Orthopedic massage - the concept and strategies

By Boris Prilutsky

Not long ago I was invited for a DPT presentation, organized by a physical therapy equipment distribution company. The audience where composed predominantly of physical therapists with some influx of orthopedic surgeons. One of orthopedic surgeons from the group talked about different types of regenerative therapy injections, but cautioned not to forget that steroids injections are still the main route for making a difference in painful post-traumatic cases. DPT’s presentation topic was manual therapy for cases of sports related injuries. Mainly, this doctor of physical therapy, talked about soft tissue mobilization such as myofascial mobilization, trigger points therapy, and mentioned deep tissue mobilization as well as stretching.

When it was my turn to speak, I pointed out that actually and traditionally this type of soft tissue mobilization is called orthopedic massage, to which he gladly agreed. The disagreement was on presented diagnosed cases and chosen treatment direction. Discussing collateral ligaments injuries case due to severe sprain, the DTP proposed therapy by direct hands-on stimulation of injured component, and limited area around this injury, in the fact, proposing orthopedic surgeons’, rather than physical therapy rehabilitation strategy. Such treatment could inhibit pain, but would not provide adequate therapy and it only be a question of time when this post-traumatic region would re-injure and demonstrate accelerated developments of degenerative diseases such as arthritis.

Ultimately, “is orthopedic surgeons’ strategy wrong?” as one of the orthopedic surgeons in the audience put it, challenging my position.

My answer was: “In general it’s not about right or wrong. Orthopedic surgeons have very powerful methods in their arsenal, which are applicable under variety of specific circumstances. But massage therapy implements altogether different approach, the approach that is not local, but comprehensive rehabilitative one. To their own admission, orthopedic surgeons are not experts in physical rehabilitation, while as massage therapists are, or should be. The concept of targeting inflamed components is incompatible with physical rehabilitation by means of massage conceptually, and as treatment strategy. Injections, by means of which orthopedic surgeons target inflamed components, don’t accomplish extended comprehensive rehabilitation and therefore shouldn’t be a resource in massage therapist strategic arsenal.”

Knowing that some of our colleagues are still adopting orthopedic surgeon strategy, I would like to suggest viewing the following short video clip that includes extended explanations on the subject.