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massage case studies
| Medical Benefits of Deep Tissue Massage Case History One |
| Author Tanya Milne MDip DTM, Dip SRM, MISRM, MSMA |
Despite much anecdotal evidence to the effectiveness of Sports Massage, or other forms of deep
tissue manipulation, from the majority of sports performers, little empirical scientific evidence
exists to support the claims for any benefit from such treatment. The clinical studies that do exist*
remain equivocal, suggesting effects may be psychological or the result of a placebo effect.
The medical consultant to the client in the following case was, and still is despite the evidence, of
such an opinion. The statement made about the client’s condition before massage treatment was,
“…it’s as good as it’s going to get… …massage treatment won’t do any harm, but I sincerely doubt
it will have any benefit…”! The opinion was that the client’s condition would not improve past the
point reached by conventional treatment i.e. no further range of movement (ROM) in the digits,
constant pain, and no possibility of a return to the client’s occupation. This case study is therefore
presented, not as empirical evidence, but as just one more piece in the experiential jigsaw.
CLIENT
Male - Age 47; Occupation - Fork Lift Truck Driver; Past Medical History - none relevant, client
previously fit and active.
ORIGINATING CONDITION
Client suffered a crush injury to the left arm complicated by a fracture of the left proximal radius.
tissue manipulation, from the majority of sports performers, little empirical scientific evidence
exists to support the claims for any benefit from such treatment. The clinical studies that do exist*
remain equivocal, suggesting effects may be psychological or the result of a placebo effect.
The medical consultant to the client in the following case was, and still is despite the evidence, of
such an opinion. The statement made about the client’s condition before massage treatment was,
“…it’s as good as it’s going to get… …massage treatment won’t do any harm, but I sincerely doubt
it will have any benefit…”! The opinion was that the client’s condition would not improve past the
point reached by conventional treatment i.e. no further range of movement (ROM) in the digits,
constant pain, and no possibility of a return to the client’s occupation. This case study is therefore
presented, not as empirical evidence, but as just one more piece in the experiential jigsaw.
CLIENT
Male - Age 47; Occupation - Fork Lift Truck Driver; Past Medical History - none relevant, client
previously fit and active.
ORIGINATING CONDITION
Client suffered a crush injury to the left arm complicated by a fracture of the left proximal radius.
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| Table 1: Initial presenting problems and actions taken |
The client was provided with splints, remedial activities, gentle surface massage, and stretch exercises. The client attended
the OT Department twice weekly, in combination with physiotherapy treatments, for two months and, as a result, had some
improvement to his ROM (Table 2).
the OT Department twice weekly, in combination with physiotherapy treatments, for two months and, as a result, had some
improvement to his ROM (Table 2).
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The client continued to attend OT three times a week for the following six months. Progress had been made initially in
restoring ROM, but after several weeks little further improvement occurred (Figs 1 & 2; Table 2). At this stage a Remedial
Sports Massage Practitioner was brought into the case at the request of Occupational Therapist in charge of case. The
Occupational Therapist felt that deep tissue manipulation techniques, as used in Clinical/Remedial or Sports Massage, might
be of more benefit.
restoring ROM, but after several weeks little further improvement occurred (Figs 1 & 2; Table 2). At this stage a Remedial
Sports Massage Practitioner was brought into the case at the request of Occupational Therapist in charge of case. The
Occupational Therapist felt that deep tissue manipulation techniques, as used in Clinical/Remedial or Sports Massage, might
be of more benefit.
SUBSEQUENT MEDICAL TREATMENT
The client attended the Occupational Therapy (OT) Department and was referred for a full physiotherapy assessment carried
out by the Senior Physiotherapist. The main concern centred on the increasing loss of active and passive ROM in the left hand
middle and ring fingers. The problems highlighted, and initial actions taken are given in Table 1. In addition the client ’s
consultant had new X-Rays carried out to confirm there were no problems with the arm plate, and carried out tests to ensure
there was no nerve damage present. All tests came back clear; no obvious reason for the problem presented.
The client attended the Occupational Therapy (OT) Department and was referred for a full physiotherapy assessment carried
out by the Senior Physiotherapist. The main concern centred on the increasing loss of active and passive ROM in the left hand
middle and ring fingers. The problems highlighted, and initial actions taken are given in Table 1. In addition the client ’s
consultant had new X-Rays carried out to confirm there were no problems with the arm plate, and carried out tests to ensure
there was no nerve damage present. All tests came back clear; no obvious reason for the problem presented.
INITIAL MEDICAL TREATMENT
The client underwent surgery for Open Reduction and fitting of a metal plate. The operation was successful, following which
he was sent to the Outpatients department at the local hospital for physiotherapy. At this time there was no sign of future
problems. Two months after the operation the arm became painful and ROM was affected in the middle and ring fingers -
extension to middle/ ring fingers was reduced, full motion ROM - left hand 50º, right hand 65º. The client was unable to
move his wrist, to fully form a fist, or fully open his hand, which resulted in inability to carry out everyday tasks, such as
cutting up food, washing up, driving etc. He was beginning to suffer from depression as a result of this problem.
The client underwent surgery for Open Reduction and fitting of a metal plate. The operation was successful, following which
he was sent to the Outpatients department at the local hospital for physiotherapy. At this time there was no sign of future
problems. Two months after the operation the arm became painful and ROM was affected in the middle and ring fingers -
extension to middle/ ring fingers was reduced, full motion ROM - left hand 50º, right hand 65º. The client was unable to
move his wrist, to fully form a fist, or fully open his hand, which resulted in inability to carry out everyday tasks, such as
cutting up food, washing up, driving etc. He was beginning to suffer from depression as a result of this problem.
| Fig 1: Finger Extension and ROM after 8 months of Occupational Therapy |
| Fig 2: Finger Extension and ROM after 8 months of Occupational Therapy |
| Table 2: Left Hand ROM and grip strength assessment results |
CLINICAL MASSAGE TREATMENT
At the first session, working with the Occupational Therapist, the Massage Practitioner carried out an examination of the
affected right arm noting that it was pale and cold compared to the left arm. All the flexor/extensor muscles and tendons
appeared to be 'stuck' together, and there was a 'lump' on the wrist extensors. Not only was there loss of ROM to the middle
and ring fingers, but also ROM in the wrist and the joints of the metacarpals and phalanges were also badly affected. (No
treatment was carried out at this session). The practitioner believed that it might be possible to help, but required the exact
location of plate and requested sight of the X-rays.
The second session took place one week later, once the X-rays were available. The exact location of the plate was
ascertained. The X-rays indicated that one of the screws was proud of the plate, and might be a contributing factor to the
formation of the 'lump' on the wrist extensors. Care would be needed when working deep tissues, to ensure that no further
trauma to area was caused whilst treatment was given.
Treatments took place every three weeks over the following six months (in conjunction with OT every week). Each session
commenced with warming, stimulating moves (effleurage/petrissage) to the forearm, hand, and fingers, monitoring at all
times the client ’s tolerance for pain, as some massage techniques, especially in the early stages of treatment could be very
painful. The techniques used were deep tissue work including soft tissue release, trigger point therapy, neuromuscular
therapy, cross fibre frictions, and compressions.
At the first session, working with the Occupational Therapist, the Massage Practitioner carried out an examination of the
affected right arm noting that it was pale and cold compared to the left arm. All the flexor/extensor muscles and tendons
appeared to be 'stuck' together, and there was a 'lump' on the wrist extensors. Not only was there loss of ROM to the middle
and ring fingers, but also ROM in the wrist and the joints of the metacarpals and phalanges were also badly affected. (No
treatment was carried out at this session). The practitioner believed that it might be possible to help, but required the exact
location of plate and requested sight of the X-rays.
The second session took place one week later, once the X-rays were available. The exact location of the plate was
ascertained. The X-rays indicated that one of the screws was proud of the plate, and might be a contributing factor to the
formation of the 'lump' on the wrist extensors. Care would be needed when working deep tissues, to ensure that no further
trauma to area was caused whilst treatment was given.
Treatments took place every three weeks over the following six months (in conjunction with OT every week). Each session
commenced with warming, stimulating moves (effleurage/petrissage) to the forearm, hand, and fingers, monitoring at all
times the client ’s tolerance for pain, as some massage techniques, especially in the early stages of treatment could be very
painful. The techniques used were deep tissue work including soft tissue release, trigger point therapy, neuromuscular
therapy, cross fibre frictions, and compressions.
| Fig 3: Finger Extension and ROM after a further six months of DTM |
| Fig 4: Finger Extension and ROM after a further six months of DTM |
Treatment to begin with, centred on restoring general mobility to flexor/extensor muscles and tendons, and breaking down
adhesions in forearm, hand, and fingers. The majority of treatments carried out were to the flexor digitorum superficialis and
tendon. Treatment also incorporated assisted stretches and mobilisation of wrist and the joints of the metacarpals and
phalanges. Treatment of the 'lump' was carried out simultaneously, working from the lateral edge inward, gradually breaking
down the mass. The 'lump' dispersed over a period of five weeks. The forearm still had slight raised aspect at the 'lump' site -
believed to be due to a proud screw in the plate. The pain suffered in the forearm gradually decreased during this period.
After six months treatment the client ’s condition had improved greatly (Figs 3 & 4, Tables 2/3). OT was then reduced to one
session a week, focusing on grip strength, function, and return to work (Table 3).
adhesions in forearm, hand, and fingers. The majority of treatments carried out were to the flexor digitorum superficialis and
tendon. Treatment also incorporated assisted stretches and mobilisation of wrist and the joints of the metacarpals and
phalanges. Treatment of the 'lump' was carried out simultaneously, working from the lateral edge inward, gradually breaking
down the mass. The 'lump' dispersed over a period of five weeks. The forearm still had slight raised aspect at the 'lump' site -
believed to be due to a proud screw in the plate. The pain suffered in the forearm gradually decreased during this period.
After six months treatment the client ’s condition had improved greatly (Figs 3 & 4, Tables 2/3). OT was then reduced to one
session a week, focusing on grip strength, function, and return to work (Table 3).
| Table 3: Subjective assessment after 6 months DTM |
CONTINUING TREATMENT
The client continued to get OT and further deep tissue massage treatment, once or twice a month or when required, for a
further year, until it was certain that the improvement was maintained. The client had remaining concerns linked with the plate
in his forearm, where he thought the screw ends were causing some soft tissue soreness. It is now two years since the
cessation of regular treatment; the client is back in work and only occasionally requires massage to the affected area.
The client continued to get OT and further deep tissue massage treatment, once or twice a month or when required, for a
further year, until it was certain that the improvement was maintained. The client had remaining concerns linked with the plate
in his forearm, where he thought the screw ends were causing some soft tissue soreness. It is now two years since the
cessation of regular treatment; the client is back in work and only occasionally requires massage to the affected area.
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| Table 4: Continuing problems and actions after 6 months DTM |
|
CONCLUSION
It is thought that this problem may have been the result of several factors combining - scar tissue formation after the original
trauma and operation, one of the screws being proud on the plate, and a shortening of tendons during healing due to the cast
on the arm only extending to the metacarpals.
* Apart from many studies carried out by the Touch Research Institute at the University of Miami, Florida, USA and the recent
research at Leeds University concerning neck/shoulder massage and reductions in hypertension, the following are typical of
the contradictory articles found in Scientific Sports Journals:
Martin et al, J of Ath Tng 33, 30-35 (1998)
Tiidus & Shoemaker, Int J Sp Med 16 478-483 (1995)
Rodenburg et al, Int J Sp Med 15 414-419 (1994)
Coats, Br J Sp Med 1991 25(3), & 1994 28(3)
Carafelli & Flint, Sp Med 14 (11) 1-9 (1992)
Carafelli et al, Int J Sp Med 11 474-478 (1991)
Samples, Phys & Sp Med Vol 15 No 3 (1987)
It is thought that this problem may have been the result of several factors combining - scar tissue formation after the original
trauma and operation, one of the screws being proud on the plate, and a shortening of tendons during healing due to the cast
on the arm only extending to the metacarpals.
* Apart from many studies carried out by the Touch Research Institute at the University of Miami, Florida, USA and the recent
research at Leeds University concerning neck/shoulder massage and reductions in hypertension, the following are typical of
the contradictory articles found in Scientific Sports Journals:
Martin et al, J of Ath Tng 33, 30-35 (1998)
Tiidus & Shoemaker, Int J Sp Med 16 478-483 (1995)
Rodenburg et al, Int J Sp Med 15 414-419 (1994)
Coats, Br J Sp Med 1991 25(3), & 1994 28(3)
Carafelli & Flint, Sp Med 14 (11) 1-9 (1992)
Carafelli et al, Int J Sp Med 11 474-478 (1991)
Samples, Phys & Sp Med Vol 15 No 3 (1987)
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