Editor's Note: This article is the first in a quarterly series by James Waslaski.

Client History & Ortho Testing

The first part of orthopedic massage is to get a detailed client history and to perform special orthopedic tests, along with doing detailed functional assessments on the client. This allows you to apply the appropriate modality, or discipline, to specifically address the client's chief complaint, or clinical condition. Corrective exercises are also given to every client, specific to correcting the musculoskeletal imbalance contributing to each clinical condition.

Orthopedic massage is so much more than learning a single massage modality. The focus is on restoring muscular and skeletal balance throughout the body, based on structural integration. In my model of orthopedic massage, the emphasis is to first treat the cause of complicated pain patterns, rather than focusing on the symptoms.

For example, tendon pain around a joint is usually caused by opposing muscle groups being out of balance. It starts out as tendon tension in opposing muscle groups, where one group of muscles is short and tight, while the antagonist muscle group becomes weak and inhibited. In the tendons of the elbow the flexors are usually short and tight, while the extensors are weak and inhibited. This sets off a myofascial and neuromuscular pain pattern, and can lead to conditions like tendinosis or tendonitis. Often times, simply balancing out opposing muscle groups around a joint will eliminate the majority of tendon pain.

Pain Patterns

Whatever you do to restore normal muscle resting lengths, to opposing muscle groups, can reduce or eliminate the majority of myofascial pain patterns, neuromuscular pain patterns, tendon pain patterns, and nerve entrapment pain patterns. Imagine if you went through the entire body, and lengthened short tight muscle groups to their normal resting lengths to allow the opposing weak and inhibited muscle groups to relax and go back to their resting lengths.

Since muscles pull bones out of alignment, the bones would stay in proper alignment. Since muscles pull bones onto nerves and blood vessels, nerves would not be compressed and circulation would not be compromised. Then imagine if each patient was taught to stretch tight muscle groups and strengthen weak muscle groups throughout the body.

To achieve musculoskeletal balance, the therapist would be taught to blend modalities like functional assessment, posturology, myofascial release, neuromuscular therapy, myoskeletal alignment, scar tissue mobilization, joint capsule release, active isolated stretching, strengthening exercises, etc. The focus would be on balancing all muscle groups around the pelvis, neck, shoulder, elbow, wrist, hand, knee and ankle. You would see that the majority of pain patterns would go away in just doing that. That way when the clinical symptoms around the joints like muscle-tendon pain, joint pain and degeneration of the structures of the joint are addressed, you would have addressed the cause of joint pain prior to addressing the clinical symptoms.

Techniques for Hips & Shoulders

The technique manual therapists will learn in my series of articles will be releasing joint capsule adhesions of the hips and shoulders. This is often known as adhesive capsulitis, or frozen shoulders. By looking at underlying pathologies for each clinical condition, you will be able to look inside the human body and match each specific technique to each specific pathology, or clinical condition.

I will teach you the dance between muscle imbalance work, scar tissue work, gentle joint mobilization techniques, decompressing nerves, treating sprains and strains and understanding emotional holding patterns. This work is user friendly, and can be applied by manual therapists working in any environment from the spa to the hospital, to the sports arena.

The next article in this series will feed off this article, and address complicated shoulder conditions, which will include non-surgical treatments for rotator cuff injuries, fast and easy techniques for eliminating shoulder impingement, and thoracic outlet conditions. The highlight of the next article will explain amazing therapeutic techniques for the treatment of various stages of adhesive capsulitis "frozen shoulders."

Resources

• Dalton E. Myoskeletal Alignment Techniques. Dalton Myoskeletal (erikdalton.com), 2018.
• St. John P, Clark R. Neurosomaitic Educators & Posturology. St. John-Clark Pain Treatment Center (stjohn-clarkptc.com), 2018.
• Lowe W. Functional Assessment in Massage Therapy 3rd edition. Orthopedic Massage Education, 1997.
• Waslaski J. Clinical Massage Therapy-A Structural Approach to Pain Management. London: Pearson, 2012.