Massage & Bodywork

November | December 2014

Issue link: https://www.massageandbodyworkdigital.com/i/398416

Contents of this Issue

Navigation

Page 99 of 133

F r e e m u s i c d o w n l o a d s f o r C e r t i f i e d m e m b e r s : 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 97 CLINICAL APPS Stripping techniques with and without movement on the abductor pollicis longus and extensor pollicis brevis muscles. Image courtesy Whitney Lowe. 6 Following the initial stripping techniques, perform those same stripping techniques simultaneously with movement that lengthens the muscle. Use one hand to perform the stripping technique, and the other hand to pull the client's hand into ulnar deviation, just like in the Finklestein test. Stretching the muscle-tendon unit in this direction as the stripping technique is applied is highly effective in achieving the best muscle relaxation for the thumb muscles. Recent studies have highlighted the benefits of conservative soft-tissue manipulation techniques in treating tenosynovitis. 2 Some of these techniques are performed with the hands, while others such as gua sha and Graston technique are performed with a specific tool. There is a fair amount of controversy about some of the instrument- assisted soft-tissue treatments because they can appear to cause tissue damage and bruising. However, evidence suggests they are effective, so further research is warranted. Only those skilled in these techniques should use them. Treating the key muscle bellies will allow them to relax, and will reduce the load on the tendon. Attention can now focus on addressing the specific tendon dysfunction. Deep-friction massage to the affected tendon is the treatment of choice. The primary purpose of friction to treat tenosynovitis is to address the fibrous adhesions and encourage tendon healing. Friction treatment is applied to the damaged tendon to stimulate fibroblast proliferation, which will encourage tissue repair. Studies have shown that the key to effective fibroblast stimulation is pressure and movement applied to the tendon. The friction can be applied in different directions (longitudinally or transverse) and still produce beneficial effects. 3 However, sometimes transverse friction is more effective in breaking up fibrous adhesions that develop between the tendon and its surrounding synovial sheath. Putting the tendon on a stretch when friction is applied also increases the effectiveness of the technique. With the tendon pulled taut, the pressure is more effectively delivered to the tendon and it can help break up any fibrous adhesions. Tenosynovitis treatments are most effective when they are performed frequently. The more often the pressure and movement are applied to the tendon, the more effective the treatment. When there is tenosynovitis in the thumb tendons, as in Alan's case, massage treatments that are applied to the entire upper extremity are also valuable. It will be important for Alan to continue his treatments for long-term resolution. However, Alan can also be taught to perform these friction treatments on himself, and the more frequently he does the techniques, the faster he can restore optimum function. CONCLUSION Clients may often come in with preconceived fears or concerns that they have a particular pathology, especially if it is something extremely common like carpal tunnel syndrome. However, as in Alan's case, sometimes our analytical skills help clarify the real nature of the problem through evidence-based rationale. When you do this, you increase the confidence your client places in you, while greatly improving your treatment success at the same time. Notes 1. Maryam Ali et al., "Frequency of De Quervain's Tenosynovitis and Its Association with SMS Texting," Muscles, Ligaments and Tendons Journal 4, no. 1 (2014): 74–8. 2. John A. Papa, "Conservative Management of De Quervain's Stenosing Tenosynovitis: A Case Report," Journal of the Canadian Chiropractic Association 56, no. 2 (2012): 112–20; Emily R. Howell, "Conservative Care of De Quervain's Tenosynovitis/Tendinopathy in a Warehouse Worker and Recreational Cyclist: A Case Report," Journal of the Canadian Chiropractic Association 56, no. 2 (2012): 121–7; Warren I. Hammer, "The Effect of Mechanical Load on Degenerated Soft Tissue," Journal of Bodywork and Movement Therapies 12, no. 3 (2008): 246–56. 3. G. M. Gehlsen, L. R. Ganion, and R. Helfst, "Fibroblast Responses to Variation in Soft Tissue Mobilization Pressure," Medicine & Science in Sport & Exercise 31, no. 4 (1999): 531–35. 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.

Articles in this issue

Links on this page

Archives of this issue

view archives of Massage & Bodywork - November | December 2014