torn muscle - ripped muscle - muscle tear ??

[Vanessa M]

Hey guys. I did a search, but oddly couldn't find anything. In fact, I scoured all my books at home and still oddly could not find anything on a torn muscle.

I have a client who is presenting pain in his deltoid, superior (proximal) to the deltoid attachment on the humerus, roughly on the medial (to anterior) aspect of the deltoid. He also has sensitive trigger points pretty much everywhere in his upper back/shoulders area. He's been injured many times (serious car accident, roping steers, etc). He re-injured this recently when lifting weights.

He is going to get an MRI soon, but not before I work on him next and he thinks "his muscle is torn" also "it's not rrrtatercuff", his doctor told him. lol. Love doctors and their view of muscles. His doctor also told him that his erector spinae was his "tenderloin." uhhhmmmmm. yeah. (hello psoas!)

Anyway, I'm interested in any ideas on treating this, but mainly I'm wondering that if it IS torn, is it contraindicated to work the area (that he thinks is torn)? Obviously the whole muscle is not torn, just possibly a portion of it. He feels the pain mainly when he reaches his arm straight forward, perpendicular to the ground.

I've worked trigger points and did fascial meltling in all the major nearby areas including subscap, pec minor, supraspinatus, traps, rhomboids, pec major, both teres, and more. I have not addressed much of biceps, or brachioradialis. This helped the pain for a day or so, and then it came back. Then he did more roping and then it got a lot worse. He has promised no roping and we are planning 3 sessions within the next week paired with his self care to hopefully start to take care of it. He is very self motivated and has an ultrasonic machine at home that he just started using.

Any comments welcome. But mainly I'm wondering about the torn muscle thing. Would it make it work to do deep work over an area of muscle that is torn? Or are tears relatively normal and cause pain but benefit from deep work? Also, if you know where they mention it in a book that would be very helpful as I am completely freaked out that I can't find what seems to be the most basic think in any of my extensive massage book collection. (or maybe it's not extensive?) Thanks.

 

[JGV]

torn muscle - ripped muscle - muscle tear ??

I have a client who is presenting pain in his deltoid, superior (proximal) to the deltoid attachment on the humerus, roughly on the medial (to anterior) aspect of the deltoid.

Anyway, I'm interested in any ideas on treating this, but mainly I'm wondering that if it IS torn, is it contraindicated to work the area (that he thinks is torn)? Obviously the whole muscle is not torn, just possibly a portion of it. He feels the pain mainly when he reaches his arm straight forward, perpendicular to the ground.

But mainly I'm wondering about the torn muscle thing. Would it make it work to do deep work over an area of muscle that is torn? Or are tears relatively normal and cause pain but benefit from deep work? Also, if you know where they mention it in a book that would be very helpful as I am completely freaked out that I can't find what seems to be the most basic think in any of my extensive massage book collection. (or maybe it's not extensive?) Thanks.

hi shiva. actually, massage is indicated for muscle tear. this info comes out of a MTs guide to pathology. hope it helps.

Strains
Defintion: What are they?
Strains are a subject of semantic debate. Some people say that the word strain applies only to tendon tears; others insist it refers only to muscle tears. In this text, the word strain will refer to an injury to the muscle-tendon unit, with an emphasis on muscles.

Is massage indicated or contraindicated?
Muscle strains indicate massage, which can powerfully influence the production of useful scar tissue, reduce adhesions and edema, and reestablish range of motion. Once a thrapist has a clear picture of what structure or structures have been injured, various kinds of lymphatic drainage techniques can help to limit edema. Cross-fiber and linear friction can influence the way old scar tissue matures and new scar tissue lays down. Passive stretches of healing muscles can also influence the correct alignment of collagen.

pg. 82-85 third edition

 

[Pompal 09.]

Definitely work on it... your main goal is to make sure that the blood flow is maintained in the area. Increasing the flow is the best thing for it... as is teaching him how to cross fiber friction the area that is in pain, so that it promotes the muscle fibers healing and not forming adhesions where he doesn't want them... also ice and heat to comfort level... and probably some arnica on the area...

 

[Mejo]

another thing,

i was looking at my nmt book, and checking the trigger point zones.

of course the anterior fibers of deltiod should be investigated. scalenes can even refer strongly to that part of the shoulder. so does supraspinatus, which might tie in with pain with shoulder flexion. besides pec major, biceps brachii has strong referal in the area you describe, as well as coracobrachialis (roping steer???) and brachialis had a more mild referral to that area.

obviously once he has the mri done, you will know more about which muscle(s) have injury and which are compensating.

on a side note, i am working with a pregnant client. she has a diagnosed tear of the biceps brachii long head. she won't be able to get the needed surgical repair until after the baby is born and at least old enough that she doesn't always need both arms. she gets a lot of tension head aches from holding her arm in medial rotation to protect it. she has a history of subluxation of both shoulders, and was a competitive swimmer and now teaches (coaches) swimming. (her workouts have prevented her from having torn rotator cuff muscles.) she appreciates cervical and scalp work, as well as all the work around her shoulder girdle, she particularly likes when i strum medially along the bicep long head tendon. maybe the massage will be so effective over the next 2 or 3 years that she won't need the surgery after all. i guess that is what we all kind of hope for.

 

[Ham and Cucumber]

Yes, the long head of the biceps helps to stabilize the glenohumeral joint so it is a very important muscle in terms of shoulder stability and function.

 

[Lozziiee_Baybee]

Thanks all! Now that I look back on my question and the simple answer (yes, work on it) I feel kinda silly. Of course we work on these things! And I probably have a million times. But he repeated the word "torn" several times and I started getting this image of me digging into a "torn" muscle and it made me hesitant. ccMarie, the quote from your book really helped, and realizing that I am keeping blood flow going and prohibiting scar formation are good images to have in my mind.

I will definitely address all the areas that have been mentioned, especially the biceps and close-by muscles that I hadn't given as much thought to.

and good luck with your pregnant woman, ccMarie!

 

[Bozema]

and good luck with your pregnant woman, ccMarie!

thanks, she is actually my brother's gf, so i should become an aunt, sometime in november...

 

[Miki Takei]

Remember that what a client thinks they have isn't always so. If the muscle was strained, sprained or actually sustained a good tear, you should be able to palpate it. It will feel very different than healthy tissue. Do what you are doing already and then when the verdict comes in, change your work for what is needed.

Since your work helped his pain for a couple days, you are on the right track. Try not to get disheartened because the pain returned. That is completely normal--things won't resolve instantly, especially since most musculoskeletal problems have been developing over time before the client is usually really affected by them.

If the 'tear' is recent, you wouldn't want to use deep tissue work over the specific area anyway for at least two to three weeks. Generally, pain over the deltoid is usually local and not referred from another source. And this is not to say that the related areas don't need work.

 

[a r]

I worked with a client once who had TORN (as in torn off the tendon) his biceps and b/c he didn't have insurance he never went in. Yeah as in to the doctor. So 2 years and medical insurance later he's at the chiro with several upper trap pain that caused major restrictions in his cervical region. (ie - "I gots this crick in my neck").

Anyway - the muscle has completely reattached and healed in a location lower down from the shoulder joint where it usually sits so it was very odd to work on. But yeah - even with major tears.....especially older or chronic injuries, massage can be VERY helpful. Releasing some of the fibrotic and super tight/restricted areas really gave him a lot of relief and restored most of his range of motion. Not sure it would ever have matched the other side but he could twirl a rope again, ride his horse again and swing a hammer to fix fence (he hadn't been able to raise his arm above the shoulder level AT ALL when he first came in.

I ALWAYS tell my clients with chronic pain like that - it is two steps forward and one step back adn that is totally normal. I usually say "It took a lot of years of abuse to get in this shape and it will take me more than one hour to help you clear it up." which helps them not get impatient.

Angela