Remedial Massage Case Study - Forearm Pain/Repetitive Strain Injury
Subject: Male aged 29yrs, employed as a hairdresser for 14yrs, began experiencing left forearm pain (his cutting arm) after 5yrs on the job.
Overview: Work induced chronic pain not relieved by conventional treatment. One treatment with a mix of Remedial Massage, Osteopathic and Traditional Chinese Medical philosophy and technique eliminates all pain. A follow-up finalised treatment and instructed patient on necessary exercises to maintain good condition.
Case Study: The patient's condition was tentatively diagnosed as Carpal Tunnel Syndrome by a medical practitioner. Treatment focused on the forearm and wrist, and gave negligible relief. My examination revealed near full range of motion and no injury at shoulder; restriction being experienced as tightness under the arm when raised vertically. Palpation revealed thickening and tightness in both the forearm and shoulder. High degrees of pain experienced on palpation of the elbow and forearm at the medial and lateral epicondyles.
My old teacher Professor Wong Lun first taught me the adage, “Problem in the arm, come from the shoulder” and I later experienced first-hand work related chronic forearm pain that culminated in breakdown. When all else had failed, partial recovery was achieved through massage treatment. Full recovery did not occur until I recalled my teacher’s words and began addressing tightness deep in the shoulder and torso.
As a practising Remedial Massage Therapist I frequently encounter similar cases where no particular single event caused soft tissue injury to the forearm or wrist but, due to long term work activity, a repetitive strain condition develops and chronic pain results. This is due to accumulated tension and tightness in the body blocking the circulation of energy to the limb...thickening and hardening of the soft tissue results together with pain. This is a common condition in workers using their arms for extended periods of time; the shoulders normally being a highly mobile foundation for the arms, gradually tighten and rigid holding patterns set in. Without regular mobilising exercise, chronic pain and breakdown is inevitable. In my clinical experience, the majority of patients presenting with chronic forearm pain are due to this cause. A limited number are due to actual injury to the limb through accident or over enthusiastic weight lifting.
The patient in question advised no injury had occurred. He did not undertake any form of high intensity athletics or extreme sports and he worked exclusively as a hairdresser. Hence, the treatment I gave primarily targeted neck, shoulder and torso with cursory treatment only to the forearm. The shoulder was dense and movement restrained by holding patterns.
Full neck and shoulder treatment (excepting Cupping) was carried out on 26 Sep 16. Brief Effleurage and Myofascial Release treatment was given to the forearm. 90% release of the shoulder was achieved. 100% of the arm pain was relieved. Condition was good with no pain or stiffness for two days. Then shoulder began to stiffen again. The arm remained pain free on return to work.
A second full neck and shoulder treatment was carried out on 7 Oct 16 and, this time, including Cupping for upper back and shoulder. Instruction was given for mobilising the shoulder (rotational exercise) and stretching by hanging from a bar.
If the patient is diligent with their rehabilitation and mobility exercises, I do not expect he will require further treatment for this condition.