Massage & Bodywork

NOVEMBER | DECEMBER 2019

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Ta k e 5 a n d t r y A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 93 two structures are pressed together) and tension (when tissue between two contact points is pulled in opposite directions). Consequently, biomechanical assessment strategies focus primarily on compression and tension forces as well. APPLIED ANATOMY IS ESSENTIAL TO ASSESSMENT BIOMECHANICS Applied anatomy is another essential component of assessment biomechanics. A key goal of the assessment process is to identify specific tissues that are likely involved in the client's current pain complaint. Recognizing what happens to specific tissues during various movements or positions and under different movement conditions (active, passive, or resisted) helps identify when those tissues may be at the root of a particular pain complaint. An enhanced understanding of musculoskeletal anatomy is essential to accurately apply these concepts in the assessment process. The standard assessment procedure used as the basis for this discussion of assessment biomechanics is the HOPRS procedure, an acronym that stands for history, observation, palpation, range-of- motion and resistance testing, and special orthopedic tests. The HOPRS procedure is outlined in the text Orthopedic Assessment in Massage Therapy (Daviau Scott, 2006). ASSESSMENT BIOMECHANICS: RANGE-OF-MOTION AND RESISTANCE TESTING This discussion of assessment biomechanics focuses on the R portion (range-of- motion and resistance testing) of the HOPRS model. Interpreting results from the range-of-motion and resistance testing is the most important aspect of the physical examination for determining likely tissues involved. The results from the range-of-motion and resistance testing help evaluate compression and tension forces various tissues are subjected to during those movements. If a specific movement reproduces the client's primary pain complaint, there is a good chance the tissues being stressed (with compression or tension) during that movement are involved. The practitioner then cross-references movements in that region to see if a pattern of results emerges that would further implicate or exclude a particular tissue(s). There are five different evaluation scenarios where the compression and tension forces on various soft tissues are analyzed, including active shortening, active lengthening, passive shortening, passive lengthening, and isometric (manual resistance). Certain musculoskeletal conditions (mainly those involving some degree of mechanical tissue insult or injury) produce common patterns during the five evaluation situations. Recognizing the specific pattern Condition Active Shortening Active Lengthening Passive Shortening Passive Lengthening Manual Resistance Muscle Strain Generally painful if load is sufficient. May not be painful if not enough load on the muscle tendon unit. Usually most painful at end range of muscle lengthening. May be painful through active lengthening, with sufficient eccentric load on muscle. Rarely produces pain because load is removed from affected tissues. Pain likely at or near the end range, in which the muscle is stretched and tensile load is on the strain site. Very likely to reproduce pain from load applied to the strained fibers. of pain reproduction or pain relief can help clarify the presence or absence of various pathologies. For example, a muscle strain will have a particular pattern of results for each of the five evaluation procedures. If a muscle strain is suspected during the evaluation, the practitioner can determine whether the various movements that produce or don't produce pain fit the pattern. An easy way to evaluate these patterns is to look at them in a chart, such as the one illustrated in Table 1. Now, let's take a look at what happens in each of those five scenarios. Active Shortening In a strain, muscle fibers have been overstretched or torn. When there is an active shortening contraction of the target muscle, the site of injury is pulled, and pain is generally reproduced. Sometimes when you have a large muscle or a movement that does not require a high force load, a strain will not be painful with active movement unless there is additional resistance. For example, a strain of the gastrocnemius may not be painful if the client is sitting on the edge of the table and simply moving their foot in the air (active non-weight-bearing plantar flexion). Even though the muscle is being engaged, there is not a high load demand on the involved muscle. Without a significant contraction 1 Five Biomechanical Scenarios for a Muscle Strain

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