Issue link: https://www.massageandbodyworkdigital.com/i/1128556
Ta k e 5 a n d t r y A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 99 joint pathology tends to be more proximal and would likely increase with palpation of the joint itself. TREATMENT The fi rst component in addressing tendinopathy is to rest from the offending activity. Usually, there is some activity performed with repetition that led to the tendon pathology. Reducing the constant irritating load on the tendon helps prevent it from getting worse and also gives the tissue a better opportunity to repair. However, the idea about rest from offending activity has been modifi ed in recent years with recent research regarding tendon healing. 1 It now seems most appropriate to talk about relative rest from offending activity as opposed to cessation of activity. It turns out that one of the most helpful factors for stimulating some of the key healing properties for various tendinopathies is putting a reasonable load on the tendon. Consequently, exercise and movement are good for addressing the condition. The trick is fi nding the right amount of exercise and load for the tendon that doesn't put too much load on the tissue and perpetuate the problem. One of the more common approaches used to treat tendinopathy in many regions of the body is deep transverse friction. For many years, transverse friction was advocated because it was theorized to help break up misaligned scar tissue associated with tendon repair in tendinitis. However, we now recognize that most tendinopathy does not involve tendon fi ber tearing and infl ammatory reactions, but friction treatment is still effective. Consequently, there must be some other key mechanism of benefi t for this technique. We have known for quite some time that friction massage is benefi cial for tendinopathies. While very little research has confi rmed the specifi c physiological effects of friction massage, there is some evidence that it encourages fi broblast proliferation that will help repair damaged collagen tissue within the tendon. It may also help reduce any fi brous adhesion that has developed between the tendon and the surrounding synovial sheath in tenosynovitis. There is a signifi cant caution with applying deep transverse friction to the bicipital tendon in this region. The tendon is held within the bicipital groove by the transverse humeral ligament, but if that ligament is somewhat loose or the friction is applied too vigorously, it is possible to dislodge the tendon out of the groove with the transverse movement. A way to avoid that is to perform the friction massage longitudinally (up and down on the tendon), so there are no transverse forces applied to the tendon that may potentially dislodge it from the grove. When treating any tendinopathy, it is important to address the corresponding muscles that pull on the tendon. There are a wide variety of massage techniques that may help reduce bicipital tendinopathies. Of particular interest are some of the active engagement techniques that encourage active movement along with massage. Now that research has suggested that putting a load on these tendons can help in the rehabilitation process, there is a reason to explore the mechanical and neurological benefi ts of these approaches further. One of the more effective methods for addressing these chronic overuse disorders involves active eccentric engagement of the muscle along with a longitudinal stripping technique. The client is in a supine position with the elbow fl exed to about 90 degrees. Instruct the client to slowly extend the forearm to straighten their arm fully. As they straighten their arm, perform a longitudinal stripping technique along the length of the biceps brachii muscle. It is most effective to do this several times in a repeated fashion. Simply instruct the client to repeatedly fl ex and extend their forearm at a slow, moderate pace, and then each time the client extends the forearm the practitioner performs the stripping technique on the biceps muscle. The stripping technique can be performed with a broad contact surface like the backside of the fi st or with a more specifi c and focused contact surface like a fi ngertip or thumb. As treatment progresses, the intensity and effectiveness of this technique can be increased by incorporating active movement against resistance. For this variation, use the initial starting position with the elbow fl exed at 90 degrees. Instruct the client to hold that position while you pull back against their resistance. Then, tell the client to slowly let go of the contraction so you can slowly pull the forearm into full extension. This process is repeated several times to encourage neurological facilitation and active load on the tendon while it is being worked. Bicipital tendinopathy is a common shoulder complaint and, as noted earlier, is easy to confuse with several other shoulder pathologies. Based on what we now know about overuse tendon disorders, various massage approaches can be helpful in addressing this problem and alleviating the client's complaint. Note 1. Ebonie Rio et al., "Tendon Neuroplastic Training: Changing the Way We Think About Tendon Rehabilitation: A Narrative Review," British Journal of Sports Medicine 50, no. 4 (September 2015): 209–15, https://doi.org/10.1136/bjsports-2015-095215. Whiney Lowe is the developer and instructor of one of the profession's most popular orthopedic massage training programs. His text and programs have been used by professionals and schools for almost 30 years. Learn more at www.academyofclinicalmassage.com. Watch "Active Engagement Lengthening for Biceps Brachii"