Why we start treatment by getting to the other side. Orthopedic Protocol

I have been teaching a lot recently and it has gotten me thinking about what I want to say in my blogs. Recently, I have become incredibly aware of how lucky I was with my initial training and the early part of my career. I have been blessed enough to go to a 2800+ hour Orthopedic program and then travel the world learning more,  I have almost always worked with medical company's or for insurance claims, seeing clients that had issues that there was no guide book for. I was also lucky enough to do this early enough in my career that I did not know how little I knew, and it gave me free range to experiment with what worked for me, not just with what I had been taught as a base.

For the rest of my blogs I am going to change the focus from the general public, to speaking to other therapists. Teaching here in NYC has shown me that the information I was given freely, is not given to others freely and I want to share what I have. Some of the information will seem obvious to some, but here in the states therapists can either have very little training or quite a lot of training. By no means do I reserve the right to tell people what to think.  However, I can present a structure based on my training and experience on how to think like an orthopedic massage therapist. .

    Starting on the other side........

When you have finished all of your assessments and are ready to treat your client, how do you decide where to start? If a client has back pain do you jump right to the pain point? If they came in for a pulled hamstring do you start with the back because that is where you always start?

 Starting on the other side is a basic orthopedic principle. For some of you this will be a basic principle tried and true, but for some you will never have heard of it.  All this means is that after you assess your client, whatever the probable problem is, you are meant to begin treatment on the opposite side of the body. For example, if the client comes in with a problem in their right leg, the treatment starts with the left leg. It begins an important practice in orthopedic treatment, as using your treatment as an assessment protocol. Starting on the opposite side allows you to do three things.

1. Use your massage to asses what the 'normal' tissue and ROM is, thereby using it to compare to the dysfunctional side, making more objective decisions about your treatment.
2. Decide on a depth of reasonable pressure on the patient's healthy tissue.
3. Get the client used to your touch so that you can work in more sensitive areas that they might guard and get them into a relaxed state with the muscle pump 'on'.

This all seems straight forward when you first think of it, but can get a little confusing if you think on it too much. Obviously if its a limb problem, such as the left arm, you would begin on the right, etc. But issues with the body are not always cut and dry. Take these for example, if the complaint is in the low back, what is the opposite side?

Well, is its low back  right side SI joint, then the opposite side is the left side SI joint. However if its is low back L5-S1 center, and both QL's seem equally tight, then the opposite side is likely glutes. Issues on the main part of the trunk of the body might often use 'up/down'  as the 'opposite side' and that is totally fine. The idea is to start giving yourself a structure to understand the tissue and to gather information as you are treating.

More complexity can be added if you are working with time constraints. You will not always be doing a full body massage. If someone comes in for a 30 minute treatment, and the complaint is a pulled calf muscle, you might only be working one leg, so you might start at hamstring, once again using 'up/down' as opposites, rather than left right. While hamstrings and gastrox are not technically opposite muscles, it still gives you a place to start.

The most valuable information for learning and assessment perhaps comes from using this principle on a micro scale. When you are working for insurance companies, PT's, or chiros, you are often only given 15 min or so to treat. It's really not enough time to reap the benefits of massage, you are just working the prescribed area. In this scenario, I would recommend working 'antagonist/agonist' starting of course with the opposite muscle of complaint. Not only as a beginner does this give you an excellent opportunity to review valuable information about which muscles counteract which movements, but what is fascinating here is you will start to see patterns in pain emerge. You will find that much of the time when you begin with the area that is opposite of the complaint, that the muscle in question will be tight, splinted and in fact the cause of the problem. So when you treat it first, and then move onto the original area of complaint there is no complaint left to treat, other than compensatory issues. And this should get you thinking about pain in general,why it occurs, where it occurs, and how you can rethink you assessments to make them more objective.

Regardless if you are treating whole body, or micro areas, treating on the opposite side is a valuable tool for organization, assessment and gives your client a better treatment on the whole. Even in a relaxation session, small things like this, a can improve a client experience without them ever knowing it was done. Once you start to apply structures in thinking to your treatments, your ability to find patterns within them will quickly develop.

*QL-Quadratus Lumborum
*SI-Sacroilliac Joint
*PT- Physical Therapist

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By Beret Kirkeby