Can Massage Therapy Treat Fracture Injuries?
August 6, 2009 by whymassagetherapy
Filed under Treatments
Massage therapy treatment can help maintain and improve tissue health in a fracture injury, enabling a person to regain his or her full function sooner.
Massage therapy is a treatment option which can reduce pain and discomfort in the soft tissue surrounding a fracture injury, and it can also assist in reducing edema and muscle tension of both the affected and compensating structures. When a massage therapy treatment plan is carried out correctly, once the cast is removed, a client can regain full function sooner as the health and mobility of compensating muscles has been addressed.
Initially, your massage therapist will only work above the cast, and will take care to not disturb the healing bone. Eventually, when the cast is removed, massage therapy will continue to restore the health of the tissue by increasing circulation, restoring function and strength, and reducing any scar tissue.
Considerations for treatment
It is highly recommended that your physician provide a written recommendation for massage, and your therapist probably won’t agree to treat you until your doctor has given the green light.
In all likelihood, you will also be seeing a physical (physio) therapist. It’s a good idea to provide written permission for your massage therapist to collaborate with your other health care professionals to ensure the best possible care and treatment outcome.
Before your massage therapist begins to treat you, he or she will want to verify the following information:
- your physician has approved massage therapy
- are you on any type of medication? (anti-inflammatory, analgesic, anti-coagulant, antibiotics).
- what is your general health – for example, consider age, fitness prior to injury, nutrition (your MT may refer you to a nutritionist, as proper nutrition impacts the healing process), lifestyle (i.e. do you smoke?)
- are there any open wounds which must be addressed? (i.e. with a compound fracture)
- Will treating the affected limb with massage therapy stress and disrupt the healing of bone, muscle, skin or nerve tissue?
- is there any neurological or vascular impairment in the area which prevents the use of certain massage techniques or modalities?
- do you have any plates, wires or pins? If so, hydrotherapy over the site will be contraindicated.
- the most important consideration is to avoid stressing and interfering with healing tissue. Any pressure or traction applied to the affected bone is contraindicated.
- have other types of injuries been sustained, such as sprains or contusions? (in all likelihood, there will be other injuries)
- muscle atrophy from disuse will be present when the cast is removed. Provided that the injury is not an avulsion fracture, the development of atrophy can be reduced by the use of isometric contractions at the appropriate time with cast on. If an avulsion fracture is present, avoid isometric contractions, as this may disrupt the healing bone.
- tissue under the cast will be fragile when the cast is removed, so extra care must be taken when massaging this tissue
As treatment progresses and the injury heals, issues such as tissue atrophy, altered biomechanics and altered proprioception must be taken into account. For this reason, there are different considerations for treatment with cast on and cast off.
Types of fractures
There are several basic types of fractures:
1. Simple – there is no broken skin, and the break is clean. Also known as a “closed” fracture.
2. Compound – the broken bone damages surrounding tissue and skin by piercing it. There is a greater risk of infection in this type of break due to breaking of the skin and protrusion of the injured bone.
3. Comminuted – a fracture that is in several pieces – common among a population with more brittle bones (i.e. elderly)
4. Compression – a fracture where the bone is crushed
5. Depression – a fracture where the bone is crushed and pressed inward
6. Impacted – bony surfaces are forced into each other (impacted)
7. Spiral – an break with ragged edges that result from twisting
8. Greenstick – an incomplete break that is common in children, as bones are more flexible
9. Stress fracture – a.k.a. hairline fracture, is a tiny crack in the bone and may not be visible with an x-ray
10. Avulsion – this occurs when a ligament or tendon pulls away a chunk of bone to which it is attached.
Fractures and breaks are repaired by “reduction” – when the bony ends are placed back together. A closed reduction is done manually by a physician, whereas an open reduction involves surgery, and possibly the placement of pins or wires to hold the bony surfaces together.
Finding the best massage therapist for you
It goes without saying that an injury as serious as a fracture or break will require treatment from a therapist who really knows his or her stuff and understands the healing process. Personally, I would ask my physical therapist if he or she could refer me to a qualified and experienced massage therapist, and then ensure that I give them both permission to communicate with each other so that my treatment plan would address all of my needs and concerns.
© Copyright 2009
All Rights Reserved.
What is muscular atrophy, and what causes denervation and disuse atrophy?
July 16, 2009 by whymassagetherapy
Filed under Anatomy
What does atrophy mean, and what causes atrophy of a muscle?
The definition of Atrophy, according to Human Anatomy and Physiology (8th Edition)
Atrophy of a muscle can occur in 2 ways – from disuse or denervation.
Disuse atrophy will occur when a person is unable to use a muscle for any number of reasons. It is very common when a limb has been cast from a break or fracture, or a person has been on bed rest for a extended length of time. Once a person is mobile again, or a cast has been removed, the client should undergo a rehabilitation process designed to challenge and strengthen the involved structures. Assuming that the atrophy was only caused by lack of use, the patient will eventually regain strength and normal size of the muscle.
Denervation atrophy occurs when the nerve supply to a muscle is interrupted and the muscle no longer receives signals or stimulus from the nervous system. This type of atrophy can occur from injury to the central nervous system, as in a spinal cord injury, or in the peripheral nervous system, such as a broken bone which damages surrounding nerve. Damage doesn’t necessarily mean a complete severing of the nerve, in which case nerve tissue is not known to regenerate. Damage will occur in varying degrees of severity, and may be a result of compression (impingement), crushing or partial tearing. If this is the case, with proper care and rehabilitation the injury will heal and muscle strength can be regained.
Why is this important to a Massage Therapist?
Massage therapists are specialists in treating the dysfunctions of the musculoskeletal system, and understanding the anatomy of the involved structures is key to providing a successful treatment. Odds are that you will see quite a few conditions throughout your career that will either cause, or have the potential to cause, muscle atrophy. Conditions such as chronic Thoracic Outlet Syndrome or Carpal Tunnel Syndrome may cause denervation atrophy due to impingement or compression of the ulnar nerve root and median nerve respectively, and can be successfully resolved once the underlying cause of the compression has been addressed.
Atrophied tissue is very fragile, and deep techniques are contraindicated until the condition of the tissue improves. Initially, the primary goal of treatment for atrophied tissue is to increase circulation and to stimulate the nerves – this can be accomplished by gentle dry brushing, followed up by light stimulating techniques such as stroking, effleurage or c-scooping. Great care must be taken if there has been crushing or tearing of the nerve, as any local techniques which apply pressure or traction can disrupt the healing of the injury.
It is highly recommended that you consult with the client’s physician, physiotherapist or chiropractor to verify the cause of atrophy, and that you work under his or her supervision and guidance if the atrophy is caused by denervation.
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www.whymassagetherapy.com
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Carpal Tunnel Syndrome, Massage Therapy and Surgery Prevention
May 8, 2009 by whymassagetherapy
Filed under Treatments
Carpal tunnel syndrome is a compression of the median nerve as it passes through the carpal tunnel of the wrist. Caught early enough, carpal tunnel syndrome, or CTS, doesn’t have to progress to the point where it is debilitating or affects activities of daily living. The incidence of surgery, which involves cutting the carpal tunnel ligament (aka flexor retinaculum) could very well be reduced if massage therapy was used more frequently as an early intervention.
Symptoms of Carpal Tunnel Syndrome:
The median nerve is not the only structure that passes through the carpal tunnel – the muscles of the anterior forearm (the forearm and wrist flexors) also figure prominently in CTS. In early stages there is often numbness, tingling or “pins and needles” in the lateral 31/2 digits of the hand (thumb through to 1/2 of the ring finger). There could also be pain and local inflammation or swelling over the wrist on the palmar surface of the heel of the hand. In later or more chronic stages, there could be atrophy of the thenar emminence (muscles which move the thumb), or trophic skin changes in the same area, such as redness, dry or scaly skin. At this stage, there may also be altered sensation in the forearm and axilla (armpit).
In conjunction with the muscle wasting, there may also be difficulty in activities which require fine motor control (i.e. picking up car keys, buttoning a shirt). It is not unusual for people with more severe or chronic cases of CTS to wake at night from pain, which is relieved by moving or elevating the limb.
Who is at risk for Carpal Tunnel Syndrome?
CTS often affects people whose activities of daily living (either work or hobbies) involve repetitive motion of the fingers and hands. (Think of a data entry clerk, a musician, a massage therapist or someone who knits a lot). Repetitive motion causes “hypertonicity” of the muscles of the forearm, and as they pass through the carpal tunnel, the larger size of the tendons impinge the nerve. Left long term, the muscles are unable to function as they should and they become weak.
Injuries to the wrist, with displacement of the carpal bones, may also compress the median nerve or cause swelling of the tendons that pass through the carpal tunnel; edema during late stages of pregnancy or during illness may also narrow the tunnel, compressing the median nerve.
How can massage therapy help prevent and treat carpal tunnel syndrome?
Massage therapy can provide valuable assistance to someone suffering from CTS, either as a stand-alone treatment, or in conjunction with other modalities. Massage can also assist in prevention of the syndrome; when treatment is started early enough, muscle hypertonicity is decreased, and edema can be reduced.
Treatment will depend on the actual cause and stage of presentation of the condition. For example, in a case where repetitive stress is the cause, the therapist will attempt to decrease hypertonicity and myofascial trigger points of the brachium, ante-brachium, all of which are proximal to the site of compression. This can be achieved by doing deep work to the muscles of the arm and forearm, as well as stretching of the forearm flexors.
If the structures in the carpal tunnel are impinged due to thickening or scarring of the flexor retinaculum, friction therapy to break down the tissue can be invaluable, if painful, to reduce compression.
Manual lymph drainage can assist in the reduction of fluid build up post treatment.
The therapist may also stretch the carpal ligament and palmar tissue & fascia, reducing compression of the structures, and finish with a cold hydrotherapy application on the site to reduce any inflammation.
Outside of surgery, there is no “cure” for carpal tunnel syndrome which results from hypertonicity of the forearm flexors. If CTS is caused by a repetitive stress injury (RSI), then maintenance will be necessary. Maintenance in this case will involve a program of stretching, hydrotherapy, massage therapy and possibly a wrist brace. The use of ergonomically correct keyboards for those whose work involves a lot of typing can also be useful.
Depending on the severity of the condition, a treatment plan may involve a few weeks of treatments 2 times per week, in addition to a homecare plan to reinforce the effects of the treatment. As hypertonicity of the forearm flexors is reduced, the frequency of the treatment is reduced to once a week for several weeks.If you have questions concerning the treatment plan, your massage therapist should be more than willing to discuss it with you.
© Copyright 2008-2009
Jodi Forsythe
www.whymassagetherapy.com
All Rights Reserved.
