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I began including active range of motion of wrist, forearm supination, and pronation, and active elbow flexion and extension. • Hands-on treatment, such as stretching, joint mobilization, and soft-tissue release, help control edema and scarring and maintain normal joint play. For example, adhesions over the ulnar nerve and between the biceps and brachialis tendons were treated with manual therapy, while twisting or restriction of the brachial nerve near the elbow and compression of the brachial nerve by deep pectoral fascia were treated with neural manipulation. Several months after my arm came out of the cast, my shoulder extension became very painful because the triceps tendon had become tight and was pressing on the bursae. Manual release of the tendon helped the pain disappear. 2. Massage In the early stages of injury, massage helped decrease the inflammation and pain in my arm and upper body. It also eased muscle tightness caused by improper movements and relieved emotional stress. Regular self-massage changed a thick, irregular scar to one that is flexible, adhesion-free, and barely discernable. As rehabilitation went on, massage was helpful for releasing muscle tension in the neck and shoulders, arm, chest, and upper back, which was related to my making effort-full movements since my arm was stiff and painful. (Trying to brush your hair or put on an earring with limited elbow flexion can cause all kinds of strange compensatory movements!) Later on in rehab, massage also helped me become more graceful and less tight all over. 3. Supplements and herbal treatments I took a variety of supplements prescribed by a knowledgeable herbalist to treat inflammation, stimulate healing of the surgical wound and bone, and promote cartilage regrowth on top of the original injury. Every night, using herbal teas and/or anti-inflammatory essential oils, I made an elbow compress and left it on all night. at the joint, as well as strengthening and stretching the tissues of my wrist and shoulder joints. Six months after my arm was out of the cast, I had roughly 85 percent range of motion (extension 10 degrees, flexion 120 degrees). Supination, pronation, shoulder range of motion, neck range of motion, and spinal rotation became normal. By 10 months, I had gained 90 percent of full range of motion (extension 5 degrees, flexion 130 degrees). This far exceeded my original prognosis, as my arm was expected to be permanently bent at 30 degrees of extension, with greatly reduced flexion and practically no supination. My physical therapists labeled my progress "amazing," and six months after my fall, I was back at work doing Swedish and deep-tissue massage. I also had the arm strength to lift heavy objects and do intense garden work like shoveling. MY PROGRAM Here is the program I put together: 1. Standard physical therapy program 8 • Twenty percent loss of muscle strength occurs each week in a cast, 9 and when my cast was first taken off, my arm was very weak. I was given therapeutic exercises to restore strength, including active flexion and extension of the wrist and elbow, radial deviation, pronation, and supination. • Immobilizing any joint can cause shrinkage of the joint capsule and actual contracture, so restoring full range of motion began immediately by stretching the joint in all directions. Movements were passive in the early stages, but later, 76 m a s s a g e & b o d y w o r k j a n u a r y / f e b r u a r y 2 0 1 7 Incision after daily self-massage for six months with vitamin E oil. Elbow incision after surgery.