ATTENTION!!! The physician responsible for the patient’s treatment must be informed of the MEDICAL MASSAGE PROTOCOLs that will be used in manual therapy, and the practitioner must obtain the physician’s permission prior to the initiation of such therapy.
This video is a presentation of the MEDICAL MASSAGE PROTOCOL in cases of Tendinitis of the Triceps Brachii Muscle.
In the videos, we will repeat each technique and approach only two or three times to save time and space. Follow the time guidelines shown at the beginning of each step.
MEDICAL MASSAGE PROTOCOL IN CASES OF TENDINITIS OF THE TRICEPS BRACHII MUSCLE
Duration: 40 to 45 min
Step 1. Increase drainage from the arm
Duration: 2 min
Pressure: below the pain threshold
Begin with superficial effleurage in the direction of drainage, and after several repetitions increase the pressure, switching to deep effleurage. Be sure that the pressure applied allows you to form and push a fold of the skin in front of your hands. Also notice that deep effleurage strokes starts above the inflamed tendon.
Step 2. Relaxation of the triceps brachii muscles
Duration: 3 min
Pressure: below the pain threshold
On the posterior upper arm muscles, employ kneading techniques in the inhibitory regime (to review Protocol #1, click here).
Step 3. Friction on the triceps brachii muscle
Duration: 4 min
Pressure: at the level of the pain threshold (first sensation of discomfort)
Begin with the application of friction along the fibers of the triceps brachii muscle. Apply friction along the entire muscle belly, but stay away from the tendon itself. The video shows the application of friction using the thumb, as well as ridging friction using the proximal interphalangeal joints.
The next step is the application of cross-fiber friction on the belly of the triceps brachii muscle. End this step with the application of cross-fiber friction on area where the triceps brachii muscle transitions into its tendon.
While applying cross-fiber friction, be sure to compress the skin against the muscle. That is, do not slide on the skin surface itself.
Step 4. Trigger point therapy on the triceps brachii muscle
Duration: 5 min
Pressure: above the pain threshold
This video shows only the location of the trigger points in the triceps brachii muscle. The practitioner should use trigger point therapy only if active or “sleeping” trigger points are present. To review the applicable scientifically based trigger point therapy protocol, see pp. 101-105 of the Medical Massage, Vol. I textbook, as well as click here.
Step 5. Work on the tendon of the triceps brachii muscle
a. Effleurage along the tendon
Duration: 3 min
Pressure: below the pain threshold
Begin with flat superficial effleurage along the inflamed tendon of the triceps brachii muscle. Stabilize the soft tissue over the tendon while applying the effleurage strokes.
The next step is the application of squeezing effleurage strokes in which the thumb and the rest of the fingers slide in the direction of drainage along the opposite surfaces of the tendon. Be sure that the strokes are applied with pressure below the pain threshold.
b. Electric vibration along the triceps brachii muscle and its tendon
Duration: 1 min
Pressure: below the pain threshold
Apply electric vibration in the permanent, mobile mode along the belly of the triceps brachii muscle and its tendon. In the case of significant inflammation and pain, apply the vibration through a towel.
c. Friction on the tendon of the triceps brachii muscle
Duration: 5 min
Pressure: at the level of the pain threshold (first sensation of discomfort)
Stretch the skin over the tendon using the thumb and index finger of the left hand to stabilize the tendon. Using the thumb, apply careful friction along the inflamed tendon.
For the next part, apply several superficial effleurage strokes on the tendon in the direction of drainage.
End this part of the step with the application of cross-fiber friction on the tendon of the triceps brachii muscle. Be sure to stabilize the tendon and apply friction with the skin compressed against the tendon.
d. Local stretching of the tendon
Duration: 2 min
Pressure: below the pain threshold
Apply local stretching along the tendon of the triceps brachii muscle. After this, apply local stretching in the medial and lateral directions. To laterally or medially stretch the tendon, twist it between both thumbs.
Be sure that stretches are applied during the patient’s prolonged exhalation. Repeat the same procedure in the lateral direction.
At the end, repeat local stretching of the tendon along its axis.
Step 6. PIR for the triceps brachii muscle
Duration: 4 min
Pressure: below the pain threshold
For the triceps brachii muscle, use PIR on three levels. On the first level, flex the elbow to an angle of 100 degrees and ask the patient to extend the forearm against your resistance.
Apply three passive stretches after each level of the contraction-against-resistance. The white arrows indicate the direction of the contraction.
On the second level, place the elbow in 90 degrees flexion and ask the patient to repeat the forearm extension. Repeat three passive stretches.
Finally, on the third level, flex the elbow completely and have the patient repeat the extension against your resistance one more time.
Step 7. Increase drainage from the arm
Duration: 2 min
Pressure: below the pain threshold
Repeat the application of superficial and deep effleurage in the direction of drainage.
Full Protocol:
