Massage & Bodywork

NOVEMBER | DECEMBER 2018

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CLINICAL E XPLORATIONS it takes a significant force load to cause a hard tissue like bone to bend. When impacted from the side, a long bone will bend somewhat before it breaks. Treatment. Bending isn't a prominent factor of any soft-tissue treatments in terms of individual tissues. Bending a body segment, as in stretching, is frequently used. 5. Shear Shear is a type of force that involves two structures sliding in relation to each other. Shear forces are at play in many different situations in the body. Friction is the result of shear forces, and there are numerous locations where the body has adapted to reduce friction from shear force stress. A great example of reducing friction from shear forces is the synovial sheaths that surround tendons in the distal extremities. These sheaths reduce shear between the tendon and binding retinacula. Injuries. Tenosynovitis is a condition that develops from excessive shear force. This is a condition involving inflammation and adhesion development between a tendon and its surrounding synovial sheath. Collagen degeneration (tendinosis) in a tendon can also develop from a tendon rubbing against a bone with shearing forces during movement. Another pathological condition that involves excessive shear force is spondylolisthesis. In this condition, one vertebra (usually L5) slips forward in relation to the sacrum (Image 4). The suffix listhesis refers to sliding down a slope, and this is essentially what is happening to the L5 vertebra as it moves forward on the sacrum. Treatment. Shear force is used a fair amount in soft-tissue treatment. Most techniques of massage involve some type of gliding or sliding on the skin where there is a shear force between the therapist's hands and the client's body. We know that the gliding hand produces therapeutic effects on the nervous system, even though we are still discovering much more about how this actually works. CONCLUSION Biomechanical forces play a major role in injury conditions as well as treatment choices. A skillful clinician can analyze these biomechanical forces and make predictions about tissues that have likely been injured. These analytical skills are a foundation of effective assessment and play a major role in constructing appropriate treatment plans. Next time you have a client describing an injury condition, see if you can tease apart the various biomechanical forces that were likely at play. In addition, when performing various massage techniques, consider the type of force applications you are using and what their primary physiological effects are likely to be. The more you practice and consider these concepts, the better you will get at using them. Whitney Lowe is the developer and instructor of one of the profession's most popular orthopedic massage training programs. His texts and programs have been used by professionals and schools for almost 30 years. Learn more at www.academyofclinicalmassage.com. Spondylolisthesis as a shear force. 4 Yo u r M & B i s w o r t h 2 C E s ! G o t o w w w. a b m p . c o m / c e t o l e a r n m o r e . 91

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