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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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