In the past week, I've had two clients come to me with a dislocated shoulder (still dislocated). Caught me completely off guard. One client DESPARATELY wanted some type of relief; I worked around the area to loosen things up so that when they put it in place, the muscles were 'calmer'. I had hoped that it would also kick in some endorphins and get the circulation going. He said that the 10 minutes that I spent on him gave him some relief.
WHAT TO DO??????
WHAT TO DO??????
Fri, October 27, 2006 - 6:30 PMI would probably tell them to go to a doctor before I ever worked on them. I'd say in terms of relief, short term pain drugs are in order on this one.
What to do if you are going to attempt helping out a person who needs a more skilled practitioner. First stay the hell away from that shoulder, work on their adductors and flexors, rubbing the musculotendonous junctions, work on the hand on the same side, and the foot and hip on the opposite side. All this should help reduce the ammount of startle response that they are in. Working the local musculature is most likely going to increase the inflamation and could potentially lead to something like say a lawsuit.
Tue, October 31, 2006 - 11:23 AMI agree that working locally would not be a great idea, esp. if inflamed, but working other areas would be beneficial in helping prevent damage from overcompensation. Ice. ice. ice. I would never recommend to anyone that taking pain pills is their best option for pain relief. Personally, I would refer to an acupuncturist for their pain relief. After a doctor resets the shoulder and there is no inflammation, local massage would help the healing process.
Tue, October 31, 2006 - 6:34 PMSo you have a dislocated shoulder, you are in severe nervous system distress, shock, pain etc. Chronic injuries come from not being able to release the bracing response that is protecting your injured tissues and joints from further injury. The longer the traumatic nervous system response lasts once injured, the longer it will take to habituate the responses out of your movements and posture. Pain pills cut that CNS response down significantly, shutting down our fight or flight nervous system response so that we can focus on healing, which at that acute point is more or less just resting and relaxing, maybe moving our other joints in a relaxed manner. I'll agree that pain drugs are way over used, but they have their uses. Of course accupuncture will help too, but I'm talking into the ER to get the shoulder set while under the influence of a pain drug or muscle relaxant of some sort. Then the lasting effects of the pain meds will also help you get from the ER to the accupuncturist with as little pain and shock as possible.
Ice is something to be careful with. Use it sparingly, less than 2 minutes at a time. With ice you are dealing with a balance of how much numbing of the injury and increasing blood flow can be accomplished, and how much it crystalizes the protein structure of the inflamatory materials in the damaged tissues. I've heard people say to use ice for 20min at a time, that will not only embed an injury in the structure of the scar tissue it will give you frostbite which further damages the tissues by rupturing cell walls. I am much more apt to use a hot and cold shower as described in Cami's post over ice.
I wouldn't work on someone with a dislocated shoulder unless I was very confident that I could skillfully relacate it for them. Outside my scope of practice for now, and unfortunately that is exactly what they need before any particularly useful work can be accomplished on my end.
Like I said above, skin stim around the musculotendenous junctions of the adductors and flexors of the body will decrease the pain sensation and the startle response temporarily. That is about all you've got unless you know how to get that shoulder back in without causing further injury. I'm driving them to the hospital to get that thing popped back in, I want to watch the procedure, just in case I ever end up needing the knowledge.
I've worked with a few very fresh injuries, most recently a sprained SI joint and a massive deep bruise on the thigh. Daily Epsom salt baths with about 5lbs of Epsom salt and 20grams of MSM work wonders for decreasing inflamation and supporting rapid tissue remodeling in any stage of healing. Contrast showers a couple times a day helps a lot with your entire constitution. Wobenzym N is the best and safest anti-inflamatory I've ever experienced. Working passive, assisted and active ranges of motion of the injured joints and tissues as soon as it is comfortable is very helpful with an efficient tissue remodeling process and neurological re-integration.
Tue, November 7, 2006 - 2:07 PManyone heard of an old trick of putting a hot pack on the sacrum?
that will change the shock repsonse really quick! and its mechanical rather than pharmeceutical.
just apply for about 5-10 mintues, affects the cauda equina, and can swing the whole NS into a different state.
Marty you are making a large number of assumptions in your response, and operating from them. Ya need to treat each situation differently, and watch out for the flow chart of Tx depending upon what the sitch is. that goes for everyone working with this kind of thing.
Yes, there are certian aspects which are givens with dislocations: NS response, possible tissue tearing, ligamentus issues, inflammation, muscular splinting.
cheq TO WHAT DEGREE certain things are happening to the affected area.
stupidity on the part of the client for not having it put back in place is not your responsibility as a therapist.
it also depends on what KIND of dislocation it is.
YES, get it popped back in if you don't have training in restoration.
get that generalized heightened NS response down...(hot pack on the tush)
reduce inflammation topically rather than pharmaceutically unless, its severe.
muscles are really difficult to work with and get an acurate palpation response from if they are chemically altered. at least that's my experience.
unfortunately, there isn't much in the way of oriental emergency medicine, albeit it can be very effective in certain sitches.
get them muscles out of spasm, and out of inflammation as best you can, as quickly as you can.
I've found a little MET does wonders, to keep a muscle moving and prevents it from splinting.
Cami's got a good thing for starters...
contralateral work is amazing and reflexive. it also helps your fingers to feel what normal tissue is like in that area.
really gentle MET on the agonists and antagonists keeps the muscles from splinting, and freezing up
the whole ice thing is just as contentious as the actions of certian muscles. keep a good eye on it and don't overwork the area either with ice or heat or your fingers and maintain awareness of the mobility and severity of the area.
work aouond all sides of the injury, all planes, not just the directly affected one.
do some work with the Cx so that the Cx can maintain awareness of the area, and not just drop into pain denial and unconsciousness around the body part.
mon deux centimes
Thu, November 9, 2006 - 8:59 PMOkay... didn't see that one coming (hot pack on the sacrum). Sounds good as we speak, ah, type. Sounds like the 'hitting of the thumb to get your mind off the headache' type of treatment. Was this part of the trick? A little more detail please.
The event happened at the motorcycle track (gran prix) and I was the first 'station' he came to. Normally the medics get them first. He showed up on my table as I came back from a break. Told him I couldn't put it back and that he needed to make the walk to the medics. Wanting to help I kept to very minimal to the opposite areas not affected. Nor more than 10 minutes.
SIDENOTE: This was my first year of doing sport massages on grand prix motorcycle racers. They ARE quite the athletes. Every one of them seems to have broken their collarbones - I think that's their initiation fee. The dislocated shoulder has been the wrost case that I've had to work on.
You guys gave some great inputs to what I needed to hear. THanx!!
Sat, November 11, 2006 - 11:02 AMhot pack on the sacrum mechanically turns down the sympathetic response in the nervous system.
ok try this. Just as you start a massage, put the hot pack on prone client. watch, and within 5 mintues, their whole body will kinda sigh and relax!
takes all the fun out of trying to fight your clients unconscious general resting tonus in their body...
remember hjow it used to take up to 20 minteus for aCx to relax FULLY before you can really get into their sitch?
DO NOT do this procdure if you are working on someone (like in MotorX) who needs to reamin on top of their game. the hotpack is to bring them DOWN, especailly out of shock and injury NS rush.
try it, I dare ya!
then get back to me.
'hitting the thumb' look up gate theory. its an entirely different animal.
no, not alot of people will talk about this procuedure, its not expensive and it works and its not pharmeceutically based. anyone ever take a good look at the allopathic model?
oh check THIS out...
Doctors Are The Third Leading Cause of Death in the US, Causing 225,000 Deaths Every Year
Dr. Barbara Starfield of the Johns Hopkins School of Hygiene and Public Health and she desribes how the US health care system may contribute to poor health.
ALL THESE ARE DEATHS PER YEAR:
* 12,000 -- unnecessary surgery
* 7,000 -- medication errors in hospitals
* 20,000 -- other errors in hospitals
* 80,000 -- infections in hospitals
* 106,000 -- non-error, negative effects of drugs
These total to 225,000 deaths per year from iatrogenic causes!!
What does the word iatrogenic mean? This term is defined as induced in a patient by a physician's activity, manner, or therapy. Used especially of a complication of treatment.
REF: Department of Health Policy and Management: Barbara Starfield, MD, MPH, Department of Health Policy and Management, Johns Hopkins School of Hygiene and Public Health, 624 N Broadway, Room 452, Baltimore, MD 21205-1996
Fri, November 17, 2006 - 8:05 PMWhat do they call the student that graduates at the bottom of their class???
Tito... I shall keep your suggestion at the front of my brain. It definitely can't hurt.
But... (sorry) just how hot?? At these events I'm lucky I can keep my cold-packs cold. Having an 'instant heat source' might be difficult to obtain. Any ideas??
This is the maximum depth. Additional responses will not be threaded.
Tue, November 21, 2006 - 8:39 AMJust light skin rubbing especially at the musculotendenous junctions of any of the adductors and flexors, I typically use my first row of knuckles. The mechano stimulation is sent faster and louder to the CNS than pain reception signals, so it effectively drowns out the pain signals temporarily.
If you are dealing with an injury it will work really well to go to the opposite lower or upper apendage depending on where the injury is and do it on that part of the body.
Examply: right shoulder dislocated, start skin stim on the left leg, inside of the knee/thigh, front of the hip, back of the knee, foot, abdominals then just keep on going with any and all adductors and flexors that can be rubbed without pain or discomfort. This should take no longer than 5-10 min.
Tue, October 31, 2006 - 12:29 PMHi. I recently dislocated my elbow, and have been healing from it for a couple of weeks now. I have found some methods that really really work.
First off if the shoulder is dislocated have him/her go to the ER and have them pop it back in place ( if they don't feel comfortable doing it themselves), because there is no use doing any, and I mean ANY work until that point. ER dr.'s are trained in that, and they do a very good job.
But the aftermath, that's where you come in. You can work on the opposite shoulder first, I have found in my healing process my right elbow hurts when my left elbow(the injuried elbow) is hurting. If i massage my right elbow, my left elbow pain starts to lessen. Also my lymphs have been compromised during this whole process, so possibly doing a light lymph massage could be very benefical.
Second have them take hot and cold showers for the pain post massage. (always ending with the cold)
Unsu...Tue, November 21, 2006 - 4:47 PMFirst I used to work as a registered physiotherapist-
a couple of improtant points
As mentioned in the last post-*********** it usually takes no more than a couple of minutes max to relocate a shoulder (if it is truly dislocated (90% anteriorly dislocate) GO TO THE ER
do NOT move a dislocating shoulder into hands up position (abducted, externally rotated )
that is the position it happens in.
first hand and elbow exercises, then isometrics, elbow by the side, then gentle active motion.