Pain, Assessment, and Treatment

By Darren Buford
[Editor's Note]

“Who wrote this?” the doctor of osteopathic medicine asked, looking at a bulleted list of 10 items with the heading “Basic Assessment” written at the top.
“My massage therapist,” I answered.
The doctor carefully looked over the list again and, after a minute or two, said, “Impressive. There are some suggestions here that we haven’t been considering in
our approach.”
In October 2015, while playing golf, I felt what can only be described as a rip or tear in my right forearm. I knew something was wrong because of the sudden rush of acute pain and throbbing I felt at the medial epicondyle. Little did I know that this incident was only the beginning of a two-year-plus (and ongoing) experience.
This marks my second trip down this path. I had previously suffered the same injury (coupled with lateral epicondylitis) in my left arm. With that injury, physical therapy—complemented by massage therapy—brought me back to full recovery. However, as you might imagine, I was overcompensating with the right arm the entire time during the previous left-arm injury, and thus brewed the “perfect storm” for the new, more severe right-arm injury.
The long road to recovery still continues: X-rays, three rounds of physical therapy, platelet-rich plasma injections, an MRI, and now a scheduled EMG nerve study to see if the pain is originating from the nerves in the elbow versus the joint and tendons themselves. All of this with the hope of avoiding an all-to-eager physician happy to perform surgery.
But this is not a pity party. Rather, it’s a story about the power of bodywork. You may know or have heard of my massage therapist: Clint Chandler, BS, LMT, CNMT, teacher-of-the-year recipient, national presenter, and published researcher and author. At the request of someone in our office, I scheduled my first appointment with Clint a few months ago. What followed was the most thorough assessment of my condition I have ever received: by a physician, by a physical therapist, by anyone. It opened my eyes to the synergy that can happen between physicians and massage therapists, when both parties are educated and properly trained in assessment and treatment. Clint describes his own bodywork approach as “specific, thorough, and result-oriented.” And he’s not kidding.
Here are some of the notes from our session: “significant muscular imbalance of shoulder, arm, forearm, and hand musculature,” “overuse and misuse of the forearm extensors and flexors, forward-head posture, and rounded shoulders,” “depressed and medially rotated right shoulder—inappropriate placement of the head of the humerus in the glenoid fossa due to the muscular imbalance,” “significant imbalance between the forearm extensors and forearm flexors,” “flexor carpi ulnaris and flexor carpi radialis are both weak and painful,” “brachioradialis is painful and congested upon palpation,” “teres major refers down into the arm when compressed,” “the infraspinatus is tight and tender.”
Why do I relay all this information? Because this issue of Massage & Bodywork focuses on the importance of orthopedic assessment skills tailored to bodywork. How are your assessment skills? Be sure to read Ben Benjamin’s “Pain Points” and Whitney Lowe’s “Pain Science Research.” These two master technicians have dedicated their lives to assessment and treatment of pain and injury conditions.
While I continue to pursue the traditional medical route for my elbow— coupled with the guidance of one exceptional bodyworker, and eagerly await to return to the activities I love, I applaud you MTs and bodyworkers: keep on doing what you’re doing. Your work is vital and valuable, and you likely have a client like me who thanks you profoundly.
Want to know what the last thing the doctor said while I was exiting his office? “What’s the phone number of that massage therapist? We need someone like that.”

Darren Buford