Issue link: https://www.massageandbodyworkdigital.com/i/1208028
Ta k e 5 a n d t r y t h e 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 . 97 Another factor that has shown significant benefit in tendinopathy treatment is progressive loading of the tendon. Eccentric exercise appears to be the most effective means of increasing load on the tendon for these rehabilitation strategies. Eccentric loading on the tendon seems to have both neurological and mechanical responses in the tendon that help encourage a more rapid return to function. Many of the active engagement techniques mentioned previously use eccentric actions on the tendon while massage is applied. That may be one of the main reasons why they appear so effective. Chronic overuse tendon disorders are one of the most common soft-tissue problems you are likely to see in your practice. Isolating the problem and distinguishing tendon pathology from other soft-tissue causes will help you construct the most appropriate treatment strategy. In CLINICAL E XPLORATIONS addition to the soft-tissue work we employ, we are also client educators. Clients spend the majority of their lives outside our treatment room, so we should help them understand things they should avoid and things they can do to enhance the treatment plan. To paraphrase Canadian physiotherapist Greg Lehman, our primary goal in any treatment strategy for these problems should be first to "calm things down, and then to eventually build them back up." The fundamental approach to effectiveness is recognizing where that Goldilocks zone is for calming things down and building them back up. If you don't decrease irritability in the tissues enough, or if you try to strengthen them too fast, you are likely to perpetuate the problem. If you spend too much time trying to decrease irritability and never focus on strengthening and treating the tendon, you may delay appropriate healing. Like so many things in our field, finding the ideal balance is the trick! Notes 1. Jill Cook and Craig Purdam, "Is Compressive Load a Factor in the Development of Tendinopathy?," British Journal of Sports Medicine 46, no. 3 (March 2012):163– 68, http://dx.doi.org/10.1136/bjsports-2011-090414. 2. Arco C. van der Vlist et al., "Clinical Risk Factors for Achilles Tendinopathy: A Systematic Review," British Journal of Sports Medicine 53, no. 21 (November 2019): 1352–61, https:// doi.org/10.1136/bjsports-2018-099991. 3. Bruno Magnan et al., "The Pathogenesis of Achilles Tendinopathy: A Systematic Review," Foot and Ankle Surgery 20, no. 3 (September 2014): 154–59. Whitney Lowe is the developer and instructor of one of the profession's most popular orthopedic massage training programs. His text and programs have been used by professionals and schools for almost 30 years. Learn more at www.academyofclinicalmassage.com. Deep transverse friction applied to the Achilles tendon. Image from 3D4Medical's Complete Anatomy application. Practitioner offering resistance to eccentric flexion in an active engagement technique for the wrist extensor muscles. Image from 3D4Medical's Complete Anatomy application. 4 5 Massage helps manage pain through a process called descending modulation, in which a particular stimulus (the therapeutic touch of massage) helps turn down the volume on sensory information that heightens the pain response. It is the exact mechanism behind soothing a sore arm or leg by gently rubbing it. Massage techniques that stimulate the sensory and proprioceptive activity of the involved muscles may be quite effective in initiating this process. For example, active engagement techniques that use active muscle contraction along with a specific massage technique are beneficial for encouraging the descending modulation response (Image 5). Also, see a video demonstration of this technique at www.vimeo.com/207882834/d3819168c9.