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L i s te n to T h e A B M P Po d c a s t a t a b m m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 31 and trapezoid are sometimes referred to as one structure called the coracoclavicular (CC) ligament(s). It is the AC ligament that is usually injured in a shoulder separation, but more severe injuries affect the coracoclavicular ligament complex as well. In addition to damaging the acromioclavicular and coracoclavicular ligaments, falls or impacts to this region can cause a sprain and/or dislocation to the sternoclavicular joint. Sternoclavicular sprains are not as common but can be serious because a dislocation of the proximal end of the clavicle may cause it to press on or rupture the trachea or jugular vein. Sprains or dislocations at the sternoclavicular joint are considered a separate pathology and are not called shoulder separations. Physical therapy is a common course of treatment to reestablish stability and proper movement in the acromioclavicular complex. The clavicle should be in the proper position when the ligaments start the rebuilding process and scar tissue develops. An arm sling is generally used to maintain proper alignment of the acromioclavicular complex. In some cases, the clavicle is not positioned ideally and heals in a slightly different position. The altered position rarely causes long-term functional impairment and is primarily a cosmetic issue because it results in an enlarged bump at the AC joint from the protruding distal end of the clavicle. Deep friction massage is helpful to encourage collagen rebuilding in the damaged ligament fibers. However, if the tear is severe, friction should not be performed until well after the initial inf lammatory phase (up to 72 hours post-injury). If the injury is more severe, waiting longer is warranted, and consultation with a physician would be helpful. Massage and stretching applied to the entire shoulder girdle are useful to prevent spasm of the surrounding muscles. Treatment of the entire shoulder complex may also reduce capsular adhesions due to long periods of relative immobility that may be necessary to encourage ligament rebuilding. Spinal Ligament Sprain A complex webbing of ligaments runs throughout the spine and is designed to aid in spinal stability. Spinal ligaments have different anatomical characteristics depending on their location and primary function. For example, the intertransverse ligaments run between adjacent transverse processes in the spine (Image 4). However, they are so small that they provide only a minimal amount of stability. The dorsal portion of the supraspinous ligaments from the erector spinae muscles are really more tendinous than ligamentous, as they are primarily composed of tendinous fibers. Consequently, they play a role in transmitting contraction forces from the erector spinae to the spine. An important supporting ligament in the lumbar region is the iliolumbar ligament. This ligament anchors the L5 vertebra to the pelvic girdle and helps prevent forward sliding and rotational distortions of the lower lumbar vertebrae (Image 4). Due to its position and mechanical vulnerability, the iliolumbar ligament is susceptible to sprain from sudden forces to the lower lumbar or sacral regions. Identifying spinal ligament sprains through physical examination is difficult due to the depth of the spinal ligaments and the abundance of soft tissues around the spine. A high-tech diagnostic procedure such as MRI is usually required. However, being familiar with the characteristics of ligament sprains and knowing how to do detailed movement testing can help you assess these injuries. As with other ligament sprains, massage can be helpful mainly by normalizing surrounding soft tissues. Deep friction massage, which is used for other ligament sprains, has very little effectiveness for most spinal ligament sprains because the ligaments are so deep and difficult to access. However, larger and more superficial ligaments, such as the iliolumbar ligament, may respond well to friction massage. Rest from offending activities is crucial, as is preventing spinal motions that further stress the ligaments. Massage can be effective for addressing muscle spasm that develops as a result of pain. THE LIMITATIONS OF A MUSCLE-CENTRIC VIEW OF THE BODY Each professional health-care field has its own lens of bias. As massage therapists, we tend to be muscle- centric in our view of the body. That means when someone comes in with a pain complaint, our tendency might be to assume muscle involvement first. Learning more about other common disorders such as ligament sprains helps us be more accurate clinicians and thus achieve more success with our clients. Whitney 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 TECHNIQUE

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