Massage & Bodywork

November/December 2013

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@WORK Another common injury that occurs from chronic overuse of the wrist flexor and extensor tendons and those of the thumb and fingers is tenosynovitis. This is a condition involving inflammation or irritation between a tendon and its surrounding synovial sheath. It frequently develops along the radial aspect of the wrist in a condition called De Quervain's tenosynovitis (Image 4), but it can also develop in the extensor or flexor tendons on the dorsal or palmar side of the wrist. Tenosynovitis of the flexor tendons as they travel through the carpal tunnel is a common cause of the nerve compression in carpal-tunnel syndrome. The inflammation and irritation of tenosynovitis develops as a result of chronic overload on the tendons. It is most effectively addressed by reducing the overload demand on the wrist flexor and extensor muscle-tendon units. Deep stripping techniques applied specifically to the affected tendons can help reduce chronic overload in the muscle-tendon unit. Even more effective are active engagement techniques where a deep stripping method is performed as the muscle is elongating, while a stripping technique with additional resistance is simultaneously applied (Image 5). The additional resistance increases density in the muscle and helps improve the penetrating effect of the stripping technique. It is also helpful to apply deep friction directly to the affected tendon because tenosynovitis frequently involves fibrous adhesion between a tendon and its surrounding synovial sheath. Friction techniques applied to the affected tendon are likely to be painful, but they will be helpful in resolving the issue. After friction techniques have been applied, it is beneficial to encourage Retinaculum Affected thumb tendons 4 The thumb tendons involved in De Quervain's tenosynovitis. Mediclip image copyright Lippincott Williams & Wilkins, 1998. All rights reserved. 5 Deep stripping technique applied to the affected thumb tendons while the client offers resistance to ulnar deviation movement. freedom of movement between a tendon and the surrounding synovial sheath, using movements that put the tendon through its full range of motion. Massage therapists also routinely sustain nerve-compression pathologies in the forearm and wrist region. The most common locations of nerve entrapments involve compression of the median nerve in the carpal tunnel or between the two heads of the pronator teres muscle. Compression of the ulnar nerve is common in the cubital tunnel of the elbow or Guyon's tunnel (also called Guyon's canal) in the wrist. The most effective way to address any nervecompression pathology is to reduce compression on the affected nerve, which often results from tightness or binding by soft tissues such as muscles or tendons. Consequently, it is very important to reduce hypertonicity in these muscles so that appropriate nerve function can return, along with a decrease in pain. We have addressed these common upper-extremity nerve-compression problems in other articles in this series, so I recommend looking at those articles to examine nerve-compression pathologies in greater detail. Regular self-care should include stretching and relaxation exercises, as well as protocols that relieve chronic tension in these regions. NECK AND BACK PAIN Another common complaint is neck and upperback pain. These two are closely related, and a look at the biomechanics of massage delivery positions shows why these conditions are so frequent. One of the key biomechanical challenges facing massage therapists is one that we investigated early in this series as a chronic complaint in the dental profession ("Brushing Up on Dental Worker Care," March/April 2012, page 106). Like dental See what benefits await you. 105

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