Issue link: https://www.massageandbodyworkdigital.com/i/494122
F r e e S O A P n o t e s w i t h M a s s a g e B o o k f o r A B M P m e m b e r s : a b m p . u s / M a s s a g e b o o k 97 CLINICAL APPS from compression injury. The most important goal is to get pressure off the nerve so that it can heal on its own. In Monica's case, it appears that residual muscle tightness or splinting was compressing the nerve and further restricting its free movement, thereby causing symptoms. Consequently, massage treatment focused on reducing tightness in the lateral cervical muscles, pectoralis minor, and associated muscles, which were likely compressing the lower brachial plexus. Prior to treating the pectoralis minor, it is important to reduce tightness in the overlying pectoralis major muscle first. Once the pectoralis major is relaxed, deeper stripping applications can be applied to the pectoralis minor to reduce tightness or existing myofascial trigger points that might be causing the muscle to bind and restrict the brachial plexus. Be sure to note if the client experiences any symptoms or sensations when working the pectoralis minor to make sure you don't put additional pressure on the brachial plexus and further aggravate nerve compression. Deep stripping applications can also be applied to the anterior and lateral neck muscles to make sure they are not binding or restricting the brachial plexus. Special attention should be focused on the anterior and middle scalene muscles, as these are the ones most likely to bind the brachial plexus in the cervical region (Image 3). One of the key goals of treatment in Monica's condition is to encourage free movement of the nerve, which might be bound and restricted by muscle tightness. Once the muscles surrounding the nerve have been somewhat relaxed with the massage techniques described above, you may use a neural mobilization technique. The technique used with Monica uses the same positions as the neurodynamic test described earlier. The arm is then gently moved in and out of the stressful position in order to reduce adhesions that might have bound or restricted the nerve. This technique attempts to move the nerve through its range of motion. You can see a demonstration of the neural mobilization technique for the ulnar nerve in the digital version of this publication, www.massage andbodyworkdigital.com. Monica required once-a-week sessions for six weeks. Nerves are slow to heal, and though Monica saw immediate improvement, the nature of her art form and activities meant that there was previously existing tightness in her upper body musculature that complicated her situation. Monica performed stretching activities at home as well. She also stayed off the silks completely for two weeks, which was critical for her to stop the progression of the condition. However, after that initial period, she was able to gradually and gently resume her routines. CONCLUSION This case with Monica is an excellent example of the importance of a comprehensive assessment for creating a treatment plan. Though a client may see another health-care professional, your assessment and evaluation skills are crucial parts of successful treatment for these types of cases. Though nerve injuries cannot be directly treated with massage, the surrounding tissues are often involved and there are indirect approaches that can help tremendously in solving these potentially complicated cases. Earn CE credit for this article and learn about Whitney Lowe's innovative, engaging, and interactive instructional designs. Lowe's texts and courses have benefited professionals and schools for more than 25 years. For more information, visit www.academyofclinicalmassage.com. Brachial plexus nerves course between the scalene muscles and under the pectoralis minor. Image is from 3D4Medical's Essential Anatomy 5 application. 3 Pectoralis minor Brachial plexus nerves Scalene muscles