Integrated Manual Therapy & Orthopedic Massage
Integrated Manual Therapy & Orthopedic Massage For Complicated Forearm, Wrist & Hand Conditions Assessment Protocols Treatment Protocols Treatment Protocols Corrective Exercises Artwork and slides taken from the book Clinical Massage Therapy: A Structural Approach to Pain Management Published by Pearson Education By Author & International Lecturer James Waslaski LMT, CPT Integrated Manual Therapy & Orthopedic Massage For Complicated Forearm, Wrist, & Hand Conditions Today’s manual therapist needs to have multiple skills in order to address a wide variety of complicated musculoskeletal pain conditions. Specialization in just one modality is becoming a thing of the past because of limited patient outcomes. This unique total system consists of orthopedic assessment, clinical reasoning, multidisciplinary and multimodality therapies, and precise corrective stretching and strengthening exercises. Participants will learn to integrate the skills of leading practitioners from the fields of massage therapy, physical therapy, athletic training, personal training, osteopathic and chiropractic to restore balance, posture, function and pain free living. Recent clinical studies will forever change the way manual therapists look at musculoskeletal pain, muscle-tendon strain pain, and adhesive capsular pain. This seminar will teach manual therapists to isolate and treat multiple nerve compression areas, tendonitis and tendinosis of the elbow, pronator teres syndrome, carpal tunnel syndrome, tenosynovitis, fixated joints, and trigger finger. Corrective stretching and strengthening techniques will be also taught to keep the muscles balanced, and joints aligned for pain free living. Twelve Steps: 1. Client History 2. Assess Active Range of Motion 3. Assess Passive Range of Motion 4. Assess Resisted Range of Motion 5. Area Preparation 6. Myofascial Release/ Compression Broadening 7. Cross Fiber Gliding/Trigger Point Therapy 8. Multidirectional Friction 9. Pain Free Movement 10. Eccentric Scar Tissue Alignment 11. Stretching 12. Strengthening James Waslaski is an Author & International Lecturer who teaches approximately 40 seminars per year around the globe. He’s served as AMTA Sports massage Chair and FSMTA Professional Relations Chair. He’s developed 8 Orthopedic Massage and Sports Injury DVDs, and authored manuals on Advanced Orthopedic Massage and Client Self Care. His new book, Clinical Massage Therapy: A Structural Approach to Pain Management was published by Pearson Education in 2011. James presents at state, national and international massage, chiropractic, and osteopathic conventions including keynote addresses at the FSMTA, World of Wellness, New England Regional Conference, the World Massage Festival, and Australian National Massage Conventions. His audience includes massage and physical therapists as well as athletic trainers, chiropractors, osteopaths, nurses and physicians. He is a certified personal trainer with NASM. James received the 1999 FSMTA International Achievement Award and was inducted into the 2008 Massage Therapy Hall of Fame. www.orthomassage.net 8/3/2013 CLINICAL MASSAGE THERAPY Chapter Outline A Structural Approach to Pain Management CHAPTER 7 Elbow, Forearm, Wrist, and Hand Conditions Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski • Twelve-Step Approach to Elbow, Forearm, Wrist, and Hand Conditions • Medial Epicondylosis (Golfer’s Elbow) • Lateral Epicondylosis (Tennis Elbow) • Carpal Tunnel Syndrome • Thumb Strain or Sprain • Degenerative Arthritis • Trigger Finger Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Learning Objectives • Choose the appropriate manual therapy modality, or treatment protocol, for specific clinical conditions of the elbow, forearm, wrist, and hand • Restore normal muscle resting lengths and soft-tissue balance to the muscle groups of the elbow, forearm, wrist, and hand Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Learning Objectives Learning Objectives • Eliminate the soft-tissue causes of forearm, wrist, and hand conditions before addressing the clinical symptoms • Restore pain-free movement of the elbow, forearm, wrist, and hand Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-9 Forearm Muscle Reference. • Differentiate among elbow, forearm, wrist, and hand problems caused by – myofascial imbalance and myofascial restrictions – muscle–tendon tension and imbalance – myoskeletal alignment problems – trigger point pain or tension – strained muscle fibers – nerve compression problems Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski 1 8/3/2013 Figure 7-10 Resisted Test, Forearm Flexors. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-12 Resisted Test, Biceps. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-24 Resisted Test, Forearm Supinator. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-11 Resisted Test, Pronator Teres. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-23 Resisted Test, Wrist Extensors. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-13A Myofascial Spreading, Forearm/ Wrist Flexors. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski 2 8/3/2013 Figure 7-13B Compression Broadening, Forearm/ Wrist Flexors. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-14 Myofascial Spreading, Flexor Retinaculum. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-15B Arthrokinetics (Traction). Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-13C Cross-Fiber Gliding Strokes and Trigger Point Work. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-15A Arthrokinetics (Gentle Compression). Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-16A Separate Tendon Sheaths. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski 3 8/3/2013 Figure 7-16B Pin Each Tendon Sheath and Passively Extend Wrist. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-18 Myofascial Release of the Interosseous Membrane Using Radius—Ulna Movement. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-30 Anatomy Reference, Wrist and Hand. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-17 Forearm Flexor Stretch. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-31B Stretch Deep Fascial Layers Using Metacarpals. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-31A Myofascial Release and Compression Broadening. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski 4 8/3/2013 Figure 7-34A Resisted Test, Thumb Strain. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-34C Eccentric Contraction, Thumb Strain. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-35B Arthrokinetics (Traction or Decompression). Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-34B Multidirectional Friction, Thumb Strain. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-35A Arthrokinetics (Gentle Compression). Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-35C Stretch Hand Muscles. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski 5 8/3/2013 Figure 7-19 Pronator Teres Release. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-22 Anatomy Reference, Posterior Arm. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-25B Compression Broadening, Wrist Extensors. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-20 Stretch Pronator Teres. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-25A Myofascial Spreading, Wrist Extensors. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-25C Cross-Fiber Gliding Strokes and Trigger Point Work, Wrist Extensors. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski 6 8/3/2013 Figure 7-26A Resisted Test, Wrist Extensors. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-26C Eccentric Muscle Contraction. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-28 Myofascial Release, Forearm Supinator. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-26B Multidirectional Friction. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-27 Resisted Wrist Extension. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-29A Resisted Forearm Supination. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski 7 8/3/2013 Figure 7-29B Multidirectional Friction, Supinator. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-32B Carpal Bone Mobilization. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-33A Carpal Bone Mobilization— Ulnar Deviation. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-29C Eccentric Muscle Contraction, Supinator. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-32C Carpal Bone Mobilization. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-33D Carpal Bone Mobilization— Radial Deviation. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski 8 8/3/2013 Figure 7-33B Carpal Bone Mobilization—Wrist Flexion. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-33E Tunnel. Deep Gliding Strokes Through Carpal Figure 7-33C Carpal Bone Mobilization— Wrist Extension. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Stretching (Client Self-Care) • Client self-care is important to maintain the soft-tissue balance that was restored by therapy. As the client goes back to normal day-to-day activities, muscle groups (usually the wrist flexors, hand flexors, and forearm pronators) will become short and tight and the antagonists (usually the forearm supinator and wrist extensors) will become weak and inhibited. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Stretching Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-36 Forearm/Wrist Flexors Stretch. • Daily stretches and therapeutic exercise will help keep those muscle groups in balance. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski 9 8/3/2013 Figure 7-37 Hand Flexors Stretch. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Strengthening (Client Self-Care) • Wrist and Hand Extensors – The client’s elbow is bent at 90 degrees along the side of the body. – He or she wraps a Thera-Band around the involved hand, both ends anchored with the other hand. – The client slowly extends the fingers and then the wrist from the neutral position taking 2 seconds (concentric contraction). Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-39 Strengthen Hand and Wrist Extensors. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-38 Pronator Teres Stretch. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Strengthening • Wrist and Hand Extensors – He or she slowly returns the fingers and wrist back to the neutral position taking 4 seconds (eccentric contraction) – The client repeats this exercise 8 to 10 times Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-39 (continued) Wrist Extensors. Strengthen Hand and Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski 10 8/3/2013 Figure 7-40 Strengthen Forearm Supinator. Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski Figure 7-40 (continued) Forearm Supinator. Strengthen Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski 11
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