Massage & Bodywork

November/December 2012

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@WORK 5 Treating the deep, intrinsic spinal muscles. Image courtesy Whitney Lowe. Numerous techniques can be used to address low-back tightness; however, it is crucial to get to the often-ignored, deeper intrinsic spinal muscles. Your technique needs to be deep and specific to get to these muscles. Make sure you are familiar with the anatomical structures in this area and recognize where you can put pressure on muscles without adversely compressing bony prominences such as the transverse or spinous processes of the lumbar vertebra. The deep, intrinsic spinal muscles frequently hold myofascial trigger points. Static compression and deep stripping techniques will address chronic tightness and neutralize trigger points (Image 5). If the contact surface is too broad (e.g., using the palm, open hand, or flat fingertips), you will not accurately get at the very deep muscles, such as the lumbar multifidus. It is wise to use a broader contact surface first, but make sure to eventually get into these areas with a small contact surface as well. Stripping techniques are particularly valuable in encouraging elongation and relaxing the shortened sarcomeres that result from overload. Knee Anterior knee pain can sometimes be a bit misleading, so accurate assessment is important. Most of the involved structures are superficial, so palpation plays a primary role in evaluating dysfunction in the knee extensor complex. Anterior knee pain prominently reproduced when pressure is applied to the infrapatellar tendon is strongly indicative of patellar tendinosis. The chronic collagen degeneration of tendinosis takes a long time to heal, but should be addressed with a comprehensive treatment approach, including reducing tightness in the quadriceps along with deep-friction techniques directly on the tendon. Working the quadriceps reduces the pull on the tendon. The primary function of friction techniques to the tendon is stimulating fibroblast proliferation, which helps heal collagen degeneration. Patellar tracking disorders can be challenging to identify, but frequently involve significant tenderness in the retinaculum around the knee, which is indicative of imbalanced forces pulling on the retinacular tissues. The primary massage methods for patellar tracking disorders emphasize reducing the excessive pulling load of the quadriceps muscle group on the patellar tendon. This is accomplished by treating the quadriceps with deep, compressive effleurage, sweeping cross-fiber techniques, and longitudinal stripping methods. Stretching is particularly valuable to encourage flexibility and elongation in the quadriceps. It is crucial to address the patellar retinaculum as well as the quadriceps group. The patellar retinaculum is an expanse of connective tissue that extends from the distal quadriceps muscle fibers into the patellar tendon and its associated attachment at the tibial tuberosity. The retinaculum is richly innervated, so it is a likely source of anterior knee pain when overstressed. An excellent way to address the patellar retinaculum and patellar tendon is with active engagement methods. Because the quadriceps are a dense muscle group, particularly in certain individuals, common treatment methods may not provide adequate force to access the deeper tissues. Active engagement methods produce effective results because of the additional force involved in the treatment technique. MASSAGE AS SOLUTION Cumulative effects and high physical demands are exaggerated with delivery workers. However, numerous other activities pose similar biomechanical challenges for the body. As always, proper assessment and evaluation are key factors before attempting any treatment approach. Armed with a good understanding of biomechanical relationships in these regions and the physiological impact of our treatments, massage therapists are in an excellent position to offer great help to this worker population. 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. Contact him at www.omeri.com. www.abmp.com. See what benefits await you. 109

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