Integrated Manual Therapy & Orthopedic Massage For ... · PDF fileIntegrated Manual Therapy & Orthopedic Massage For Complicated Forearm, Wrist, & Hand Conditions Today’s manual

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 multi-

modality 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

http://www.orthomassage.net/

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CLINICAL MASSAGE THERAPYA Structural Approach to Pain Management

CHAPTER

Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski

Elbow, Forearm, Wrist, and Hand Conditions

7


Chapter Outline

• 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


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


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


Learning Objectives

• 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


Figure 7-9 Forearm Muscle Reference.

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Figure 7-10 Resisted Test, Forearm Flexors.


Figure 7-11 Resisted Test, Pronator Teres.


Figure 7-12 Resisted Test, Biceps.


Figure 7-23 Resisted Test, Wrist Extensors.


Figure 7-24 Resisted Test, Forearm Supinator.


Figure 7-13A Myofascial Spreading, Forearm/Wrist Flexors.

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Figure 7-13B Compression Broadening, Forearm/Wrist Flexors.


Figure 7-13C Cross-Fiber Gliding Strokes and Trigger Point Work.


Figure 7-14 Myofascial Spreading, Flexor Retinaculum.


Figure 7-15A Arthrokinetics (Gentle Compression).


Figure 7-15B Arthrokinetics (Traction).


Figure 7-16A Separate Tendon Sheaths.

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Figure 7-16B Pin Each Tendon Sheath and Passively Extend Wrist.


Figure 7-17 Forearm Flexor Stretch.


Figure 7-18 Myofascial Release of the Interosseous Membrane Using Radius—Ulna Movement.


Figure 7-31B Stretch Deep Fascial Layers Using Metacarpals.


Figure 7-30 Anatomy Reference, Wrist and Hand.


Figure 7-31A Myofascial Release andCompression Broadening.

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Figure 7-34A Resisted Test, Thumb Strain.


Figure 7-34B Multidirectional Friction, Thumb Strain.


Figure 7-34C Eccentric Contraction, Thumb Strain.


Figure 7-35A Arthrokinetics (Gentle Compression).


Figure 7-35B Arthrokinetics (Traction or Decompression).


Figure 7-35C Stretch Hand Muscles.

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Figure 7-19 Pronator Teres Release.


Figure 7-20 Stretch Pronator Teres.


Figure 7-22 Anatomy Reference, Posterior Arm.


Figure 7-25A Myofascial Spreading, Wrist Extensors.


Figure 7-25B Compression Broadening, Wrist Extensors.


Figure 7-25C Cross-Fiber Gliding Strokes and Trigger Point Work, Wrist Extensors.

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Figure 7-26A Resisted Test, Wrist Extensors.


Figure 7-26B Multidirectional Friction.


Figure 7-26C Eccentric Muscle Contraction.


Figure 7-27 Resisted Wrist Extension.


Figure 7-28 Myofascial Release, Forearm Supinator.


Figure 7-29A Resisted Forearm Supination.

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Figure 7-29B Multidirectional Friction, Supinator.


Figure 7-29C Eccentric Muscle Contraction, Supinator.


Figure 7-32B Carpal Bone Mobilization.


Figure 7-32C Carpal Bone Mobilization.


Figure 7-33A Carpal Bone Mobilization—Ulnar Deviation.


Figure 7-33D Carpal Bone Mobilization—Radial Deviation.

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Figure 7-33B Carpal Bone Mobilization—Wrist Flexion.


Figure 7-33C Carpal Bone Mobilization—Wrist Extension.


Figure 7-33E Deep Gliding Strokes Through Carpal Tunnel.


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.


Stretching

• Daily stretches and therapeutic exercise will help keep those muscle groups in balance.


Figure 7-36 Forearm/Wrist Flexors Stretch.

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Figure 7-37 Hand Flexors Stretch.


Figure 7-38 Pronator Teres Stretch.


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).


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


Figure 7-39 Strengthen Hand and Wrist Extensors.


Figure 7-39 (continued) Strengthen Hand and Wrist Extensors.

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Figure 7-40 Strengthen Forearm Supinator.


Figure 7-40 (continued) StrengthenForearm Supinator.

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Integrated Manual Therapy & Orthopedic Massage For ... · PDF fileIntegrated Manual Therapy & Orthopedic Massage For Complicated Forearm, Wrist, & Hand Conditions Today’s manual