To understand the technique known as orthopedic massage, the first thing you need to know is it is difficult to define due to its broad scope.
Whitney Lowe, who first introduced me to orthopedic massage, recently shared with me his current definition: “Orthopedic massage is not a technique or specific modality.
Rather, it is a comprehensive approach that involves thorough assessment and a wide variety of treatment methods or techniques for using massage to treat soft-tissue musculoskeletal disorders.”
I first met Whitney around 1995, when he served on an educational council with me, and I read his book, Functional Assessment in Massage Therapy. That book changed the clinical sports massage work I was doing, and ultimately my entire career in the world of manual therapy.
That book is in front of me as I write this article, and the first sentence I highlighted in 1995 was “Functional assessment skills are systematic problem solving methods that will give the massage practitioner a sound basis for making educated decisions about treatment with massage.”
Orthopedic massage is defined not only by how you manipulate a client’s tissues with your hands, but also by your assessment of the client’s condition and your approach to addressing it.
How Orthopedic Massage Changed My Career
Prior to meeting Whitney, I had studied with Benny Vaughn and Mike McGillicuddy—two of the top sports massage educators in the country—and my specialty was clinical sports massage.
That education opened so many doors, including working with collegiate athletes at the University of South Florida; three years working with the New York Yankees; working at the 1996 Olympic Games in Atlanta; and the opportunity to teach at the Olympic Training Center in Australia prior to the 2000 Olympic Games in Sydney.
With my practice focused mostly on athletes early in my massage career, it became increasingly obvious that almost every time an athlete got a major sports injury they would see an orthopedic physician for their orthopedic condition. So I began to ask myself if I would treat such an injury as a rotator cuff tear, runner’s knee, shin splints or golfer’s elbow any differently in an athlete versus the average person.
Sports terms like runner’s knee had little specific meaning because this knee issue can be caused by a muscle-tendon strain, a ligament injury, a meniscus injury, patellar tendon pain, nerve entrapment or conditions like bursitis. The athlete with runner’s knee would most likely be treated the same way as the non-athlete.
Likewise, golfer’s elbow could be caused by cubital tunnel (Fig. 1), joint fixation pain, muscle-tendon strain, ligament sprain or ulnar nerve pain. Without special orthopedic tests, evaluation, palpation and clinical reasoning—before, during and after treating the elbow—a manual therapist could be further irritating the ulnar nerve while doing multidirectional friction to treat the strain or sprain conditions.
It also became obvious that these musculoskeletal injuries were orthopedic conditions—meaning, those having to do with muscular or skeletal injuries or disorders—and the client would choose to see a specialist in the field of orthopedic medicine.
My passion became learning as much as possible about orthopedic massage to attract a greater variety of clientele, as well as participants to my seminars besides those working primarily with athletes.
The Key to Orthopedic Massage: Assessment
One of the most important things I ever learned from educators like Whitney, early in my career, was how critical it is to use assessment and clinical reasoning skills to match each technique to the underlying pathology of each client’s condition.
I realized other health care providers such as physical therapists, athletic trainers, osteopaths, chiropractors and physicians had detailed assessment training. I knew that was the missing link in my early massage training, and therefore limited client outcomes early in my career.
For example, if the client has thoracic outlet, in which blood vessels or nerves between the clavicle and first rib are compressed, a therapist trained well in orthopedic massage would do special orthopedic tests such as the Eden’s Test (Fig. 2), the Adson’s Test (Fig. 3) and the Wright Abduction Test (Fig. 4).
A massage therapist would then use very specific manual therapy techniques that would elevate and stabilize the clavicle (Fig 5), stretch the anterior and middle scalenes (Fig. 6), and release and stretch out the pectoralis minor muscle (Fig. 7). This set of techniques would address the cause of the client’s clinical symptoms such as numbness, tingling, weakness or pain in the shoulder, arm, wrist, hands or fingers.
Not only should we start treatment with a thorough client history, every client should have detailed clinical assessments and special orthopedic tests done before and after treatment. I now teach that every single technique throughout the entire treatment should start and finish with assessment. This way we can know whether we are using the correct technique or modality to get the desired results for that specific clinical condition.
Orthopedic Massage vs. Medical Massage
In my seminars throughout the world, I often get asked what the difference is between orthopedic massage and medical massage. I asked one of my teaching assistants, TC Cameron, to define medical massage, because she has taught medical massage for quite a few years.
Part of her response was what I first learned from Vivian Madison Mahoney in the early 1990s: “Medical Massage is not a ‘massage’; it simply means that the doctor has written a prescription for medically necessary care.
Cameron continued: “The techniques performed for the patient’s care [are] based on what the therapist has in their tool box and what is prescribed by the physician.”
Orthopedic massage and medical massage are similar in that they do not rely on a specific set of techniques to effect change, but rather on in-depth assessment followed by application of appropriate techniques.
Learning Orthopedic Massage
In practicing orthopedic massage, since we are taking and combining the styles and techniques the practitioner knows and applying them to specific conditions to bring about specific outcomes, I encourage manual therapists to be lifelong learners.
My seminars are now called Integrated Manual Therapy, because I have spent close to 30 years training with industry leaders in manual therapy, including Erik Dalton (Myoskeletal Alignment Techniques); Randy Clark and Paul St. John (Posturology); Aaron Mattes (Active Isolated Stretching); Kerry D’Ambrogio (Total Body Lymphatic Balancing); Don McCann (Cranial Structural Energetic Therapy for concussions and head injuries); and many more.
If we continue to integrate the many incredible manual therapy trainings available in this great industry, I feel certain our work will become an even more valued and utilized component of health care.
About the Author:
James Waslaski, LMT, CPT, is a published author, an international lecturer and a certified personal trainer with the National Academy of Sports Medicine. He presents at state, national and international chiropractic, osteopathic, athletic training and massage conventions. He was inducted into the 2008 Massage Therapy Hall of Fame, and was also named Teacher of the Year in 2015 at the World Massage Festival.