Massage Today
Massage Today dotted line
dotted line

dotted line
Share |
  Forward PDF Version  
Massage Today
April, 2008, Vol. 08, Issue 04 >> Musculoskeletal Pain

The Structural Component of Soft-Tissue Rehabilitation


One of the most important factors in understanding and treating clients in pain who need therapeutic massage is evaluating the cause of the discomfort. We often look directly to the area of discomfort and find inflammation, swelling, ischemia, trigger points, buildup of fiber, scar tissue and adhesions, and think treating this is the key factor in our client's recovery. However, when we treat only the symptomatic areas, we are doing our clients a major disservice. There always is a reason for any area of the body to be in distress. One factor that is ever-present is the relationship of structural imbalance to the area of pain.

Structural balance allows the body and its musculature to function with strength and flexibility. When there is an imbalance in the structure, specific areas of the structure will overwork or be weakened to the point of injury or distress. This can be understood when looking at muscles moving bones in a lever relationship. When the structure is balanced, the lever and fulcrum are in an optimal performance relationship. With structural imbalance, the fulcrum/lever relationship is, at worst, totally dysfunctional and subject to breakdown or, at best, weakened and in need of additional support from surrounding soft tissue. This is inefficient and, in essence, the muscle that is supposed to be doing the work only has a third to half of its strength. This leaves that muscle very susceptible to strain or injury. In addition, the joint or spine is unstable and weakened and subject to strain or injury.

Thus, in therapeutic massage, a major treatment goal is to release the structural imbalance. Let's look at what happens when this is not factored into the treatment protocol. One of the easiest ways to understand this is to look at an area where most clients experience pain - the top of the shoulder, which includes the trapezius, levator scapula, supraspinatus and rhomboids. When this area is hot, inflamed, spasmed or strained, clients will present wanting relief ASAP. If the massage treatment is focused only within this area, there might be short-term relief; however, in the long run the condition could worsen. If the soft tissue in the top of the shoulder is released without balancing the shoulder, the muscles in the front of the chest will have less resistance and pull the shoulder farther forward into additional imbalance. The long-term result is that the client will most likely have more pain, discomfort and dysfunction in the area due to the increased distortion. To make matters worse, the soft tissue in the top and back of the shoulder actually are counterbalancing and actively working to hold against the stress in the soft tissue in the front of the shoulder.

So, when therapeutic massage techniques are applied first to the spasmed tissue on the top and back of the shoulder, which is invested in maintaining its holding pattern, the area will be resistant to the technique being applied. The sensation for the client is intensified and the client will experience greater discomfort because of the difficulty in relaxing that musculature. Plus, it will take two to three times the amount of work and pressure by the massage therapist to achieve results in the area. This obviously is a lose-lose proposition.

If the theory of releasing the shoulder into structural balance is applied, the muscles in the front of the shoulder are treated first, releasing the shoulder back into structural balance, and allowing the muscles in the back and top of the shoulder to release their compensation holding pattern that was counteracting the tension from the muscles in the front of the shoulder. The massage therapist will achieve greater results with much less work. In addition, the client will experience less discomfort and will be able to maintain structural balance and long term homeostasis.

Neck problems. Most clients will complain of pain in the back of the neck and at the base of the cranium. The majority of them will be holding the head forward, resulting in a reverse curvature of the cervical spine. In order to achieve structural balance, you will need to first release the soft tissue that is responsible for pulling the head and neck forward before releasing or treating the tissues at the back of the neck where the pain is located.

Low back. When clients present with low back pain, there is an imbalance in the pelvis that includes the legs and feet. This imbalance is not only front to back, but also involves torsion where one ilium rotates anteriorly, and the other rotates posteriorly. The most effective way to move the client into structural balance to relieve the pain is to release the leg and ilium that is rotated anteriorly first, and then the posteriorly rotated ilium/leg side.

This concept of structural balancing to achieve long-term results, while working within client comfort levels, can be applied to any musculoskeletal imbalance found in the body.
Click here for more information about Don McCann, MA, LMT, LMHC, CSETT.


Join the conversation
Comments are encouraged, but you must follow our User Agreement
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.
comments powered by Disqus
dotted line