Massage & Bodywork

January | February 2014

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5 Active engagement with additional resistance. Image courtesy Whitney Lowe. band, handheld weight, or manual resistance from the therapist (Image 5). The additional resistance recruits a greater number of muscle fibers and allows the stripping technique to address even deeper myofascial layers within the muscle. The additional resistance also reduces the effort the practitioner must expend for deep, effective pressure on the muscle. Reducing tightness in the associated muscletendon unit is of key importance, but the primary pain Melvin is experiencing is likely originating from the biceps tendons and we need to address this tissue as well. Tendinosis is generally treated with deep friction massage, with the goal of stimulating fibroblast activity to encourage collagen rebuilding. Pressure and movement are the key factors that help encourage fibroblast proliferation. In most cases, friction massage can be performed in a transverse or longitudinal direction. However, when treating the biceps tendon, massage only in a longitudinal direction (Image 6) because it is possible, though uncommon, that deep and vigorous transverse friction could dislodge the tendon from the bicipital groove. In tenosynovitis, the primary problem is fibrous adhesion between the tendon and surrounding synovial sheath. In this case, deep friction applied directly to the tendon helps break up the adhesion and encourage a free gliding motion between the adjacent tissues. Because there may be some inflammatory reaction associated with this treatment, it is a good idea to be conservative with the friction technique until you find out how the individual client's tissues respond. Tendinosis and tenosynovitis are both conditions that commonly linger, so it is unlikely Melvin will see immediate results from just a treatment or two. Although it has been recommended that he refrain from the activities that aggravate his symptoms, he is not able to 6 Friction massage on the biceps tendon. Image courtesy Whitney Lowe. completely do that in his work. In this case, the goal is to focus on restoration of optimum function while he continues in activity. Now that he understands the type of activities that aggravate the condition, he can attempt to reduce those activities to help the treatment process. It is impossible to know exactly how many treatments will be required to achieve these goals because of individual variables with each client. As treatment progresses, it becomes easier to make estimations on the rate of a full recovery. In this case, Melvin presented with a shoulder complaint and the cause was not easily identifiable or immediately apparent. The evaluation highlighted how easy it might be to make incorrect assumptions about other, more superficial, tissues being at fault and consequently our treatment would have addressed the wrong tissues and not been successful. Success in clinical treatment results not from simply applying techniques we've learned in a shotgun approach, but by considering the evidence our client presents with and how that fits with recognizable patterns of soft-tissue dysfunction. The conscientious and skilled practitioners who can apply these fundamental concepts most effectively will be the most successful in treating their clients. Whitney Lowe is the author of Orthopedic Assessment in Massage Therapy (Daviau-Scott, 2006) and Orthopedic Massage: Theory and Technique (Mosby, 2009). He teaches advanced clinical massage in seminars, online courses, books, and DVDs. You can find more ideas in Lowe's free enewsletter—and his books, course offerings, and DVDs—at www.omeri.com. It pays to be ABMP Certified: www.abmp.com/go/certifiedcentral 103

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