Can I get your guys opinion on clients dog-walking injury?

[Horror Movie Addict #7]

I am a new therapist and am starting to build a book of regular clients. One in particular I see often and he is an obese man in his 50's with a number of conditions including scoliosis, diabetes, arthritis, sciatica, you name it! I am having some success treating his sciatica but his main complaint everytime he comes in is constant pain in his L shoulder and L elbow. He says that his dog has injured him several times by pulling his arm around his back with a lot of force and this was years ago. He also seems to have elbow pain that is maybe half tennis elbow and half because of the injury. He never saw a doctor and guesses it is a RC injury. The entire upper arm is tight and feels contracted - brachialis, ant and med deltoid, triceps, everything! He says rubbing the area helps but I feel bad because I don't know exactly what to do for this guy's injury. I told him that it is likey a strain injury and that massage is limited to what it can do.

Im not asking for a diagnosis on the muscles involved, although I suspect subscapularis. When I mimic the movement he described I can feel a pinch under my scapula/

Any advice would be much appreciated!

 

[Spindrift]

Can I get your guys opinion on clients dog-walking injury?

Check out his supraspinatus using resisted testing. I see dog walking injuries a few times a year and the supra is usually the primary injury.

 

[ctopher]

Can I get your guys opinion on clients dog-walking injury?

I have three large dogs and have problems with my left shoulder, as well. Check out infraspinatus, deltoid and bicipital tendon. Also, maybe some healing salve for bursa inflammation.

 

[Aleksey]

Can I get your guys opinion on clients dog-walking injury?

Oh and tell the guy to get a dog trainer or else his shoulder problems will never go away.

 

[Nathaniel G]

Can I get your guys opinion on clients dog-walking injury?

Oh and tell the guy to get a dog trainer or else his shoulder problems will never go away.

:grin: Haha! Love it.

 

[The orginal Stay with me]

Can I get your guys opinion on clients dog-walking injury?

well, he mentioned that the same big dog has REINJURED the site a few times!!! What kind of injury are we talking here? Is it likely a torn muscle or tendon strain...

Being that it is an old injury is there much I can do for him that isn't just palliative?

 

[VICTORY]

Can I get your guys opinion on clients dog-walking injury?

So, you can find where the injury is specifically by using resisted muscle testing. Aaron Mattes has done some great work with learning to isolate the muscles, using his work you can find where the exact injury is. Once you know where it is, work all surrounding tissues and save the spot for last. Use transverse friction over the specific injury in multiple directions. After about a minute, then retest for the specific point of injury, if the client doesn't feel it, you can then put the muscle through a resisted eccentric contraction, where the client contracts the muscle against your resistance --- but lets you win against their contraction. Fantastic stuff-- it's been shown that it's eccentric resistance that re-aligns scar tissue, not friction alone.

It works really well for old and new strain/sprain injuries. If you have trouble understanding that I recommend you attend one of Waslaski's seminars for more info on dealing with those types of injuries.

Or you can refer him out to find relief from that injury. If he's injured one of the rotator cuff muscles and then keeps re-injuring it, he will most likely continue to have shoulder problems and that can evolve into more serious issues down the road.

 

[parijatha]

Can I get your guys opinion on clients dog-walking injury?

Being that it is an old injury is there much I can do for him that isn't just palliative?

In my case, I feel that it is a structural issue at this point. Initially irritated my shoulder back in 2002 while walking my dogs on the left side...although they weren't pulling, there was just enough repetitive tension applied to cause a problem. Fast forward to a few years ago when a naughty horse yanked that same left shoulder out of its socket. Range of motion has since severely declined. I have not had a diagnosis, even though that is what I would suggest for your client...to see if there is a soft tissue tear, or other injury to joint. I feel that knowing this will help you help your client more easily.

I have not found massage to help the joint pain. Massage has relieved tension in the muscles and soft tissue surrounding the joint, as well as painful nerve sensation in the medial deltoid and increased overall range of motion. Any kind of stretching increases discomfort. Herbs and herbal tinctures, specifically for plumping soft tissue and to decrease inflammation, have helped more in that regard. Very gentle strengthening exercises have helped...chiropractic care seemed to make a marked improvement...and less touch invasive therapies like energywork have more of a lasting effect.

Sleeping - therefore restorative restful sleep - has to be tough for him. I would suggest he really pay attention to his body positioning while sleeping. I think massage can help greatly with sleep, too!

 

[Annabel]

Can I get your guys opinion on clients dog-walking injury?

hmmm, did i mention he an insomniac???

i like the idea about muscle testing. i would have to look into it more. he says it hurts the worst when he abducts the humerus, so i suspect supraspinatus as far as RC is concerned and definitnetly some deltoid and biceps/brachialis damage. I did some research on massage and strain and there is some evidence that massage can influence the way old scar tissue lays.

 

[Alice D]

Can I get your guys opinion on clients dog-walking injury?

I encourage you to get your client to see a physical therapist or other healthcare professional for a diagnosis. Although it does sound like he just strained a muscle/ligament, if that's the case it's helpful to know which one since certain movements or stretching of the affected area can actually aggravate it further. Or if the client tore his labrum (of which there is just a very slight possibility depending on how hard and fast his dog pulled) you would want to know since again certain movements in the massage would need to be avoided and you'll know you can't do much for that.

Yes, usually when the supra is injured, folks feel it in their deltoid/biceps. You can see if there's a painful arc, meaning how far can he abduct his arm before he feels the pain-- the deltoid abducts the arm for the first 20 degrees and after that the supra takes over, so any pain after the initial 20 degree of movement is indicative of the supra.

Although we aren't allowed to really diagnose, learning assessment skills are valuable to help us know what techniques can be applied (or not) during the session.

 

[Mooky69]

Can I get your guys opinion on clients dog-walking injury?

Something else I just thought of. Maybe you're already doing this. As you're working, your client might find it more comfortable if you tuck a rolled towel up under the injured shoulder for support while he's lying prone. This makes a huge difference for me while receiving, as well as for clients I have seen with shoulder/rotator cuff injuries.

At times, allowing the arm to hang off the side or front of the table can be more comfortable during massage as well.