Massage & Bodywork

September/October 2012

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@WORK INJURIES IN OTHER REGIONS In addition to low-back problems, numerous other musculoskeletal injuries also occur and can be serious problems. There is a clear and obvious myofascial continuity of muscles from the lumbar region through the thoracic and cervical regions. Chronic tension that develops in the lumbar musculature from overuse is frequently transferred to the thoracic and cervical regions. Postural disorders in the cervical region, such as forward head posture, put increased tension on these myofascial tissues. Nurses are frequently bent over with excessive forward head posture as they treat patients who are lying in a bed. Neck pain may result from this postural strain, but this stress can also be a significant component of pain in other areas, such as the low back. Musculoskeletal disorders of the neck are the second most common complaint for those in the nursing profession and also include myofascial trigger point development, nerve entrapment, and headache pain that develop from chronic muscle tension. Consequently, comprehensive treatment of any musculoskeletal condition in the torso region should include not only treatment of the thigh, gluteal, and lumbar regions mentioned earlier, but also significant attention to all the myofascial tissues throughout the thoracic and cervical regions as well. While lower-extremity injuries do not occur as often as lumbar and cervical complaints, there are some important biomechanical considerations that make this type of injury common for nurses. Long shifts mean nurses are on their feet for long periods of time, producing compressive loads that are compounded at the knees, as well as at the foot and ankle complex. In many facilities, these shifts are done on cement floors, intensifying these problems. Long durations of compressive loads on the knee joints can cause early development of arthritis. Disorders of the knee are exacerbated by the presence of other postural or alignment problems such as genu valgum (knock- knees). Extensive compressive loads are particularly challenging for force distribution in the foot. As a result, plantar fasciitis and chronic overuse disorders affecting the tibialis posterior muscle are potential problems as well. Massage therapy approaches cannot reverse the compressive loads on these joint regions. However, massage is a valuable approach for reducing the cumulative stresses absorbed by the soft tissues. Deep, longitudinal stripping techniques and active engagement methods applied to the tibialis posterior and other posterior calf muscles are very effective in addressing the chronic cumulative stresses in the distal lower extremities. Similar deep stripping techniques applied to the plantar fascia help reduce chronic tension loads in these soft tissues that support the longitudinal arch of the foot. While health-care workers are highly compassionate for those in their care, it is often at the expense of their own health, especially when it comes to musculoskeletal overuse. Massage therapists can do much to tend to these workers who play an often undervalued but critical role in our communities. However, those in the profession must also be willing to let someone else nurse them once in awhile—letting go of the caregiver role and learning to enjoy being cared for. Want more treatment options? Visit to see Whitney Lowe's webinars where he explores specific treatment approaches for common pathologies. Notes 1. Bureau of Labor Statistics, "Occupational Employment and Wages, May 2011," accessed August 2012, oes291111.htm. 2. A.M. Trinkoff et al., "Perceived Physical Demands and Reported Musculoskeletal Problems in Registered Nurses," American Journal of Preventive Medicine 24, no. 3 (2003): 270–5. 3. D.R. Smith and P.A. Leggat, "Musculoskeletal Disorders Among Rural Australian Nursing Students," The Australian Journal of Rural Health 12, no. 6 (2004): 241–5. 4. R.F. Edlich, "A Tribute to a Gifted Scholar, Anne Hudson, Who Has Made Revolutionary Advances in Healthcare and Patient Safety in our Nation," Journal of Long-Term Effects of Medical Implants 16, no. 3 (2006): 207–22. 5. T.M. Gropelli and K. Corle, "Nurses' and Therapists' Experiences with Occupational Musculoskeletal Injuries," American Association of Occupational Health Nurses Journal 58, no. 4 (2010): 159–66. 6. R.F. Edlich et al., "Prevention of Disabling Back Injuries in Nurses by the use of Mechanical Patient Lift Systems," Journal of Long-Term Effects of Medical Implants 14, no. 6 (2004): 521–33. 7. Edlich, "A Tribute to a Gifted Scholar, Anne Hudson, Who Has Made Revolutionary Advances in Healthcare and Patient Safety in our Nation." 8. M. Adams et al., The Biomechanics of Back Pain (Edinburgh: Churchill Livingstone, 2002). 9. D.R. Smith et al., "Musculoskeletal Disorders among Professional Nurses in Mainland China," Journal of Professional Nursing 20, no. 6 (2004): 390–5. 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. Contact him at Visit the newly designed Log in. Explore. Enjoy. 109

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