0RTHOPEDIC MASSAGE Orthopedic Massage involves therapeutic assessment, manipulation, and movement of locomotor soft tissues to eliminate pain and dysfunction throughout the body. It is more than a technique. It involves thorough functional assessment skills, multidisciplinary and multimodality treatments, and specific client self care protocols designed for each clinical condition. The goal is to understand and identify the underlying structures involved in each clinical condition, and then apply the most appropriate modality or discipline to eliminate the underlying cause before treating the resulting clinical symptoms. Orthopedic Massage Training is uniquely different from one instructor to the next: some are strongest in assessment, others in treatments, but most trainings lack the critical piece of client self care. Orthopedic Massage Applications The following clinical conditions are just some of the many things that can be addressed with orthopedic massage: Lower Body: Low Back Pain, Sciatica, Bulging Discs, Scoliosis, Spinal S Stenosis,, SI Joint Dysfunction, Hip Capsule Adhesions, IT Band Friction Syndrome, Patellar Tendinosis, Chondromalacia,, Adductor Strains, Hamstring Starins,, Achilles Tendinosis, Plantarfasciitis,, Ankle Sprains, Posterior Medial Shin Splints, Anterior Compartment Syndrome, Bunions, Hammer Toes, Neuromas,, etc. Upper Body: Scoliosis, Upper Cross Syndrome, Rotator Cuff Injuries, Shoulder Impingement, Thoracic Outlet, Frozen Shoulders, Bicipital Tendinosis, Pectoralis Minor Strain, Cervical Sprain/ Strain, Forward Head Posture, C1/C2 Dysfunction, Migraine Headaches, TMJ, Medial and Lateral Elbow Pain, Pronator Teres Syndrome, Carpal Tunnel Syndrome, etc. You will understand which structures cause each condition, and develop a systematic approach to bring the body back into balance. Orthopedic Massage Benefits Pain Management Injury Prevention Injury Rehabilitation Performance Enhancement Chronic Pain Sports Injuries Structural Integration Easily Integrated into a Relaxation Massage 1
Orthopedic Massage Modalities & Disciplines: A Structural Approach to Pain Management Functional Assessment Myofascial Release Neuromuscular Therapy Scar Tissue Mobilization Arthro-Kinetics Myoskeletal Alignment Techniques Active Isolated Stretching-Tight Muscles Strengthening-Weak Inhibited Antagonists The Ultimate Goal is to Restore Structural & Postural Balance Throughout the Body. Unique Trademarks-Waslaski Method of Orthopedic Massage We have a user friendly method, that uses a unique 12 step multidisciplinary protocol, for balancing all muscle groups around the major joints of the body. Restoring normal muscle resting lengths of opposing muscle groups throughout the body, based on normal joint range of motion, is a key component of this work. This includes the pelvis, shoulder, neck, elbow, wrist, hand, knee, ankle and foot. This unique method allows us to create muscle balance and increase joint space throughout the body, prior to treating the clinical symptoms that result from myoskeletal imbalance. Unique Trademarks-Waslaski Method of Orthopedic Massage Revolutionary methods for releasing even the most complicated Frozen Shoulders and Frozen Hips. This is where we combine science with presence, intention, compassion and intuition. You must learn to not give up intuition for science. You will learn to dance between emotional guarding, soft tissue imbalance, soft tissue injuries, joint capsule adhesions, visualization and critical interactive healing conversations. This is where you will set yourself apart from limited results often achieved in traditional western medicine. 2
Unique Trademarks-Waslaski Method of Orthopedic Massage Revolutionary approach in differentiating and treating tendon tension versus tendonitis versus tendinosis. Most health care providers will never see tendonitis and our current treatment techniques should be challenged. This revolutionary paradigm shift is based on the incredible research studies found in archives dating back to 1946 on tendinitis versus tendinosis, and research recently presented at Harvard Medical School from the First World Fascial Congress. Tendinosis of the elbow: Muscle-Tendon Strain without inflammation. Clinical Features and Findings of Histological, Immunohistochemical, and Electron Microscopy Studies. Investigation performed at Nirschl Orthopedic Sportsmedicine Clinic, Arlington; Arlington Hospital, Arlington and Georgetown Medical Center, Washington, D.C. Barry S. Kraushaar,M.D., Emerson, New Jersey and Robert P. Nirschl, M.D., M.S., Arlington, Virginia. Tendinosis or Tendinitis? While the terms epicondylitis and tendinitis commonly are used to describe tennis elbow, histopathological studies have demonstrated that tennis elbow is not an inflammatory condition. It is a fibroblastic and vascular response called angiofibroblastic degeneration, now more commonly called tendinosis. Thus proper treatment depends on a correct understanding of the nature of the injury and goals of therapeutic intervention. 3
Tendinosis vs. Tendinitis Tendinitis-Acute tendon injuries such as laceration of the flexor tendons of the fingers, are traumatic in nature and have associated inflammation. Tendinosis-Chronic overuse injuries are the result of multiple microtraumatic events that cause disruption of the internal structure of the tendon and degeneration of the cells and matrix, which fail to mature into normal tendon; at times such injuries result in tendinosis. There is an absence of acute inflammatory cells in tendinosis. Tendinosis vs. Tendinitis Tendinosis is incompletely understood. Although the term tendinitis is used frequently and indiscriminately, histopathological studies have shown that specimens of tendon obtained from areas of chronic overuse do not contain large numbers of macrophages, lymphocytes, or neutriphils. Rather tendinosis appears to be characterized by the presence of dense populations of fibroblasts, vascular hyperplasia, and disorganized collagen. It is not sure why tendinosis is painful, given the absence of acute inflammatory cells, nor is it known why the collagen fails to mature. Tendinosis-Tendon Tendon strain without inflammation. Examinations of specimens from patients who have tennis elbow serve as a model for investigation of other areas where tendinosis has been reported. Other areas include the rotator cuff, Achilles tendon, patellar ligament, the adductors of the hip, the triceps, the flexors and extensors of the elbow, and the plantar fascia. Barry S Kraushaar M.D. & Robert P. Nirshcl M.D., M.S. Nirschl Orthopedic Sports Medicine & Georgetown University Medical center 4
Tendinosis Treatment Hypothesis by Author & International Lecturer James Waslaski Based on this research study it is not known why the dysfunctional collagen fibers fail to heal. It is my firm belief, based on many years of tendon pain treatments, that functional collagen or fibroblast formation is only possible when the underlying cause of tendinosis conditions are addressed prior to addressing the resultant microtraumatic symptoms. We must restore normal muscle resting length to antagonistic muscle groups prior to treating the resulting tendon pain, and we w must be less aggressive and more specific in our approach to the working on the resultant strained fibers. Tendinosis Treatment Hypothesis by Author & International Lecturer James Waslaski Healthcare practitioners throughout the world have been treating tendinosis too aggressively, and often without eliminating the underlying cause first The use of deep cross fiber friction for 6 minutes, in one direction only, is not appropriate for tendinosis. We must realize that Dr. Cyriax may have meant for us to use cross fiber friction, to go across the thickest fibers of the dysfunctional collagen matrix, in order to soften the scar and create a more functional collagen matrix. It appears we can perform this technique for shorter time periods, to reduce or eliminate creating inflammation, in areas of tendinosis where we now know inflammation is not present. I firmly believe healthcare practitioners have been creating inflammation in patients throughout the world, in clients that do not have inflammation when they come in with tendon pain. That results in the practitioner having to apply ice and suggest anti- inflammatories to treat the new symptoms caused by the therapist. I also believe that too many health care practitioners think deep cross fiber friction actually re-aligns the collagen fibers, when it is actually the pain free movement and pain free eccentric contractions that re-directs the scar. Hypothesis & Research from the st Fascial Congress-Harvard University 1 st Evidence indicates that fascia has a stretch reflex, thus leading to the idea that kinetic movement may mobilize fascia better than deep static pressure. Certain research experts believe it may take too much deep static pressure to change the thixatropic state of fascia, and encourage movement either by the client or the therapist. The same thing is thought about static pressure on tendons to re-set the tension in the muscle. It may be better to have the client contract the muscle with static pressure on the tendon to affect the golgi-tendon response. 5
Orthopedic Massage Case Study: Tennis Elbow or Extensor Tendinosis Refer to the notes for more on tendinosis research, and the suggested treatment of lateral epicondyle pain (often called tennis elbow) as well as medial epicondyle pain (often called golfers elbow). These conditions are too often generically and inappropriately called lateral epicondylitis, medial epicondylitis or simply tendonitis. Restore normal muscle resting length to the flexors of the wrist prior to treating extensor tendinosis. This allows you to relax the extensors and be less aggressive in treating the extensor strain. (See case study in notes) 6