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Bridging the Gap

Palpation is a skill that takes not only experience but also intent and perception to develop. Once the therapist can skillfully implement this level of palpation expertise, the body exposes a deeper paradigm. This internal world can be explored specifically or with a broad focus. Using skillful palpation along with the modality of acupuncture in treating second- and third-degree muscle strains have been extremely effective.

For the purpose of this article, I will review the signs and symptoms of second- and third-degree muscle strains to enhance the clinical component of treating this type of injury.

Second-degree muscle strain:

• moderate tearing
• loss of strength
• decreased range of motion
• muscle splinting
• compensation of surrounding structures
• function is compromised
• inflammatory response occurs
• pain.

Third-degree muscle strain:

• definite tear with a noticeable and/or palpable gap at
• point of injury
• loss of function
• signs and symptoms are the same as second degree.

A therapist’s goal is to decrease inflammation by using lymph drainage techniques, to ensure the integrity of surrounding healthy tissue, and assist with keeping connective tissue contracture to a minimum. Please remember that upon initial injury, protective muscle spasm must be respected and not completely removed.

From experience, attaining proper fibre alignment within the injured structure in both second- and third-degree strain is paramount to enhance healing. During the acute phase of such an injury (acute phase can last four to six days), besides lymphatic drainage, there are a limited amount of  massage techniques available to use directly on the site. This is when acupuncture can “bridge the gap.”

The “art” of palpating the exact border of where the muscle tissue is healthy, versus the starting point of the tear, is essential for proper needle placement. Needles are inserted in a line along the width of the proximal and distal borders of the muscle tissue. So, picture two rows of needles bordering above and below the injury. The depth of needle insertion can be perceived by the change in tissue “feel” as the needle is going deeper. A needle inserted into healthy tissue seems to “slide in” whereas adhered/injured tissue feels “gummy.”  

At this point, an “electric acupuncture stimulation machine” is hooked up to all needles or to a specific above and below pairing of needles. A gentle electric current then travels from needle to needle. The intensity of the current depends on the severity and the stage of inflammation the injury is at. The therapist should always be aware of the comfort and pain level of the client during such a treatment. A pain scale should be established prior to the treatment.

This treatment has many benefits that aid in healing. These include:

• a decrease in inflammation
• a decrease in adhesions
• a realignment of muscle fibres
• a decrease in sympathetic nervous system firing.

Once the needles are removed, massage is then used to flush out the tissue. Lymphatic drainage techniques are highly effective after the acupuncture treatment as well as before. Remember to start the lymphatic techniques on the proximal half of the injury due to the lack of tissue integrity. If you started your lymphatic techniques on the distal end of the injury you could put your client at risk of a “pooling” of inflammation within the injured tissue.

After drainage techniques, the therapist can work proximal to the injury site and ensure tissue and joint health.

Ice is then applied to the injury site and left on for 10 minutes. The ice will help to constrict the blood vessels, a process that will aid in a reduction of inflammation.

There are several variables that will affect the success of treatment. These include:

• the severity of muscle strain (first- versus third-degree tear)
• the overall health and age of the client (for example, a diabetic will take longer to heal)
• the location of the injury (a muscle strain in a weight-bearing muscle will take longer to heal than a strain in a non-weight-bearing muscle)
• surgical intervention in severe cases.

Over the years, I have had clients who have had their healing time reduced by 25 to 50 per cent by implementing the above procedure.

The bottom line: if a massage therapist can facilitate the healing process by utilizing skills such as palpation and other modalities like acupuncture, the client’s recovery time will be reduced and health to the tissue will be restored.

Renee Sheldon is an RMT who has worked with athletes at various competitive levels. She has written for a number of publications, and is a recent graduate of the Connecticut School of Integrative Manual Therapy. Renee practises in Pickering, Ont.