr. George Sheehan had once forwarded a desperate letter to Noakes from a runner who had tried everything to overcome a chronic muscle tear, having suffered from the tear for more than a year. Noakes wrote to the runner, advising him of the cross-friction techniques. He also suggested that he stay away from static stretching exercises, as it would only exacerbate the problem until it was sufficiently healed.

As I mentioned, when I found the Noakes material, I had made no progress whatsoever in getting effective treatment. Within a week of cross-frictions and no stretching, I observed a substantial and positive change in the strength within my hamstring. A month later, I was able to perform speed workouts again without deteriorating into a limp.

Once a chronic muscle tear has been tamed, an athlete should work aggressively to prevent a recurrence of the problem.

Incorporating a quality weight-training program into your training schedule, including moderate amounts of stretching and upon noticing the first hint of reinjury immediately apply more cross-frictions.

A little treatment early on in these injuries saves a great deal of agony later, Noakes says.


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