Massage Case Study: Rock Climber with Elbow Pain
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- čas přidán 19. 06. 2024
- My new book is out! It's called Massage Is Weird: massagesloth.com/book/
Here's how I work with a massage client who has persistent elbow pain.
0:00 Introduction
0:30 Client interview
2:12 How to begin the massage (neck warm-up)
2:56 My clinical reasoning: Possible ulnar nerve involvement
5:45 Myofascial release for the scalenes
6:40 Targeting trapezius
7:44 Contacting deltoid and pec
9:45 Incorporating passive movement/mobilization
11:54 How I work near painful areas
12:40 Working with biceps with passive movement
15:52 Clinical reasoning: Why I work with related structures
16:25 Working with the forearm broadly while preventing thumb stress
17:25 Active engagement during forearm massage
18:04 Myofascial release for the wrist extensors
20:23 Myofascial release for the wrist flexors (client prone)
21:23 Avoiding impingement of the ulnar nerve
22:57 Working with triceps
My main goal in making this video was to demonstrate my timing. I start with a long interview, which I trimmed down during editing. If you're able to take ten minutes with a first time client interview, I strongly recommend it. Ask about the history of the pain as well as what currently provokes it. Ask about possibly related pain/dysfunction both proximally and distally. As you ask, show no attachment or preference for any answer (don't "lead the witness" by getting excited about confirmation of your suspicions, or by dwelling too much on any line of questioning). As the client points out areas of pain, mirror this on your own body. Mirroring isn't just good for showing the client that you've heard them, it can be useful later when you're trying to recall what you heard!
During the massage, notice how little of my time is spent on or near the area of greatest pain. That's not to say that you should avoid the client's area of concern; that can actually be really frustrating and cause them to question whether you heard them in the first place. Just make sure to work with possibly related areas thoroughly, and to not over-focus on the symptomatic region.
For this client with complex elbow pain (posterior near the olecranon process; anterior near the biceps insertion; both epicondyles), I wanted to start by working with the route of the brachial plexus. I contacted the neck and shoulders, giving extra attention to the scalenes and pecs. I then worked with the muscles that attach near the areas of pain: The biceps, triceps, wrist extensors, and wrist flexors. During the first session I incorporated some limited passive range-of-motion, which I could change to active ROM as sessions pass and I'm sure that the client tolerates them well.
Thanks for watching, and let me know if you have any questions or if you'd do anything different!
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THANK YOU for case studies! I really felt lost after graduation as to how to do assessments and determining a treatment plan. I love that you think out loud and tell us what you are thinking while you are working , as well as the continual reminders on proper body mechanics. I wish I would have found you while I was still in school!
Ian I want to thank you for making me a better Therapist... Love from Egypt
Ian's back! Or... maybe he never left? This is the Massage Sloth channel after all! lol
I really love this idea of case study videos.
Totally 100% love your videos and the Sloth community on FB. I’m so happy to be a part of that even though I only have a year and change under my massage license. Keep up the amazing work 😭❤️
« Think locally and act globally » thanks for this reminder!🙏✨👍👍👍
My favorite channel ever. I'm so happy when I get notifications 😁😁😁
I'm a rock climber studying to be a massage therapist. Actually in class this very moment studying the muscles of the forearm right now so this is some cool validation by fate!
Awesome! And what a great combo, that sounds like darn fine cross-training.
I am also a massage therapy student. A blind one… I really appreciate these videos because of how much is verbalized. Very helpful stuff!
Missed your content. Please dont leave again.
So glad you made a new video, gotta get all the info I can for the MBLEX, and videos on helping people that do certain activities like this are great!
One of the best massage channel on youtube. Regard from Indonesia 🙏🙏🙏
Thank you! I love how you teach as you are very good at explaining in detail! This was awesome as always!! Keep up the amazing work!
Thanks Ian please keep these videos up!
Thanks so much for making this video! Elbow pain on client can be tricky to work on. Would love to see more case study vids!!
You are so good at what you do.
Amazing, you're an excellent teacher
Very good teacher, I really learned from all of your vedios, I've always watching again and again
please more case study videos!! love your content!
Thank you for your video from Vietnam!
Ian!!! Your videos are so valuable and truly appreciated! I'm a new LMT and just find your techniques to be so straightforward and helpful. Love this, and I look forward to any achilles work (for my sprinters) or IT band (for my cyclists). I really dig your style.
Thanks so much, Tracie!
Brilliant tutorial! Thank you!!!
Ian!! great videos!! you are an amazing asset to the community!!!!
Thanks Randy!
This was super helpful. I really learnt so much. Thank you 😊
Hey, how about a case study (or two?) on common massage therapist pains?
Thanks for all the cool videos!
If only I could do this on my own arm!!! Thanks for the vid!
I heard her story and I went, "That's me!" I had a repetitive use injury on both my arms in college from, kid you not, playing piano. I was practicing hours a day for a show, often in cold rooms. It started off sharp and intense, and became swollen and tender. I had the numbness, the tingling, the pain that moved from the front to the back, to the upper arm. I spent a while on NSAIDS and using ice, but it didn't help.
So what did help?
1. Rest. I couldn't quit piano because I had a scholarship and had piano courses towards college credit. I did end up turning down more piano gigs and giving up handbells. I attempted to type my papers using speech to text software and changed my everyday movements to prevent sudden shocks to my arms.
2. Physical Therapy. PT used heat and electrostim to stimulate my muscles at first, then built up to concentrated exercises that increased my grip strength. I also had homework exercises to do every night.
3. Braces. Simple, run of the mill arm braces from Walmart, marketed for tennis elbow. They have an air bladder, so it can put target pressure on an area. Just place the bladder where it hurts and tighten. Pay attention to your circulation.
Today, most days are pain free! Sometimes I'll overdue it with repetitive motions and end up in pain. However, a heat pack overnight will have me feeling good as new in the morning. My PT aunt also suggested light massages, which I think helped with extra blood flow.
Thank you for this video, Ian!
I appreciate the account of your self-directed case study, and I'm glad to hear that you're doing well!
Thanks Ian, love your method. Question- no special test to determine the root cause ? Or is this a country thing (as in Australia we're required to do special test to determine root cause for the treatment to qualify as Remedial Massage treatment for healthcare rebates). Cheers, Pete.
Would the use of towel rolls help the client more to open up the chest? And also help with the internal rotation
wow her neck is so shredded!
can you do an achilles video please
oh, that would be amazing!
How do your hands bend like that comfortably? I'm a student. Have you any tips on how a therapist can strengthen their wrists, hands, fingers and thumb? Also how to avoid straining the hands/fingers/thumbs? We were given some tips in class, but thought you might have some handy advice (scuse the pun).
I touch on (excuse the pun) these ideas in my wrist and thumb pain videos, including showing some exercises and stretches that are also good for daily self-care. The general gist is to spend some time with therapy putty and rubber bands a few times a week, There are also some great free weight wrist extension and flexion exercises you can do in the gym, but I leave those instructions up to specialized websites (search for "wrist curls"). Also realize that there are lots of stabilizing muscles to strengthen and routines for your cerebellum to co-opt, so it's also a matter of time and patience. So, give yourself time, keep stretching, and start a strengthening routine as you progress. Let me know if you hit any roadblocks and we'll reassess!
Your neck work looks amazing. Do your wrists ever hurt after bending like that?? Mine do. 🙁
It's something I try to be intentional about. Basically, I think I'd have wrist pain if I spent 10+ minutes of each massage using my wrist flexors and extensors to do work, but a minute here or there doesn't seem to cause me trouble. As long as I mostly use stacked joints and my body weight to do the work, I seem to be able to get away with a fair amount of "breaking the rules."
Watched this twice and took notes to try tomorrow on my client who has tennis elbow from excessive weed-whacking. Pain started about a month ago and hasn’t gotten much better. Worked on her two weeks ago, but didn’t know of her elbow anguish until she came in so i had to wing it. This time, thanks to you, I’m better prepared. She’s continued daily icing (and refraining from yard work) but it hasn’t improved. I’m not a big icing fan, but if it helps relieve her pain I guess it’s better than pain pills. But doesn’t ice slow the healing process?
Tennis elbow can take a long time to heal even with frequent massage and good home care, right?
What about the suggestion someone made in the comments about using an arm brace with an air bladder made especially for elbow pain?
Also, please confirm my understanding- you did say NOT to friction the triceps attachment site while elbow pain is acute, right? So when would you do it, later in the healing stages of healing, or never? Anything else you’d do differently for elbow pain from weed whacking rather than rock-climbing?
I only got licensed mid-July so please forgive all the rookie questions. 🤓
Great questions! Ice is fine. Inflammation can be a self-perpetuating cycle, so occasionally reducing it fractionally could interrupt that loop. As for slowing healing, icing actually increases circulation following the initial vasoconstriction, so I don't see that being plausible (despite many people making the claim). If ice works for her, I say keep it up.
Tennis elbow can indeed take a long time to heal, which is good to emphasize to the client. While it might seem like a single incident caused this, I think it's likely that the predisposition was building up for years in the form of forearm tension and overuse. Just a theory though! In any case, she can expect this to be a matter of weeks to several months. If the two of you aren't seeing progress within the next session or two (or if she wants to hedge her bets and increase her odds of quick resolution), I'd recommend that she ask her doctor for a referral to a physical therapist or occupational therapist, especially one who specializes in elbow issues. A customized regimen of stretching and strengthening from a PT or OT could do a lot to help, and possibly prevent recurrence.
As for frictioning the local attachment sites, that can feel really nice in people who don't have sensitivity there, and it can send ripple effects up and down the arm. I love working with tendons! But, it's just a toy in your toybox, not a goal you have to pursue. I would happily avoid attachment site work for a whole year on a client's elbow if it meant avoiding a flare-up of symptoms. Ironing out the forearm and having them engage in some movement can do all the work. That was all kind of vague, so here's something more concrete: I'd avoid direct tendon work for as long as it hurts, then gradually reintroduce it when it starts feeling good, or at least neutral. This will happen naturally as her arm recovers, and it might be a matter of weeks or months.
And I'm happy to answer questions! Feel free to hit us up on the forum: search "Massage sloth clubhouse" on Facebook and you'll find us.
@@MassageSloth very helpful, thanks, Ian. I will share your feedback with her. I thought I might suggest to her that she try cross-frictioning herself after icing, to her comfort level, the benefit being to create strong and resilient repair of the tendon attachment. She can do that daily and save the less specific more holistic work for me. I do follow the Sloth group on Facebook but i wanted to ask the question right here in CZcams this time, while i was here anyway. Thanks again for the swift and thorough reply. 🤓
Hey there! Are you still in the Pensacola area?
Hi! I've been moving around a bit lately, but I should have news about my new office soon. Stay tuned here or to my other social media!
Nice way to make a living.
I want to study massage
im here for the asmr