What Does Muscle Strain Mean?

Muscle strain is a very common injury treated effectively with massage therapy. What does muscle strain mean, and how does this type of injury happen?

Strain is a term used to describe an injury to the musculotendinous unit, or the muscle and the tendon which attaches it to bone.

Muscle and tendon is known as contractile tissue due to its ability to contract (shorten) and extend (lengthen). This contraction and extension of muscle causes movement, and because of this, muscle strain will be noticed when you attempt to use the muscle, either contracting or stretching it during movement.

There are basically 2 mechanisms of injury which cause muscle strain:  overloading the muscle (too much pressure or weight), or overstretching muscle (think of trying to catch a falling object that is really heavy – weight is suddenly applied to muscle that is stretched. It could also happen, for example, due to a sudden slip or fall.

Symptoms of Muscle Strain:

The symptoms of a muscle strain will depend on the severity of the condition. Muscle strains are classified as mild (1^st degree), moderate (2^nd degree) and severe (3^rd degree).

Mild muscle strains occur when there is some tearing of the muscle or tendon fibres.  While you may still be able to carry on activities at the time of the injury, there is obvious muscle stiffness the following day.  In spite of the discomfort (with or without palpation) and stiffness, there is no loss of function.

In addition to muscle stiffness and soreness, there may be some minor weakness, a decrease in normal range of motion, some minor swelling and spasm, and minor pain with either contraction or stretching of the affected muscle.

Moderate muscle strains may have considerably more (up to 75%) muscle tissue damaged.  At the time of injury, you will be unable to continue activity, and there will be considerable pain. Inflammation will be present at the injury site, with increased muscle spasm and possible bruising.

Severe muscle strains usually result in immediate and complete loss of function due to disruption of the tissue. There may be extreme pain, however, if there is a complete rupture of the muscle or tendon, there may be no pain due to the lack of muscle contraction.  There may be visible and palpable gapping of the muscle tissue.

You’ve just hurt yourself, what do you do now?

Whether you slipped and fell, or were being a hero rescuing Granny’s kitten from a tree, it doesn’t really matter at this point. Let’s just hope it’s a mild strain and nothing more serious.  If you are in a lot of pain, or the body part in question doesn’t look like it usually does, please see a physician or medical professional ASAP who can diagnose and treat the problem.

You should, however, do something about it quickly. “Quickly” is the key word here, as a muscle strain injury (or any other type of injury) that is addressed immediately often is less complicated and takes less time to heal.

For an acute injury, remember R.I.C.E:

R is for Rest – don’t aggravate an injury and cause more damage by continuing on. Stop what you’re doing. Now. Ok, if it’s a mild injury, you may be able to get back to mild activity in a day or two which is good for the body (“mild” is the key) If it’s more serious, then I probably didn’t have to tell you to stop, because you (hopefully) would have anyway.

I is for Ice – great for controlling the degree of inflammation, ice is also great for controlling pain, as we all know. And here is why:

When tissue is injured, inflammation begins immediately in response to the injury. Inflammation is not necessarily a bad thing, as it can stabilize an unstable joint, and will clean away cellular debris and dead cells, increase circulation and cellular metabolism by delivering oxygen and nutrients via blood flow.  Due to this increase in fluid build up in the area, pain is caused because tissue is stretched and the pain receptors (nociceptors) in the tissue are irritated.

I have been made aware by colleagues who are physiotherapists that the “newer” approach is to place heat on an acute injury. Why? you might ask. (I asked the same question). Apparently (in theory) to increase the blood flow will increase the rate of healing. However, I will take this opportunity to respectfully disagree;   based on my experience, my clients who have had this type of treatment have been in absolute agony, as if the injury wasn’t enough.  The use of cold and ice isn’t long term, but in the acute stage, it is a great tool to control pain.

C is for compression – once again, compression will control the degree of edema (swelling) which occurs. It is imperative that it be done correctly; bandages that are too tight will completely cut off circulation, and uneven bandage pressure can also damage tissue. My suggestion is that if you can’t find a medical professional trained in wrapping to do it, than it might be better to forgo it altogether. Remember, too, that the bandage will have to be removed and reapplied at least once a day.

E is for elevation – elevation will help the blood and lymph flow away from the injury site, reducing the edema and relieving pain.

Disclaimer: This information is provided for educational purposes only, and is not meant to replace the advice of your primary health care provider. When in doubt, please consult a qualified medical professional in your area.

© Copyright 2009
www.whymassagetherapy.com
All Rights Reserved.

Can Massage Therapy Treat Fracture Injuries?

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

www.whymassagetherapy.com

All Rights Reserved.

Carpal Tunnel Syndrome, Massage Therapy and Surgery Prevention

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.