Begin with client’s arm palm-down on table, with the therapist placing proximal portion of the forearm tool at the inferior end of lateral epicondyle landmark (See Figure 15). Slowly glide the forearm distally until muscle bellies end (where tendons begin to be felt). Repeat two to three times. Figure 15: Forearm Distally
almond shaped piece of bone. Hold pressure firmly at the radial tuberosity landmark for five to 10 seconds. 2. Slowly, holding firm pressure, glide fingers toward the medial epicondyle landmark. Your fingers will move in a diagonal direction toward the medial side of the antebrachium. End stroke when medial epicondyle is contacted. Using thumbs, knuckles or fingertips, strip through the antebrachial muscles, both anterior and posterior, to feel for trigger points within the flexors and extensors. Pause when twitch responses and radiating pain are experienced to apply effective therapy. Turning the hand to create pronation and supination of the proximal radial-ulnar joint will make efforts more intense. Spread the palmar surface of the hand (Figure 20). The therapist uses his/her thumbs to apply pressure into the thenar and hypothenar musculature. Trigger points here may feel as small as grains of rice or sand. Close your eyes to sense changes in muscle texture and tonicity. Stretching the hand will be a welcome addition. Figure 18: Address Pronator Teres Muscle
Begin with the client’s arm palm down on table, with the therapist placing the elbow tool at the inferior end of lateral epicondyle landmark (See Figure 16). Slowly glide the elbow distally until muscle bellies end (where tendons begin to be felt). Repeat two to three times. Figure 16: Elbow Distally
As seen in Figure 17, begin with client’s arm palm down on table, with the therapist grasping the brachioradialis muscle with a pincer grip (using fingers and thumbs). Pull the muscle away from bone and apply friction and petrissage strokes. Try to grasp the entire muscle both proximal and distal to the elbow (cubital fossa) region. In many people, this muscle can be felt a third of the way into the brachium region. Figure 17: Soften Brachioradialis Muscle
Figure 19: Work Trigger Points within Flexors
Figure 20: Locate Trigger Points within Hands
Two steps: 1. Locate the distal pronator teres tendon at the radial tuberosity landmark of the radius (Figure 18), which lies deep in the brachioradialis muscle; ensure this muscle has softened before attempting to go deeper. Pull the brachioradialis laterally as therapist places fingers approximately three fingers distal to the elbow (cubital fossa) crease. The therapist curls fingers into the antebrachium to feel for an
RECOMMENDATIONS TO PROVIDE CLIENTS
Recommending exercises and activities for a client to perform between massage therapy sessions is a necessary part of client- therapist communication. Here are ten recommended items to suggest to clients to augment their self-care regiments and carpal tunnel recovery care. Be mindful of how much torqueing and bending an activity creates on the wrist joints. Excessive flexion (bending) and rotation (torqueing) of the wrist can create injury to the anatomical structures of the carpal tunnel region, thereby undoing much of the progress made in massage therapy treatments, as well as further exacerbating an already-weakened region. 1. Employ stretching as often as possible. A general recommendation is to stretch every day for at least 10 minutes. If pain is present when an activity or an exercise is performed, pausing to stretch can prevent injury and allow
restricted tissue to free and ease pressure from the median nerve. Topical agents (such as analgesic creams, gels, and rubs) can bring temporary relief to carpal tunnel-related pain. There are three main ingredients of these agents: counterirritants such as menthol and camphor, which create a burning or cooling sensation to mask pain; salicylates, which relieve pain in the same manner as aspirin; and capsaicin, which creates a warming sensation to ease nerve pain. 2. Self-massage techniques to bring temporary relief to carpal tunnel related pain. Pressing with moderate pressure (never deep enough to cause pain) into the thenar (thumb pad) or hypothenar (pinky pad) muscles can ease pressure within these muscle groups. Massaging into the anterior antebrachium (front side of forearm) can take pressure off of the major muscle group, causing compression upon the median nerve.
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