Issue link: https://www.massageandbodyworkdigital.com/i/1234356
CLINICAL E XPLORATIONS consider a torsion force applied to a larger structure, such as an entire joint. 4. Bending force applies to rigid structures when one side of the rigid structure is exposed to compression and the other side to tension. Bending force requires a rigid structure, so it only applies to bone. 5. Shear force is when two structures slide against each other. Tendons in the distal extremities are exposed to shear force as they slide back and forth within their synovial sheaths. Clinical Applications of Biomechanics It may not be immediately apparent, but all of the physics involved with a kinetic analysis can play a crucial role in understanding what is involved in a particular injury. Kinetic analysis may also help us understand how forces we apply to a client's body may affect the various tissues under our fingers. It may seem a little daunting at first, but when you begin to look at the body and how we work with it through a lens of kinetic analysis, you gain an appreciation for how this information can significantly enhance your clinical success. KINESIOLOGY IN ACTION Let's take a look at a short case study example of how we might put some of this information into practice: Ellen has come to our clinic complaining of sharp pains in her hand, which began shortly after an incident at her workplace where she grabbed a door handle to open the door at the same moment someone on the other side of the door rapidly pulled it open. Ellen's hand was still firmly on the door latch when this happened, so she was quickly pulled into the other room. Ellen immediately felt pain through her arm and into the palm of her hand, which has continued ever since that incident over a week and a half ago. Her description of the pain through her forearm and hand was that it was a sharp, shooting pain sensation. Ellen is now wondering whether massage might help address the problem. The sharp, shooting pain sensation is a frequent description of various nerve compression pathologies. However, if we think about the injury from a biomechanical perspective, a nerve compression is not likely. The client described a situation in which she was holding onto a door handle as it was suddenly pulled away from her. That motion would have put a sudden tensile (pulling) load on her upper extremity. In this case, she likely suffered excessive neural tension, in which the nerve is exposed to excessive pulling stress. There could also have been significant tensile loads on the other soft tissues in the forearm or hand that could also be producing the symptoms. It is valuable to consider a neural tension injury here as we construct a treatment plan for her. In neural tension injuries, it is very important to be cautious about applying pressure throughout the forearm muscles because if the nerve has been overstretched, applying any additional irritation to that nerve could aggravate the symptoms. Neural tension injuries are best treated with very light work and treatment strategies that emphasize decreasing any additional loads on the nerve. We can focus on gentle, easy movement of the nervous system throughout the whole upper extremity and advise Ellen to avoid movements that further stretch the nerve. We would also let her know that nerves take more time to heal than muscles, and to be patient. Had we not considered the kinesiology of Ellen's condition, and simply treated her for generalized pain and hypertonicity, we could have easily worsened her condition. Or, had we made a quick determination based on her neurological symptoms that she had a compressive type nerve injury, we could have again not been effective at addressing the complaint. Kinesiology, in this case, makes our assessment more precise and accurate. Thus, her treatment will be more successful. KINESIOLOGY IN ACTION Not only is kinesiology a much broader science than you may have realized, it is also an integral part of becoming a highly skilled soft-tissue therapist when working with pain and injury complaints. An arsenal of techniques is essentially your bag of tools. However, even with a great bag of tools, if you don't understand when to use a wrench and when to use a screwdriver—and how much force to use when you apply it—your work will be much less effective. Notes 1. Robert Schleip, "Fascial Plasticity: A New Neurobiological Explanation, Part 1," Journal of Bodywork and Movement Therapies 7, no. 1 (January 2003): 11–19, https://doi. org/10.1016/S1360-8592(02)00067-0. 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. ABMP members can take advantage of in-depth training with an exclusive discount on Whitney Lowe's 130-hour Orthopedic Massage online program. Normally $750, ABMP members pay only $650. Use this code when purchasing: ABMP PRO. N e w ! A B M P P o c k e t P a t h o l o g y a t w w w. a b m p . c o m / a b m p - p o c k e t - p a t h o l o g y - a p p . 87