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A B M P m e m b e r s ea r n F R E E C E h o u r s by rea d i n g t h i s i s s u e ! 31 Compression with active engagement on the subscapularis. 3 A B M P m e m b e r s ea r n F R E E C E h o u r s by rea d i n g t h i s i s s u e ! 31 TECHNIQUE tendon. A detailed history is essential to determine the age of the injury. • Severe tissue damage—In cases of signifi cant tears or ruptures of the rotator cuff tendons, massage may not be appropriate. An accurate assessment will help you evaluate the severity of the condition. Severe conditions require a referral to another health-care provider. • Postsurgical caution—For those who have undergone surgery, the area needs adequate time to heal before massage is considered. Massage can be benefi cial in postsurgical rehabilitation. However, use precautions with any postsurgical treatment and do not work near any incision site until it has had appropriate healing time. • Bursitis—Infl ammation of the subacromial bursa (bursitis) can worsen with direct massage. Learn about potential signs of subacromial bursa involvement to ensure massage techniques do not further aggravate an irritated bursa. • Bone abnormalities—Issues like bone spurs or abnormal bone growth can be underlying causes of rotator cuff disorders. Massage does not provide relief in these cases and could worsen the condition. Bone spurs are not likely evident with physical examination and will need diagnostic procedures like an X-ray or MRI to identify. If you are suspicious of a condition, referring the client to another provider for further evaluation is wise. • Infections—Sometimes, a rotator cuff injury is associated with other pathologies and may involve potential infections in the area. Any infections in the shoulder area, including skin or deeper tissue infections, should be considered when developing a plan of care. • Neurological symptoms—If the client exhibits neurological symptoms like numbness, tingling, or weakness in the arm, there is likely neurological involvement, and it should be appropriately evaluated. Pressure on irritated nerves can signifi cantly increase symptoms, so be cautious. • Pain threshold—Always work within the client's pain threshold. Excessive pressure can exacerbate pain and further injure the tissue. More pressure is not always benefi cial, and it does not necessarily mean you are more effectively accessing "deeper" tissues. Harder pressure might access more tissues, but it can also cause more tissue injury or neural irritation. For this reason, knowing the physiological effects of your treatment methods is important. Be sure to maintain open communication with the client throughout the massage session. Adjust the technique or stop altogether if they experience sharp pain, discomfort, or any unusual sensations. ENHANCE THE RECOVERY In the realm of rotator cuff disorders, there is no single approach that works. Personalized treatment plans tailored to an individual's unique circumstances and needs are most effective. Massage therapy, with its diverse range of techniques, offers significant potential as a primary treatment method and as a complementary modality that enhances the care of rotator cuff disorders. Note 1. Anssi Ryosa et al., "Surgery or Conservative Treatment for Rotator Cuff Tear: A Meta- analysis," Disability and Rehabilitation 39, no. 14 (July 2017): 1357–63, https://doi.org/10.1 080/09638288.2016.1198431; Umile Giuseppe, "Correction to: Conservative Versus Surgical Management for Patients with Rotator Cuff Tears: A Systematic Review and META-analysis," BMC Musculoskeletal Disorders 22, (September 2021), https://doi.org/10.1186/s12891-021-04525-w. 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 academyofclinicalmassage.com. ABMP members, check out one of your f ree CE courses "The Challenge of Upper Extremity Overuse Disorders" by Whitney Lowe. abmp.com/learn/course/ challenge-upper-extremity- overuse-disorders WATCH: "ACTIVE ENGAGEMENT COMPRESSION: SUBSCAPULARIS" 1. Open your camera 2. Scan the code 3. Tap on notification