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Active Engagement Technique An even more effective application of this technique might involve active eccentric engagement of these muscles as they are worked. An example of the active engagement technique applied to the APL and EPB tendons is shown in the associated video (link below). To apply the active engagement technique, grasp the client's hand in the handshake position. Passively move the client's hand into full radial deviation first to shorten the affected tissues. Once the hand is in full radial deviation, ask the client to hold that position and don't let you move it. This will establish an isometric contraction in the affected muscles. Use a moderate amount of force, since the contraction does not have to be strong. Once the contraction is established, ask the client to slowly let go of that contraction and you will gradually pull their wrist into ulnar deviation. As you slowly pull the wrist into ulnar deviation, perform a stripping technique moving from distal to proximal on the affected muscle bellies (Image 5). Keep in mind that this technique can feel somewhat intense and uncomfortable for the client, so adjust your pressure accordingly. A minor degree of discomfort is acceptable, but if the discomfort is too much, it may further aggravate the nervous system to the point of increasing overall pain in the region and would be counterproductive. Friction Technique Another treatment approach that is frequently advocated for overuse tendon disorders is friction to the affected tendons. The initial rationale for friction applications was that they help break up fibrous adhesions between the tendon and surrounding synovial sheath. Recently, some clinicians and researchers have suggested that this mechanical effect may not be occurring the way we once described. However, we do know that this technique tends to get very beneficial results in many cases. Another potential explanation for this process could be that the pressure and movement of the friction technique helps stimulate fibroblast activity and positively contributes to repairing the damaged tendon. The most effective treatment approaches are likely to include a variety of these different methods that address both the contractile components of the muscle belly farther up in the forearm as well as direct applications to the affected tendons themselves. Kinesiology taping has also shown some benefit in recent cases and is particularly helpful in reducing pain and increasing proprioceptive awareness about movement in the area after treatment has completed. As with other chronic overuse muscle conditions, strength training should come along with activity modification once the initial symptoms have been reduced. Beginning strength training too soon can further aggravate the affected tendons. A good guideline is to protect and nurture the area more than you might think at the outset, and gradually work activity and strength training back in slowly and easily. CONCLUSION Overuse disorders of the upper extremity are a rampant problem in our society with both active individuals and occupational athletes (those with repetitive motion jobs), and massage therapy and other soft-tissue manipulation approaches are particularly helpful in addressing these types of problems. These conditions should be of particular interest to us as professionals because they can significantly impact us and produce career-ending injuries if we don't manage them appropriately. 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 academyofclinicalmassage.com. CLINICAL EXPLOR ATIONS L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 85 4 5 The Finkelstein test has the wrist in either active or passive ulnar deviation with the fingers wrapping over the thumb. Active engagement in ulnar deviation for the affected thumb and wrist tendons. SCAN AND WATCH "Deep Stripping Thumb"