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@work 5 painful during palpation, and if the muscle tendon unit is stretched. Managing Strains Numerous factors place an individual at risk for developing muscle strains, and many of these factors are present in routine construction work: repetitive movements, heavy lifting, sustained awkward postures, and fatigue from the chronic contraction of holding power tools. Educating the client about precipitating factors is a valuable way to reduce the likelihood of a strain injury developing. If a strain injury has already occurred, a detailed history will reveal some or all of these factors and will help to understand what initially caused the injury. Massage treatment strategies for muscle strains should focus primarily on managing the tissue-tear site and the scar tissue that the body uses to repair the damaged muscle fibers. Deep transverse friction massage applied directly to the site of the tissue injury can reduce any fibrous adhesion from the scar tissue that may adversely adhere adjacent fibers during the injury repair process (Image 6). An injured muscle, along with surrounding muscles, may become hypertonic in a protective spasm. While muscle tightness can protect the region in the initial stages of injury, it can very quickly set up a pattern of dysfunctional hypertonicity that can remain long after the injury has healed. Massage treatment is highly valuable at this point to reduce the muscle tightness and restore normal functional mechanics. Massage techniques that will be most advantageous are those that encourage tissue lengthening, such as longitudinal stripping techniques. Stretching is also highly valuable to maintain tissue elasticity. A crucial part of the rehabilitation process is rest from offending activities, yet many workers simply cannot A cervical strain in an ipsilateral rotator like the splenius capitis would be reproduced as the client attempts to rotate the head against resistance in this manual resistive test. Image courtesy OMERI. 6 Deep transverse friction is applied to the site of a strain in the hamstring muscle group to reduce any fibrous adhesions. Image courtesy OMERI. take time off. Work modifications are important, as are splints or braces to support tissues as they heal. Due to the nature of these injuries, and the nature of the tissue-repair process, massage is an outstanding approach that will help reduce longterm tissue dysfunction and get the individual back to healthy activity as soon as possible. Note 1. X.S. Dong et al., "Lifetime Risk of Occupational Injuries & Illnesses Among Construction Workers," American Public Health Association, accessed December 2012, www.cpwr. com/pdfs/Dong_APHA_Lifetime risk_103111.pdf. 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 www.omeri.com. www.abmp.com. See what benefits await you. 109