Issue link: https://www.massageandbodyworkdigital.com/i/1496639
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 75 interest. Any work that stimulates inf lammation and the production of collagen can exacerbate the processes that cause this problem. By contrast, in a situation where the surgery or trauma was recent, then pain-free massage in combination with pain-free exercise and stretching could help prevent the processes that start arthrofibrosis to begin with, and it could undo some of the contributing factors that restrict range of motion as the condition develops. When inf lammation settles, neuromuscular strategies like proprioceptive neuromuscular facilitation or muscle energy technique may help reset the resting tone of affected muscles, which could then improve range of motion at the joint—but only if this work does not initiate any adverse reactions in terms of pain, heat, or swelling at the joint. How much difference massage therapy might make for a long-term fibrotic joint is an open question, however. But even for clients with longstanding limitations, the experience of educated touch that respects their pain tolerance, range of motion, and other physical compensations that they have had to make to accommodate for a "frozen" joint could be strength- and health-promoting. Kayley Usher, PhD, a leading expert on arthrofibrosis and founder of the International Arthrofibrosis Association, suggests a conservative approach to avoid causing inadvertent injury and renewed ECM production is preferable. But to date, the only published study about massage and arthrofibrosis is a case report that suggests that a modified version of cross-fiber friction using tools (the Graston technique) and exercise to "release adhesions, scar tissue, and fascial restrictions" was effective. This type of work can cause bruising, and the supposition that this strategy does indeed "break down" scar tissue is questionable. But the results of this single-person case report were clear: The client had improvement in range of motion and muscle strength, where other interventions had not succeeded. That said, the data describes only one person, and covered only short-term effects. We don't know the long-term outcomes for this patient. 5 I agree with Dr. Usher that a strategy that does not promote more scar tissue is better than one that causes inf lammation and bruising for a person whose injury- response processes have a history of being hyperreactive. The video that accompanies this column shows more of my conversation with Dr. Usher about her experience with arthrofibrosis, the inf lammatory process, and the work of the International Arthrofibrosis Association. Notes 1. K. M. Usher et al., "Pathological Mechanisms and Therapeutic Outlooks for Arthrofi brosis," Bone Research 7, 9 (2019): https://doi.org/10.1038/s41413-019-0047-x. 2. B. T. Velasco et al., "Arthrofi brosis of the Ankle," Foot & Ankle Orthopaedics 5, no. 4 (2020): https:// doi.org/10.1177/2473011420970463. 3. Usher et al., "Pathological Mechanisms and Therapeutic Outlooks for Arthrofi brosis." 4. B. P. Dyer et al., "Diabetes as a Prognostic Factor in Frozen Shoulder: A Systematic Review," Archives of Rehabilitation Research and Clinical Translation 3, no. 3 (2021): 100141, https://doi. org/10.1016/j.arrct.2021.100141. 5. D. W. Black, "Treatment of Knee Arthrofi brosis and Quadriceps Insuffi ciency after Patellar Tendon Repair: A Case Report Including Use of the Graston Technique," International Journal of Therapeutic Massage & Bodywork 3, no. 2 (2010): 14–21. Author's note: I want to offer my special gratitude to Kayley Usher, PhD, a leading expert on arthrofibrosis and founder of the International Arthrofibrosis Association. Dr. Usher was the lead author on a 2019 review article published in Bone Research titled "Pathological Mechanisms and Therapeutic Outlooks for Arthrofibrosis," and she generously let me interview her twice: once for a podcast about arthrofibrosis (see page 73), and again for this column. Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology (available at booksofdiscovery.com), now in its seventh edition, which is used in massage schools worldwide. Werner is available at ruthwerner.com. PATHOLOGY PERSPECTIVES VIDEO: "ARTHROFIBROSIS" 1. Open your camera 2. Scan the code 3. Tap on notification 4. Watch!