Treat Cervical Trauma successfully while using Deep-Tissue Techniques
Tom, a patient in his twenties, suffered a cervical flexion/extension injury (whiplash) in an auto accident. After chiropractor exhausted his personal injury protection (PIP) coverage, his chiropractor released him saying he had reached maximum medical improvement. Even though, he was still having severe neck and shoulder pain, and headaches. He sought treatment from several massage therapists whose advertised saying that they did deep tissue, therapeutic massage, medical massage and still had little to no results. A friend referred him to Cedar River Medical Massage with the reassurance that not all deep-tissue therapy had to be a painful, That you will set the pain limits. and a little discomfort should be expected. The main thing he was promised was that he would see results.
During Tom’s initial visit, A structural evaluation revealed a forward head posture. On his intake form he complained of pain in the back of the neck and top of the shoulders. We explained to him that his treatment would address the pectoralis and anterior neck muscles first, and then the painful areas in the back of his neck and the top of his shoulders. Tom was amazed because previous therapists had only concentrated on the areas of pain in the back of his neck and upperback. We aslo asked him if he was experiencing tingling or numbness in his arms or hands. He stated he did usually when sleeping. As the treatment proceeded, he was surprised to find these muscles in the front tender and pleased to find that this therapy was very tolerable even though some of the strokes were worked deeper than they had been worked previously, He also noted that he was feeling much better and felt he had finally stumbled onto someone who could really help him.
The important thing to learn from this is to have a structurally-based strategy and evaluate more than just the area of pain for applying therapeutic massage techniques. Deep tissue therapy, whether it is myofascial release, myofascial unwinding, myofascial stretching, neuromuscular therapy or trigger-point release, will result in significant long-term structural changes. If these are releasesed changes in the structural balance should follow. If changes are not made then they are likely to contribute to structural distortion patterns and structural dysfunction, which tend to have little long term effects.
In Tom's case, the tension was released from the musculature of the anterior shoulder and neck first, this allowed the shoulders and neck to move back thus facilitating the initial structural improvement. As the shoulders and neck released, the spasms in the back of the neck and top of the shoulders decreased and the muscles began releasing even before treatment was ever applied to these areas. He aslo noted he was amazed at how his hands felt warm again. If therapy had been applied to the primary areas of pain in the back of the neck and top of the shoulders first, the tight musculature in the anterior neck and pectoralis muscles would have pulled his head and shoulders even further forward as the posterior muscles were released. The structure would have went further out alingment by the increased inballance resulting in increased pain and discomfort. Thus, it is very important for therapists doing therapeutic massage to approach their work in the proper order to address the structural consequences and ramifications of releasing fascia, adhesions and shortened muscles. A three step approach will reduce pain experienced during the work to mild discomfort.
The first step is to use milking strokes to release the fluids, carbon dioxide, lactic acid and other waste products from the natural process of the muscles being used. This reduces the inflammation and tends to clear trigger points. Swollen and inflamed tissues are extremely sensitive and painful to touch, so light, slow, gentle strokes should be followed by deeper and deeper strokes. This results in a decreased sensitivity of the tissues, which allows palpation of the tissues without major discomfort and prepares the tissues for deep work.
The second step is directed myofascial unwinding strokes to release the holding patterns of fascia in the areas of structural dysfunction and to further clear trigger points. These strokes are very slow. Sink in until you feel the resistance in the tissue and hold constant steady pressure until the resistance starts to melt. Follow the tissue as it melts; keep the pressure slow, steady and constant. You will feel many layers soften and release into deeper levels. The deeper you go, the slower you go. These strokes will release most of the myofascial holding patterns and structural distortions; with this work done Tom's neck and shoulders were prepared for more specific deep work to release scar tissue/adhesions and tightened individual fibers.
The third step is individual fiber strokes to release deep fascia, adhesions, scar tissue and atrophied tissues locked in the soft tissue. Many of these deep adhesions, along with scar tissue, will entrap nerves in structural distortion. These are deep, specific strokes, moving very slowly, staying at or below mild discomfort levels.
This three step approach can be used in any area of the body and will allow you to apply effective, deep therapeutic massage while staying within your clients' pain tolerance. Tom stated that, even though these strokes appeared to release tissues more deeply than he had experierced before. He did not have the discomfort that he experienced in those treatments and his pain complaints immediately started to decrease and were completely gone after 6 sessions.
By Pete Spairring L.M.P.
