Massage Case Study: Rock Climber with Elbow Pain

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Here's how I work with a massage client who has persistent elbow pain.
0:00 Introduction
0:30 Client interview
2:12 How to begin the massage (neck warm-up)
2:56 My clinical reasoning: Possible ulnar nerve involvement
5:45 Myofascial release for the scalenes
6:40 Targeting trapezius
7:44 Contacting deltoid and pec
9:45 Incorporating passive movement/mobilization
11:54 How I work near painful areas
12:40 Working with biceps with passive movement
15:52 Clinical reasoning: Why I work with related structures
16:25 Working with the forearm broadly while preventing thumb stress
17:25 Active engagement during forearm massage
18:04 Myofascial release for the wrist extensors
20:23 Myofascial release for the wrist flexors (client prone)
21:23 Avoiding impingement of the ulnar nerve
22:57 Working with triceps

My main goal in making this video was to demonstrate my timing. I start with a long interview, which I trimmed down during editing. If you're able to take ten minutes with a first time client interview, I strongly recommend it. Ask about the history of the pain as well as what currently provokes it. Ask about possibly related pain/dysfunction both proximally and distally. As you ask, show no attachment or preference for any answer (don't "lead the witness" by getting excited about confirmation of your suspicions, or by dwelling too much on any line of questioning). As the client points out areas of pain, mirror this on your own body. Mirroring isn't just good for showing the client that you've heard them, it can be useful later when you're trying to recall what you heard!

During the massage, notice how little of my time is spent on or near the area of greatest pain. That's not to say that you should avoid the client's area of concern; that can actually be really frustrating and cause them to question whether you heard them in the first place. Just make sure to work with possibly related areas thoroughly, and to not over-focus on the symptomatic region.

For this client with complex elbow pain (posterior near the olecranon process; anterior near the biceps insertion; both epicondyles), I wanted to start by working with the route of the brachial plexus. I contacted the neck and shoulders, giving extra attention to the scalenes and pecs. I then worked with the muscles that attach near the areas of pain: The biceps, triceps, wrist extensors, and wrist flexors. During the first session I incorporated some limited passive range-of-motion, which I could change to active ROM as sessions pass and I'm sure that the client tolerates them well.

Thanks for watching, and let me know if you have any questions or if you'd do anything different!

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