Issue link: https://www.massageandbodyworkdigital.com/i/365665
I t p a y s t o b e A B M P C e r t i f i e d : w w w. a b m p . c o m / g o / c e r t i f i e d c e n t r a l 103 Distal supraspinatus musculotendinous junction Infraspinatus and teres minor 5 The distal supraspinatus musculotendinous junction. Image is from 3D4Medical's Essential Anatomy 3 application, available on the App Store. 6 Friction applied to posterior cuff tissues. Image courtesy of Whitney Lowe. 7 Posterior rotator cuff in active engagement technique. Image courtesy of Whitney Lowe. The most effective way to access the distal musculotendinous junction is to have the client's arm pulled as close in to her side as possible. In this position, deep friction can be applied just inferior to the acromion process. This friction technique will help manage scar tissue and encourage fibroblast proliferation to provide the optimal healing environment for the torn muscle and tendon fibers. A similar treatment strategy can be used for the posterior rotator cuff tendons, which sustained a similar injury. These tendons are far more accessible on the posterior aspect of the shoulder. Friction techniques can be applied directly to the site of greatest tissue tenderness (usually the musculotendinous junction) to help encourage tissue repair and optimum return to function (Image 6). Later in Emily's rehabilitation process, we can encourage greater tissue function through active engagement methods. For the posterior rotator cuff group, deep stripping techniques are applied to the infraspinatus and teres minor as she moves her shoulder into medial rotation (Image 7). Performing longitudinal stripping techniques on these muscles as they elongate helps encourage tissue alignment and restore optimal function. Similar treatment can be used with the supraspinatus muscle by performing stripping techniques as the shoulder is moved into adduction. The traction injury Emily sustained to her brachial plexus and median nerve in her upper extremity is going to be more difficult to address. When a nerve has been overstretched, there is nothing that soft-tissue manipulation can do to the nerve to correct the stress. It is simply a matter of allowing time for the damaged nerve tissue to heal appropriately. However, massage can play a role in making sure the surrounding region and tissues do not further aggravate the nerve traction injury. In Emily's case, massage is applied to the lateral cervical region and throughout the length of the upper extremity to help reduce any further aggravation on the upper extremity nerves or brachial plexus by surrounding muscles, which may become hypertonic and may be compressing or irritating the nerves. CONCLUSION Emily's case demonstrates that accurate biomechanical analysis of the forces affecting a tissue injury can be crucial for determining the nature of the injury. Treatment strategies should be specific for each individual. Emily's treatment strategy was determined by in-depth mechanical analysis of the forces impacting her at the time of the injury. This analysis educates your client with valuable information about the injury, and directs the course of your treatment. 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. You can find more ideas in Lowe's free enewsletter—and his books, course offerings, and DVDs—at www.omeri.com.