Issue link: https://www.massageandbodyworkdigital.com/i/530196
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 93 The therapist begins over the retinaculum of the wrist slightly superior to where Image 15 shows, and then gradually works his way down into the wrist and hands. Start on the midline of the forearm, or actually, in between the radius and the ulna. This work has you start on the midline, get contact with the tissue over the bone by touching into the bone, and then add a second vector by spreading the tissue laterally away from the midline. As you spread the tissue down into the wrist and away from the midline, you can also ask the client to bend her elbow in toward her body slowly and then back out. This will have a very big effect on the interosseous membrane, as well as the carpal tunnel. This is another area of the body where the superficial fascia and deep fascia of the body merge at the surface or outer layer of the body. People with chronic upper girdle problems have rarely had work done below the level of their elbows. You must remember, however, these fascia are interconnected, and most everyone has experienced falls on their hands and wrists at some time in their life. The interosseous membrane is an excellent entry point into work for the whole arm, shoulder girdle, neck, TMJ, and trunk. In Image 16, the therapist is working on the flexor compartments of the forearm and also the interosseous membrane. This is a very effective and simple technique, and begins right over the carpal tunnel of the wrist and continues all the way up to the elbow. The pressure is deep, firm, and continuous for several inches at a time. The client should be reminded to keep her fingers stretched and extended while you are working, and she can also roll her forearm by pronating and supinating occasionally while you are between the radius and the ulna. When you get close to the elbow, you can then ask the client to flex her forearm slightly. This will have an effect on the fascia of the coracobrachialis and biceps muscles. All in all, these two techniques are the ones you may use consistently with clients with upper extremity problems, and especially for TMJ disorder and cervical whiplash. Remember that the driver in every single whiplash case is usually gripping the steering wheel very powerfully, and the point of impact causes a force vector to come through the hands and wrists directly. Again, this is a forgotten element in the treatment of high-velocity impact traumas. The Work: Extensor Retinaculum of the Wrist and the Flexor Compartment of the Forearm Client Position: Supine 1. To work the extensor retinaculum, have the client pronate her forearm with her hand flat to the table. 2. Start at the midline over the retinaculum of the wrist. 3. Apply pressure using flat knuckles or fingers, and spread laterally, working down into the wrist and hand. 4. The client can slowly bend her elbow toward her body and back out in small movements. 5. To work the flexor compartment, have the client supinate her forearm with an open palm. 6. Start at the carpal tunnel of the wrist. 7. Apply pressure using fingers or elbow and work up to the elbow. 8. Keep pressure deep and continuous, and move only a few inches at a time. 9. The client can slowly pronate and supinate forearm while you work between the ulna and radius. 10. The client can flex her forearm while you work close to the elbow. Michael J. Shea, PhD, LMT, has been a massage therapist in Florida since 1975. He completed advanced Rolf training and was an assistant instructor at the Rolf Institute before obtaining a doctorate in Somatic Psychology. He was a member of the Massage Therapy Body of Knowledge Task Force that set nationwide standards of practice for the massage therapy profession. For more information, visit www.michaelsheateaching.com. MYOFASCIAL RELE ASE TECHNIQUES 15 16