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Building From the Bottom Up
I caught up with my dear friend Honora Wolfe, in her Colorado painting studio where, if she is not praying in Bhutan or doing charitable work in a Nepali free clinic, she spends most of her time now.
Pain Underfoot: Metatarsalgia
Foot pain can interfere significantly with normal activities and severely limit participation in sports. Metatarsalgia is foot pain involving the metatarsal bones in the forefoot – the complaint of pain on the bottom of the ball of the foot.
Waking Up the Gluteus Maximus
In previous articles in this series, we expounded on the importance of the gluteus maximus (GM) in athletic performance and protecting the knee from injury. We also know there is a link between iliotibial band syndrome and GM weakness.
News in Brief
National Chiropractic Health Month: Be Proactive; Collegiate Roundup: Academic Appointments at Parker, Logan.
Why Young People Need Chiropractic Now More Than Ever
According to a recent study published in BMC Musculoskeletal Disorders, "It is now widely acknowledged that neck pain (NP), mid back pain (MBP), and low back pain (LBP) (spinal pain) start early in life and that the lifetime prevalence increases rapidly during adolescence to reach adult levels at the age of 18."
Peer Points: Always Seeking To Grow
Ellen "Kiki" Geary has spent the last decade honing her craft. As a specialist in integrative holistic care, she went straight from completing her master's degree in acupuncture and chinese herbal medicine from Bastyr University to building a successful and thriving practice in the small community of Anacortes, Washington.
Finders Keepers: The Secret to Relationship-Based Marketing
Becoming a successful practitioner has less to do with what you learned in school, and more to do with your ability to find new patients and keep them!
A Guide for Talking to Doctors about Acupuncture and Brain Chemistry
Before I begin any discussion of how to talk about the effects of acupuncture on brain chemistry, nervous and endocrine function, it is essential to understand just what physicians most need help with.
Don't Turn a 2 Into a 10
The Wong-Baker FACES Pain Rating Scale1 is so useful because it can be used by almost anyone. Patients can use the numbers associated with the faces depicted on the scale or select the face that demonstrates their current level of pain from 0-10.
A History Worth Telling
The popularity and the use of acupuncture for the treatment of animals in the United States is at its peak.
CCE Finally Takes a "Baby Step" Toward Reform
During a 16-month period from October 2010 to February 2012, I devoted four separate columns to the heavy-handed attempt by the Council on Chiropractic Education to radically change the chiropractic profession through the accreditation process.
Chiropractic Research in Review
Chiropractic Treatment of Lateral Epicondylitis; Cost / Benefit Analysis: Different Doses of SMT for Low Back Pain; Imaging for Occult Rib and Costal Cartilage Fractures; Treating Neck Pain: Thoracic Thrust Manipulation vs. Non-Thrust Mobilization.
9 Common Causes of Thyroid Imbalance and How You Can Help
How you sleep, how easily you wake up, and how much energy and stamina you have during the day are directly related to levels of the thyroid hormones.
A Vibrating Capsule for Constipation? Relevance to Your Chiropractic Practice
The relationship between gastrointestinal (GI) complaints and back pain is not typically written about or discussed.
New Medical Technologies You Need to Know
We're all familiar with how fast computers become obsolete, as well as the rapid pace of development in the field of cell phone technology. The latest smart phones are far more powerful than desktop computers were only a few years ago.
Medical Qigong for the Heart: Part III
Part 1 and Part II of this series focused on the physical aspect of the Heart and mental emotional aspects of the Heart respectively. Now, I would like to focus on the spiritual aspect of the Heart.
MPA Media Wins 7 Publishing Awards
MPA Media, publisher of Dynamic Chiropractic and DC Practice Insights, among other titles, has been recognized for editorial and design excellence with an unprecedented seven publishing awards by the American Society of Business Publication Editors (ASBPE), the nation's largest organization for business-to-business publications.
January, 2011, Vol. 11, Issue 01
Rehabilitation: The Protocol Defined
By Whitney Lowe, LMT
Orthopedic massage is a highly effective system for addressing soft-tissue pain and injury complaints. What makes this approach so effective with a wide variety of movement system disorders is the fact that it is a comprehensive treatment approach and not just a massage technique.In the mid-1990s, I proposed a model for an orthopedic massage system that included four primary components. These four components are: 1) orthopedic assessment, 2) matching the physiology of the tissue injury with the physiological effects of treatment, 3) using a variety of treatment approaches, and 4) appropriate use of the rehabilitation protocol. It is this fourth and final component of the system (the rehabilitation protocol) that requires some additional explanation, as it is a comprehensive topic on its own.
In the late 1980s through the 1990s, I spent a number of years working in orthopedic, chiropractic, and physical therapy clinics. These experiences were invaluable in helping to shape and mold my understanding of how to evaluate and treat all kinds of soft-tissue injuries. It was during this time that I began to observe an interesting pattern occurring with many of the patients who were being seen in treatment.
As part of the treatment process, patients were often given rehabilitative exercises to perform. Many of the patients performed the exercises, but then reported that their condition actually worsened instead of improving. While it is natural to assume that some people might not benefit from a particular treatment approach, there was a disproportionate number of people who were having adverse effects to this treatment regimen. Many people were being given strengthening and conditioning exercises when there was still a serious tissue dysfunction present. The strengthening exercises then aggravated the existing complaint. This situation started me investigating what could be different in the treatment approach to prevent this large number of adverse outcomes. It was out of this exploration that I developed the rehabilitation protocol concept as a fundamental component of the orthopedic massage system.
Soft-tissue pain and injury conditions may involve fiber damage like that occurring in muscle strains or ligament sprains. In other situations the dysfunction may simply result from impaired function, like that seen in myofascial trigger point pathologies or nerve impingement syndromes. However, despite the wide array of tissue pathologies there is a progression of tissue healing that is similar in all these conditions. As clinicians our treatments must maximize and take advantage of this healing response. Appropriate use of the rehabilitation protocol helps you accomplish this crucial treatment goal.
The rehabilitation protocol has four separate stages: normalize the soft tissue dysfunction, improve flexibility, reestablish appropriate movement patterns, and strength conditioning. Let's take a look at each one of these stages in greater detail to understand how they work with your massage treatments.
The first stage is to normalize soft tissue dysfunction. Regardless of what type of tissue injury or dysfunction has occurred the first thing that must happen is to bring that tissue dysfunction back to its normal state or at least as close to its normal state as possible. For example, if there is a muscle strain with torn fibers, normalizing the soft tissue dysfunction means addressing the torn muscle fibers and resultant scar tissue with deep transverse friction massage. If the primary dysfunction is a myofascial trigger point, normalizing the soft tissue dysfunction involves neutralizing that trigger point so the muscle spindle cells are not overly activated and the muscle tissue can return to its normal state.
The second stage is to improve flexibility. Soft tissues require adequate flexibility and pliability to work at their optimal state. If they are bound and restricted by scar tissue, movement and function are impaired. In the event that muscles are chronically tight from excessive trigger point activity, there are likely to be biomechanical distortions or problems in the regions acted upon by those muscles. Full restoration of functional movement cannot return if adequate flexibility is not restored. Once the soft-tissue dysfunction has been normalized and tissue flexibility has been restored, it is now appropriate to move on to the next stage.
The third stage is to re-establish appropriate movement patterns. Proper movement patterns need to be introduced to the soft tissues in the healing process to encourage optimal function. There are many ways to restore proper movement patterns after a soft-tissue injury. Sometimes movement restoration includes specific exercises such as those performed in physical therapy or a movement-oriented discipline like Feldenkrais or Aston Patterning. In other situations restoring proper movement might simply be making ergonomic changes in a person's workstation or the way in which they engage with tools in their daily activities. The initial tissue dysfunction must be addressed and flexibility restored before these correct movement patterns can be reinforced. If the first two stages have not been accomplished it will not be easy, or in some cases even possible, to restore proper movement patterns.
The final stage is strengthening and conditioning. It is this stage which is often performed too early in the rehabilitative environment. Strengthening or conditioning activities do not require you to be lifting weights in a gym or working out in a formal exercise facility. Sometimes it is as simple as training your body for the demands it faces. For example, massage therapists benefit from hand and finger strengthening exercises which could be performed with simple rubber bands. These conditioning methods prepare the practitioner for the physical demands of daily work activities.
In most cases, a massage therapist is not directly involved with strengthening or conditioning activities for the individual if those activities are being performed for the purpose of injury rehabilitation, as it is outside our scope of practice. However, knowledge of the process of strengthening and conditioning is exceptionally valuable and will help guide appropriate treatment decisions throughout the course of treatment.
The rehabilitation protocol should be considered a set of guidelines, not strict rules. There is a progression through the rehabilitation protocol from the first stage through the fourth. However, it should not be viewed as a strict process where all of the first stage must be accomplished before moving to the second stage and all of the second stage accomplished before moving to the third, etc. There can be overlap between the different stages, but you should see your client's soft-tissue injury or pain complaint move through these stages and not jump to the end of the protocol before the earlier stages have been mostly accomplished.
It is our job to recognize what stage our clients are at in the rehabilitation protocol and adjust our treatment approaches accordingly. It is through accurate orthopedic assessment processes that we make the determination of where they are in the recovery process. Once you understand and appropriately apply the rehabilitation protocol you will find much greater success in your treatment outcomes with a wide variety of pain and injury complaints.
Click here for more information about Whitney Lowe, LMT.
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