Massage & Bodywork

July | August 2014

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I t p a y s t o b e A B M P C e r t i f i e d : w w w. a b m p . c o m / g o / c e r t i f i e d c e n t r a l 103 This case highlights the importance of having a high degree of knowledge about several contributing elements of advanced massage: anatomy, assessment protocols, biomechanics, and the soft-tissue rehabilitation process. After each treatment session, heat was applied to the tissues to enhance connective tissue pliability. Immediately after the heat treatment, we stretched him in flexion as far as possible. The stretch position was held for about 20 to 30 seconds and repeated three to four times. Holding stretches for this length of time helps encourage elasticity and creep (tissue elongation) in the connective tissues much better than a short duration stretch. For treatment support, I taught Patrick to perform many of the friction techniques and encouraged him to use them prior to the daily stretching routine he was doing at home. Regular application of the massage technique prior to the stretching helped increase his range of motion even more. After four weeks of twice-weekly therapy, there was marked improvement in range of motion (about 60 degrees of knee flexion) and a reduction in associated pain. At this point, Patrick had a follow-up appointment with the orthopedist who was very excited about our results and encouraged us to continue the same treatment process. At six weeks, Patrick was getting close to 110 degrees of knee flexion and there was a clear reduction in the amount of fibrous tissue that was palpable in the injury area. It was determined that he could space the treatments out, but continue his vigorous home treatment regimen. CONCLUSION This case was successful for a number of reasons. First, the injury was addressed early in the healing process when the tissue was still pliable. In many cases, you don't have the opportunity to intervene until an injury is much older. The older the scar tissue is when treatment begins, the more challenging it is to make significant tissue consistency changes. The fact that Patrick was a former athlete, highly motivated, and willing to endure significant pain during treatment helped achieve these results. Many soft-tissue treatments can be performed without inducing pain, but there are certain conditions in which the intended results are difficult to achieve without some degree of discomfort. It takes skillful evaluation by the therapist to determine what pain levels are acceptable and when it is too much. This case highlights the importance of having a high degree of knowledge about several contributing elements of advanced massage: anatomy, assessment protocols, biomechanics, and the soft-tissue rehabilitation process. Proper massage technique was clearly necessary, but technique knowledge alone would not have been sufficient to create this treatment plan. Patrick's case emphasizes that effective treatment is a compendium of cognitive and functional knowledge and physical skills. It is valuable when we have clinical references in textbooks or resource material that give us guidelines about how to address certain pain or injury complaints. However, nothing can replace good clinical reasoning based on substantive knowledge and understanding, because the majority of the time we are presented with unique individuals and presentations that may differ significantly from common pain or injury condition descriptions. 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.

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