Issue link: https://www.massageandbodyworkdigital.com/i/766890
For example, you may have a client with neck pain who comes to see you years after her whiplash injury; or another who presents with frequent knee injuries after a poorly healed knee sprain left him with a limp and an incorrect foot plant; or a young client who is considering a hip replacement, likely as the result of an old running injury that somehow left her hip hurting constantly. In contrast, I recently suffered a serious injury that healed very well, and I believe my case illustrates not only the importance of intensive rehabilitation, but the level of improvement that can be reached. With my knowledge of bodywork and complementary therapies, and examples of individuals who gave their rehab a lot of energy, my injury healed far beyond my medical team's expectations. At the same time, I learned a great deal about how to assist my injured clients in their own journeys. MY REHABILITATION To perform massage, therapists need strength, dexterity, and full range of motion of all the joints of the upper extremities. My injury was severe, and many surgeons believe the elbow is a joint that does not recover well from trauma and has a high tendency to degenerate and become stiff afterward. 2 I will never forget the look of dismay on the elbow surgeon's face when he found out I was a massage therapist! Although he promised to do his best, he told me I might never do massage again. Chances were my arm would be permanently crooked and my ability to extend, flex, and supinate my elbow joint would be severely compromised. This would also change how I used my shoulder joint, leaving me open to shoulder injury. Strokes performed by most massage therapists would be well-nigh impossible. For example, Swedish effleurage strokes require applying pressure downward with a straight arm and fully extended elbow on 74 m a s s a g e & b o d y w o r k j a n u a r y / f e b r u a r y 2 0 1 7 Two similar injuries, one intensively rehabilitated, one with no rehabilitation Upper extremity after elbow fracture (right). The fall onto the elbow fractured the radial head and shattered the medial epicondyle into seven separate, tiny fragments. The arm is seen after surgery and 10 months of intensive rehabilitation. Elbow extension is 5 degrees, flexion is 130 degrees (90 percent of original elbow range of motion). Supination and pronation are normal; shoulder and wrist range of motion are normal. Biceps and hand flexors are slightly shortened. The elbow joint is pain-free except at extremes of flexion and extension; then, it is a 2 out of 10 on the pain scale. Upper extremity after elbow fracture (below). The fall onto the elbow fractured the olecranon into eight tiny fragments. The arm is seen after surgery and with no rehabilitation. The image shows her maximum elbow extension and shoulder elevation. Supination is also severely limited. Her elbow is painful and sensitive to the touch, and the olecranon bursa is also swollen and painful. She frequently has tingling in her elbow and hand—a sign of damage to the ulnar nerve. Due to limited extension, both biceps and forearm flexors are very short. When lifting a box or using a shovel, instead of flexing and supinating the elbow to bring the hand under the box or around the shovel handle, this client has to compensate by rotating her humerus externally, contracting the quadratus lumborum and external oblique muscles in order to flex the torso sideways. This substitution pattern could eventually lead to shoulder impingement, subacromial bursitis, or a rotator cuff tear. Limited elbow flexion, over time, may also result in chronic tightness and/ or pain in the opposite-side hip flexor muscles, as they counterbalance a changed arm swing. Medial epicondyle Both the hand flexor and the wrist flexor tendons insert on the medial epicondyle.