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Need advice for client with forearm pain

I have a client who is in dental school who presented to me with pain in his forearm extensor and flexor muscles, some symptoms of carpal tunnel, with some tenderness around the medial and lateral epicondyle. I have used various techniques on him from general stripping of the muscles to trigger point to deep kneading. He is typing a lot, using dental instruments, etc. and cannot just stop doing these activities as he is in school for quite a while. He is icing the areas at least a couple times per day.

I worked on him a 2nd time and now his forearms are more achy and one of his doctors told him that he could go through some discomfort thru the healing process.

Any insight you could give me would be greatly appreciated here. I would like to eventually use hot stone therapy with him but not sure if I can since he continues to have these issues. I have so very much to learn. I am usually able to help people with forearm issues really well, but this case has me stumped.

Replies to This Discussion

Permalink Reply by Jenny Ray on May 7, 2010 at 1:24pm

You are on the right track...
Warm the entire arm and shoulder (you can even place a few stones under his scap area...be sure to cover them with a towel so he is not burned!! keep temps around 110 for this...
To warm the rest of the arm use temps of about 110-108, (these are stone temps not water temps, you can only know stone temps if you use a digital laser thermometer...available at Harbor Freight for around $20...point, click and read..) this will feel pretty hot so use lots of oil and keep them moving...begin each stroke on the largest muscle mass....use as much pressure as he can tolerate...stroke towards the body away from the hand....smaller stones will serve best in this case...nothing larger than the palm of your hand....once you have raised the temperature the blood and fluids in the forearm will have dispersed a bit due to vasodilation...now come back with cold to constrict the vessels and create the pumping action that can help detox the area.... Use small stones again and have them at about 32-40 degrees [about 20 minutes in an ice water (more ice than water) bath will do it]....hold deep firm pressure and do not move the stones once they are in contact with the body...begin at the wrist and slowly (change stones often to maintain cold) step by step press deeply in to each muscle bed. When the stone has warmed a bit because of the heat it has absorbed from the client's muscles, go into each insertion and slowly stroke towards the body. This will move lymph and blood flow to help oxygenate the sore areas.....do not over work this area...less is best...one stroke with a stone of temperature is worth ten with the hand....now apply a good brand of Arnica oil...the oil will penetrate quickly, has an anesthetic action to relieve pain.
Client should wear wrist supports (i.e. carpal tunnel bands) while working at computer...and ice is only good when alternating it with heat...be careful about hot pads and then ice cubes in a bag as it can create burns to the skin...trigger point work with cold stones will benefit but be careful with deep kneading. Stripping with cool stones will also help pain and increase oxygen...
you'll be his hero in no time!!...short 30 min sessions twice a week rather than a full hour once a week with a focus on all upper body will help a lot...
let us know how it goes...

Permalink Reply by Mieka Davis atc,cmt on July 17, 2010 at 9:08pm

I suggest to try working on the muscles from his neck down to his arm and back up with myofascial release and lifting the muscles with petrissage instead of pressing down- (which can sometimes cause more micromuscle tearing.) I have two denists clients, and I do more work on their Pectorals because their posture is always in horizontal adduction during the day. So encouraging back extension work, stretching arms behind back with palms facing down between clients, and stretching chest muscles frequently during the day has improved effect on posture and on reducing tension in the brachial plexus. The symptoms you are talking about sound like he needs to re-visit an orthopedic doctor too. Sometimes by asking clients to bring you a note for what their doctor suggests (doctors can give you specific goals to work with your client,) it builds a rapport with your client as a medical professional team that works just for them:)